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Albers P, Kinnaird A. Advanced Imaging for Localized Prostate Cancer. Cancers (Basel) 2024; 16:3490. [PMID: 39456584 PMCID: PMC11506824 DOI: 10.3390/cancers16203490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 10/10/2024] [Accepted: 10/14/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Prostate cancer is a prevalent malignancy often presenting without early symptoms. Advanced imaging technologies have revolutionized its diagnosis and management. This review discusses the principles, benefits, and clinical applications of multiparametric magnetic resonance imaging (mpMRI), micro-ultrasound (microUS), and prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET/CT) in localized prostate cancer. METHODS We conducted a comprehensive literature review of recent studies and guidelines on mpMRI, microUS, and PSMA PET/CT in prostate cancer diagnosis, focusing on their applications in biopsy-naïve patients, those with previous negative biopsies, and patients under active surveillance. RESULTS MpMRI has demonstrated high sensitivity and negative predictive value in detecting clinically significant prostate cancer (csPCa). MicroUS, a newer technology, has shown promising results in early studies, with sensitivity and specificity comparable to mpMRI. PSMA PET/CT has emerged as a highly sensitive and specific imaging modality, particularly valuable for staging and detecting metastatic disease. All three technologies have been incorporated into urologic practice for prostate cancer diagnosis and management, with each offering unique advantages in different clinical scenarios. CONCLUSIONS Advanced imaging techniques, including mpMRI, microUS, and PSMA PET/CT, have significantly improved the accuracy of prostate cancer diagnosis, staging, and management. These technologies enable more precise targeting of suspicious lesions during biopsy and therapy planning. However, further research, especially randomized controlled trials, is needed to fully establish the optimal use and inclusion of these imaging modalities in various stages of prostate cancer care.
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Affiliation(s)
- Patrick Albers
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB T6G 1Z2, Canada;
| | - Adam Kinnaird
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB T6G 1Z2, Canada;
- Alberta Prostate Cancer Research Initiative (APCaRI), Edmonton, AB T6G 1Z2, Canada
- Cancer Research Institute of Northern Alberta (CRINA), Edmonton, AB T6G 2E1, Canada
- Alberta Center for Urologic Research and Excellence (ACURE), Edmonton, AB T6G 1Z2, Canada
- Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
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Liu J, Lin X, Huang D, Zhang M, Liu A, Ruan X, Jiang J, Huang H, Chen L, Xu D. Diagnostic value comparison of the combination of prostate-specific membrane antigen-body PET/MR and the prostate health index with each alone in early diagnosis of prostate cancer. Asian J Urol 2024; 11:555-562. [PMID: 39534010 PMCID: PMC11551469 DOI: 10.1016/j.ajur.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2024] Open
Abstract
Objective This study aimed to figure out whether the combination of the prostate health index (PHI) and prostate-specific membrane antigen (PSMA)-PET/MR could improve the diagnostic accuracy for prostate cancer (PCa) than that of each individual method used alone. Methods In this prospective, observational study, 41 patients who underwent the systematic prostate biopsy between June 2019 and September 2022 were enrolled. Both the PHI test and 18F-PSMA-1007-PET/MR were performed prior to biopsies. The diagnostic accuracy of different models was compared by logistic regression, areas under the curve (AUCs) of the receiver operating characteristic, and net reclassification index (NRI). Results Among the 41 patients, 14 (34.1%) were pathologically diagnosed with PCa. The PHI in the PCa group was significantly higher than that in the benign group (44.4 vs. 35.0, p=0.048). Similarly, all the patients in the PCa group received positive results of 18F-PSMA-1007-PET/MR, of which the positive rate was significantly higher than that in benign group (100% vs. 62.96%, p=0.025). The 18F-PSMA-1007-PET/MR provided additional diagnostic values to the PHI (AUC: 0.802 vs. 0.692, p=0.025). However, there was no significant difference between the combination model and the 18F-PSMA-1007-PET/MR alone (AUC 0.802 vs. 0.685, p=0.071). The optimal PHI cutoff of the combination model is 32, with which the model could significantly reduce unnecessary biopsies (NRI: 22.22%, 95% confidence interval: 6.54%-37.90%, p=0.005). However, among patients with the PHI of ≥43.5, there was no significant difference between the combination model and the PHI alone (NRI: 11.11%, 95% confidence interval: -0.74%-22.97%, p=0.066). Conclusion The combination of the PHI and 18F-PSMA-1007-PET/MR outperforms the PHI alone for predicting PCa, especially in avoiding unnecessary biopsies. However, for patients with the PHI of ≥43.5, the addition of 18F-PSMA-1007-PET/MR to the PHI does not yield additional benefits.
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Affiliation(s)
- Jiacheng Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Lin
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Miao Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ao Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohao Ruan
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingrong Jiang
- Shanghai Yuye Medical Technology Co. Ltd, Shanghai, China
| | - Hai Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Chen
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhang T, Zhou Z, Li W, Xu C, Zhao S, Wei H, Huang Z, Zhao X. Application value of magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer. Sci Rep 2024; 14:22278. [PMID: 39333720 PMCID: PMC11437187 DOI: 10.1038/s41598-024-73605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/19/2024] [Indexed: 09/29/2024] Open
Abstract
Magnetic resonance spectroscopy (MRSI) can distinguish between benign and malignant prostate diseases. This study investigated the potential of MRSI for diagnosing prostate cancer and guiding prostate biopsy. We retrospectively reviewed 234 patients with suspected prostate cancer who underwent MRSI with targeted prostate biopsy. Patients were divided into two groups according to their puncture pathology: prostate cancer (n = 103, 44.02%) and benign prostatic disease (n = 131, 55.98%). The t-test, Mann-Whitney U test, or chi-square test was used to compare the groups. The diagnostic abilities of MRSI, prostate-specific antigen level, digital rectal examination, and magnetic resonance imaging without contrast for prostate cancer were compared using the area under the receiver operating characteristic curve (AUC-ROC); the ARC-ROC values were 0.831, 0.768, 0.692, and 0.656, respectively. The AUC-ROC value for diagnosing prostate cancer using the CC/c ratio was 0.853. CC/c ratio > 0.97 was identified as the optimal threshold for diagnosing prostate cancer (sensitivity, 86.5%; specificity, 78.6%; Youden index, 0.651). Spearman correlation analysis revealed a correlation between the CC/c ratio and Gleason score (r = 0.737, p < 0.001). Using the CC/c ratio of MRSI as an adjunct to targeted prostate biopsy can improve the detection rate of positive biopsies and evaluate prostate cancer invasiveness.
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Affiliation(s)
- Tianhe Zhang
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Zhiyong Zhou
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Wuxue Li
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Changbao Xu
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Shuailin Zhao
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Haiyang Wei
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Zhiheng Huang
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China
| | - Xinghua Zhao
- Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Road, Jinshui District, Zhengzhou, 450014, China.
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Ye Z, Kou Y, Shen J, Dang J, Tan X, Jiang X, Wang X, Lu H, Chen S, Cheng Z. A comparative study of 18F-PSMA-1007 PET/CT and pelvic MRI in newly diagnosed prostate cancer. BMC Med Imaging 2024; 24:192. [PMID: 39080625 PMCID: PMC11290235 DOI: 10.1186/s12880-024-01376-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE To evaluate the difference in the diagnostic efficacy of 18F-PSMA-1007 PET/CT and pelvic MRI in primary prostate cancer, as well as the correlation between the two methods and histopathological parameters and serum PSA levels. METHODS A total of 41 patients with suspected prostate cancer who underwent 18F-PSMA-1007 PET/CT imaging in our department from 2018 to 2023 were retrospectively collected. All patients underwent 18F-PSMA-1007 PET/CT and MRI scans. The sensitivity, PPV and diagnostic accuracy of MRI and 18F-PSMA-1007 PET/CT in the diagnosis of prostate cancer were calculated after comparing the results of MRI and 18F-PSMA-1007 PET/CT with biopsy. The Spearman test was used to calculate the correlation between 18F-PSMA-1007 PET/CT, MRI parameters, histopathological indicators, and serum PSA levels. RESULTS Compared with histopathological results, the sensitivity, PPV and diagnostic accuracy of 18F-PSMA-1007 PET/CT in the diagnosis of prostate cancer were 95.1%, 100.0% and 95.1%, respectively. The sensitivity, PPV and diagnostic accuracy of MRI in the diagnosis of prostate cancer were 82.9%, 100.0% and 82.9%, respectively. There was a mild to moderately positive correlation between Gleason (Gs) score, Ki-67 index, serum PSA level and 18F-PSMA-1007 PET/CT parameters (p < 0.05). There was a moderately negative correlation between the expression of AMACR (P504S) and 18F-PSMA-1007 PET/CT parameters (p < 0.05). The serum PSA level and the Gs score were moderately positively correlated with the MRI parameters (p < 0.05). There was no correlation between histopathological parameters and MRI parameters (p > 0.05). CONCLUSION Compared with MRI, 18F-PSMA-1007 PET/CT has higher sensitivity and diagnostic accuracy in the detection of malignant prostate tumors. In addition, the Ki-67 index and AMACR (P504S) expression were only correlated with 18F-PSMA-1007 PET/CT parameters. Gs score and serum PSA level were correlated with 18F-PSMA-1007 PET/CT and MRI parameters. 18F-PSMA-1007 PET/CT examination can provide certain reference values for the clinical diagnosis, evaluation, and treatment of malignant prostate tumors.
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Affiliation(s)
- Zhenyan Ye
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Guang'an District People's Hospital, Guangan, China
| | - Ying Kou
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Jiaqi Shen
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Dang
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaofei Tan
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xiao Jiang
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoxiong Wang
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Lu
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Shirong Chen
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Zhuzhong Cheng
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
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Jiang Z, Guo J, Hu L, Yang S, Meng B, Tang Q. Diagnostic performance of 18F‑DCFPyL PET vs. 68Ga‑PSMA PET/CT in patients with suspected prostate cancer: A systemic review and meta‑analysis. Oncol Lett 2024; 27:188. [PMID: 38486944 PMCID: PMC10938285 DOI: 10.3892/ol.2024.14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
In this systematic review and meta-analysis, the diagnostic performance of 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/CT was compared with that of 18F-DCFPyL PET for patients with suspected prostate cancer (PCa). Up to September 2023, the PubMed, Embase and Web of Science databases were thoroughly searched for relevant papers. Studies examining the diagnostic performance of 18F-DCFPyL PET and 68Ga-PSMA PET/CT in patients with suspected PCa were included in the present review. The Quality Assessment of Diagnostic Performance Studies-2 tool was used to rate the diagnostic performance of each study. The diagnostic performance of 18F-DCFPyL PET and 68Ga-PSMA PET/CT for primary PCa was examined by 13 studies included, comprising 1,178 patients. The pooled sensitivity and specificity of 18F-DCFPyL PET were 0.92 (95% CI, 0.85-0.96) and 0.59 (95% CI, 0.08-0.96), respectively. For 68Ga-PSMA PET/CT, the pooled sensitivity and specificity were 0.96 (95% CI, 0.88-0.99) and 0.71 (95% CI, 0.57-0.82), respectively. 18F-DCFPyL PET and 68Ga-PSMA PET/CT both had an area under the receiver operating characteristic curve of 0.92 (95% CI, 0.89-0.94). In addition, the Fagan nomogram revealed that the post-test probabilities for 18F-DCFPyL PET and 68Ga-PSMA PET/CT could rise to 69 and 77% when the pre-test probability was set at 50%. In conclusion, a comparable diagnostic performance for patients with suspected PCa was determined for 18F-DCFPyL PET and 68Ga-PSMA PET/CT. However, it is crucial to keep in mind that the findings of the present meta-analysis come from investigations with modest sample sizes. Therefore, more extensive research is required to obtain more solid data.
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Affiliation(s)
- Zhibing Jiang
- Department of Clinical Medicine, Medical College, Hunan University of Chinese Medicine, Changsha, Hunan 410208, P.R. China
| | - Jinjing Guo
- Department of Clinical Medicine, Medical College, Hunan University of Chinese Medicine, Changsha, Hunan 410208, P.R. China
| | - Liang Hu
- Department of Clinical Medicine, Medical College, Hunan University of Chinese Medicine, Changsha, Hunan 410208, P.R. China
| | - Siyu Yang
- Department of Clinical Medicine, Medical College, Hunan University of Chinese Medicine, Changsha, Hunan 410208, P.R. China
| | - Bin Meng
- Department of Clinical Medicine, Medical College, Hunan University of Chinese Medicine, Changsha, Hunan 410208, P.R. China
| | - Qun Tang
- Department of Clinical Medicine, Medical College, Hunan University of Chinese Medicine, Changsha, Hunan 410208, P.R. China
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Büttner T, Gärtner F, Essler M, Weiten R, Kristiansen G, Ellinger J, Ritter M, Krausewitz P. Key learnings from concordant systematic biopsies in prostate-specific membrane antigen positron emission tomography/computed tomography-guided prostate biopsies: Enhancing targeting accuracy. Prostate 2024. [PMID: 38504659 DOI: 10.1002/pros.24694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Prostate cancer (PCa) diagnosis and staging have evolved with the advent of 68Ga-Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT). This study investigates the role of complementary systematic biopsies (SB) during PSMA-PET/CT-guided targeted prostate biopsies (PET-TB) for PCa detection, grading, and distribution. We address the uncertainty surrounding the necessity of SB in conjunction with PET-TB. METHODS We analyzed PCa grading and distribution in 30 men who underwent PET-TB and SB because of contraindication to magnetic resonance imaging or high clinical suspicion of PCa. Tumor distribution was assessed in relation to the PET-highlighted lesions. Standardized reporting schemes, encompassing SUVmax , PRIMARY score, and miTNM classification, were evaluated. RESULTS 80% of patients were diagnosed with PCa, with 70% classified as clinically significant (csPCa). SB detected more csPCa cases than PET-TB, but the differences were not statistically significant. Discordant results were observed in 25% of cases, where SB outperformed PET-TB. Spatial analysis revealed that tumor-bearing cores from SB were often located in close proximity to the PET-highlighted region. Reporting schemes showed potential for csPCa detection with significantly increased SUVmax in csPCA patients. Subsequent follow-up data underscored the importance of SB in precise PCa grading and staging. CONCLUSIONS While PET-TB can simplify prostate biopsy and reduce invasiveness by core number, SB cannot be omitted yet due to potential PET-TB targeting errors. Factors such as limited spatial resolution and fusion inaccuracies contribute to the need for SB. Standardization in reporting schemes currently cannot compensate for targeting errors highlighting the need for refinement.
