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Predictors of PSA Persistence After RP for Node-Positive Prostate Cancer ID’d – Renal and Urology News

Investigators have identified predictors of PSA persistence after prostate cancer surgery in men with positive lymph nodes on preoperative prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT).

Among 519 patients who underwent radical prostatectomy (RP) and extended lymph node dissection, 88 (17%) had nodal uptake on preoperative PSMA PET (using 68Ga-PSMA-11 or 18F-PSMA-1007). Lymph node invasion was detected at surgical pathology in 63 patients (72%).

PSA persistence, defined as a PSA value of 0.1 ng/mL or greater at the first post-operative measurement, occurred in 32 of the 88 men (36%), Elio Mazzone, MD, of IRCCS Ospedale San Raffaele in Milan, Italy, and colleagues reported in European Urology Oncology.

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According to multivariable analyses, having more than 2 positive lymph node findings at preoperative PSMA PET, seminal vesicle invasion (SVI) staging at prebiopsy multiparametric magnetic resonance imaging (mpMRI), or International Society of Urological Pathology (ISUP) grade group 4-5 at biopsy significantly predicted PSA persistence. Men with SVI, more than 2 positive nodes, and ISUP grade group 4-5 (vs grade group 2-3) disease had significant 2.1-, 2.6-, and 5.1-fold increased odds of PSA persistence, respectively, compared with men without these characteristics.

“One out of three [node-positive] patients showed PSA persistence after surgery,” Dr Mazzone’s team wrote. “Patients with ISUP grade 2-3, as well as patients with organ-confined disease at MRI and a single or two positive nodal findings at PET are those in whom RP may achieve the best oncological outcomes in the context of a multimodal approach. Conversely, patients with a high ISUP grade and extracapsular extension or SVI or more than two spots at PSMA PET should be considered as potentially affected by systemic disease upfront.”

The investigators created and internally validated a risk stratification model based on the independent predictors and found good discrimination (area under the curve 78%). They defined low-, intermediate-, high-, and very high-risk groups for PSA persistence. External validation is still needed.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mazzone E, Gandaglia G, Robesti D, et al. Which patients with prostate cancer and lymph node uptake at preoperative prostate-specific membrane antigen positron emission tomography/computerized tomography scan are at a higher risk of prostate-specific antigen persistence after radical prostatectomy? Identifying indicators of systemic disease by integrating clinical, magnetic resonance imaging, and functional imaging parameters. Eur Urol Oncol. 2023 Sep 7:S2588-9311(23)00173-6. doi: 10.1016/j.euo.2023.08.010