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@ARTICLE{Mazzone:282722,
      author       = {E. Mazzone and G. Gandaglia and D. Robesti and P. Rajwa and
                      J. Gomez Rivas and L. Ibáñez and T. F. W. Soeterik and L.
                      Bianchi and L. Afferi and C. Kesch$^*$ and C. Darr$^*$ and
                      H. Guo and J. Zhuang and F. Zattoni and W. P. Fendler$^*$
                      and D. Amparore and N. A. Huebner and A. Giesen and S.
                      Joniau and R. Schiavina and E. Brunocilla and A. Mattei and
                      F. Dal Moro and J. Moreno Sierra and F. Porpiglia and M.
                      Picchio and A. Chiti and R. van den Bergh and S. F. Shariat
                      and F. Montorsi and A. Briganti},
      title        = {{W}hich {P}atients with {P}rostate {C}ancer and {L}ymph
                      {N}ode {U}ptake at {P}reoperative {P}rostate-specific
                      {M}embrane {A}ntigen {P}ositron {E}mission
                      {T}omography/{C}omputerized {T}omography {S}can {A}re at a
                      {H}igher {R}isk of {P}rostate-specific {A}ntigen
                      {P}ersistence {A}fter {R}adical {P}rostatectomy?
                      {I}dentifying {I}ndicators of {S}ystemic {D}isease by
                      {I}ntegrating {C}linical, {M}agnetic {R}esonance {I}maging,
                      and {F}unctional {I}maging {P}arameters.},
      journal      = {European urology oncology},
      volume       = {7},
      number       = {2},
      issn         = {2588-9311},
      address      = {Amsterdam},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2023-01848},
      pages        = {231-240},
      year         = {2024},
      note         = {2024 Apr;7(2):231-240},
      abstract     = {The role of local therapies including radical prostatectomy
                      (RP) in prostate cancer (PCa) patients with clinical
                      lymphadenopathies on prostate-specific membrane antigen
                      (PSMA) positron emission tomography/computerized tomography
                      (PET/CT) has scarcely been explored. Limited data are
                      available to identify men who would benefit from RP; on the
                      contrary, those more likely to benefit already have systemic
                      disease.We aimed to assess the predictors of
                      prostate-specific antigen (PSA) persistence in surgically
                      managed PCa patients with lymphadenopathies on a PSMA PET/CT
                      scan by integrating clinical, magnetic resonance imaging
                      (MRI), and PSMA PET/CT parameters.We identified 519 patients
                      treated with RP and extended lymph node dissection, and who
                      received preoperative PSMA PET between 2017 and 2022 in nine
                      referral centers. Among them, we selected 88 patients with
                      nodal uptake at preoperative PSMA PET (miTxN1M0).The outcome
                      was PSA persistence, defined as a PSA value of ≥0.1 ng/ml
                      at the first measurement after surgery. Multivariable
                      logistic regression models tested the predictors of PSA
                      persistence. Covariates consisted of biopsy International
                      Society of Urological Pathology (ISUP) grade group, clinical
                      stage at MRI, and number of positive spots at a PET/CT scan.
                      A regression tree analysis stratified patients into risk
                      groups based on preoperative characteristics.Overall, lymph
                      node invasion (LNI) was detected in 63 patients $(72\%)$ and
                      32 $(36\%)$ experienced PSA persistence after RP. At
                      multivariable analyses, having more than two lymph nodal
                      positive findings at PSMA PET, seminal vesicle invasion
                      (SVI) at MRI, and ISUP grade group >3 at biopsy were
                      independent predictors of PSA persistence (all p < 0.05). At
                      the regression tree analysis, patients were stratified in
                      four risk groups according to biopsy ISUP grade, number of
                      positive findings at PET/CT, and clinical stage at MRI. The
                      model depicted good discrimination at internal validation
                      (area under the curve $78\%).One$ out of three miN1M0
                      patients showed PSA persistence after surgery. 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.Our novel and straightforward risk
                      classification integrates currently available preoperative
                      risk tools and should, therefore, assist physician in
                      preoperative counseling of men candidates for radical
                      treatment for prostate cancer with positive lymph node
                      uptake at prostate-specific membrane antigen positron
                      emission tomography.},
      keywords     = {Multiparametric magnetic resonance imaging (Other) /
                      Nomogram (Other) / Prostate cancer (Other) /
                      Prostate-specific antigen persistence (Other) /
                      Prostate-specific membrane antigen positron emission
                      tomography (Other) / Risk category (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37689506},
      doi          = {10.1016/j.euo.2023.08.010},
      url          = {https://inrepo02.dkfz.de/record/282722},
}