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Affiliation(s)
- Thomas Büttner
- Department of Urology and Paediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Florian Gärtner
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Richard Weiten
- Department of Urology and Paediatric Urology, University Hospital Bonn, Bonn, Germany
| | | | - Jörg Ellinger
- Department of Urology and Paediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Manuel Ritter
- Department of Urology and Paediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Philipp Krausewitz
- Department of Urology and Paediatric Urology, University Hospital Bonn, Bonn, Germany
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7
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Bagheri H, Mahdavi SR, Geramifar P, Neshasteh-Riz A, Sajadi Rad M, Dadgar H, Arabi H, Zaidi H. An Update on the Role of mpMRI and 68Ga-PSMA PET Imaging in Primary and Recurrent Prostate Cancer. Clin Genitourin Cancer 2024; 22:102076. [PMID: 38593599 DOI: 10.1016/j.clgc.2024.102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/28/2024] [Accepted: 03/09/2024] [Indexed: 04/11/2024]
Abstract
The objective of this work was to review comparisons of the efficacy of 68Ga-PSMA-11 (prostate-specific membrane antigen) PET/CT and multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer among patients undergoing initial staging prior to radical prostatectomy or experiencing recurrent prostate cancer, based on histopathological data. A comprehensive search was conducted in PubMed and Web of Science, and relevant articles were analyzed with various parameters, including year of publication, study design, patient count, age, PSA (prostate-specific antigen) value, Gleason score, standardized uptake value (SUVmax), detection rate, treatment history, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and PI-RADS (prostate imaging reporting and data system) scores. Only studies directly comparing PSMA-PET and mpMRI were considered, while those examining combined accuracy or focusing on either modality alone were excluded. In total, 24 studies comprising 1717 patients were analyzed, with the most common indication for screening being staging, followed by relapse. The findings indicated that 68Ga-PSMA-PET/CT effectively diagnosed prostate cancer in patients with suspected or confirmed disease, and both methods exhibited comparable efficacy in identifying lesion-specific information. However, notable heterogeneity was observed, highlighting the necessity for standardization of imaging and histopathology systems to mitigate inter-study variability. Future research should prioritize evaluating the combined diagnostic performance of both modalities to enhance sensitivity and reduce unnecessary biopsies. Overall, the utilization of PSMA-PET and mpMRI in combination holds substantial potential for significantly advancing the diagnosis and management of prostate cancer.
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Affiliation(s)
- Hamed Bagheri
- Radiation Biology Research Center, Iran University of Medical Science (IUMS), Tehran, Iran
| | - Seyed Rabi Mahdavi
- Radiation Biology Research Center and Department of Medical Physics, Iran University of Medical Sciences, Tehran, Iran.
| | - Parham Geramifar
- Department Nuclear Medicine, School of Medicine Shariati Hospital, Tehran, Iran
| | - Ali Neshasteh-Riz
- Radiation Biology Research Center, Iran University of Medical Science (IUMS), Tehran, Iran
| | - Masoumeh Sajadi Rad
- Radiation Biology Research Center, Iran University of Medical Science (IUMS), Tehran, Iran
| | - Habibollah Dadgar
- Imam Reza research Center, Nuclear Medicine and Molecular imaging department, RAZAVI Hospital, Mashhad, Iran
| | - Hossein Arabi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University 6Medical Center Groningen, Groningen, Netherlands; Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark; University Research and Innovation Center, Óbuda University, Budapest, Hungary.
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8
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Ren X, Nur Salihin Yusoff M, Hartini Mohd Taib N, Zhang L, Wang K. 68Ga-prostate specific membrane antigen-11 PET/CT versus multiparametric MRI in the detection of primary prostate cancer: A systematic review and head-to-head comparative meta-analysis. Eur J Radiol 2024; 170:111274. [PMID: 38147764 DOI: 10.1016/j.ejrad.2023.111274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE The goal of this study was to evaluate the effectiveness of two diagnostic methods, 68Ga-PSMA-11 PET/CT and mpMRI, in detecting primary prostate cancer without limitations on the Gleason score. METHODS We conducted a comprehensive literature review, searching databases such as PubMed, Embase, and Web of Science until June 2023. Our objective was to identify studies that compared the efficacy of 68Ga-PSMA-11 PET/CT and mpMRI in detecting primary prostate cancer. To determine heterogeneity, the I2 statistic was used. Meta-regression analysis and leave-one-out sensitivity analysis were conducted to identify potential sources of heterogeneity. RESULTS Initially, 1286 publications were found, but after careful evaluation, only 16 studies involving 1227 patients were analyzed thoroughly. The results showed that the 68Ga-PSMA-11 PET/CT method had a pooled sensitivity and specificity of 0.87 (95 % CI: 0.80-0.92) and 0.80 (95 % CI: 0.69-0.89), respectively, for diagnosing prostatic cancer. Similarly, the values for mpMRI were determined as 0.84 (95 % CI: 0.75-0.92) and 0.74 (95 % CI: 0.61-0.86), respectively. There were no significant differences in diagnostic effectiveness observed when comparing two primary prostate cancer methodologies (pooled sensitivity P = 0.62, pooled specificity P = 0.50). Despite this, the funnel plots showed symmetry and the Egger test results (P values > 0.05) suggested there was no publication bias. CONCLUSIONS After an extensive meta-analysis, it was found that both 68Ga-PSMA-11 PET/CT and mpMRI demonstrate similar diagnostic effectiveness in detecting primary prostate cancer. Future larger prospective studies are warranted to investigate this issue further.
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Affiliation(s)
- Xiaolu Ren
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan 750004, China; School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | - Nur Hartini Mohd Taib
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Li Zhang
- Department of Urology, People's Hospital of Wuzhong, Wuzhong 751100, China
| | - Kehua Wang
- Department of Vascular Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
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9
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Caracciolo M, Castello A, Lopci E. PSMA PET/CT Versus mpMRI for the Detection of Clinically Significant Prostate Cancer: An Updated Overview. Semin Nucl Med 2024; 54:30-38. [PMID: 37951766 DOI: 10.1053/j.semnuclmed.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
In the last years, PSMA-PET imaging and multiparametric MRI (mpMRI) have improved the clinical management of prostate cancer (PCa) patients. Currently, mpMRI is recommended by the EAU (European Association of Urology) guidelines for the primary diagnosis of PCa, whereas PSMA-PET is reserved for disease staging, particularly in high risk localized or locally advanced disease, as well as for biochemical recurrence after surgery. Nevertheless, several studies have explored the added value of PSMA-PET in other clinical scenarios, including primary diagnosis and especially for the detection of clinically significant PCa (csPCa). In the present contribution, we will provide an overview and an update on the current literature on imaging detection of csPCa, with a particular focus on mpMRI, PSMA-PET and their comparison.
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Affiliation(s)
- Matteo Caracciolo
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Angelo Castello
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS - Humanitas Research Hospital, Rozzano, Milan, Italy.
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10
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Jochumsen MR, Bouchelouche K. PSMA PET/CT for Primary Staging of Prostate Cancer - An Updated Overview. Semin Nucl Med 2024; 54:39-45. [PMID: 37487824 DOI: 10.1053/j.semnuclmed.2023.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
Prostate-specific membrane antigen PET/CT for primary staging of prostate cancer is becoming increasingly popular due to simultaneous assessment of whole-body disease burden, with superior sensitivity and specificity for detecting metastases compared to conventional imaging. PSMA PET in combination with multiparametric MRI (mpMRI) improves the sensitivity of assessment of extra-prostatic extension and seminal vesicle invasion compared to mpMRI alone, and may serve as a second line modality for image-guided biopsy in selected patients with negative mpMRI and/or negative primary biopsies. The superior diagnostic accuracy of PSMA PET/CT affects clinical decision-making with a change of clinical management in one-fourth of patients compared to conventional imaging. However, at present, the effect of implementing PSMA PET/CT for primary staging on patient outcomes is not clear, and prospective studies are warranted. There are several PSMA tracers with similar performance and minor individual pharmacokinetic differences such as higher rate of unspecific bone uptake with 18F-PSMA-1007, but on the other hand, lower urinary excretion, which could give an advantage in the detection of local recurrence. Proper training of the reporting physicians and knowledge of the pitfalls of the specific PSMA tracer used is of utmost importance for high-quality reading. We aim to provide an overview of the current literature and an update on the status of PSMA PET/CT for primary staging of prostate cancer.
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Affiliation(s)
- Mads Ryø Jochumsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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11
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Ding Y, Mo C, Ding Q, Lin T, Gao J, Chen M, Lu W, Sun J, Wang F, Zang S, Zhang Q, Zhang S, Guo H. Prediction of T staging in PI-RADS 4-5 prostate cancer by combination of multiparametric MRI and 68Ga-PSMA-11 PET/CT. BMC Urol 2023; 23:206. [PMID: 38082379 PMCID: PMC10712094 DOI: 10.1186/s12894-023-01376-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In this study, we explored the diagnostic performances of multiparametric magnetic resonance imaging (mpMRI), 68 Ga-PSMA-11 PET/CT and combination of 68 Ga-PSMA-11 PET/CT and mpMRI (mpMRI + PET/CT) for extracapsular extension (ECE). Based on the analyses above, we tested the feasibility of using mpMRI + PET/CT results to predict T staging in prostate cancer patients. METHODS By enrolling 75 patients of prostate cancer with mpMRI and 68 Ga-PSMA-11 PET/CT before radical prostatectomy, we analyzed the detection performances of ECE in mpMRI, 68 Ga-PSMA-11 PET/CT and mpMRI + PET/CT on their lesion images matched with their pathological sample images layer by layer through receiver operating characteristics (ROC) analysis. By inputting the lesion data into Prostate Imaging Reporting and Data System (PI-RADS), we divided the lesions into different PI-RADS scores. The improvement of detecting ECE was analyzed by net reclassification improvement (NRI). The predictors for T staging were evaluated by using univariate and multivariable analysis. The Kappa test was used to evaluate the prediction ability. RESULTS One hundred three regions of lesion were identified from 75 patients. 50 of 103 regions were positive for ECE. The ECE diagnosis AUC of mpMRI + PET/CT is higher than that of mpMRI alone (ΔAUC = 0.101; 95% CI, 0.0148 to 0.1860; p < 0.05, respectively). Compared to mpMRI, mpMRI + PET/CT has a significant improvement in detecting ECE in PI-RADS 4-5 (NRI 36.1%, p < 0.01). The diagnosis power of mpMRI + PET/CT was an independent predictor for T staging (p < 0.001) in logistic regression analysis. In patients with PI-RADS 4-5 lesions, 40 of 46 (87.0%) patients have correct T staging prediction from mpMRI + PET/CT (κ 0.70, p < 0.01). CONCLUSION The prediction of T staging in PI-RADS 4-5 prostate cancer patients by mpMRI + PET/CT had a quite good performance.
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Affiliation(s)
- Yuanzhen Ding
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Chenghao Mo
- Department of Urology, Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Qiubo Ding
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Tingsheng Lin
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Jie Gao
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Mengxia Chen
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Wenfeng Lu
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Jiyuan Sun
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Shiming Zang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Qing Zhang
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| | - Shiwei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
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12
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Bodar YJL, Boevé LMS, van Leeuwen PJ, Baars PC, Nieuwenhuijzen JA, van Haarst EP, Oddens JR, Donswijk ML, van Riel LAMJG, Scheltema MJ, Meijer D, Hendrikse NH, Oprea-Lager DE, Vis AN. Using prostate-specific membrane antigen positron-emission tomography to guide prostate biopsies and stage men at high-risk of prostate cancer. BJU Int 2023; 132:705-712. [PMID: 37620288 DOI: 10.1111/bju.16167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To assess whether a diagnostic pathway in which prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) is used as a single imaging modality is feasible to guide targeted biopsy and to detect clinically significant prostate cancer (csPCa) in biopsy-naïve men at high-risk of disease. PATIENTS AND METHODS A total of 60 men with a prostate-specific antigen (PSA) level of 20-50 ng/mL underwent 18 F-PSMA(DCFPyL)-PET/CT prior to prostate biopsies in this prospective, non-randomised cohort study. Magnetic resonance imaging (MRI) was not performed. Using a 12-segment mapping model of the prostate, PSMA-guided targeted biopsy was performed along with systematic biopsies. The detection rate of PCa and csPCa was assessed for combined systematic and targeted biopsy, and for targeted biopsy only. csPCa was defined as a prostate biopsy with an International Society of Uropathology (ISUP) Grade Group ≥2. RESULTS Lesions suspicious for PCa in the prostate gland were observed on all PSMA-PET/CTs. A total of 27/60 men (45%) already had metastatic disease on staging 18 F-PSMA(DCFPyL)-PET/CT. Combined PSMA-guided targeted and systematic biopsies detected PCa in 56/60 (93.3%) patients, with 52 of them (92.9%) having csPCa. PSMA-guided targeted biopsy, if performed as a single biopsy modality, identified PCa in 52/60 men (86.7%) and in 27/27 men (100%) men with metastases. CONCLUSIONS Using the PSMA-driven single imaging modality pathway in biopsy-naïve men at high-risk of PCa, a substantial number of diagnostic MRI scans could be avoided while at the same time obtaining adequate targeting, staging, and detection of csPCa.
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Affiliation(s)
- Yves J L Bodar
- Department of Urology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Radiology and Nuclear medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
- Prostate Cancer Network, Amsterdam, The Netherlands
| | - Liselotte M S Boevé
- Department of Urology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Prostate Cancer Network, Amsterdam, The Netherlands
- Department of Urology, Netherlands Cancer Institute (NCI), Amsterdam, The Netherlands
| | - Phillippe C Baars
- Department of Radiology and Nuclear Medicine, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Jakko A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Prostate Cancer Network, Amsterdam, The Netherlands
| | - Ernst P van Haarst
- Department of Urology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Jorg R Oddens
- Department of Urology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Radiology and Nuclear Medicine, Netherlands Cancer Institute (NCI), Amsterdam, The Netherlands
| | - Luigi A M J G van Riel
- Department of Urology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Prostate Cancer Network, Amsterdam, The Netherlands
| | - Matthijs J Scheltema
- Department of Urology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Prostate Cancer Network, Amsterdam, The Netherlands
| | - Dennie Meijer
- Department of Urology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Radiology and Nuclear medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
- Prostate Cancer Network, Amsterdam, The Netherlands
| | - N Harry Hendrikse
- Department of Radiology and Nuclear medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Prostate Cancer Network, Amsterdam, The Netherlands
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13
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Avolio PP, Fasulo V, Sanchez-Salas R, Maffei D, Frego N, Lazzeri M, Paciotti M, Saita A, Hurle R, Guazzoni G, Casale P, Buffi NM, Lughezzani G. Diagnostic accuracy of multiparametric MRI- and microultrasound-targeted biopsy in biopsy-naïve patients with a PI-RADS 5 lesion: a single-institutional study. World J Urol 2023; 41:2335-2342. [PMID: 37418017 DOI: 10.1007/s00345-023-04480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI)- and microultrasound (microUS)-guided targeted biopsy (TBx) in detecting prostate cancer (PCa) and clinically significant (cs) PCa among men with Prostate Imaging Reporting and Data System (PI-RADS 5) lesions and to compare this combined TBx (CTBx) strategy with CTBx plus systemic biopsy (SBx). METHODS One hundred and thirty-six biopsy-naïve patients with PI-RADS 5 lesion at multiparametric MRI undergoing CTBx plus SBx were retrospectively evaluated. Analysis of diagnostic performance of microUS-TBx, MRI-TBx, CTBx, SBx and combined CTBx plus SBx was performed. Cost (downgrade, upgrade and biopsy core) to effectiveness (detection rate) was compared. RESULTS CTBx achieved a comparable detection rate to CTBx plus SBx in diagnosis of PCa and csPCa (PCa: 78.7% [107/136] vs 79.4% [108/136]; csPCa: 67.6% [92/136] vs 67.6% [92/136]; p > 0.05) and outperformed SBx (PCa: 58.8% [80/136]; csPCa: 47.8% [65/136]; p < 0.001). Using CTB would have avoided 41.1% (56/136) unnecessary SBx, without missing any csPCa. The rate of any upgrading or csPCa upgrading was significantly higher by SBx than by CTBx [33/65 (50.8%) vs 17/65 (26.1%) and 20/65 (30.8%) vs 4/65 (6.15%), respectively, p < 0.05]. Considering csPCa detection rate, microUS showed high sensitivity and positive predictive value (94.6%, 87.9%, respectively), with lower specificity and negative predictive value (25.0% and 44.4%, respectively). At multivariable logistic regression models, positive microUS was identified as an independent predictor of csPCa (p = 0.024). CONCLUSIONS A combined microUS/MRI-TBx approach could be the ideal imaging tool for characterizing primary disease in PI-RADS five patients, allowing SBx to be avoided.
