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Zang J, Yang Y, Chen S, Wang C, Chen S, Hu S, Cai H, Li X, Xu N, Chen X, Zhang J, Miao W. Diagnostic Performance of [ 18F]AlF-Thretide PET/CT in Patients with Newly Diagnosed Prostate Cancer Using Histopathology as Reference Standard. J Nucl Med 2024; 65:1021-1026. [PMID: 38724276 DOI: 10.2967/jnumed.123.266940] [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: 10/24/2023] [Accepted: 03/25/2024] [Indexed: 07/03/2024] Open
Abstract
This study aimed to assess the diagnostic value of [18F]AlF-thretide PET/CT in patients with newly diagnosed prostate cancer (PCa). Methods: In total, 49 patients with biopsy-proven PCa were enrolled in this prospective study. All patients underwent [18F]AlF-thretide PET/CT, and the scoring system of the PRIMARY trial was used for PET image analysis. The dosimetry evaluation of [18F]AlF-thretide was performed on 3 patients. Pathologic examination was used as the reference standard to evaluate the location, number, size, and Gleason score of tumors, for comparison with the [18F]AlF-thretide PET/CT results. PSMA expression was evaluated by immunohistochemical staining. Results: All patients tolerated the [18F]AlF-thretide PET/CT well. The total effective dose of [18F]AlF-thretide was 1.16E-02 mSv/MBq. For patient-based analysis of intraprostatic tumors, 46 of 49 (93.9%) patients showed pathologic uptake on [18F]AlF-thretide PET/CT. For lesion-based analysis of intraprostatic tumors, the sensitivity and positive predictive value for [18F]AlF-thretide PET/CT were 58.2% and 90.5%, respectively. Delayed images can detect more lesions than standard images (n = 57 vs. 49, P = 0.005), and the SUVmax and tumor-to-background ratio of the former were higher than those of the latter (SUVmax: 14.5 ± 16.7 vs. 11.4 ± 13.6, P < 0.001; tumor-to-background ratio: 37.1 ± 42.3 vs. 23.1 ± 27.4, P < 0.001). The receiver-operating-characteristic curve analysis showed that the areas under the curve for PRIMARY score-predicted true-positive and false-positive lesions were significantly higher than those for the SUVmax of standard images (P = 0.015) and seemed higher than those for the SUVmax of delayed images (P = 0.257). [18F]AlF-thretide PET/CT showed a higher detection rate than multiparametric MRI for all intraprostatic foci (53.5% vs. 40.8%, P = 0.012) and clinically significant PCa (75.0% vs. 61.4%, P = 0.031). Conclusion: [18F]AlF-thretide PET/CT showed high diagnostic value for patients with primary PCa and can be used as an excellent imaging modality for preoperative evaluation of PCa patients.
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Affiliation(s)
- Jie Zang
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yun Yang
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shaoming Chen
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chao Wang
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shaohao Chen
- Department of Urology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shun Hu
- Department of Pathology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hai Cai
- Department of Urology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaodong Li
- Department of Urology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Urology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaoyuan Chen
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Chemical and Biomolecular Engineering and Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology, and Research, Proteos, Singapore, Singapore; and
| | - Jingjing Zhang
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Weibing Miao
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China;
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Precision Medicine for Cancer, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Dullea A, O'Sullivan L, O'Brien KK, Carrigan M, Ahern S, McGarry M, Harrington P, Walsh KA, Smith SM, Ryan M. Diagnostic Accuracy of 18F-Prostate Specific Membrane Antigen (PSMA) PET/CT Radiotracers in Staging and Restaging of Patients With High-Risk Prostate Cancer or Biochemical Recurrence: An Overview of Reviews. Semin Nucl Med 2024:S0001-2998(24)00044-8. [PMID: 38906759 DOI: 10.1053/j.semnuclmed.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/03/2024] [Indexed: 06/23/2024]
Abstract
The aim of this overview was to consolidate existing evidence syntheses and provide a comprehensive overview of the evidence for 18F-prostate specific membrane antigen (PSMA) PET/CT in the staging of high-risk prostate cancer and restaging after biochemical recurrence. An overview of reviews was performed and reported in line with the preferred reporting items for overview of reviews (PRIOR) statement and synthesis without meta-analysis (SWiM) reporting guidelines. A comprehensive database and grey literature search were conducted up to July 18, 2023. Systematic reviews were assessed using the risk of bias in systematic reviews (ROBIS) tool. The certainty of the evidence was assessed using grading of recommendations, assessment, development and evaluations (GRADE). 11 systematic reviews were identified; 10 were at high or unclear risk of bias. Evidence reported on a per-patient, per-lymph node, and per-lesion basis for sensitivity, specificity and overall accuracy was identified. There was a lack of data on dose, adverse events and evidence directly comparing 18F-PSMA PET/CT to other imaging modalities. Evidence with moderate to very low certainty indicated high sensitivity, specificity and accuracy of 18F-PSMA PET/CT in patients with high-risk prostate cancer and biochemical recurrence. There was considerably lower certainty evidence and greater variability in effect estimates for outcomes for the combined intermediate/high-risk cohort. While evidence gaps remain for some outcomes, and most systematic reviews were at high or unclear risk of bias, the current evidence base is broadly supportive of 18F-PSMA PET/CT imaging in the staging and restaging of patients with high-risk prostate cancer and biochemical recurrence.
