Micro‐Abstract We retrospectively evaluated 262 individuals with intermediate‐ or high‐risk prostate cancer. Among patients at high risk, we identified a subgroup of individuals harboring very high‐risk (VHR) disease. Considering men… Click to show full abstract
Micro‐Abstract We retrospectively evaluated 262 individuals with intermediate‐ or high‐risk prostate cancer. Among patients at high risk, we identified a subgroup of individuals harboring very high‐risk (VHR) disease. Considering men with VHR disease (n = 28), 11C‐choline positron emission tomography/computed tomography versus contrast‐enhanced computed tomography had sensitivity and specificity of 71% and 92% versus 25% and 79%, respectively. Purpose: To evaluate the accuracy of 11C‐choline positron emission tomography (PET)/computed tomography (CT) for nodal staging of prostate cancer (PCa) in different populations of high‐risk patients. Patients and Methods: We evaluated 262 individuals with intermediate‐ or high‐risk PCa submitted to radical prostatectomy and extended pelvic lymph node dissection. Within men with high‐risk disease, we identified a subgroup of individuals harboring very high‐risk (VHR, n = 28) disease: clinical stage ≥ T2c and more than 5 cores with Gleason score 8‐10; primary biopsy Gleason score of 5; 3 high‐risk features; or prostate‐specific antigen ≥ 30 ng/mL. The diagnostic accuracy of PET/CT and contrast‐enhanced CT (CECT) was assessed after stratifying patients according to risk group classification on a patient‐ and anatomic region–based analysis. Results: On patient‐based analysis, considering high‐risk patients (n = 155), 11C‐choline PET/CT versus CECT had sensitivity and specificity of 50% and 76% versus 21% and 92%, respectively. Considering VHR men as separate subgroups (n = 28), 11C‐choline PET/CT versus CECT had sensitivity and specificity of 71% and 93% versus 25% and 79%, respectively. Accordingly, in the VHR category, the area under the curve of 11C‐choline PET/CT versus CECT was 0.86 (95% confidence interval, 0.71‐1.0) versus 0.69 (95% confidence interval, 0.52‐0.86), respectively. On anatomic region–based analysis, considering the VHR group, 11C‐choline PET/CT versus CECT had sensitivity and specificity of 70.6% and 95.5% versus 35.3% and 98.5%, respectively. Conclusion: Patients with VHR characteristics could represent the ideal candidate to undergo disease staging with PET/CT before surgery with the highest cost efficacy.
               
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