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Laparoscopic extended pelvic lymph node (LN) dissection as validation of the performance of [(11) C]-acetate positron emission tomography/computer tomography in the detection of LN metastasis in intermediate- and high-risk prostate cancer
Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden.
Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden.
Department of Pathology, Central Hospital of Karlstad, Karlstad, Sweden.
Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden.
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2016 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 118, no 1, p. 77-83Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the accuracy of the radiopharmaceutical [(11) C]-acetate combined with positron emission tomography/computer tomography (acetate-PET/CT) in lymph node (LN) staging in newly diagnosed prostate cancer cases. A second aim was to evaluate the potential discriminative properties of acetate-PET/CT in clinical routine.

PATIENTS AND METHODS: In a prospective comparative study, from July 2010 to June 2013, 53 men with newly histologically diagnosed intermediate- or high-risk prostate cancer underwent acetate-PET/CT investigation at one regional centre before laparoscopic extended pelvic LN dissection (ePLND) at one referral centre. The sensitivity, specificity and accuracy of acetate-PET/CT were calculated. Comparisons were made between true-positive and false-negative PET/CT cases to identify differences in the clinical parameters: PSA level, Gleason status, lymph metastasis burden and size, calculated risk of LN involvement, and curative treatment decisions.

RESULTS: In all, 26 patients had surgically/histologically confirmed LN metastasis (LN+). Acetate-PET/CT was true positive in 10 patients, false positive in one, false negative in 16, and true negative in 26. The individual sensitivity was 38%, specificity 96%, and accuracy 68%. The acetate-PET/CT positive cases had significantly more involved LNs (mean 7.9 vs 2.4, P < 0.001) with larger cancer diameters (14.1 vs 4.9 mm, P = 0.001) and fewer eventually had treatment with curative intent (40% vs 94%, P <0.005), although we lack long-term outcome data.

CONCLUSION: Acetate-PET/CT has too low a sensitivity for routine LN staging but the specificity is high. The acetate-PET/CT positive cases have a very high burden of LN spread.

Place, publisher, year, edition, pages
Blackwell Publishing, 2016. Vol. 118, no 1, p. 77-83
Keywords [en]
Laparoscopy, lymph node staging, lymph nodes, position emission tomography, prostate cancer
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:oru:diva-88720DOI: 10.1111/bju.13202ISI: 000378042700015PubMedID: 26074275Scopus ID: 2-s2.0-84975127275OAI: oai:DiVA.org:oru-88720DiVA, id: diva2:1519890
Available from: 2021-01-19 Created: 2021-01-19 Last updated: 2021-01-20Bibliographically approved

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