2
|
Woythal N, Arsenic R, Kempkensteffen C, Miller K, Janssen JC, Huang K, Makowski MR, Brenner W, Prasad V. Immunohistochemical Validation of PSMA Expression Measured by 68Ga-PSMA PET/CT in Primary Prostate Cancer. J Nucl Med 2017; 59:238-243. [PMID: 28775203 DOI: 10.2967/jnumed.117.195172] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/06/2017] [Indexed: 12/30/2022] Open
Abstract
68Ga-labeled prostate-specific membrane antigen (68Ga-PSMA) PET/CT has a proven role in staging and restaging of prostate cancer (PCA). The aims of this study were to evaluate the association of intraprostatic 68Ga-PSMA PET/CT findings and PSMA expression in immunohistochemical staining and generate a cutoff value for differentiation between normal prostate (PN) and PCA. Methods: The data of 31 patients (mean age, 67.2 y) who underwent prostatectomy and preoperative PET were retrospectively analyzed. On PET, focally increased uptake in the prostate was suggestive of tumor. A region of interest was placed on the suggestive area to generate an SUVmax; a similar region of interest was placed on adjacent visually PN. Both PCA and PN were stained with monoclonal anti-PSMA antibody (clone 3E6, 1:100, M3620). Results: All intraprostatic PCA lesions on PET could be confirmed histopathologically. In PN sections (n = 31), median staining intensity was mild, median percentage of stained cells was 20% ± 14.24%, and median immunoreactive score (IRS) was 1. In PCA sections (n = 31), median IRS was 3, median staining intensity was strong, and median percentage of stained cells was 80% ± 16.46%. The mean SUVmax (±SD) of PCA (14.06 ± 15.56) was significantly higher than that of PN (2.43 ± 0.63; P < 0.001). Receiver-operating-characteristic curve analyses of the SUVmax of PCA, validated by immunohistochemical staining in 62 tissue samples, showed the best cutoff to be 3.15 (sensitivity, 97%; specificity, 90%; area under curve, 0.987). Applied to multifocal PCA, it resulted in sensitivity and specificity of 87% and 97% respectively. The mean SUVmax of PCA and PN for an IRS of less than 2 (n = 26; 2.52 ± 0.64) was significantly lower than the mean SUVmax for an IRS of 2 or more (n = 36; 12.38 ± 15.02; P < 0.001). The mean SUVmax was significantly lower in PCA samples with fewer than 50% stained cells (n = 30; 2.81 ± 2.35) than in samples with 50% or more (n = 32; 13.34 ± 15.55; P < 0.001). There was no correlation between the SUVmax of PCA and Gleason score (P = 0.54). Conclusion: This study showed that SUVmax on 68Ga-PSMA PET/CT correlates significantly with PSMA expression in primary PCA, enabling the detection of PCA with a high sensitivity and specificity.
Collapse
Affiliation(s)
- Nadine Woythal
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ruza Arsenic
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Kurt Miller
- Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany; and
| | - Jan-Carlo Janssen
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kai Huang
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
4
|
Keck B, Hammon M, Uder M, Huber J, Goebell PJ, Kunath F, Wullich B, Richter RH. [Vertebral metastases of urogenital carcinomas: Diagnosis and conservative therapy]. Urologe A 2015; 55:226-31. [PMID: 26450096 DOI: 10.1007/s00120-015-3977-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The high incidence of bone metastases of urologic neoplasms and their morbidity, especially of vertebral metastases, requires exact diagnosis and consequent therapy. Conventional radiography plays an important role in the diagnosis of symptomatic bone lesions. Computed tomography can evaluate the stability of metastatic lesions and is indispensable for therapy planning. MRI and PET-CT have the highest diagnostic accuracy for the detection of bone metastases and MRI can evaluate their intra- and extraosseus components. PET-CT, PET-MRI, or SPECT-CT in combination with specific tracers - due to their high specificity and sensitivity - have the potential to replace conventional methods in the future. Conservative treatment basically consists of analgesic therapy, the administration of calcium and vitamin D3 and bisphosphonates or inhibitors of RANKL (denosumab). Moreover radium-223-dichloride can improve overall survival and the time to the first symptomatic skeletal event in castration-resistant prostate cancer patients with bone metastases.
Collapse
Affiliation(s)
- B Keck
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland.