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Affiliation(s)
- Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- , Via Rita Levi Montalcini, 4, 20090, Rozzano, MI, Italy.
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14
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Ghezzo S, Neri I, Mapelli P, Savi A, Samanes Gajate AM, Brembilla G, Bezzi C, Maghini B, Villa T, Briganti A, Montorsi F, De Cobelli F, Freschi M, Chiti A, Picchio M, Scifo P. [ 68Ga]Ga-PSMA and [ 68Ga]Ga-RM2 PET/MRI vs. Histopathological Images in Prostate Cancer: A New Workflow for Spatial Co-Registration. Bioengineering (Basel) 2023; 10:953. [PMID: 37627838 PMCID: PMC10451901 DOI: 10.3390/bioengineering10080953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
This study proposed a new workflow for co-registering prostate PET images from a dual-tracer PET/MRI study with histopathological images of resected prostate specimens. The method aims to establish an accurate correspondence between PET/MRI findings and histology, facilitating a deeper understanding of PET tracer distribution and enabling advanced analyses like radiomics. To achieve this, images derived by three patients who underwent both [68Ga]Ga-PSMA and [68Ga]Ga-RM2 PET/MRI before radical prostatectomy were selected. After surgery, in the resected fresh specimens, fiducial markers visible on both histology and MR images were inserted. An ex vivo MRI of the prostate served as an intermediate step for co-registration between histological specimens and in vivo MRI examinations. The co-registration workflow involved five steps, ensuring alignment between histopathological images and PET/MRI data. The target registration error (TRE) was calculated to assess the precision of the co-registration. Furthermore, the DICE score was computed between the dominant intraprostatic tumor lesions delineated by the pathologist and the nuclear medicine physician. The TRE for the co-registration of histopathology and in vivo images was 1.59 mm, while the DICE score related to the site of increased intraprostatic uptake on [68Ga]Ga-PSMA and [68Ga]Ga-RM2 PET images was 0.54 and 0.75, respectively. This work shows an accurate co-registration method for histopathological and in vivo PET/MRI prostate examinations that allows the quantitative assessment of dual-tracer PET/MRI diagnostic accuracy at a millimetric scale. This approach may unveil radiotracer uptake mechanisms and identify new PET/MRI biomarkers, thus establishing the basis for precision medicine and future analyses, such as radiomics.
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Affiliation(s)
- Samuele Ghezzo
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.S.); (A.M.S.G.)
| | - Ilaria Neri
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.S.); (A.M.S.G.)
| | - Paola Mapelli
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.S.); (A.M.S.G.)
| | - Annarita Savi
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.S.); (A.M.S.G.)
| | - Ana Maria Samanes Gajate
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.S.); (A.M.S.G.)
| | - Giorgio Brembilla
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Carolina Bezzi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.S.); (A.M.S.G.)
| | - Beatrice Maghini
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (B.M.); (M.F.)
| | - Tommaso Villa
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
| | - Alberto Briganti
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Montorsi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco De Cobelli
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Massimo Freschi
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (B.M.); (M.F.)
| | - Arturo Chiti
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.S.); (A.M.S.G.)
| | - Maria Picchio
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (S.G.); (I.N.); (P.M.); (G.B.); (C.B.); (T.V.); (A.B.); (F.M.); (F.D.C.); (A.C.); (M.P.)
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.S.); (A.M.S.G.)
| | - Paola Scifo
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.S.); (A.M.S.G.)
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15
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A Systematic Review of the Variability in Performing and Reporting Intraprostatic Prostate-specific Membrane Antigen Positron Emission Tomography in Primary Staging Studies. EUR UROL SUPPL 2023; 50:91-105. [PMID: 37101769 PMCID: PMC10123424 DOI: 10.1016/j.euros.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 03/06/2023] Open
Abstract
Context Prostate cancer (PCa) remains one of the leading causes of cancer-related deaths in men worldwide. Men at risk are typically offered multiparametric magnetic resonance imaging and, if suspicious, a targeted biopsy. However, false-negative rates of magnetic resonance imaging are consistently 18%; therefore, there is growing interest in improving the diagnostic performance of imaging through novel technologies. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for PCa staging and, more recently, for intraprostatic tumour localisation. However, significant variability has been observed in how PSMA PET is performed and reported. Objective In this review, we aim to evaluate how pervasive this variability is in trials investigating the performance of PSMA PET in primary PCa workup. Evidence acquisition Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed an optimal search in five different databases. After removing duplicates, 65 studies were included in our review. Evidence synthesis Studies dated back as early as 2016, with numerous different source countries. There was variation in the reference standard for PSMA PET, with some using biopsy specimens or surgical specimens, and in some cases, a combination of the two. Similar inconsistencies were noted when studies selected histological definitions of clinically significant PCa, while some omitted their definition altogether. The most significant variations in performing PSMA PET were the radiotracer type, dose, acquisition time after injection, and the PET camera being utilised. Substantial variation in the reporting of PSMA PET was noted, with no consistency in defining what constitutes a positive intraprostatic lesion. Across 65 studies, four different definitions were used. Conclusions This systematic review has highlighted considerable variation in obtaining and performing a PSMA PET study in the context of primary PCa diagnosis. Given the discrepancy in how PSMA PET was performed and reported, it questions the homogony of studies from centre to centre. Standardisation of PSMA PET is required for this to become a consistently useful and reproducible modality in the diagnosis of PCa. Patient summary Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for staging and localisation of prostate cancer (PCa); however, there is significant variability in performing and reporting PSMA PET. Standardisation of PSMA PET is required for results to be consistently useful and reproducible for the diagnosis of PCa.
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16
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Krausewitz P, Bundschuh RA, Gaertner FC, Essler M, Attenberger U, Luetkens J, Kristiansen G, Muders M, Ohlmann CH, Hauser S, Ellinger J, Ritter M. DEPROMP Trial: the additive value of PSMA-PET/CT-guided biopsy for prostate cancer management in biopsy naïve men-study protocol for a randomized trial. Trials 2023; 24:167. [PMID: 36879271 PMCID: PMC9987083 DOI: 10.1186/s13063-023-07197-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The primary objective is to determine the proportion of men with suspected prostate cancer (PCA) in whom the management plans are changed by additive gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) guided prostate biopsy (PET-TB) in combination with standard of care (SOC) using systematic (SB) and multiparametric magnetic resonance imaging-guided biopsy (MR-TB) compared with SOC alone. The major secondary objectives are to determine the additive value of the combined approach of SB + MR-TB + PET-TB (PET/MR-TB) for detecting clinically significant PCA (csPCA) compared to SOC; to determine sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of imaging techniques, respective imaging classification systems, and each biopsy method; and to compare preoperatively defined tumor burden and biomarker expression and pathological tumor extent in prostate specimens. METHODS The DEPROMP study is a prospective, open-label, interventional investigator-initiated trial. Risk stratification and management plans after PET/MR-TB are conducted randomized and blinded by different evaluation teams of experienced urologists based on histopathological analysis and imaging information: one including all results of the PET/MR-TB and one excluding the additional information gained by PSMA-PET/CT guided biopsy. The power calculation was centered on pilot data, and we will recruit up to 230 biopsy-naïve men who will undergo PET/MR-TB for suspected PCA. Conduct and reporting of MRI and PSMA-PET/CT will be performed in a blinded fashion. DISCUSSION The DEPROMP Trial will be the first to evaluate the clinically relevant effects of the use of PSMA-PET/CT in patients with suspected PCA compared to current SOC. The study will provide prospective data to determine the diagnostic yields of additional PET-TB in men with suspected PCA and the impact on treatment plans in terms of intra- and intermodal changes. The results will allow a comparative analysis of risk stratification by each biopsy method, including a performance analysis of the corresponding rating systems. This will reveal potential intermethod and pre- and postoperative discordances of tumor stage and grading, providing the opportunity to critically assess the need for multiple biopsies. TRIAL REGISTRATION German Clinical Study Register DRKS 00024134. Registered on 26 January 2021.
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Affiliation(s)
- P Krausewitz
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany.
| | - R A Bundschuh
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - F C Gaertner
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - M Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - U Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - J Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - G Kristiansen
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - M Muders
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - C-H Ohlmann
- Department of Urology, Johanniter Hospital Bonn, Bonn, Germany
| | - S Hauser
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - J Ellinger
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - M Ritter
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
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Niu S, Liu Y, Ding X, Xu Y, Yu H, Feng X, Chang X, Wang H, Li J, Gong H, Ao L, Liu J, Lin M, Wang B, Ma X, Xu B, Zhang X. 18 F-DCFPyL positron emission tomography/magnetic resonance imaging-guided ultrasound fusion biopsy is an identical pathway in prostate cancer diagnosis. Prostate 2023; 83:142-150. [PMID: 36281654 DOI: 10.1002/pros.24446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prostate biopsy is still unavoidable in patients with a rising prostate-specific antigen even though multiparametric magnetic resonance imaging (MRI) is widely used. 18 F-DCFPyL positron emission tomography (PET)/MRI was proved to be promising both in sensitivity and specificity. But its guiding fusion biopsy and the advantages in the diagnosis of prostate disease is seldom reported. This study aimed to verify the feasibility and advantage of 18 F-DCFPyL PET/MRI-guided fusion targeted biopsy (TB) over whole-mount histopathology (WMH) for prostate cancer diagnosis. METHODS A prospective study of 94 biopsy-naïve patients were conducted using 18 F-DCFPyL PET/MRI scans and scored on a scale of 1-4. Systematic biopsy was performed for all patients. Patients with suspicious lesions also underwent PET/MRI/transrectal ultrasound-guided fusion biopsy. Patients with pathologically confirmed cancer underwent surgery and WMH sections. Systematic biopsy was compared with TB for the detection of index tumors (ITs). Significant cancer was defined as Grade group (GG) 2 or higher no matter the length of the cancer core. RESULTS 18 F-DCFPyL PET/MRI detected 30/94 (32%) patients with a score of 4, all of whom were verified to have prostate cancer. While it detected 10 patients with a score of 1 (10.6%), they were shown to have no cancer. The sensitivity and specificity of 18 F-DCFPyL PET/MRI were 94.4% and 75%, respectively, if images with a score of 3 are defined as positive. Systematic biopsy detected 18% (203/1128) samples as prostate cancer; conversely, TB detected 113 samples out of 259 scores (43.6%). A statistically significant difference was seen between the PCa detection rates by TB and SB (p < 0.001). All targeted lesions were pathologically proven to be the IT on WMH. CONCLUSIONS In biopsy-naïve patients, the ultrasound fusion biopsy targeted by 18 F-DCFPyL PET/MRI is an identical pathway for the detection of prostate cancer.
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Affiliation(s)
- Shaoxi Niu
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Yachao Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaohui Ding
- Department of Pathology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yong Xu
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Hongkai Yu
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Xiaodong Feng
- Student Brigade of Basic Medicine School, Air Force Medical University, Xi'an, China
| | - Xiao Chang
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Haiyi Wang
- Department of Radiology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jinhang Li
- Department of Pathology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Huijie Gong
- Department of Urology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Liyan Ao
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mu Lin
- MR Collaborations, Diagnostic Imaging, Siemens Healthcare, Shanghai, China
| | - Baojun Wang
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
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Assessing the Role of High-resolution Microultrasound Among Naïve Patients with Negative Multiparametric Magnetic Resonance Imaging and a Persistently High Suspicion of Prostate Cancer. EUR UROL SUPPL 2022; 47:73-79. [PMID: 36601049 PMCID: PMC9806704 DOI: 10.1016/j.euros.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background Multiparametric magnetic resonance imaging (mpMRI) is an invaluable diagnostic tool in the decision-making for prostate biopsies (PBx). However, a non-negligible proportion of patients with negative MRI (nMRI) may still harbour prostate cancer (PCa). Objective To assess whether microultrasound (micro-US) can help in substratifying the presence of PCa and clinically significant PCa (csPCa; ie, any Gleason score ≥7 PCa) in patients with nMRI despite a persistently high clinical suspicion of PCa. Design setting and participants A total of 125 biopsy-naïve patients who underwent micro-US-guided PBx with the ExactVu system for a persistently high suspicion of PCa despite nMRI were prospectively enrolled. Intervention The Prostate Risk Identification using micro-US (PRI-MUS) protocol was used to identify suspicious areas; PBx included targeted sampling of PRI-MUS ≥3 areas and systematic sampling. Outcome measurements and statistical analysis The primary endpoint was the assessment of micro-US diagnostic accuracy in detecting csPCa. Secondary endpoints included determining the proportion of patients with nMRI who may avoid PBx after micro-US or transrectal US, presence of cribriform and intraductal patterns on biopsy core examination, predictors of csPCa in patients presenting with nMRI, and comparing micro-US-targeted and systematic PBx in identifying csPCa. Results and limitations Considering csPCa detection rate, micro-US showed optimal sensitivity and negative predictive value (respectively, 97.1% and 96.4%), while specificity and positive predictive value were 29.7% and 34.0%, respectively. Twenty-eight (22.4%) patients with a negative micro-US examination could have avoided PBx with one (2.9%) missed csPCa. Cribriform and intraductal patterns were found in 14 (41.2%) and four (11.8%) of csPCa patients, respectively. In multivariable logistic regression models, positive micro-US, age, digital rectal examination, and prostate-specific antigen density ≥0.15 emerged as independent predictors of PCa. Targeted and systematic sampling identified 33 (97.1%) and 26 (76.5%) csPCa cases, respectively. The main limitation of the current study is represented by its retrospective single-centre nature on an operator-dependent technology. Conclusions Micro-US represents a valuable tool to rule out the presence of csPCa among patients with a persistent clinical suspicion despite nMRI. Patient summary According to our results, microultrasound (micro-US) may represent an effective tool for the diagnosis of clinically significant prostate cancer in patients with negative magnetic resonance imaging (nMRI), providing high sensitivity and negative predictive value. Further randomised studies are needed to confirm the potential role of micro-US in the diagnostic pathway of patients with a persistent suspicion of prostate cancer despite nMRI.