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Affiliation(s)
- Andrew Dullea
- Discipline of Public Health & Primary Care, School of Medicine, Trinity College, Dublin, Ireland; Health Technology Assessment Directorate, Health Information and Quality Authority, Cork, Ireland.
| | - Lydia O'Sullivan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Cork, Ireland; Health Research Board-Trials Methodology Research Network, College of Medicine, Nursing and Health Sciences, University of Galway, County Galway, Galway, Ireland
| | - Kirsty K O'Brien
- Health Technology Assessment Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Marie Carrigan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Susan Ahern
- Health Technology Assessment Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Maeve McGarry
- Health Technology Assessment Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Patricia Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Kieran A Walsh
- Health Technology Assessment Directorate, Health Information and Quality Authority, Cork, Ireland; School of Pharmacy, University College Cork, County Cork, Cork, Ireland
| | - Susan M Smith
- Discipline of Public Health & Primary Care, School of Medicine, Trinity College, Dublin, Ireland
| | - Máirín Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Cork, Ireland; Department of Pharmacology and Therapeutics, Trinity College, Dublin, Ireland
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Ma J, Yang Q, Ye X, Xu W, Chang Y, Chen R, Wang Y, Luo M, Lou Y, Yang X, Li D, Xu Y, He W, Cai M, Cao W, Ju G, Yin L, Wang J, Ren J, Ma Z, Zuo C, Ren S. Head-to-head comparison of prostate-specific membrane antigen PET and multiparametric MRI in the diagnosis of pretreatment patients with prostate cancer: a meta-analysis. Eur Radiol 2024; 34:4017-4037. [PMID: 37981590 DOI: 10.1007/s00330-023-10436-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To compare prostate-specific membrane antigen (PSMA) PET with multiparametric MRI (mpMRI) in the diagnosis of pretreatment prostate cancer (PCa). METHODS Pubmed, Embase, Medline, Web of Science, and Cochrane Library were searched for eligible studies published before June 22, 2022. We assessed risk of bias and applicability by using QUADAS-2 tool. Data synthesis was performed with Stata 17.0 software, using the "midas" and "meqrlogit" packages. RESULTS We included 29 articles focusing on primary cancer detection, 18 articles about primary staging, and two articles containing them both. For PSMA PET versus mpMRI in primary PCa detection, sensitivities and specificities in the per-patient analysis were 0.90 and 0.84 (p<0.0001), and 0.66 and 0.60 (p <0.0001), and in the per-lesion analysis they were 0.79 and 0.78 (p <0.0001), and 0.84 and 0.82 (p <0.0001). For the per-patient analysis of PSMA PET versus mpMRI in primary staging, sensitivities and specificities in extracapsular extension detection were 0.59 and 0.66 (p =0.005), and 0.79 and 0.76 (p =0.0074), and in seminal vesicle infiltration (SVI) detection they were 0.51 and 0.60 (p =0.0008), and 0.93 and 0.96 (p =0.0092). For PSMA PET versus mpMRI in lymph node metastasis (LNM) detection, sensitivities and specificities in the per-patient analysis were 0.68 and 0.46 (p <0.0001), and 0.91 and 0.90 (p =0.81), and in the per-lesion analysis they were 0.67 and 0.36 (p <0.0001), and 0.99 and 0.99 (p =0.18). CONCLUSION PSMA PET has higher diagnostic value than mpMRI in the detection of primary PCa. Regarding the primary staging, mpMRI has potential advantages in SVI detection, while PSMA PET has relative advantages in LNM detection. CLINICAL RELEVANCE STATEMENT The integration of prostate-specific membrane antigen (PSMA) PET into the diagnostic pathway may be helpful for improving the accuracy of prostate cancer detection. However, further studies are needed to address the cost implications and evaluate its utility in specific patient populations or clinical scenarios. Moreover, we recommend the combination of PSMA PET and mpMRI for cancer staging. KEY POINTS • Prostate-specific membrane antigen PET has higher sensitivity and specificity for primary tumor detection in prostate cancer compared to multiparametric MRI. • Prostate-specific membrane antigen PET also has significantly better sensitivity and specificity for lymph node metastases of prostate cancer compared to multiparametric MRI. • Multiparametric MRI has better accuracy for extracapsular extension and seminal vesicle infiltration compared to ate-specific membrane antigen PET.
