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Staging Imaging Outcomes for Patients with Unfavorable Intermediate Risk Prostate Cancer Following Updates to the NCCN Guidelines
Ling Chi, BS1, Dylan Buller, MD
2, Ilene Staff, PhD
3, Kevin Pinto, BS
3, Tara McLaughlin, PhD
3, Laura Olivo Valentin, BS
3, Joseph Tortora, MS
3, Andrew Salner, MD
4, Joseph Wagner, MD
4.
1University of Connecticut School of Medicine, Farmington, CT, USA,
2UConn Health, Farmington, CT, USA,
3Hartford Healthcare, Hartford, CT, USA,
4Hartford Healthcare Medical Group, Hartford, CT, USA.
BACKGROUND: Since September, 2021, the NCCN Prostate Cancer Guidelines have recommended staging imaging for all patients diagnosed with unfavorable intermediate risk (UIR) prostate cancer (PCa). Conversely, the AUA/ASTRO guidelines recommend against staging imaging in asymptomatic patients with intermediate risk PCa. The value of universal staging imaging for UIR PCa has not been studied. We sought to determine the frequency and results of staging imaging in this population.
METHODS: We queried a prospectively maintained prostate biopsy database to identify all patients diagnosed with UIR PCa at our institution between 9/1/2021 and 9/1/2024. Data on staging imaging, oncologic characteristics, and primary treatment were obtained from the electronic medical record. Descriptive statistics were calculated; chi-square and Wilcoxon rank-sum were also used (SPSSv26).
RESULTS: 397 patients were diagnosed with UIR PCa at our institution during the study period (Table 1). 373 patients (94%) had staging imaging performed, with positive or suspicious findings for regional or distant metastases in 0% of MRIs, 2% of CTs, 1% of bone scans, and 6% of PSMA PETs. Overall, advanced disease was identified in 10 patients (3%). Among individual UIR PCa diagnostic components, only T-stage (cT2b-c) was associated with positive staging imaging findings (Table 2).
CONCLUSIONS:Few patients with UIR PCa had advanced disease identified on staging imaging. cT2b-c was predictive of positive staging imaging. Though PSMA PET identified more advanced disease than conventional imaging, given the rarity of positive findings and potential associated costs, we recommend an individualized approach to staging imaging for patients with UIR PCa.
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