Supraclavicular nodal metastasis at primary staging of prostate cancer using ¹⁸F-PSMA-1007 PET/CT

The most common sites of metastasis in prostate cancer are bone, pelvic and retroperitoneal lymph nodes, liver and lungs. This study aimed to evaluate the prevalence of supraclavicular nodal metastasis in newly diagnosed prostate cancer using ¹⁸F-PSMA-1007 PET/CT which has hitherto been understudied.

¹⁸F-PSMA-1007 PET/CT examinations performed at our institution between June 2020 and June 2022 for primary staging of prostate cancer were reviewed to identify supraclavicular nodal metastasis from prostate cancer. Data variables included age, stage of disease, PSA level, Gleason score and ISUP/WHO grade group and how these compare with the presence of supraclavicular nodal metastasis.

A total of 240 patients with prostate cancer staged with ¹⁸F-PSMA-1007 PET/CT were analyzed. More than half of the patients presented with stage IVA or IVB disease, 54.1% (n = 130/240), and with high or very high-risk disease, 74.6% (n = 179/240). The prevalence of supraclavicular nodal metastasis in this cohort was 7.9% (n = 19/240). Advanced stage and high-risk groups were strongly associated with the presence of supraclavicular nodal metastasis.

There is moderate prevalence of supraclavicular nodal metastasis in patients with intermediate to very high-risk prostate cancer which has likely previously been underdiagnosed with conventional imaging and has been brought to the fore with new-generation imaging such as PSMA PET/CT. It should therefore be an area of consideration during diagnostic work up and follow up of prostate cancer patients. The prognostic significance of supraclavicular nodal metastasis in prostate cancer requires further research.