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Affiliation(s)
- Jianglei Ma
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Qinqin Yang
- Department of Nuclear Medicine, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University, Shanghai, 200433, China
| | - Weidong Xu
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Yifan Chang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Rui Chen
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Ye Wang
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Mengting Luo
- College of Basic Medical Sciences, Naval Medical University, Shanghai, 200433, China
| | - Yihaoyun Lou
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Xuming Yang
- Department of Urology, Hengyang Central Hospital, Hengyang, 421001, Hu'nan, China
| | - Duocai Li
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Yusi Xu
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Wei He
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Minglei Cai
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Wanli Cao
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Guanqun Ju
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Lei Yin
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Junkai Wang
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Jizhong Ren
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Zifang Ma
- Department of Urology, Hengyang Central Hospital, Hengyang, 421001, Hu'nan, China.
| | - Changjing Zuo
- Department of Nuclear Medicine, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
| | - Shancheng Ren
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
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Jiang Z, Yang T, Xu L. Head-to-head comparison of prostate-specific membrane antigen positron emission tomography/computed tomography and multiparametric magnetic resonance imaging in the detection of biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Clin Radiol 2024; 79:436-445. [PMID: 38582633 DOI: 10.1016/j.crad.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 04/08/2024]
Abstract
AIM Our main goal of this meta-analytical analysis was to evaluate the diagnostic effectiveness of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) against multiparametric magnetic resonance imaging (mpMRI) in the context of identifying biochemical recurrence in patients with prostate cancer (PCa). MATERIALS AND METHODS A thorough search covering articles published until March 2023 was carried out across major databases such as PubMed, Embase, and Web of Science. Studies examining the direct comparison of PSMA PET/CT and mpMRI in patients with PCa suffering biochemical recurrence were included in the inclusion criteria. Using the renowned Quality Assessment of Diagnostic Performance Studies-2 technique, each study's methodological rigor was assessed. RESULTS We analyzed data from six eligible studies involving 290 patients in total. The combined data showed that for PSMA PET/CT and mpMRI, respectively, the pooled overall detection rates for recurrent PCa after definitive treatment were 0.69 (95% confidence interval [CI]: 0.45-0.89) and 0.70 (95% CI: 0.44-0.91). The detection rates for local recurrence were specifically 0.52 (95% CI: 0.39-0.65) and 0.62 (95% CI: 0.31-0.89), while they were 0.50 (95% CI: 0.26-0.74) and 0.32 (95% CI: 0.18-0.48) for lymph node metastasis. Notably, there was no discernible difference between the two imaging modalities in terms of the overall detection rate (P = 0.95). The detection rates for local recurrence and lymph node metastasis did not differ statistically significantly (P = 0.55, 0.23). CONCLUSION The performance of PSMA PET/CT and mpMRI in identifying biochemical recurrence in PCa appears to be comparable. However, the meta-analysis' findings came from research with modest sample sizes. In this context, more extensive research should be conducted in the future.