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Bukavina L, Luckenbaugh AN, Hofman MS, Hope T, Kamran SC, Murphy DG, Yamoah K, Ost P. Incorporating Prostate-specific Membrane Antigen Positron Emission Tomography in Management Decisions for Men with Newly Diagnosed or Biochemically Recurrent Prostate Cancer. Eur Urol 2022; 83:521-533. [PMID: 36404204 DOI: 10.1016/j.eururo.2022.10.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/15/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Prostate-specific membrane antigen (PSMA) is a promising molecular target for prostate cancer (PCa) that has allowed the development of a novel diagnostic approach to PCA in the primary and recurrent settings. OBJECTIVE To summarize available data and recommendations regarding the use of PSMA in newly diagnosed and recurrent PCa via a narrative review. EVIDENCE ACQUISITION A literature review was conducted using MEDLINE (via PubMed) and Scopus. The search strategy included meta-analyses, reviews, and original studies on staging and restaging with 68Ga-PSMA positron emission tomography (PET)/computed tomography (CT). EVIDENCE SYNTHESIS Studies comparing PSMA-targeted imaging and conventional imaging suggest superior performance of PSMA-targeted imaging in primary and recurrent PCa, albeit with several clinically relevant limitations. Pretreatment 68Ga-PSMA PET/CT allowed more accurate PCa staging in compared to routine practice for high-risk cases, and identified a number of otherwise unknown metastatic lesions. In biochemically recurrent PCa, PSMA PET can reveal sites of recurrence with greater sensitivity and specificity than conventional imaging, potentially detecting a major proportion of occult disease. This review will help providers in applying the most up-to-date and relevant literature to (1) determine which patients truly have oligometastatic disease and (2) ascertain who is most likely to experience a meaningful response to local consolidation in the biochemical recurrence setting. CONCLUSIONS Data on PSMA diagnostic studies in primary and recurrent PCa highlight the accuracy and clinical application of PSMA PET. While this review and the evidence to date might lead to a perception of superiority in metastasis directed therapy, fundamental lack of phase III clinical trials with clinically meaningful outcomes are yet to be determined. PATIENT SUMMARY PSMA (prostate-specific membrane antigen) scans have shown great promise for initial evaluation of prostate cancer (PCa) and in detection of PCa recurrence. The benefits are more apparent for initial staging of PCa. There are more limited clinical trial results for PCa recurrence on how best to use this new technique to guide cancer treatment.
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20
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The Role of [ 68Ga]PSMA PET/CT for Clinical Suspicion of Prostate Cancer in Patients with or without Previous Negative Biopsy: A Systematic Review. Cancers (Basel) 2022; 14:cancers14205036. [PMID: 36291820 PMCID: PMC9600353 DOI: 10.3390/cancers14205036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary In this paper we systematically evaluate the evidence regarding the role of [68Ga]PSMA PET/CT for clinical suspicions of prostate cancer in patients with or without previous negative biopsy. A critical review of PubMed and Web of Science according to the PRISMA statement was conducted. Eighteen publications were selected for inclusion in the analysis. In 8 articles, there was a direct comparison with mpMRI. [68Ga]PSMA PET/CT resulted more accurate in identifying primary prostate cancer with PSA values between 4 and 20 ng/mL than mpMRI. Moreover, its use combined with MRI improved sensitivity for csPCa detection, thus potentially avoiding unnecessary biopsies. Overall, [68Ga]PSMA PET/CT resulted a promising technique in patients with clinical suspicion of PCa and precedent negative biopsy or contraindications to MRI. Abstract The purpose of the study is to systematically evaluate the evidence regarding the role of [68Ga]PSMA PET/CT for clinical suspicions of prostate cancer in patients with or without previous negative biopsy. We performed a critical review of PubMed and Web of Science according to the PRISMA statement. Eighteen publications were selected for inclusion in this analysis. QUADAS-2 evaluation was adopted for quality analyses. [68Ga]PSMA-11 was the radiotracer of choice in 15 studies, while [68Ga]PSMA-617 was used in another 3. In 8 articles, there was a direct comparison with mpMRI. The total number of patients included was 1379, ranging from 15 to 291, with a median age of 64 years (range: 42–90). The median baseline PSA value was 12.9 ng/mL, ranging from 0.85 to 4156 ng/mL. Some studies evaluated the PSMA uptake comparing the SUVmax of suspicious lesions with the SUVmax of the normal biodistribution to find out optimal cut-off points. In addition, some studies suggested a significant association between PSA levels, PSA density, and [68Ga]PSMA PET/CT finding. [68Ga]PSMA PET/CT seems to be more accurate in identifying primary prostate cancer with PSA values between 4 and 20 ng/mL than mpMRI. Moreover, in some trials, the combination of PSMA PET/CT and MRI improved the NPV in the detection of clinically significant prostate cancer (csPCa) than MRI alone. Our findings are limited by the small numbers of studies and patient heterogeneity. [68Ga]PSMA PET/CT is a promising technique in patients with clinical suspicion of PCa and precedent negative biopsy or contraindications to MRI. Furthermore, its use combined with MRI improves sensitivity for csPCa detection and can avoid unnecessary biopsies.
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Lazzeri M, Fasulo V, Lughezzani G, Benetti A, Soldà G, Asselta R, De Simone I, Paciotti M, Avolio PP, Contieri R, Saitta C, Saita A, Hurle R, Guazzoni G, Buffi NM, Casale P. Prospective evaluation of the role of imaging techniques and TMPRSS2:ERG mutation for the diagnosis of clinically significant prostate cancer. Front Oncol 2022; 12:968384. [PMID: 36147926 PMCID: PMC9487838 DOI: 10.3389/fonc.2022.968384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To test the hypothesis of a relationship between a specific genetic lesion (T2:ERG) and imaging scores, such as PI-RADS and PRI-MUS, and to test the effectiveness of these parameters for the diagnosis of prostate cancer (PCa) and clinically significant PCa (csPCa). Materials and methods This is a prospective study of men with suspected PCa enrolled between 2016 and 2019 at a high-volume tertiary hospital. Patients underwent systematic US-guided biopsy, plus targeted biopsy if they were presenting with >=1 suspicious lesion (PI-RADS>2) at mpMRI or PR-IMUS >2 at micro-ultrasound assessment. For each patient, one core from the highest PI-RADS or PRI-MUS lesion was collected for T2:ERG analysis. Multivariable logistic regression models (LRMs) were fitted for csPCa with a clinical model (age, total PSA, previous biopsy, family history for PCa), a clinical plus PI-RADS, clinical plus T2:ERG, clinical plus PI-RADS plus T2:ERG, and T2:ERG plus PI-RADS alone. Results The cohort consists of 158 patients: 83.5% and 66.2% had respectively a diagnosis of PCa and csPCa after biopsy. A T2:ERG fusion was found in 37 men and 97.3% of these patients harbored PCa, while 81.1% were diagnosed with csPCa. SE of T2:ERG assay for csPCa was 28.8%, SP 87.0%, NPV 38.8%, and PPV 81.1%. Of 105 patients who performed mpMRI 93.% had PIRADS ≥3. SE of mpMRI for csPCa was 98.5%, SP was 12.8%, NPV was 83.3%, and PPV was 65.7%. Among 67 patients who were subjected to micro-US, 90% had a PRI-MUS ≥3. SE of micro-US for csPCa was 89.1%, SP was 9.52%, NPV was 28.6%, and PPV was 68.3%. At univariable LRM T2:ERG was confirmed as independent of mpMRI and micro-US result (OR 1.49, p=0.133 and OR 1.82, p=0.592, respectively). At multivariable LRM the clinical model alone had an AUC for csPCa of 0.74 while the clinical model including PI-RADS and T2:ERG achieved an AUC of 0.83. Conclusions T2:ERG translocation and imaging results are independent of each other, but both are related csPCa. To evaluate the best diagnostic work-up for PCa and csPCa detection, all available tools (T2:ERG detection and imaging techniques) should be employed together as they appear to have a complementary role.
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Affiliation(s)
- Massimo Lazzeri
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Vittorio Fasulo
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- *Correspondence: Giovanni Lughezzani,
| | - Alessio Benetti
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giulia Soldà
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Rosanna Asselta
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ilaria De Simone
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marco Paciotti
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pier Paolo Avolio
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberto Contieri
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Cesare Saitta
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Saita
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giorgio Guazzoni
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Paolo Casale
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
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Prostate specific membrane antigen positron emission tomography in primary prostate cancer diagnosis: First-line imaging is afoot. Cancer Lett 2022; 548:215883. [PMID: 36027998 DOI: 10.1016/j.canlet.2022.215883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022]
Abstract
Prostate specific membrane antigen positron emission tomography (PSMA PET) is an excellent molecular imaging technique for prostate cancer. Currently, PSMA PET for patients with primary prostate cancer is supplementary to conventional imaging techniques, according to guidelines. This supplementary function of PSMA PET is due to a lack of systematic review of its strengths, limitations, and potential development direction. Thus, we review PSMA ligands, detection, T, N, and M staging, treatment management, and false results of PSMA PET in clinical studies. We also discuss the strengths and challenges of PSMA PET. PSMA PET can greatly increase the detection rate of prostate cancer and accuracy of T/N/M staging, which facilitates more appropriate treatment for primary prostate cancer. Lastly, we propose that PSMA PET could become the first-line imaging modality for primary prostate cancer, and we describe its potential expanded application.
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23
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Re: Stefano Fanti, Alberto Briganti, Louise Emmett, et al. EAU-EANM Consensus Statements on the Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Patients with Prostate Cancer and with Respect to [ 177Lu]Lu-PSMA Radioligand Therapy. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2022.05.003: Extended Use of PSMA PET/CT in Candidates for Focal Therapy. Eur Urol Oncol 2022; 5:601-602. [PMID: 35835637 DOI: 10.1016/j.euo.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022]
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Feliciani G, Celli M, Ferroni F, Menghi E, Azzali I, Caroli P, Matteucci F, Barone D, Paganelli G, Sarnelli A. Radiomics Analysis on [68Ga]Ga-PSMA-11 PET and MRI-ADC for the Prediction of Prostate Cancer ISUP Grades: Preliminary Results of the BIOPSTAGE Trial. Cancers (Basel) 2022; 14:cancers14081888. [PMID: 35454793 PMCID: PMC9028386 DOI: 10.3390/cancers14081888] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Radiomics analysis is used on magnetic resonance imaging – apparent diffusion coefficient (MRI-ADC) maps and [68Ga]Ga-PSMA-11 PET uptake maps to assess unique tumor traits not visible to the naked eye and predict histology-proven ISUP grades in a cohort of 28 patients. Our study’s main goal is to report imaging features that can distinguish patients with low ISUP grades from those with higher grades (ISUP one+) by employing logistic regression statistical models based on MRI-ADC and 68Ga-PSMA data, as well as assess the features’ stability under small contouring variations. Our findings reveal that MRI-ADC and [68Ga]Ga-PSMA-11 PET imaging features-based models are equivalent and complementary for predicting low ISUP grade patients. These models can be employed in broader studies to confirm their ISUP grade prediction ability and eventually impact clinical workflow by reducing overdiagnosis of indolent, early-stage PCa. Abstract Prostate cancer (PCa) risk categorization based on clinical/PSA testing results in a substantial number of men being overdiagnosed with indolent, early-stage PCa. Clinically non-significant PCa is characterized as the presence of ISUP grade one, where PCa is found in no more than two prostate biopsy cores.MRI-ADC and [68Ga]Ga-PSMA-11 PET have been proposed as tools to predict ISUP grade one patients and consequently reduce overdiagnosis. In this study, Radiomics analysis is applied to MRI-ADC and [68Ga]Ga-PSMA-11 PET maps to quantify tumor characteristics and predict histology-proven ISUP grades. ICC was applied with a threshold of 0.6 to assess the features’ stability with variations in contouring. Logistic regression predictive models based on imaging features were trained on 31 lesions to differentiate ISUP grade one patients from ISUP two+ patients. The best model based on [68Ga]Ga-PSMA-11 PET returned a prediction efficiency of 95% in the training phase and 100% in the test phase whereas the best model based on MRI-ADC had an efficiency of 100% in both phases. Employing both imaging modalities, prediction efficiency was 100% in the training phase and 93% in the test phase. Although our patient cohort was small, it was possible to assess that both imaging modalities add information to the prediction models and show promising results for further investigations.
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Affiliation(s)
- Giacomo Feliciani
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (E.M.); (A.S.)
- Correspondence: ; Tel.: +39-327-4730398
| | - Monica Celli
- Nuclear Medicine and Radiometabolic Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.C.); (P.C.); (F.M.); (G.P.)
| | - Fabio Ferroni
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (F.F.); (D.B.)
| | - Enrico Menghi
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (E.M.); (A.S.)
| | - Irene Azzali
- Biostatistics and Clinical Trials Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Paola Caroli
- Nuclear Medicine and Radiometabolic Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.C.); (P.C.); (F.M.); (G.P.)
| | - Federica Matteucci
- Nuclear Medicine and Radiometabolic Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.C.); (P.C.); (F.M.); (G.P.)
| | - Domenico Barone
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (F.F.); (D.B.)
| | - Giovanni Paganelli
- Nuclear Medicine and Radiometabolic Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.C.); (P.C.); (F.M.); (G.P.)
| | - Anna Sarnelli
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (E.M.); (A.S.)
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Lee H, Scheuermann JS, Young AJ, Doot RK, Daube-Witherspoon ME, Schubert EK, Fillare MA, Alexoff D, Karp JS, Kung HF, Pryma DA. Preliminary Evaluation of 68Ga-P16-093, a PET Radiotracer Targeting Prostate-Specific Membrane Antigen in Prostate Cancer. Mol Imaging Biol 2022; 24:710-720. [PMID: 35349040 DOI: 10.1007/s11307-022-01720-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/20/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Prostate-specific membrane antigen (PSMA) is a promising molecular target for imaging of prostate adenocarcinoma. 68Ga-P16-093, a small molecule PSMA ligand, previously showed equivalent diagnostic performance compared to 68Ga-PSMA-11 PET/CT in a pilot study of prostate cancer patients with biochemical recurrence (BCR). We performed a pilot study for further characterization of 68Ga-P16-093 including comparison to conventional imaging. PROCEDURES Patients were enrolled into two cohorts. The biodistribution cohort included 8 treated prostate cancer patients without recurrence, who underwent 6 whole body PET/CT scans with urine sampling for dosimetry using OLINDA/EXM. The dynamic cohort included 15 patients with BCR and 2 patients with primary prostate cancer. Two patients with renal cell carcinoma were also enrolled for exploratory use. A dynamic PET/CT was followed by 2 whole body scans for imaging protocol optimization based on bootstrapped replicates. 68Ga-P16-093 PET/CT was compared for diagnostic performance against available 18F-fluciclovine PET/CT, 99mTc-MDP scintigraphy, diagnostic CT, and MRI. RESULTS 68Ga-P16-093 deposited similar effective dose (0.024 mSv/MBq) and lower urinary bladder dose (0.064 mSv/MBq) compared to 68Ga-PSMA-11. The kidneys were the critical organ (0.290 mSv/MBq). While higher injected activities were preferable, lower injected activities at 74-111 MBq (2-3 mCi) yielded 80% retention in signal-to-noise ratio. The optimal injection-to-scan interval was 60 min, with acceptable delay up to 90 min. 68Ga-P16-093 PET/CT showed superior diagnostic performance over conventional imaging with overall patient-level lesion detection rate of 71%, leading to a change in management in 42% of the patients. CONCLUSIONS Based on its favorable imaging characteristics and diagnostic performance in prostate cancer, 68Ga-P16-093 PET/CT merits further investigation in larger clinical studies.
