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See the unseen: Mesorectal lymph node metastases in prostate cancer
Author(s) -
Hijazi Sameh,
Meller Birgit,
Leitsmann Conrad,
Strauss Arne,
Ritter Christian,
Lotz Joachim,
Meller Johannis,
Trojan Lutz,
Sahlmann CarstenOliver
Publication year - 2016
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.23168
Subject(s) - medicine , prostate cancer , lymph node , hormonal therapy , prostatectomy , biochemical recurrence , dissection (medical) , lymph , prostate , radiation therapy , nuclear medicine , radiology , urology , cancer , pathology
BACKGROUND Our study is the first evaluation of nodal metastatic prostate cancer (PCa) to mesorectal lymph nodes (MLN) detected by 68 Ga‐PSMA‐PET/CT. METHODS We retrospectively analyzed 76 consecutive PCa patients who underwent 68 Ga‐PSMA‐PET/CT: 61 PCa patients with biochemical recurrence (BCR) after curative treatment and 15 high‐risk PCa before primary therapy. We assessed PET‐positive MLN, which are indicative for PCa. RESULTS We detected PET‐positive lesions for PCa in 68 Ga‐PSMA‐PET/CT in 66 of 76 (87%) patients. Nodal disease was imaged in 47 of 66 (71%) patients. Indicative mesorectal nodal lesions for PCa were detected in 12 of 76 (15.8%) patients. The median number of PET‐positive MLN was one per patient. Seven of twelve patients had recurrent PCa after radical prostatectomy with a median PSA value of 1.84 ng/ml (range 0.31–13). Five of twelve patients had untreated first diagnosed high‐risk PCa with median PSA value of 90 ng/ml (range 4.6–93) at PET/CT, respectively. For all PET positive MLN a morphological correlate was found in CT (shortest diameter median 4 mm [range 4–21]; longest diameter median 7.5 mm [range 5–25]). After PET/CT, four patients with recurrent PCa received hormonal therapy, one patient was treated with directed radiation therapy of MLN, one patient received chemotherapy, and one patient was treated with pelvic lymph node dissection. Three high‐risk PCa patients received hormonal therapy, and two patients were treated with adjuvant hormonal therapy after radical prostatectomy. CONCLUSIONS Detection and exact location of nodal metastasis for PCa is crucial for the choice of treatment and the patient's prognosis. 68 Ga‐PSMA‐PET/CT seems to improve the detection of nodal metastasis in PCa, especially concerning mesorectal lymph nodes. Prostate 76:776–780, 2016 . © 2016 Wiley Periodicals, Inc.