Introduction & objectives: Prostate Specific Membrane Antigen-PET/CT (PSMA-PET/CT) for staging high-risk prostate cancer (PCa) patients might overcome limits of conventional imaging. Accurate staging of patients suitable for radical treatments may significantly change the treatment management. We aimed to assess the management changes after PSMA-PET/CT in high risk patients before the scheduled radical prostatectomy + extended pelvic lymph node dissection [RP+ePLND] or radiotherapy [RT]). In a subgroup of patients who subsequently underwent RP, we aimed to evaluate the diagnostic performance of PSMA to detect lymph node metastases (LNM), using histology as reference standard. Materials & methods: Patients were enrolled according to the following criteria1) histopathologic diagnosis of PCa, treatment naïve, high-risk according to D’Amico, suitable for radical treatment RP or RT; 2) 68Ga-PSMA-PET/CT performed for staging proposal. We analyzed the impact of PSMA PET/CT on the intention to treat (ITT) based on a MDT decision before and after PSMA-PET/CT. The diagnostic performance of PSMA PET/CT in the detection of LNM was evaluated in a subgroup of 27 patients who underwent RP+ ePLND, using histology as reference standard. ROC curve analysis was employed to calculate the Area Under the Curve (AUC) of PSMA-PET/CT to predict LNM. Results: Overall, 88 patients were enrolled (mean age was 66 yo and mean PSA level was 13.1 ng/ml). Before PSMA PET/CT the scheduled treatment were: 66 RP + ePLND and 22 RT, respectively. Overall PSMA PET/CT was positive for metastatic disease in 51 patients (58%): LNM in 12 patients (14%), skeletal lesions in 24 (27%), LNM + skeletal lesion 12 (14%) and visceral metastases in 3 (3%). After PSMA PET/CT, the following treatments were performed: 48 (55%) RP+ePLND; 7 (8%) RP+PLND+stereotactic RT (SBRT); 13 (15%) whole pelvis RT+ Androgen Deprivation Therapy (ADT); 8 (9%) whole pelvis RT + SBRT, 2 (2%) ADT, 10 (11%) Docetaxel+ADT. Overall, 12 (14%) patients had major treatment’s change; from planned RP+ePLND or whole pelvis RT to ADT or Docetaxel + ADT); while 15 (17%) had minor treatment’s change: RP+ePLND + SBRT or whole pelvis RT + SBRT. In the subgroups of 27 who underwent RP+ePLND, 8 (30%) had LNM on histology. On a patient-based analysis, PSMA PET/CT showed 57% sensitivity, 95% specificity, 86% NPV and 80% PPV and with AUC of 0.72 in the detection of LNM. Conclusion: PSMA PET/CT had a major impact on management in 14% and a minor impact on 17% of the population. These results confirm the published literature in the same setting of patients and might encourage the extensive use of PSMA in this setting of patients. PSMA PET/CT showed good accuracy (especially specificity) in the detection of LNM.

68Ga PSMA PET/CT for staging high risk prostate cancer patients suitable for radical treatments: effective clinic implication and preliminary diagnostic performance.

For 2021, our focus remains: turning new data into your daily practice. The programme will consist of state-of-the-art lectures, case discussions and panel debates. Our faculty is a group of international & multidisciplinary experts.

We will take you on our journey to Ghent and beyond. Prior the congress, we send out case challenges, where you can compare your opinion with peers & experts. These cases will be part of the Global Congresses on Prostate & Bladder Cancer programme during the congress days (12 & 13 October for PROSCA and 14 & 15 October for BLADDR). After these days, you will be updated on prostate & bladder cancer management.