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Affiliation(s)
- Hwan Lee
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Joshua S Scheuermann
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Anthony J Young
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Robert K Doot
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Margaret E Daube-Witherspoon
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Erin K Schubert
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Matthew A Fillare
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - David Alexoff
- Five Eleven Pharma Inc., Philadelphia, PA, 19104, USA
| | - Joel S Karp
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Hank F Kung
- Five Eleven Pharma Inc., Philadelphia, PA, 19104, USA
| | - Daniel A Pryma
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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26
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Yadav D, Hwang H, Qiao W, Upadhyay R, Chapin BF, Tang C, Aparicio A, Lopez-Olivo MA, Kang SK, Macapinlac HA, Bathala TK, Surasi DS. 18F-Fluciclovine versus PSMA PET Imaging in Primary Tumor Detection during Initial Staging of High-Risk Prostate Cancer: A Systematic Review and Meta-Analysis. Radiol Imaging Cancer 2022; 4:e210091. [PMID: 35212559 PMCID: PMC8965534 DOI: 10.1148/rycan.210091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/28/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
Purpose Fluorine 18 (18F)-fluciclovine and prostate-specific membrane antigen (PSMA) tracers are commonly used for localizing biochemical recurrence of prostate cancer, but their accuracy in primary tumor detection in the initial staging of high-risk prostate cancer has not been established. Materials and Methods A systematic review was performed of the electronic databases for original studies published between 2012 and 2020. Included studies were those in which 18F-fluciclovine or PSMA PET was used for initial staging of patients with high-risk prostate cancer. The diagnostic performance data were collected for primary tumor with histopathologic results as reference standard. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used for quality appraisal. A random-effects model was used to summarize the effect sizes and to evaluate the difference between two groups. Results Overall, 28 studies met the eligibility criteria, and 17 were included in the meta-analysis (18F-fluciclovine = 4, PSMA = 13). Of these 17 studies, 12 (70%) were judged to have high risk of bias in one of the evaluated domains, and nine studies were deemed to have applicability concerns. The pooled sensitivity, specificity, and diagnostic odds ratio for 18F-fluciclovine versus PSMA were 85% (95% CI: 73%, 92%) versus 84% (95% CI: 77%, 89%) (P = .78), 77% (95% CI: 60%, 88%) versus 83% (95% CI: 76%, 89%) (P = .40), and 18.88 (95% CI: 5.01, 71.20) versus 29.37 (95% CI: 13.35, 64.60) (P = .57), respectively, with no significant difference in diagnostic test accuracy. Conclusion 18F-fluciclovine and PSMA PET demonstrated no statistically significant difference in diagnostic accuracy in primary tumor detection during initial staging of high-risk prostate cancer. Keywords: PET, Prostate, Molecular Imaging-Cancer, Staging Supplemental material is available for this article. © RSNA, 2022.
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Affiliation(s)
- Divya Yadav
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Hyunsoo Hwang
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Wei Qiao
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Rituraj Upadhyay
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Brian F. Chapin
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Chad Tang
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Ana Aparicio
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Maria A. Lopez-Olivo
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Stella K. Kang
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Homer A. Macapinlac
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Tharakeswara K. Bathala
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Devaki Shilpa Surasi
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
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Nuo Y, Li A, Yang L, Xue H, Wang F, Wang L. Efficacy of 68Ga-PSMA-11 PET/CT with biparametric MRI in diagnosing prostate cancer and predicting risk stratification: a comparative study. Quant Imaging Med Surg 2022; 12:53-65. [PMID: 34993060 DOI: 10.21037/qims-21-80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This retrospective study aimed to investigate the efficacy of the combined application of biparametric magnetic resonance imaging (bpMRI) and 68Ga-PSMA-11 positron emission computed tomography/computed tomography (bpMRI/PET) in the qualitative diagnosis of intermediate- to high-risk prostate cancer (PCa). METHODS The 105 patients with suspected PCa included in the study underwent bpMRI and PET/CT. BpMRI examinations included conventional sequences and diffusion-weighted imaging (DWI) sequences. Major lesions were qualitatively diagnosed according to the Prostate Imaging Reporting and Data System (PI-RADS). A PET/CT scan was started 60 min after intravenous 68Ga-PSMA-11 injection. The area with the highest radioactivity on PET/CT images was defined as the major lesion, and the maximum standard uptake value (SUVmax) was measured. All cases were confirmed by biopsy and pathology. Receiver operating characteristic curve (ROC) analysis was performed on the data to calculate sensitivity, specificity, and the Youden index. RESULTS Of the 105 patients, 68 patients were diagnosed with PCa, and 37 patients had benign prostatic lesions. With a PI-RADS score ≥3 as the diagnostic threshold, the accuracy of bpMRI in identifying benign and malignant prostate lesions was similar to that of PET/CT (SUVmax threshold ≥10.9), and the Youden indices were 0.60 and 0.64, respectively. The sensitivity and specificity of bpMRI in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 63% and 88%, respectively, and the Youden index was 0.51. With an SUVmax ≥12.9 as the diagnostic threshold, the sensitivity and specificity of PET/CT in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 74% and 94%, respectively, and the Youden index was 0.68. The sensitivity and specificity of bpMRI/PET in diagnosing PCa were 94% and 81%, respectively, and the Youden index was 0.75. The sensitivity and specificity of bpMRI/PET in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 80% and 88%, respectively, and the Youden index was 0.68. CONCLUSIONS The combined application of bpMRI and PET improves the accuracy of the qualitative diagnosis of prostate lesions, and its diagnostic efficacy for risk stratification in patients with intermediate- to high-risk PCa is similar to that of PET/CT and higher than that of bpMRI alone.
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Affiliation(s)
- Yi Nuo
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Aimei Li
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lulu Yang
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hailin Xue
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liwei Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Ma L, Zhang WC, Hao YX. Current state of prostate-specific membrane antigen PET/CT imaging-targeted biopsy techniques for detection of clinically significant prostate cancer. J Med Imaging Radiat Oncol 2021; 66:776-780. [PMID: 34914195 DOI: 10.1111/1754-9485.13369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022]
Abstract
Clinically significant prostate cancer (csPCa) is the focus of clinical diagnosis and treatment of prostate cancer (PCa). The current standard for diagnosing csPCa in men at risk relies on a transrectal (and in some instances transperineal) ultrasound-guided biopsy (TRUS-GB) that is blind to the location of cancer, leading to false-negative csPCa diagnoses. Over the past decade, PSMA PET/CT imaging-targeted prostate biopsy (PSMA PET/CT-TB), which obtains tissue samples from a defined suspicious area, has emerged as a promising solution for improving csPCa detection. Its feasibility and higher csPCa diagnostic value have been reported by a few case reports and studies. The current manuscript will review this latest targeted prostate puncture technology, summarize the existing applications of PSMA PET/CT-TB, including technical considerations, and discuss the advantages and challenges of each technique.
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Affiliation(s)
- Le Ma
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Wan-Chun Zhang
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Ya-Xin Hao
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
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Qiu DX, Li J, Zhang JW, Chen MF, Gao XM, Tang YX, Zhang Y, Yi XP, Yin HL, Gan Y, Wang GL, Zu XB, Hu S, Cai Y. Dual-tracer PET/CT-targeted, mpMRI-targeted, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer: a pilot study. Eur J Nucl Med Mol Imaging 2021; 49:2821-2832. [PMID: 34860277 DOI: 10.1007/s00259-021-05636-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Growing evidence proved the efficacy of multi-parametric MRI (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-guided targeted biopsy (TB) in prostate cancer (PCa) diagnosis, but there is no direct comparison between mpMRI-TB and PSMA PET/CT-TB. Gastrin-releasing peptide receptor (GRPR) is highly expressed in PCa, which can compensate for the unstable expression of PSMA in PCa. Therefore, we designed a study to compare the efficiency of mpMRI-TB, dual-tracer (GRPR and PSMA) PET/CT-TB, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer. METHODS One hundred twelve suspicious PCa patients were enrolled from September 2020 to June 2021. Patients with anyone of positive dual-tracer PET/CT or mpMRI underwent TB, and all enrolled patients underwent systematic biopsy (SB) after TB. The primary outcome was the detection rates of PCa in different biopsy strategies. Secondary outcomes were the performance of three imaging methods, omission diagnostic rates, and upgrading and downgrading of biopsy samples relative to those of prostatectomy specimens in different biopsy strategies. McNemar's tests and Bonferroni correction in multiple comparisons were used to compare the primary and secondary outcomes. RESULTS In 112 men, clinically significant PCa (grade group[GG] ≥ 2) accounted for 34.82% (39/112), and nonclinically significant PCa (GG = 1) accounted for 4.46% (5/112). 68 Ga-PSMA PET/CT-TB achieved higher PCa detection rate (69.77%) and positive ratio of biopsy cores (0.44) compared with SB (39.29% and 0.12) and mpMRI-TB (36.14% and 0.23), respectively (P < 0.005). Dual-tracer PET/CT screen out patients for avoiding 52.67% (59/112) unnecessary biopsy, whereas dual-tracer PET/CT-TB plus SB achieved high detection rate (77.36%) without misdiagnosis of csPCa. CONCLUSION Dual-tracer PET/CT might screen patients for avoiding unnecessary biopsy. Dual-tracer PET/CT-TB plus SB might be a more effective and promising strategy for the definite diagnosis of clinically significant PCa than mpMRI-TB.
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Affiliation(s)
- Dong-Xu Qiu
- Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Jian Li
- Department of PET Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Jin-Wei Zhang
- Department of Radiology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Min-Feng Chen
- Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Xiao-Mei Gao
- Department of Pathology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Yong-Xiang Tang
- Department of PET Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Ye Zhang
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Xiao-Ping Yi
- Department of Radiology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Hong-Ling Yin
- Department of Pathology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Yu Gan
- Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Gui-Lin Wang
- Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Xiong-Bing Zu
- Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Shuo Hu
- Department of PET Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
| | - Yi Cai
- Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
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O'Connor LP, Ramedani S, Daneshvar M, George AK, Abreu AL, Cacciamani GE, Lebastchi AH. Future perspective of focal therapy for localized prostate cancer. Asian J Urol 2021; 8:354-361. [PMID: 34765443 PMCID: PMC8566361 DOI: 10.1016/j.ajur.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 10/25/2022] Open
Abstract
Objective To summarize the recent literature discussing focal therapy for localized prostate cancer. Methods A thorough literature review was performed using PubMed to identify recent studies involving focal therapy for the treatment of localized prostate cancer. Results In an effort to decrease the morbidity associated with prostate cancer treatment, many urologists are turning to focal therapy as an alternative treatment option. With this approach, the cancer bearing portion of the prostate is targeted while leaving the benign tissue untouched. Multiparametric magnetic resonance imaging remains the gold standard for visualization during focal therapy, but new imaging modalities such as prostate specific membrane antigen/positron emission tomography and contrast enhanced ultrasound are being investigated. Furthermore, several biomarkers, such as prostate cancer antigen 3 and prostate health index, are used in conjunction with imaging to improve risk stratification prior to focal therapy. Lastly, there are several novel technologies such as nanoparticles and transurethral devices that are under investigation for use in focal therapy. Conclusion Focal therapy is proving to be a promising option for the treatment of localized prostate cancer. However, further study is needed to determine the true efficacy of these exciting new technologies.
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Affiliation(s)
- Luke P O'Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shayann Ramedani
- College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Michael Daneshvar
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Andre Luis Abreu
- Center for Image-Guided and Focal Therapy for Prostate Cancer, Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Center for Image-Guided and Focal Therapy for Prostate Cancer, Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amir H Lebastchi
- Center for Image-Guided and Focal Therapy for Prostate Cancer, Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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31
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Chen C, Margolis DJ. Case of the Season: Prostate Specific Membrane Antigen (PSMA) Positron-Emission Tomography (PET)-MRI to Evaluate Neoadjuvant Radiation Therapy Response. Semin Roentgenol 2021; 56:363-365. [PMID: 34688338 DOI: 10.1053/j.ro.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/08/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Christine Chen
- Department of Radiology, Weill Cornell Medical College: Weill Cornell Medicine, New York, NY.
| | - Daniel J Margolis
- Department of Radiology, Weill Cornell Medical College: Weill Cornell Medicine, New York, NY
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Smith CW, Alfano R, Hoover D, Surry K, D'Souza D, Thiessen J, Rachinsky I, Butler J, Gomez JA, Gaed M, Moussa M, Chin J, Pautler S, Bauman GS, Ward AD. Prostate specific membrane antigen positron emission tomography for lesion-directed high-dose-rate brachytherapy dose escalation. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 19:102-107. [PMID: 34589619 PMCID: PMC8459608 DOI: 10.1016/j.phro.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
This paper evaluated lesion-directed prostatic high dose rate brachytherapy. Lesions defined by prostate specific membrane antigen positron emission tomography. Dose escalation was confirmed using whole-mount digital histology. Targeting lesions led to significantly higher dose to high-grade histologic cancer.
Background and purpose Prostate specific membrane antigen positron emission tomography imaging (PSMA-PET) has demonstrated potential for intra-prostatic lesion localization. We leveraged our existing database of co-registered PSMA-PET imaging with cross sectional digitized pathology to model dose coverage of histologically-defined prostate cancer when tailoring brachytherapy dose escalation based on PSMA-PET imaging. Materials and methods Using a previously-developed automated approach, we created segmentation volumes delineating underlying dominant intraprostatic lesions for ten men with co-registered pathology-imaging datasets. To simulate realistic high-dose-rate brachytherapy (HDR-BT) treatments, we registered the PSMA-PET-defined segmentation volumes and underlying cancer to 3D trans-rectal ultrasound images of HDR-BT cases where 15 Gray (Gy) was delivered. We applied dose/volume optimization to focally target the dominant intraprostatic lesion identified on PSMA-PET. We then compared histopathology dose for all high-grade cancer within whole-gland treatment plans versus PSMA-PET-targeted plans. Histopathology dose was analyzed for all clinically significant cancer with a Gleason score of 7or greater. Results The standard whole-gland plans achieved a median [interquartile range] D98 of 15.2 [13.8–16.4] Gy to the histologically-defined cancer, while the targeted plans achieved a significantly higher D98 of 16.5 [15.0–19.0] Gy (p = 0.007). Conclusion This study is the first to use digital histology to confirm the effectiveness of PSMA-PET HDR-BT dose escalation using automatically generated contours. Based on the findings of this study, PSMA-PET lesion dose escalation can lead to increased dose to the ground truth histologically defined cancer.
