Journal Article

DKFZ-2026-00929

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Nodal maximum standardised uptake value improves PSMA-PET/CT-based nodal staging in intermediate- and high-risk prostate cancer.

Bruins Slot, A. S. ; Sweere, V. ; Heetman, J. G. ; Hermsen, R. ; Wever, L. ; Lavalaye, J. ; Vinken, M. ; Bahler, C. D. ; Tann, M. ; Kesch, C.DKFZ* ; Telli, T.DKFZ* ; Fendler, W. P.DKFZ* ; Chiu, P. K. ; Wu, K. K. ; Zattoni, F. ; Evangelista, L. ; Ceci, F. ; Miszczyk, M. ; Rajwa, P. ; Matsukawa, A. ; Fazekas, T. ; Barletta, F. ; Briganti, A. ; Montorsi, F. ; Gandaglia, G. ; Van Basten, J. A. ; Van Melick, H. H. E. ; Van den Bergh, R. C. N. ; Marra, G. ; Soeterik, T. F. W. ; Scheltema, M. J. V. ; Urologists, E. A. o. U. A. (Collaboration Author)

2026
Wiley-Blackwell Oxford

Abstract: To evaluate whether nodal maximum standardised uptake value (SUVmax) improves the positive predictive value (PPV) of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computerised tomography (CT) for detecting lymph node invasion (LNI) in prostate cancer (PCa), and to develop clinical decision tools to guide decision-making for patients with low- and high-volume nodal disease.This international multicentre study included patients with histopathologically confirmed PCa who underwent preoperative PSMA-PET and robot-assisted radical prostatectomy with extended pelvic lymph node dissection (2016-2023). Sensitivity, specificity, PPV, and negative predictive value (NPV) for LNI detection were calculated, defining a positive test as non-physiological PSMA uptake classified according to the Prostate Cancer Molecular Imaging Standardised Evaluation (PROMISE) molecular imaging Tumour-Node-Metastasis (miTNM) system. Receiver operating curves analysis identified optimal nodal SUVmax cut-offs for pelvic LNI. Logistic regression assessed predictors for pathological N1 stage (pN1) and high-volume nodal disease (four or more positive nodes). Clinical decision tools were developed to stratify patients into three risk groups for pN1 and high-volume nodal disease.A total of 521 patients were included, with a median (interquartile range) age of 66 (61-71) years and prostate-specific antigen (PSA) level of 9.9 (6.6-17.0) ng/mL. The PSMA-PET showed 45.0% sensitivity, 94.3% specificity, 64.7% PPV, and 88.3% NPV for LNI detection. Adding nodal SUVmax ≥4.9 improved the PPV to 81.1% and sensitivity to 71.4% and, combined with a PSA level ≥10 ng/mL, magnetic resonance imaging (MRI) T-stage ≥T3a, and miT-stage ≥T3a, identified 95% of pN1 cases in the high-risk group. High-volume nodal disease was found in 3.8%, including 1.1% in miN0 patients. Nodal SUVmax ≥7.2, MRI T-stage ≥T3a, and miN2 (multiple suspicious LNs) were predictors for high-volume nodal disease and, combined in a clinical decision tool, excluded all low-risk patients for high-volume nodal disease.Nodal SUVmax improves PPV of PSMA-PET for nodal staging and aids in excluding high-volume nodal disease. Clinical decision tools integrating nodal SUVmax with relevant clinical parameters demonstrate potential to guide individualised nodal management. These findings warrant external validation in larger cohorts.

Keyword(s): Prostate‐specific membrane antigen‐positron emission tomography/computerised tomography ; high‐volume nodal disease ; lymph node invasion ; maximum standardised uptake value ; prostatectomy ; staging

Note: epub

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Contributing Institute(s):

1. DKTK Koordinierungsstelle Essen/Düsseldorf (ED01)

Research Program(s):

1. 899 - ohne Topic (POF4-899) (POF4-899)

Appears in the scientific report 2026

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Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; DEAL Wiley ; Ebsco Academic Search ; Essential Science Indicators ; IF < 5 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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