| | - M Hammon
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - M Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - J Huber
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - P J Goebell
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - F Kunath
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - B Wullich
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - R H Richter
- Orthopädische Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland
| |
Collapse
|
6
|
Sadeghi-Naini A, Sofroni E, Papanicolau N, Falou O, Sugar L, Morton G, Yaffe MJ, Nam R, Sadeghian A, Kolios MC, Chung HT, Czarnota GJ. Quantitative ultrasound spectroscopic imaging for characterization of disease extent in prostate cancer patients. Transl Oncol 2015; 8:25-34. [PMID: 25749174 PMCID: PMC4350638 DOI: 10.1016/j.tranon.2014.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/13/2014] [Accepted: 11/17/2014] [Indexed: 11/26/2022] Open
Abstract
Three-dimensional quantitative ultrasound spectroscopic imaging of prostate was investigated clinically for the noninvasive detection and extent characterization of disease in cancer patients and compared to whole-mount, whole-gland histopathology of radical prostatectomy specimens. Fifteen patients with prostate cancer underwent a volumetric transrectal ultrasound scan before radical prostatectomy. Conventional-frequency (~5MHz) ultrasound images and radiofrequency data were collected from patients. Normalized power spectra were used as the basis of quantitative ultrasound spectroscopy. Specifically, color-coded parametric maps of 0-MHz intercept, midband fit, and spectral slope were computed and used to characterize prostate tissue in ultrasound images. Areas of cancer were identified in whole-mount histopathology specimens, and disease extent was correlated to that estimated from quantitative ultrasound parametric images. Midband fit and 0-MHz intercept parameters were found to be best associated with the presence of disease as located on histopathology whole-mount sections. Obtained results indicated a correlation between disease extent estimated noninvasively based on midband fit parametric images and that identified histopathologically on prostatectomy specimens, with an r(2) value of 0.71 (P<.0001). The 0-MHz intercept parameter demonstrated a lower level of correlation with histopathology. Spectral slope parametric maps offered no discrimination of disease. Multiple regression analysis produced a hybrid disease characterization model (r(2)=0.764, P<.05), implying that the midband fit biomarker had the greatest correlation with the histopathologic extent of disease. This work demonstrates that quantitative ultrasound spectroscopic imaging can be used for detecting prostate cancer and characterizing disease extent noninvasively, with corresponding gross three-dimensional histopathologic correlation.
Collapse
Affiliation(s)
- Ali Sadeghi-Naini
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5
| | - Ervis Sofroni
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Computer Science, Ryerson University, Toronto, Ontario, Canada M5B 2K3
| | - Naum Papanicolau
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Computer Science, Ryerson University, Toronto, Ontario, Canada M5B 2K3
| | - Omar Falou
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5
| | - Linda Sugar
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada M4N 3M5
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5
| | - Martin J Yaffe
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5
| | - Robert Nam
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada M4N 3M5; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M4N 3M5
| | - Alireza Sadeghian
- Department of Computer Science, Ryerson University, Toronto, Ontario, Canada M5B 2K3
| | - Michael C Kolios
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5; Department of Physics, Ryerson University, Toronto, Ontario, Canada M5B 2K3
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5
| | - Gregory J Czarnota
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5; Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5.
| |
Collapse
|
7
|
Strandberg S, Karlsson CT, Sundström T, Ögren M, Ögren M, Axelsson J, Riklund K. (11)C-acetate PET/CT in pre-therapeutic lymph node staging in high-risk prostate cancer patients and its influence on disease management - a retrospective study. EJNMMI Res 2014; 4:55. [PMID: 26116118 PMCID: PMC4452630 DOI: 10.1186/s13550-014-0055-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/28/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Radiation treatment with simultaneous integrated boost against suspected lymph node metastases may be a curative therapeutic option in patients with high-risk prostate cancer (>15% estimated risk of pelvic lymph node metastases according to the Cagiannos nomogram). (11)C-acetate positron emission tomography/computed tomography (PET/CT) can be used for primary staging as well as for detection of suspected relapse of prostate cancer. The aims of this study were to evaluate the association between positive (11)C-acetate PET/CT findings and the estimated risk of pelvic lymph node metastases and to assess the impact of (11)C-acetate PET/CT on patient management in high-risk prostate cancer patients. METHODS Fifty consecutive prostate cancer patients referred for primary staging with (11)C-acetate PET/CT prior to radiotherapy with curative intention were enrolled in this retrospective study. RESULTS All patients showed increased (11)C-acetate uptake in the prostate. Pelvic lymph node uptake was seen in 42% (21/50) of the patients, with positive external iliac lymph nodes in 71% (15/21) of these. The overall observed proportion of PET/CT-positive pelvic lymph nodes at patient level was higher than the average estimated risk, especially in low-risk groups (<15%). There was a significant association between observed proportion and estimated risk of pelvic lymph node metastases in groups with ≤45 and >45% estimated risk. Treatment strategy was altered due to (11)C-acetate PET/CT findings in 43% (20/47) of the patients. CONCLUSIONS The observed proportion of (11)C-acetate PET/CT findings suggestive of locoregional metastases was higher than the estimated risk, suggesting that the Cagiannos nomogram underestimates the risk for metastases. The imaging results with (11)C-acetate PET/CT have a considerable impact on patient management.
Collapse
Affiliation(s)
- Sara Strandberg
- Department of Radiation Sciences, Umeå University, 90185, Umeå, Sweden
| | | | | | - Mattias Ögren
- Department of Radiation Sciences, Umeå University, 90185, Umeå, Sweden
| | - Margareta Ögren
- Department of Radiation Sciences, Umeå University, 90185, Umeå, Sweden
| | - Jan Axelsson
- Department of Radiation Sciences, Umeå University, 90185, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Umeå University, 90185, Umeå, Sweden
| |
Collapse
|