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Affiliation(s)
- Christopher W Smith
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.,Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Ryan Alfano
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.,Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Douglas Hoover
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Kathleen Surry
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - David D'Souza
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Jonathan Thiessen
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Irina Rachinsky
- Western University Department of Medical Imaging, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - John Butler
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada
| | - Jose A Gomez
- Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Mena Gaed
- Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Madeleine Moussa
- Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Joseph Chin
- Western University Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Stephen Pautler
- Western University Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Glenn S Bauman
- Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Aaron D Ward
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.,Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
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Ferraro DA, Becker AS, Kranzbühler B, Mebert I, Baltensperger A, Zeimpekis KG, Grünig H, Messerli M, Rupp NJ, Rueschoff JH, Mortezavi A, Donati OF, Sapienza MT, Eberli D, Burger IA. Diagnostic performance of 68Ga-PSMA-11 PET/MRI-guided biopsy in patients with suspected prostate cancer: a prospective single-center study. Eur J Nucl Med Mol Imaging 2021; 48:3315-3324. [PMID: 33620559 PMCID: PMC8426229 DOI: 10.1007/s00259-021-05261-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/11/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE Ultrasound-guided biopsy (US biopsy) with 10-12 cores has a suboptimal sensitivity for clinically significant prostate cancer (sigPCa). If US biopsy is negative, magnetic resonance imaging (MRI)-guided biopsy is recommended, despite a low specificity for lesions with score 3-5 on Prostate Imaging Reporting and Data System (PIRADS). Screening and biopsy guidance using an imaging modality with high accuracy could reduce the number of unnecessary biopsies, reducing side effects. The aim of this study was to assess the performance of positron emission tomography/MRI with 68Ga-labeled prostate-specific membrane antigen (PSMA-PET/MRI) to detect and localize primary sigPCa (ISUP grade group 3 and/or cancer core length ≥ 6 mm) and guide biopsy. METHODS Prospective, open-label, single-center, non-randomized, diagnostic accuracy study including patients with suspected PCa by elevation of prostate-specific antigen (PSA) level and a suspicious lesion (PIRADS ≥3) on multiparametric MRI (mpMRI). Forty-two patients underwent PSMA-PET/MRI followed by both PSMA-PET/MRI-guided and section-based saturation template biopsy between May 2017 and February 2019. Primary outcome was the accuracy of PSMA-PET/MRI for biopsy guidance using section-based saturation template biopsy as the reference standard. RESULTS SigPCa was found in 62% of the patients. Patient-based sensitivity, specificity, negative and positive predictive value, and accuracy for sigPCa were 96%, 81%, 93%, 89%, and 90%, respectively. One patient had PSMA-negative sigPCa. Eight of nine false-positive lesions corresponded to cancer on prostatectomy and one in six false-negative lesions was negative on prostatectomy. CONCLUSION PSMA-PET/MRI has a high accuracy for detecting sigPCa and is a promising tool to select patients with suspicion of PCa for biopsy. TRIAL REGISTRATION This trial was retrospectively registered under the name "Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) Guided Biopsy in Men with Elevated PSA" (NCT03187990) on 06/15/2017 ( https://clinicaltrials.gov/ct2/show/NCT03187990 ).
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Affiliation(s)
- Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anton S Becker
- Institute of Interventional and Diagnostic Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Benedikt Kranzbühler
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Iliana Mebert
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Anka Baltensperger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Konstantinos G Zeimpekis
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hannes Grünig
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan H Rueschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Olivio F Donati
- Institute of Interventional and Diagnostic Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marcelo T Sapienza
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.
- Department of Nuclear Medicine, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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34
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Bodar Y, Koene B, Meijer D, van Leeuwen PJ, Nadorp S, Donswijk ML, Hendrikse NH, Oprea-Lager DE, Vis AN. Determining the diagnostic value of PSMA-PET/CT imaging in patients with persistent high prostate specific antigen levels and negative prostate biopsies. Urol Oncol 2021; 40:58.e1-58.e7. [PMID: 34404590 DOI: 10.1016/j.urolonc.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/04/2021] [Accepted: 07/02/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE To assess the diagnostic performance of prostate specific membranous antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging to localize primary prostate cancer (PCa) in men with persistent elevated prostate-specific antigen (PSA) levels and previous prostate biopsies that were negative for PCa. METHODS In this study, 34 men with persistently elevated PSA-levels, previous negative for PCa biopsies and who subsequently underwent diagnostic PSMA-PET/CT imaging were retrospectively evaluated. Men were divided into 3 groups: 1. 12 men with a previous negative mpMRI scan (PI-RADS 1-2) 2. 17 men with a positive mpMRI scan (PI-RADS 3-5), but negative MRI-targeted biopsies and 3. Four men in whom mpMRI was contraindicated. If PSMA-avid lesions were seen, patients underwent 2-4 cognitive targeted biopsies in combination with systematic biopsies. The detection rate of PSMA-PET/CT for PCa, and the accuracy of (possible) targeted biopsies were calculated. RESULTS Included men had a median PSA-level of 22.8 ng/mL (Interquartile Range 15.6-30.0) at the time of PSMA-PET/CT. Elevated PSMA-ligand uptake in the prostate suspicious for PCa was observed in 22/34 patients (64.7%). In 18/22 patients (54.5%), PSMA-targeted prostate biopsies were performed. In 3/18 patients (16.6%), the targeted biopsies showed International Society of Urological Pathology (ISUP) score 1-2 PCa. The other men had inflammation or benign findings after histopathological examination of the biopsy cores. CONCLUSION In this study, the clinical value of PSMA-PET/CT for patients with an elevated PSA-level, and negative for PCa biopsies was low. Only very few men were diagnosed with PCa, and no clinically significant PCa was found.
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Affiliation(s)
- Yjl Bodar
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland; Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland.
| | - Bpf Koene
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - D Meijer
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland; Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland
| | - P J van Leeuwen
- The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - S Nadorp
- Amstelland Hospital, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - M L Donswijk
- The Netherlands Cancer Institute, Department of Radiology and Nuclear Medicine, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - N H Hendrikse
- Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland; Amsterdam University Medical Center, VU University, Department of Clinical Pharmacology and Pharmacy, Amsterdam, Netherland
| | - D E Oprea-Lager
- Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland
| | - A N Vis
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
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Min LA, Castagnoli F, Vogel WV, Vellenga JP, van Griethuysen JJM, Lahaye MJ, Maas M, Beets Tan RGH, Lambregts DMJ. A decade of multi-modality PET and MR imaging in abdominal oncology. Br J Radiol 2021; 94:20201351. [PMID: 34387508 PMCID: PMC9328040 DOI: 10.1259/bjr.20201351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate trends observed in a decade of published research on multimodality PET(/CT)+MR imaging in abdominal oncology, and to explore how these trends are reflected by the use of multimodality imaging performed at our institution. METHODS First, we performed a literature search (2009-2018) including all papers published on the multimodality combination of PET(/CT) and MRI in abdominal oncology. Retrieved papers were categorized according to a structured labelling system, including study design and outcome, cancer and lesion type under investigation and PET-tracer type. Results were analysed using descriptive statistics and evolutions over time were plotted graphically. Second, we performed a descriptive analysis of the numbers of MRI, PET/CT and multimodality PET/CT+MRI combinations (performed within a ≤14 days interval) performed during a similar time span at our institution. RESULTS Published research papers involving multimodality PET(/CT)+MRI combinations showed an impressive increase in numbers, both for retrospective combinations of PET/CT and MRI, as well as hybrid PET/MRI. Main areas of research included new PET-tracers, visual PET(/CT)+MRI assessment for staging, and (semi-)quantitative analysis of PET-parameters compared to or combined with MRI-parameters as predictive biomarkers. In line with literature, we also observed a vast increase in numbers of multimodality PET/CT+MRI imaging in our institutional data. CONCLUSIONS The tremendous increase in published literature on multimodality imaging, reflected by our institutional data, shows the continuously growing interest in comprehensive multivariable imaging evaluations to guide oncological practice. ADVANCES IN KNOWLEDGE The role of multimodality imaging in oncology is rapidly evolving. This paper summarizes the main applications and recent developments in multimodality imaging, with a specific focus on the combination of PET+MRI in abdominal oncology.
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Affiliation(s)
- Lisa A Min
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | | | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jisk P Vellenga
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands.,Faculty or Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Rüschoff JH, Ferraro DA, Muehlematter UJ, Laudicella R, Hermanns T, Rodewald AK, Moch H, Eberli D, Burger IA, Rupp NJ. What's behind 68Ga-PSMA-11 uptake in primary prostate cancer PET? Investigation of histopathological parameters and immunohistochemical PSMA expression patterns. Eur J Nucl Med Mol Imaging 2021; 48:4042-4053. [PMID: 34386839 PMCID: PMC8484204 DOI: 10.1007/s00259-021-05501-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/18/2021] [Indexed: 02/07/2023]
Abstract
Purpose Prostate-specific membrane antigen (PSMA-) PET has become a promising tool in staging and restaging of prostate carcinoma (PCa). However, specific primary tumour features might impact accuracy of PSMA-PET for PCa detection. We investigated histopathological parameters and immunohistochemical PSMA expression patterns on radical prostatectomy (RPE) specimens and correlated them to the corresponding 68Ga-PSMA-11-PET examinations. Methods RPE specimens of 62 patients with preoperative 68Ga-PSMA-11-PET between 2016 and 2018 were analysed. WHO/ISUP grade groups, growth pattern (expansive vs. infiltrative), tumour area and diameter as well as immunohistochemical PSMA heterogeneity, intensity and negative tumour area (PSMA%neg) were correlated with spatially corresponding SUVmax on 68Ga-PSMA-11-PET in a multidisciplinary analysis. Results All tumours showed medium to strong membranous (2–3 +) and weak to strong cytoplasmic (1–3 +) PSMA expression. Heterogeneously expressed PSMA was found in 38 cases (61%). Twenty-five cases (40%) showed at least 5% and up to 80% PSMA%neg. PSMA%neg, infiltrative growth pattern, smaller tumour area and diameter and WHO/ISUP grade group 2 significantly correlated with lower SUVmax values. A ROC curve analysis revealed 20% PSMA%neg as an optimal cutoff with the highest sensitivity and specificity (89% and 86%, AUC 0.923) for a negative PSMA-PET scan. A multiple logistic regression model revealed tumoural PSMA%neg (p < 0.01, OR = 9.629) and growth pattern (p = 0.0497, OR = 306.537) as significant predictors for a negative PSMA-PET scan. Conclusions We describe PSMA%neg, infiltrative growth pattern, smaller tumour size and WHO/ISUP grade group 2 as parameters associated with a lower 68Ga-PSMA-11 uptake in prostate cancer. These findings can serve as fundament for future biopsy-based biomarker development to enable an individualized, tumour-adapted imaging approach. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05501-1.
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Affiliation(s)
- Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Urs J Muehlematter
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Riccardo Laudicella
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ann-Katrin Rodewald
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Lopci E, Colombo P, Lazzeri M. Mismatched Imaging Findings of Prostate Cancer Diagnosis: 68 Ga-PSMA PET/CT vs mpMRI. Nucl Med Mol Imaging 2021; 55:199-202. [PMID: 34422131 PMCID: PMC8322193 DOI: 10.1007/s13139-021-00701-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/10/2021] [Accepted: 05/06/2021] [Indexed: 12/01/2022] Open
Abstract
Multiparametric magnetic resonance imaging (mpMRI) is the modality of choice for initial diagnosis of prostate cancer (PCa), including biopsy-naïve patients. Nevertheless, clinicians must be aware of the possibility that up to one-fourth of clinically significant cancers might be missed by the modality. Acknowledgment of this occurrence and the increased availability of 68 Ga-PSMA PET/CT in clinical routine, open the door to new, fascinating, indications for this functional modality in the context of PCa detection. With the case herein illustrated, we report a paradigmatic example of mismatch findings between PET/CT and mpMRI better elucidating the potential indication.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine Unit, IRCCS - Humanitas Research Hospital, Via Manzoni 56, CAP 20089 Rozzano, MI Italy
| | | | - Massimo Lazzeri
- Urology, IRCCS - Humanitas Research Hospital, Rozzano, MI Italy
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38
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Wu C, Zhang R, Du W, Cheng L, Liang G. Alkaline phosphatase-triggered self-assembly of near-infrared nanoparticles for the enhanced photoacoustic imaging of tumors. Methods Enzymol 2021; 657:111-144. [PMID: 34353484 DOI: 10.1016/bs.mie.2021.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this chapter, we discuss the need for the development of enzyme-activatable probes in the field of tumor-targeted photoacoustic (PA) imaging, then we give a brief description of the innovation of designing alkaline phosphatase (ALP)-activatable probes for PA imaging. After that, we provide detailed protocols for the syntheses and characterizations of a near-infrared photoacoustic imaging probe, 1P, developed in our research group. With this tool, 1P could form nanoparticles 1-NPs under the catalysis of ALP and thus could be used to enhance PA imaging both in vitro and in vivo.
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Affiliation(s)
- Chengfan Wu
- Hefei National Laboratory of Physical Sciences at Microscale, Department of Chemistry, University of Science and Technology of China, Hefei, AH, China
| | - Rui Zhang
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, JS, China
| | - Wei Du
- Hefei National Laboratory of Physical Sciences at Microscale, Department of Chemistry, University of Science and Technology of China, Hefei, AH, China
| | - Liang Cheng
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, JS, China
| | - Gaolin Liang
- Hefei National Laboratory of Physical Sciences at Microscale, Department of Chemistry, University of Science and Technology of China, Hefei, AH, China; State Key Laboratory of Bioelectronics, School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, JS, China.
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39
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Krausewitz P, Ritter M. [Clinical aspects in the diagnosis and treatment of prostate cancer]. Radiologe 2021; 61:795-801. [PMID: 34213623 DOI: 10.1007/s00117-021-00869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnosis and treatment of primary prostate cancer (PCA) have undergone significant changes in the last few years due to modern imaging. OBJECTIVES Established and modern diagnostic and therapeutic modalities for detection and treatment of primary PCA are presented and discussed critically. MATERIALS AND METHODS Background knowledge and guideline recommendations on primary PCA are summarized and additional information from relevant publications is given. RESULTS Modern imaging, in particular multiparametric magnetic resonance imaging (mpMRI), has revolutionized the diagnostic work-up of primary PCA. Due to mpMRI, tumors are detected significantly better in both initial and re-biopsy with a significant reduction of overdiagnosis of clinically insignificant PCA. Therapeutic approaches such as active surveillance, radical prostatectomy and focal therapies are increasingly being planned and carried out relying on MR-imaging information concerning tumor extent and tumor aggressiveness. In addition, prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT) has shown superiority in assessing patients with suspected biochemical recurrence and in primary staging of PCA compared to conventional imaging in terms of detection of metastases. CONCLUSIONS Modern imaging, especially mpMRI and PSMA-PET/CT, has added substantial benefits in modern diagnosis and treatment of primary PCA. Moreover, multiparametric ultrasound is also a promising addition to the radiological armamentarium in the management of primary PCA.