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Affiliation(s)
- Z Jiang
- Medical School, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China.
| | - T Yang
- Medical School, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
| | - L Xu
- Medical School, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
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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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Tateishi U, Kimura K, Tsuchiya J, Kano D, Watabe T, Nonomura N, Saito K, Yokoyama K, Yamagiwa K, Adachi T, Kojima Y, Yoshida S, Fujii Y. Phase I/IIa trial of 18F-prostate specific membrane antigen (PSMA) 1007 PET/CT in healthy volunteers and prostate cancer patients. Jpn J Clin Oncol 2024; 54:282-291. [PMID: 38066703 DOI: 10.1093/jjco/hyad166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/15/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE 18F-PSMA 1007 is a promising PET tracer for prostate cancer. We aimed to examine the safety, biodistribution, radiation dosimetry, and clinical effectiveness in Japanese healthy volunteers and patients with prostate cancer. METHODS Part A evaluated the pharmacokinetics and exposure doses in three healthy volunteers. Part B evaluated the diagnostic accuracy in patients with untreated preoperative prostate cancer (Cohort 1, n = 7) and patients with biochemical recurrence (Cohort 2, n = 3). All subjects received a single dose of 3.7 MBq/kg 18F-PSMA 1007. Results: 18F-PSMA 1007 was found to be safe and well tolerated in all subjects. No serous AEs or drug-related AEs were identified during the present study. The average blood radioactivity concentration reached a maximum of 47.87 ± 1.05 (percentage of injected dose [%ID]/ml) at 5 min and then decreased to 1.60 ± 0.78 in 6 h. The systemic radioactivity reached a maximum of 211.05 ± 6.77 (%ID$\times$103) at 5 min and decreased to 7.18 ± 3.91 in 6 h. The sensitivity and positive predictive value were 100% and 100% based on both pathologic and imaging confirmation as gold standard. In Cohort 1, 15 primary foci (11.9%) were >5 mm in the largest diameter and identified in 39 of 126 segments (30.1%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for 60 min uptake time acquisition were 80.0, 96.5, 91.4, 91.2 and 91.3%, respectively. CONCLUSIONS Our study revealed that 18F-PSMA 1007 was safe, well tolerated and showed high accuracy in the diagnosis of prostate cancer.
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Affiliation(s)
- Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo
| | - Koichiro Kimura
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo
| | - Daisuke Kano
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo
- Pharmaceutical Department, National Cancer Center Hospital East, Chiba
| | - Tadashi Watabe
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka
| | - Norio Nonomura
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka
| | - Katsuhiko Saito
- Medical & Advanced Equipment Unit, Industrial Equipment Division, Sumitomo Heavy Industries. Ltd., Tokyo
| | - Kota Yokoyama
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo
| | - Ken Yamagiwa
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo
| | - Takuya Adachi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo
| | - Yuji Kojima
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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Ali I, Rezk M, Hamouda D, Talaat O, Omar Y, Abdel Tawab M, Nasr I. Clinical value of 18F-PSMA-1007 PET/MRI in primary staging of patients with intermediate- to high-risk prostate cancer. Br J Radiol 2024; 97:622-631. [PMID: 38265254 PMCID: PMC11027301 DOI: 10.1093/bjr/tqae021] [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: 11/14/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To assess the utility of 18F-PSMA-1007 PET/MRI in initial staging of intermediate- to high-risk prostate cancer (HRPCa). METHODS A total of 46 patients with pathologically verified intermediate and/or HRPCa who underwent 18F-PSMA-1007 PET/MRI with dedicated pelvic high-resolution multiparametric MRI (mpMRI) were included. RESULTS PET/MRI showed 100% sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy in detecting seminal vesicle (SV) and rectal invasion, versus 87.5%, 100%, 100% 93.8%, 95.7% and 50%, 100%,100%, 95.5%, and 95.7% for mpMRI respectively. However, PET/MRI had poor SN (40% and 0%) but high SP (94.4% and 100%) in detection of UB and neurovascular bundle (NV) invasion compared to 100% SN and SP for mpMRI. PET/MRI demonstrated stronger TNM staging agreement with the gold standard than mpMRI-WBMRI. It demonstrated concordance with T, N, and M stages in 40, 41, and 36 patients (k 0.84, 0.60, and 0.68, respectively) versus 29, 33, and 31 patients (k 0.54, 0.22, and 0.50) with accurate over all staging of 38/46 patients versus 30/46 patients (K 0.52 versus 0.22). CONCLUSION 18F-PSMA-1007 PET/MRI is a promising imaging modality with high diagnostic accuracy in staging intermediate- and HRPCa; it improves local tumour evaluation and provides precise TNM staging. ADVANCES IN KNOWLEDGE 18F-PSMA-1007 PET/MRI could have high diagnostic accuracy as shown in the current study for staging HRPCa patients that is crucial for treatment selection. We think that our study will contribute to the body of knowledge and improve the literature surrounding the clinical uses of integrated 18F-PSMA-1007 PET/MRI.
