Improving prediction of local stage by PSMA-PET: Development of a novel integrated tool for extracapsular extension and seminal vesicle invasion combining clinical and imaging features in localized prostate cancer

You have accessJournal of UrologyCME1 Apr 2023PD10-10 IMPROVING PREDICTION OF LOCAL STAGE BY PSMA-PET. DEVELOPMENT OF A NOVEL INTEGRATED TOOL FOR EXTRACAPSULAR EXTENSION AND SEMINAL VESICLE INVASION COMBINING CLINICAL AND IMAGING FEATURES IN LOCALIZED PROSTATE CANCER Simone Scuderi, Giorgio Gandaglia, Armando Stabile, Vito Cucchiara, Elio Mazzone, Nicolai Huebner, Eugenio Brunocilla, Agostino Mattei, Luca Afferi, Shahrok Shariat, Giancarlo Marra, Junlong Zhuang, Hongqian Guo, Riccardo Schiavina, Lorenzo Bianchi, Fabio Zattoni, Giuseppe Reitano, Pawel Rajwa, Juan Gomez Rivas, Claudia Kesch, Enrico Checcucci, Edoardo Cisero, Daniele Amparore, Francesco Porpiglia, Maria Picchio, Francesco Montorsi, and Alberto Briganti Simone ScuderiSimone Scuderi More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Armando StabileArmando Stabile More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Nicolai HuebnerNicolai Huebner More articles by this author , Eugenio BrunocillaEugenio Brunocilla More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Luca AfferiLuca Afferi More articles by this author , Shahrok ShariatShahrok Shariat More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Junlong ZhuangJunlong Zhuang More articles by this author , Hongqian GuoHongqian Guo More articles by this author , Riccardo SchiavinaRiccardo Schiavina More articles by this author , Lorenzo BianchiLorenzo Bianchi More articles by this author , Fabio ZattoniFabio Zattoni More articles by this author , Giuseppe ReitanoGiuseppe Reitano More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Juan Gomez RivasJuan Gomez Rivas More articles by this author , Claudia KeschClaudia Kesch More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Edoardo CiseroEdoardo Cisero More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Maria PicchioMaria Picchio More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003250.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Validated models predicting extracapsular extension (ECE) and seminal vesicle invasion (SVI) based on clinical parameters and mpMRI are available for prostate cancer (PCa) patients undergoing radical prostatectomy (RP). However, their performance in the PSMA era are still unknown, where the inclusion of PSMA-PET might improve their discrimination. METHODS: 195 patients staged with PSMA PET scan and treated with RP ± pelvic lymph node dissection (pLND) at 9 referral centers between 2016 and 2022 were identified. Men with nodal or extra-nodal spots at PSMA PET and those who received neoadjuvant treatments were excluded. Two existing models predicting ECE and SVI based on preoperative PSA, clinical stage, ISUP Grade Group at mpMRI, ECE and SVI at mpMRI, the maximum diameter of the index lesion at mpMRI, and the percentage of cores with significant PCa at systematic biopsy were externally validated. Logistic regression analyses tested whether intraprostatic SUVmax was associated with ECE and SVI at final pathology. We then developed a new model predicting pathological ECE (Model 1) and SVI (Model 2) based on the coefficients of the previously mentioned variables with the addition of SUVmax at PSMA PET. Calibration plots, ROC-derived AUC, and decision-curve analyses (DCAs) determined the calibration, discrimination, and net benefit of the new models. RESULTS: The median SUVmax was 12. Overall, 128 (66%) and 34 (18%) patients had ECE and SVI after RP. The existing model’s discrimination was 72% for ECE and 78% for SVI at external validation. Nonlinear associations between SUVmax and ECE and between SUVmax and SVI were observed using non-parametric curves. Two nomograms based on the new model including SUVmax considered as a restricted cubic spline showed higher discrimination for ECE (81 vs. 72%) and SVI (90% vs. 78%), and a higher net benefit compared to the available ones. Using a nomogram cut-off of 80%, the sensitivity and specificity for ECE were substantially higher for Model 1 (44% and 96%) than for mpMRI alone (31% and 94%). Moreover, for Model 2, a 40% cut-off led to higher sensitivity for SVI than mpMRI (61% vs. 52%, respectively), with similar specificity (92% vs. 95%). CONCLUSIONS: Two novel predicting models including SUVmax values showed higher performances in the prediction of ECE and SVI after RP than the currently available ones. These models showed increased sensitivity for ECE and SVI when compared to mpMRI alone. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e330 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simone Scuderi More articles by this author Giorgio Gandaglia More articles by this author Armando Stabile More articles by this author Vito Cucchiara More articles by this author Elio Mazzone More articles by this author Nicolai Huebner More articles by this author Eugenio Brunocilla More articles by this author Agostino Mattei More articles by this author Luca Afferi More articles by this author Shahrok Shariat More articles by this author Giancarlo Marra More articles by this author Junlong Zhuang More articles by this author Hongqian Guo More articles by this author Riccardo Schiavina More articles by this author Lorenzo Bianchi More articles by this author Fabio Zattoni More articles by this author Giuseppe Reitano More articles by this author Pawel Rajwa More articles by this author Juan Gomez Rivas More articles by this author Claudia Kesch More articles by this author Enrico Checcucci More articles by this author Edoardo Cisero More articles by this author Daniele Amparore More articles by this author Francesco Porpiglia More articles by this author Maria Picchio More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...