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Affiliation(s)
- Philipp Krausewitz
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - M Ritter
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Deutschland
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40
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The use of 29 MHz transrectal micro-ultrasound to stratify the prostate cancer risk in patients with PI-RADS III lesions at multiparametric MRI: A single institutional analysis. Urol Oncol 2021; 39:832.e1-832.e7. [PMID: 34183255 DOI: 10.1016/j.urolonc.2021.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/26/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Magnetic Resonance Imaging (MRI) has emerged as the most accurate diagnostic tool, showing a high sensitivity in the diagnosis of clinically significant prostate cancer (csCaP). However only a minority of patients with a PI-RADS 3 lesion at multiparametric magnetic resonance imaging (MRI) are diagnosed with csCaP. The aim of the current study was to assess whether high resolution micro-ultrasound (microUS) could help in sub-stratifying the risk of csCaP in this specific population. MATERIAL AND METHODS We retrospectively analyzed the records of 111 consecutive patients scheduled for a prostate biopsy with at least 1 PI-RADS 3 lesions at MRI. We excluded patients with a PIRADS >3 lesion, even if they had a coexisting PIRADS 3 lesions. MicroUS was performed in all patients before prostate biopsy by an operator blind to MRI results. The Prostate Risk Identification using MicroUS (PRI-MUS) protocol was used to assess the risk of CaP and csCaP. All patients received both targeted and systematic biopsies. The primary endpoint was to determine the diagnostic accuracy of microUS in detection of csCaP in patients with a PI-RADS 3 lesion at MRI. Specifically, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of microUS were determined. Multivariable logistic regression models (MLRMs) were fitted to identify predictors of CaP. The diagnostic accuracy was reported as area under the receiver operator characteristic (ROC) curve. RESULTS Overall, 43 patients (38.7%) harboured CaP and 22 (20%) csCaP. MicroUS showed a high sensitivity and negative predictive value (100%), while its specificity and positive predictive value were 33.7% and 27.2%, respectively. Among patients without lesions at microUS, 25 (83.3%) did not harbour CaP, while 5 (16.7%) patients were diagnosed with a Gleason score 6 CaP, with no patients harbouring csCaP. Using microUS, the csCaP detection would have remained 100%, while reducing the detection of insignificant CaP of a 23.8% extent (n = 5). In MLRMs, lesion identified at microUS and continuously-coded PSAd were independent predictors of CaP. The accuracy of a model including PRI-MUS score, digital rectal examination (DRE), PSA density, age and family history was 0.744 (95% CI: 0.645 - 0.843). CONCLUSION In our single-institutional retrospective study, microUS was potentially capable to stratify the presence of CaP in patients with an equivocal MRI. Further prospective studies on larger populations are needed to validate our results.
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Matushita CS, da Silva AMM, Schuck PN, Bardisserotto M, Piant DB, Pereira JL, Cerci JJ, Coura-Filho GB, Esteves FP, Amorim BJ, Gomes GV, Brito AET, Bernardo WM, Mundstock E, Fanti S, Macedo B, Roman DH, Tem-Pass CS, Hochhegger B. 68Ga-Prostate-specific membrane antigen (psma) positron emission tomography (pet) in prostate cancer: a systematic review and meta-analysis. Int Braz J Urol 2021; 47:705-729. [PMID: 33566470 PMCID: PMC8321470 DOI: 10.1590/s1677-5538.ibju.2019.0817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/14/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Prostate cancer (PC) is the second most commonly diagnosed cancer in males. 68Ga-PSMA PET/CT, a non-invasive diagnostic tool to evaluate PC with prostate-specific membrane antigen (PSMA) expression, has emerged as a more accurate alternative to assess disease staging. We aimed to identify predictors of positive 68Ga-PSMA PET and the accuracy of this technique. Materials and methods: Diagnostic accuracy cross-sectional study with prospective and retrospective approaches. We performed a comprehensive literature search on PubMed, Cochrane Library, and Embase database in search of studies including PC patients submitted to radical prostatectomy or radiotherapy with curative intent and presented biochemical recurrence following ASTRO 1996 criteria. A total of 35 studies involving 3910 patients submitted to 68-Ga-PSMA PET were included and independently assessed by two authors: 8 studies on diagnosis, four on staging, and 23 studies on restaging purposes. The significance level was α=0.05. Results: pooled sensitivity and specificity were 0.90 (0.86-0.93) and 0.90 (0.82-0.96), respectively, for diagnostic purposes; as for staging, pooled sensitivity and specificity were 0.93 (0.86-0.98) and 0.96 (0.92-0.99), respectively. In the restaging scenario, pooled sensitivity and specificity were 0.76 (0.74-0.78) and 0.45 (0.27-0.58), respectively, considering the identification of prostate cancer in each described situation. We also obtained specificity and sensitivity results for PSA subdivisions. Conclusion: 68Ga-PSMA PET provides higher sensitivity and specificity than traditional imaging for prostate cancer.
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Affiliation(s)
- Cristina S Matushita
- Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil
| | - Ana M Marques da Silva
- Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil.,Laboratório de Imagens Médicas, Faculdade de Ciências, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil
| | - Phelipi N Schuck
- Laboratório de Imagens Médicas, Faculdade de Ciências, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil
| | | | - Diego B Piant
- Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil
| | | | | | - George B Coura-Filho
- Departamento de Medicina Nuclear, Instituto do Câncer de São Paulo, São Paulo, SP, Brasil
| | | | - Barbara J Amorim
- Departamento de Medicina Nuclear, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | | | | | - Wanderley M Bernardo
- Programa de Pós-Graduação em Medicina, Faculdade de Medicina - USP, São Paulo, SP, Brasil
| | - Eduardo Mundstock
- Programa de Pós-Graduação em Saúde da Criança, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil
| | - Stefano Fanti
- Department of Experimental, Diagnostic and Specialized Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Bruna Macedo
- Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil
| | - Diego H Roman
- Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil
| | - Cinthia Scatolin Tem-Pass
- Programa de Pós-Graduação em Saúde da Criança, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil
| | - Bruno Hochhegger
- Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brasil
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Can 68Ga-PSMA-11 PET/CT predict pathological upgrading of prostate cancer from MRI-targeted biopsy to radical prostatectomy? Eur J Nucl Med Mol Imaging 2021; 48:3693-3701. [PMID: 33813594 DOI: 10.1007/s00259-021-05217-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/24/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Prostate-specific membrane antigen (PSMA) positron emission tomography (PSMA-PET) is an ideal tool for staging and restaging of prostate cancer (PCa). This study was designed to investigate the prognostic role of preoperative 68Ga-PSMA-11 PET/CT in predicting pathological upgrading from multiparametric magnetic resonance imaging-targeted biopsy (mpMRI-TB) to final radical prostatectomy (RP) specimens in patients with localized PCa. METHODS A total of 67 biopsy-confirmed localized PCa patients with mpMRI and 68Ga-PSMA-11 PET/CT prior to RP were included. Clinical and imaging characteristics derived from mpMRI and PET/CT were compared in patients with or without pathological upgrading. Predictors for pathological upgrading were evaluated by using univariate and multivariable analyses. A prediction model was developed based on the identified parameters and validated using internal validation. RESULTS Pathological upgrading from mpMRI-TB to final RP specimens occurred in 38.8% (26/67) of the patients. Multivariable logistic regression analysis showed SUVmax (OR: 1.223, 95% CI 1.068-1.399, p = 0.003); highest tumor grade at mpMRI-TB, ISUP grade group (ISUP GG) 1 vs. 4 (OR: 0.11, 95% CI 0.000-0.452, p = 0.018) and ISUP GG 2 vs. 4 (OR: 0.16, 95% CI 0.001-0.252, p = 0.003); and multifocality on PET/CT (OR: 9.821, 95% CI 1.438-67.085, p = 0.02) were independent risk factors for pathological upgrading. Our developed prediction model based on the identified parameter showed good calibration at internal validation (mean absolute error = 0.033). CONCLUSION 68Ga-PSMA-11 PET/CT was found to be an ideal biomarker for the prediction of pathological upgrading from mpMRI-TB to RP, especially for patients with lower tumor grade at mpMRI-TB.
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Kalapara AA, Ballok ZE, Ramdave S, O'Sullivan R, Ryan A, Konety B, Grummet JP, Frydenberg M. Combined Utility of 68Ga-Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging in Predicting Prostate Biopsy Pathology. Eur Urol Oncol 2021; 5:314-320. [PMID: 33741337 DOI: 10.1016/j.euo.2021.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/29/2021] [Accepted: 02/19/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND 68Gallium-labelled prostate-specific membrane antigen positron emission tomography (68Ga-PSMA-11 PET) is a valuable staging tool, but its utility in characterising primary prostate cancer remains unclear. The maximum standardised uptake value (SUVmax) is a quantification measure of highest radiotracer uptake within PET-avid lesions. OBJECTIVE To assess the utility of SUVmax in detecting clinically significant prostate cancer (csPCa) on biopsy alone and in combination with multiparametric magnetic resonance imaging (mpMRI). DESIGN, SETTING, AND PARTICIPANTS This was a retrospective analysis of 200 men who underwent 68Ga-PSMA-11 PET/CT, mpMRI, and transperineal template prostate biopsy between 2016 and 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary and secondary outcomes were detection of grade group (GG) 3-5 and GG 2-5 prostate cancer, respectively. We used the Mann-Whitney U test to compare SUVmax by GG, and calculated sensitivity and specificity for csPCa detection via 68Ga-PSMA-11 PET/CT, mpMRI, and both. Multivariable logistic regression analyses were used to identify predictors of csPCa on biopsy. RESULTS AND LIMITATIONS The median SUVmax was greater for GG 3-5 tumours (6.40, interquartile range [IQR] 4.47-11.0) than for benign and GG 1-2 tumours (3.14, IQR 2.55-3.91; p < 0.001). The median SUVmax was greater for GG 3 (5.70, IQR 3.68-8.67) than for GG 2 (3.47, IQR 2.70-4.74; p < 0.001). For GG 3-5 disease, sensitivity was 86.5%, 95.9%, and 98.6%, and the negative predictive value (NPV) was 88.4%, 88.5%, and 93.3% using SUVmax ≥4, a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3-5, and both, respectively. This combined model detected more GG 3-5 disease than mpMRI alone (98.6% vs 95.9%; p = 0.04). SUVmax was an independent predictor of csPCa for GG 3-5 disease only (odds ratio 1.27 per unit, 95% confidence interval 1.13-1.45). Our results are limited by the retrospective study design. CONCLUSIONS Greater SUVmax on 68Ga-PSMA-11 PET/CT is associated with detection of GG 3-5 cancer on biopsy. The combination of PI-RADS score and SUVmax provides higher sensitivity and NPV than either alone. 68Ga-PSMA-11 PET/CT may be useful alongside mpMRI in improving risk stratification for localised disease. PATIENT SUMMARY The amount of a radioactive tracer taken up in the prostate during a type of scan called PET (positron emission tomography) can predict whether aggressive prostate cancer is likely to be found on biopsy. This may complement the more usual type of scan, MRI (magnetic resonance imaging), used to detect prostate cancer.
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Affiliation(s)
- Arveen A Kalapara
- Department of Surgery, Monash University, Melbourne, Australia; Australian Urology Associates, Malvern, Australia; Department of Urology, University of Minnesota, Minneapolis, MN, USA.
| | | | - Shakher Ramdave
- Department of Nuclear Medicine & PET, Monash Medical Centre, Bentleigh East, Australia
| | | | | | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Jeremy P Grummet
- Department of Surgery, Monash University, Melbourne, Australia; Australian Urology Associates, Malvern, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Australia; Australian Urology Associates, Malvern, Australia; Cabrini Institute, Cabrini Health, Malvern, Australia
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Liu Y, Yu H, Liu J, Zhang X, Lin M, Schmidt H, Gao J, Xu B. A Pilot Study of 18F-DCFPyL PET/CT or PET/MRI and Ultrasound Fusion Targeted Prostate Biopsy for Intra-Prostatic PET-Positive Lesions. Front Oncol 2021; 11:612157. [PMID: 33747927 PMCID: PMC7973269 DOI: 10.3389/fonc.2021.612157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the feasibility and diagnostic performance of prostate-specific membrane antigen (PSMA) based 18F-DCFPyL PET/CT-ultrasound (PET/CT-US) or PET/MRI-ultrasound (PET/MRI-US) fusion targeted biopsy for intra-prostatic PET-positive lesions. METHODS From April 2018 to November 2019, we prospectively enrolled 55 candidates to perform PET/CT-US or PET/MRI-US fusion targeted biopsies for solitary PET-positive prostate lesions (two to four cores/lesion). The positive rates of prostate cancer based on patients and biopsy cores were calculated respectively. With reference to the pathological results of biopsy cores, the MR signal characteristics in the area of the PET-positive lesion were analyzed for the patients who underwent PET/MRI. RESULTS A total of 178 biopsy cores were taken on the 55 patients. One hundred forty-six biopsy cores (82.0%, 146/178) from 51 (92.7%, 51/55) patients were positive for prostate cancer; 47 (85.5%, 47/55) were clinically significant prostate cancer. It is noteworthy that nine patients underwent both 18F-DCFPyL PET/CT and PET/MRI examinations; the seven patients with prostate cancer showed abnormal MR signal in the area of the PET-positive lesion while the other two patients with prostatic hyperplasia and prostatitis showed normal MR signal in the area of the PET-positive lesion. CONCLUSION This study indicated that 18F-DCFPyL PET/CT-US or PET/MRI-US fusion targeted prostate biopsies may be valuable for prostate cancer diagnosis and have a high detection rate of clinically significant prostate cancer for PET-positive lesions. PET/MR can rule out some false PET-positive lesions, which may potentially reduce unnecessary prostate biopsies.
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Affiliation(s)
- Yachao Liu
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Hongkai Yu
- Department of Urology Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiaojun Zhang
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Mu Lin
- Magnetic Resonance Collaboration, Diagnostic Imaging, Siemens Healthineers Ltd., Shanghai, China
| | - Holger Schmidt
- Magnetic Resonance Education, Customer Services, Siemens Healthcare GmbH, Erlangen, Germany
| | - Jiangping Gao
- Department of Urology Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
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Satapathy S, Singh H, Kumar R, Mittal BR. Diagnostic Accuracy of 68Ga-PSMA PET/CT for Initial Detection in Patients With Suspected Prostate Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2021; 216:599-607. [PMID: 32755196 DOI: 10.2214/ajr.20.23912] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND. Early diagnosis is important in the overall management of prostate cancer (PCa). Gallium-68-labeled prostate-specific membrane antigen (PSMA) PET/CT has an established role in the detection of recurrent disease and staging of patients with intermediate- to high-risk PCa. However, only a small number of studies have evaluated its role in the initial diagnosis of PCa. OBJECTIVE. This systematic review was conducted to evaluate the diagnostic performance of 68Ga-PSMA PET/CT in the initial detection of PCa in patients with clinical or biochemical findings suspicious for PCa. EVIDENCE ACQUISITION. This systematic review followed PRISMA guidelines. Searches in PubMed, Scopus, and Embase were conducted using relevant keywords, and articles published through April 30, 2020, were included. Using histopathology results as the reference standard, the numbers of true- and false-positives and true- and false-negatives were extracted. Pooled estimates of diagnostic test accuracy-including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary ROC (SROC) curve-were generated using bivariate random-effects meta-analysis. EVIDENCE SYNTHESIS. Seven studies comprising 389 patients were included in the systematic review and meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the initial diagnosis of PCa using 68Ga-PSMA PET/CT were 0.97 (95% CI, 0.90-0.99), 0.66 (95% CI, 0.52-0.78), 2.86 (95% CI, 1.95-4.20), and 0.05 (95% CI, 0.01-0.15), respectively. The test had high accuracy; the area under the SROC curve was 0.91 (95% CI, 0.88-0.93). CONCLUSION. Gallium-68-labeled PSMA PET/CT had excellent sensitivity and negative likelihood ratio in the initial diagnosis of PCa in patients with clinical or biochemical findings suspicious for PCa. CLINICAL IMPACT. Gallium-68-labeled PSMA PET/CT had high diagnostic accuracy for the initial detection of PCa in patients with clinical or biochemical findings suspicious for PCa and has potential utility as a rule-out test for these patients.
