68 Ga-PSMA PET/CT for primary NM staging of high-risk prostate cancer

With the largest high-risk prostate cancer (PCa) cohort to date undergoing 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT primary staging, we aimed to 1) characterize the metastatic spread of PCa in relation to tumor 68 Ga-PSMA-uptake and the D’Amico classification, and 2) compare 68 Ga-PSMA PET/CT findings with radical prostatectomy (RP) with pelvic lymph node dissection (PLND) histopathology. Methods A total of 691 consecutive newly diagnosed, biopsy-proven, treatment-naïve, D’Amico high-risk PCa patients primary staged by 68 Ga-PSMA PET/CT were included. PSMA maximum standardized uptake value (SUV max ) and metastatic findings were compared to PSA level, International Society of Urologic Pathology (ISUP) grade, and clinical stage as traditional risk stratification parameters. Moreover, 68 Ga-PSMA PET/CT findings were compared with histology in RP patients undergoing PLND. Undetected lymph node metastases (LNMs) underwent immunohistochemical PSMA staining.

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