Journal
JOURNAL OF UROLOGY
Volume 208, Issue 1, Pages 90-99Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/JU.0000000000002492
Keywords
prostatic neoplasms; neoadjuvant therapy; immunohistochemistry; pathology
Categories
Funding
- Prostate Cancer Foundation
- Department of Defense Prostate Cancer Research Program [W81XWH-19-1-0712, W81XWH-16-1-0433]
- Intramural Research Program of the NIH, National Cancer Institute
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The study evaluated the ability of antibodies against PSMA to specifically detect residual tumor in patients treated with iADT and enzalutamide. The results showed that PSMA reacted positively with tumor in all cases and had high sensitivity but low specificity for benign regions. PSMA could also identify highly dedifferentiated prostate carcinomas, indicating its potential as a valuable marker.
Purpose: Neoadjuvant intense androgen deprivation therapy (iADT) can exert a wide range of histological responses, which in turn are reflected in the final prostatectomy specimen. Accurate identification and measurement of residual tumor volumes are critical for tracking and stratifying patient outcomes. Materials and Methods: The goal of this current study was to evaluate the ability of antibodies against prostate-specific membrane antigen (PSMA) to specifically detect residual tumor in a cohort of 35 patients treated with iADT plus enzalutamide for 6 months prior to radical prostatectomy. Results: Residual carcinoma was detected in 31 patients, and PSMA reacted positively with tumor in all cases. PSMA staining was 96% sensitive for tumor, with approximately 82% of benign regions showing no reactivity. By contrast, PSMA positively reacted with 72% of benign regions in a control cohort of 37 untreated cases, resulting in 28% specificity for tumor. PSMA further identified highly dedifferentiated prostate carcinomas including tumors with evidence of neuroendocrine differentiation. Conclusions: We propose that anti-PSMA immunostaining be a standardized marker for identifying residual cancer in the setting of iADT.
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