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Affiliation(s)
- Swayamjeet Satapathy
- All authors: Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Harmandeep Singh
- All authors: Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Rajender Kumar
- All authors: Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Bhagwant Rai Mittal
- All authors: Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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Liu A, Zhang M, Huang H, Zhang C, Ruan X, Lin W, Li B, Chen L, Xu D. Clinical Utility of 18F-PSMA-1007 Positron Emission Tomography/Magnetic Resonance Imaging in Prostate Cancer: A Single-Center Experience. Front Oncol 2021; 10:612701. [PMID: 33680933 PMCID: PMC7928386 DOI: 10.3389/fonc.2020.612701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose This study aimed to evaluate the clinical utility of 18F-PSMA-1007 positron emission tomography (PSMA PET)/magnetic resonance imaging (MRI) imaging in patients with suspected or defined prostate cancer. Methods In the pilot study, we retrospectively investigated 62 patients who underwent PSMA-PET/MRI for suspected or defined PCa between June 2019 and June 2020. Patients were grouped into three subgroups: (1) suspected PCa without histological evidence, (2) primary PCa, (3) biochemical recurrent prostate cancer (BRPCa). Two nuclear physicians independently interpreted the results of PSMA-PET/MRI. Management strategies before PSMA-PET/MRI were retrospectively reported, and the management strategy was re-evaluated for each patient considering the PSMA-PET/MRI result. The changes in strategies were recorded. Besides, the correlation between prostate specific antigen (PSA) level and management changes was also accessed by Fisher exact test, and two-side p < 0.05 was assumed as statistical significance. Results There were 28 patients in the suspected PCa group (group 1), 12 in the primary PCa group (group 2), and 22 in the BRPCa group (group 3). Overall, the intended decisions were changed in 26 (41.9%) of 62 patients after PSMA-PET/MRI, including 11/28 (39.3%) in suspected PCa group, 1/12 (8.4%) in primary PCa group, and 14/24 (63.6%) in BCR group. In group 1, the main impact on subsequent management included decreased active surveillance (from 20 to 9) and increased prostate biopsy (from 8 to 19). PSA levels were not significantly associated with management changes in suspected PCa patients (p = 0.865). In group 2, the main impact on subsequent management included decreased radical surgery (from 8 to 7), and multimodal therapy appearance (n = 1). Only in the category of PSA levels of ≥20 ng/ml, the management of primary PCa was changed. In group 3, the main impact on subsequent management included decreased salvage radiotherapy (from 5 to 2), increased systemic therapy (from 6 to 7), and increased multimodal therapy (from 11 to 13). The highest proportion of management changes occurred in BCR patients with 0.5≤PSA<1 ng/ml. Conclusion From our preliminary experience, PSMA-PET/MRI may be a valued tool for defining PCa lesions and changing management. The biggest impact of management intent was in patients with BRPCa, especially in patients with 0.5≤PSA<1 ng/ml. However, further studies are needed to confirm our pilot findings.
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Affiliation(s)
- Ao Liu
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Miao Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hai Huang
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chuanjie Zhang
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaohao Ruan
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenhao Lin
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lu Chen
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Danfeng Xu
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Kalapara AA, Nzenza T, Pan HYC, Ballok Z, Ramdave S, O'Sullivan R, Ryan A, Cherk M, Hofman MS, Konety BR, Lawrentschuk N, Bolton D, Murphy DG, Grummet JP, Frydenberg M. Detection and localisation of primary prostate cancer using 68 gallium prostate-specific membrane antigen positron emission tomography/computed tomography compared with multiparametric magnetic resonance imaging and radical prostatectomy specimen pathology. BJU Int 2020; 126:83-90. [PMID: 31260602 DOI: 10.1111/bju.14858] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the accuracy of 68 gallium prostate-specific membrane antigen positron emission tomography/computed tomography (68 Ga-PSMA PET/CT) with multiparametric MRI (mpMRI) in detecting and localising primary prostate cancer when compared with radical prostatectomy (RP) specimen pathology. PATIENTS AND METHODS Retrospective review of men who underwent 68 Ga-PSMA PET/CT and mpMRI for primary prostate cancer before RP across four centres between 2015 and 2018. Patients undergoing imaging for recurrent disease or before non-surgical treatment were excluded. We defined pathological index tumour as the lesion with highest International Society of Urological Pathology Grade Group (GG) on RP specimen pathology. Our primary outcomes were rates of accurate detection and localisation of RP specimen pathology index tumour using 68 Ga-PSMA PET/CT or mpMRI. We defined tumour detection as imaging lesion corresponding with RP specimen tumour on any imaging plane, and localisation as imaging lesion matching RP specimen index tumour in all sagittal, axial, and coronal planes. Secondary outcomes included localisation of clinically significant and transition zone (TZ) index tumours. We defined clinically significant disease as GG 3-5. We used descriptive statistics and the Mann-Whitney U-test to define and compare demographic and pathological characteristics between detected, missed and localised tumours using either imaging modality. We used the McNemar test to compare detection and localisation rates using 68 Ga-PSMA PET/CT and mpMRI. RESULTS In all, 205 men were included in our analysis, including 133 with clinically significant disease. There was no significant difference between 68 Ga-PSMA PET/CT and mpMRI in the detection of any tumour (94% vs 95%, P > 0.9). There was also no significant difference between localisation of all index tumours (91% vs 89%, P = 0.47), clinically significant index tumours (96% vs 91%, P = 0.15) or TZ tumours (85% vs 80%, P > 0.9) using 68 Ga-PSMA PET/CT and mpMRI. Limitations include retrospective study design and non-central review of imaging and pathology. CONCLUSION We found no significant difference in the detection or localisation of primary prostate cancer between 68 Ga-PSMA PET/CT and mpMRI. Further prospective studies are required to evaluate a combined PET/MRI model in minimising tumours missed by either modality.
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Affiliation(s)
- Arveen A Kalapara
- Department of Surgery, Monash University, Melbourne, VIC, Australia.,Australian Urology Associates, Malvern, VIC, Australia
| | - Tatenda Nzenza
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Henry Y C Pan
- Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Zita Ballok
- Healthcare Imaging Services, Richmond, VIC, Australia.,Department of Nuclear Medicine and PET, Monash Medical Centre, Bentleigh East, VIC, Australia
| | - Shakher Ramdave
- Department of Nuclear Medicine and PET, Monash Medical Centre, Bentleigh East, VIC, Australia
| | - Richard O'Sullivan
- Healthcare Imaging Services, Richmond, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Martin Cherk
- Department of Nuclear Medicine and PET, Alfred Hospital, Melbourne, VIC, Australia
| | - Michael S Hofman
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Damien Bolton
- Department of Urology, Austin Hospital, Heidelberg, VIC, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Jeremy P Grummet
- Department of Surgery, Monash University, Melbourne, VIC, Australia.,Department of Urology, Alfred Hospital, Melbourne, VIC, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, VIC, Australia.,Australian Urology Associates, Malvern, VIC, Australia
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Miyahira AK, Pienta KJ, Babich JW, Bander NH, Calais J, Choyke P, Hofman MS, Larson SM, Lin FI, Morris MJ, Pomper MG, Sandhu S, Scher HI, Tagawa ST, Williams S, Soule HR. Meeting report from the Prostate Cancer Foundation PSMA theranostics state of the science meeting. Prostate 2020; 80:1273-1296. [PMID: 32865839 PMCID: PMC8442561 DOI: 10.1002/pros.24056] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Prostate Cancer Foundation (PCF) convened a PCF prostate-specific membrane antigen (PSMA) Theranostics State of the Science Meeting on 18 November 2019, at Weill Cornell Medicine, New York, NY. METHODS The meeting was attended by 22 basic, translational, and clinical researchers from around the globe, with expertise in PSMA biology, development and use of PSMA theranostics agents, and clinical trials. The goal of this meeting was to discuss the current state of knowledge, the most important biological and clinical questions, and critical next steps for the clinical development of PSMA positron emission tomography (PET) imaging agents and PSMA-targeted radionuclide agents for patients with prostate cancer. RESULTS Several major topic areas were discussed including the biology of PSMA, the role of PSMA-targeted PET imaging in prostate cancer, the physics and performance of different PSMA-targeted PET imaging agents, the current state of clinical development of PSMA-targeted radionuclide therapy (RNT) agents, the role of dosimetry in PSMA RNT treatment planning, barriers and challenges in PSMA RNT clinical development, optimization of patient selection for PSMA RNT trials, and promising combination treatment approaches with PSMA RNT. DISCUSSION This article summarizes the presentations from the meeting for the purpose of globally disseminating this knowledge to advance the use of PSMA-targeted theranostic agents for imaging and treatment of patients with prostate cancer.
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Affiliation(s)
- Andrea K. Miyahira
- Science Department, Prostate Cancer Foundation, Santa Monica, California
| | - Kenneth J. Pienta
- Department of Urology, The Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John W. Babich
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Neil H. Bander
- Laboratory of Urologic Oncology, Department of Urology and Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Peter Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Michael S. Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Steven M. Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Frank I. Lin
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Michael J. Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin G. Pomper
- Department of Urology, The Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shahneen Sandhu
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Howard I. Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Scott T. Tagawa
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Scott Williams
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Howard R. Soule
- Science Department, Prostate Cancer Foundation, Santa Monica, California
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Singh H. Making the Case for Prostate-Specific Membrane Antigen-Targeted Positron Emission Tomography/Computed Tomography in Suspected Prostate Cancer. Indian J Nucl Med 2020; 35:281-282. [PMID: 33642750 PMCID: PMC7905282 DOI: 10.4103/ijnm.ijnm_175_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 02/04/2023] Open
Abstract
Prostate specific membrane antigen (PSMA) over-expression is a hallmark of prostate adenocarcinoma and many PSMA targeting positron emission tomography (PET) radiopharmaceuticals have been developed over the last decade. The role of 68Ga-PSMA-11 PET-computed tomography (CT) is well established in staging and biochemical recurrence of PCa, with growing interest and evidence regarding its utility in suspected prostate cancer.
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Affiliation(s)
- Harmandeep Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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50
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Alfano R, Bauman GS, Liu W, Thiessen JD, Rachinsky I, Pavlosky W, Butler J, Gaed M, Moussa M, Gomez JA, Chin JL, Pautler S, Ward AD. Histologic validation of auto-contoured dominant intraprostatic lesions on [ 18F] DCFPyL PSMA-PET imaging. Radiother Oncol 2020; 152:34-41. [PMID: 32827589 DOI: 10.1016/j.radonc.2020.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/22/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND PSMA-PET1 has shown good concordance with histology, but there is a need to investigate the ability of PSMA-PET to delineate DIL2 boundaries for guided biopsy and focal therapy planning. OBJECTIVE To determine threshold and margin combinations that satisfy the following criteria: ≥95% sensitivity with max specificity and ≥95% specificity with max sensitivity. DESIGN, SETTING AND PARTICIPANTS We registered pathologist-annotated whole-mount mid-gland prostatectomy histology sections cut in 4.4 mm intervals from 12 patients to pre-surgical PSMA-PET/MRI by mapping histology to ex-vivo imaging to in-vivo imaging. We generated PET-derived tumor volumes using boundaries defined by thresholded PET volumes from 1-100% of SUV3max in 1% intervals. At each interval, we applied margins of 0-30 voxels in one voxel increments, giving 3000 volumes/patient. OUTCOME MEASUREMENTS Mean and standard deviation of sensitivity and specificity for cancer detection within the 2D oblique histologic planes that intersected with the 3D PET volume for each patient. RESULTS AND LIMITATIONS A threshold of 67% SUV max with an 8.4 mm margin achieved a (mean ± std.) sensitivity of 95.0 ± 7.8% and specificity of 76.4 ± 14.7%. A threshold of 81% SUV max with a 5.1 mm margin achieved sensitivity of 65.1 ± 28.4% and specificity of 95.1 ± 5.2%. CONCLUSIONS Preliminary evidence of thresholding and margin expansion of PSMA-PET images targeted at DILs validated with histopathology demonstrated excellent mean sensitivity and specificity in the setting of focal therapy/boosting and guided biopsy. These parameters can be used in a larger validation study supporting clinical translation.
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Affiliation(s)
- Ryan Alfano
- Baines Imaging Research Laboratory, London, Canada; London Health Sciences Centre, London, Canada; Western University Department of Medical Biophysics, London, Canada.
| | - Glenn S Bauman
- London Health Sciences Centre, London, Canada; Western University Department of Medical Biophysics, London, Canada; Western University Department of Oncology, London, Canada.
| | - Wei Liu
- London Health Sciences Centre, London, Canada; Western University Department of Oncology, London, Canada.
| | - Jonathan D Thiessen
- Western University Department of Medical Biophysics, London, Canada; St. Joseph's Health Centre, London, Canada; Western University Department of Medical Imaging, London, Canada.
| | - Irina Rachinsky
- London Health Sciences Centre, London, Canada; Western University Department of Medical Imaging, London, Canada.
| | - William Pavlosky
- Western University Department of Medical Imaging, London, Canada.
| | | | - Mena Gaed
- Western University Department of Pathology and Laboratory Medicine, London, Canada.
| | - Madeleine Moussa
- London Health Sciences Centre, London, Canada; Western University Department of Pathology and Laboratory Medicine, London, Canada.
| | - Jose A Gomez
- London Health Sciences Centre, London, Canada; Western University Department of Pathology and Laboratory Medicine, London, Canada.
| | - Joseph L Chin
- London Health Sciences Centre, London, Canada; Western University Department of Surgery, London, Canada; Western University Department of Oncology, London, Canada.
| | - Stephen Pautler
- St. Joseph's Health Centre, London, Canada; Western University Department of Oncology, London, Canada.
| | - Aaron D Ward
- Baines Imaging Research Laboratory, London, Canada; London Health Sciences Centre, London, Canada; Western University Department of Medical Biophysics, London, Canada; Western University Department of Oncology, London, Canada.
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