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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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Abstract
PURPOSE OF REVIEW In recent years, a large number of reports have been published on prostate-specific membrane antigen (PSMA)/PET in prostate cancer (PCa). This review highlights advances in PSMA PET in PCa during the past year. RECENT FINDINGS PSMA PET/computed tomography (CT) is useful in detection of biochemical recurrence, especially at low prostate-specific antigen (PSA) values. The detection rate of PSMA PET is influenced by PSA level. For primary PCa, PSMA PET/CT shows promise for tumour localization in the prostate, especially in combination with multiparametric MRI (mpMRI). For primary staging, PSMA PET/CT can be used in intermediate and high-risk PCa. Intraoperative PSMA radioligand guidance seems promising for detection of malignant lymph nodes. While the use of PSMA PET/MRI in primary localized disease is limited to high and intermediate-risk patients and localized staging, in the recurrence setting, PET/MRI can be particularly helpful when the lesions are subtle. PSMA PET/CT is superior to choline PET/CT and other conventional imaging modalities. SUMMARY Molecular imaging with PSMA PET continues to pave the way for personalized medicine in PCa.However, large prospective clinical studies are still needed to fully evaluate the role of PSMA PET/CT and PET/MRI in the clinical workflow of PCa.
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Barbosa FDG, Queiroz MA, Nunes RF, Marin JFG, Buchpiguel CA, Cerri GG. Clinical perspectives of PSMA PET/MRI for prostate cancer. Clinics (Sao Paulo) 2018; 73:e586s. [PMID: 30281701 PMCID: PMC6142859 DOI: 10.6061/clinics/2018/e586s] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/16/2018] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer imaging has become an important diagnostic modality for tumor evaluation. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has been extensively studied, and the results are robust and promising. The advent of the PET/magnetic resonance imaging (MRI) has added morphofunctional information from the standard of reference MRI to highly accurate molecular information from PET. Different PSMA ligands have been used for this purpose including 68gallium and 18fluorine-labeled PET probes, which have particular features including spatial resolution, imaging quality and tracer biodistribution. The use of PSMA PET imaging is well established for evaluating biochemical recurrence, even at low prostate-specific antigen (PSA) levels, but has also shown interesting applications for tumor detection, primary staging, assessment of therapeutic responses and treatment planning. This review will outline the potential role of PSMA PET/MRI for the clinical assessment of PCa.
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Affiliation(s)
- Felipe de Galiza Barbosa
- Departamento de Radiologia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Marcelo Araújo Queiroz
- Departamento de Radiologia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - José Flávio Gomes Marin
- Departamento de Radiologia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carlos Alberto Buchpiguel
- Departamento de Radiologia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Giovanni Guido Cerri
- Departamento de Radiologia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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