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Affiliation(s)
- Ismail Ali
- Radiology Department, Faculty of Human Medicine, Zagazig University, Zagazig, Faculty of medicine street, Zagazig, Sharkia, 44519, Egypt
| | - Mahmoud Rezk
- Radiology Department, National cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Dalia Hamouda
- Medical Oncology Department, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Omnia Talaat
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Yehia Omar
- Director of PET/MRI unit, Misr Radiology Cente, Cairo, 11766, Egypt
| | - Mohamed Abdel Tawab
- Radiology Department, Faculty of Human Medicine, Alazhar University, Cairo, 11651, Egypt
| | - Ibrahim Nasr
- Clinical Oncology and Nuclear Medicine Department, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
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8
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García Vicente AM, Lucas Lucas C, Pérez-Beteta J, Borrelli P, García Zoghby L, Amo-Salas M, Soriano Castrejón ÁM. Analytical performance validation of aPROMISE platform for prostate tumor burden, index and dominant tumor assessment with 18F-DCFPyL PET/CT. A pilot study. Sci Rep 2024; 14:3001. [PMID: 38321201 PMCID: PMC10847509 DOI: 10.1038/s41598-024-53683-z] [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: 09/16/2023] [Accepted: 02/03/2024] [Indexed: 02/08/2024] Open
Abstract
To validate the performance of automated Prostate Cancer Molecular Imaging Standardized Evaluation (aPROMISE) in quantifying total prostate disease burden with 18F-DCFPyL PET/CT and to evaluate the interobserver and histopathologic concordance in the establishment of dominant and index tumor. Patients with a recent diagnosis of intermediate/high-risk prostate cancer underwent 18F-DCFPyL-PET/CT for staging purpose. In positive-18F-DCFPyL-PET/CT scans, automated prostate tumor segmentation was performed using aPROMISE software and compared to an in-house semiautomatic-manual guided segmentation procedure. SUV and volume related variables were obtained with two softwares. A blinded evaluation of dominant tumor (DT) and index tumor (IT) location was assessed by both groups of observers. In histopathological analysis, Gleason, International Society of Urological Pathology (ISUP) group, DT and IT location were obtained. We compared all the obtained variables by both software packages using intraclass correlation coefficient (ICC) and Cohen's kappa coefficient (k) for the concordance analysis. Fifty-four patients with a positive 18F-DCFPyL PET/CT were evaluated. The ICC for the SUVmax, SUVpeak, SUVmean, tumor volume (TV) and total lesion activity (TLA) was: 1, 0.833, 0.615, 0.494 and 0.950, respectively (p < 0.001 in all cases). For DT and IT detection, a high agreement was observed between both softwares (k = 0.733; p < 0.001 and k = 0.812; p < 0.001, respectively) although the concordances with histopathology were moderate (p < 0001). The analytical validation of aPROMISE showed a good performance for the SUVmax, TLA, DT and IT definition in comparison to our in-house method, although the concordance was moderate with histopathology for DT and IT.
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Affiliation(s)
- Ana María García Vicente
- Nuclear Medicine Department, Complejo Hospitalario Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain.
| | | | - Julián Pérez-Beteta
- Mathematical Oncology Laboratory (MOLab), Castilla-La Mancha University, Ciudad Real, Spain
- Department of Mathematics, Castilla-La Mancha University, Ciudad Real, Spain
| | - Pablo Borrelli
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Laura García Zoghby
- Nuclear Medicine Department, Complejo Hospitalario Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, Ciudad Real, Spain
| | - Ángel María Soriano Castrejón
- Nuclear Medicine Department, Complejo Hospitalario Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain
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Capasso G, Stefanucci A, Tolomeo A. A systematic review on the current status of PSMA-targeted imaging and radioligand therapy. Eur J Med Chem 2024; 263:115966. [PMID: 37992520 DOI: 10.1016/j.ejmech.2023.115966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
Prostate specific membrane antigen (PSMA) has been the subject of several studies in recent decades as a promising molecular target for prostate cancer (PCa), in fact it is considered an excellent molecular target for both PCa imaging (both for staging and follow-up), by means of PET/CT and for radioligand therapy. Its interesting molecular features have enabled the development of a new diagnostic and therapeutic approach for PCa, called "theranostics." Considering the abundance of PSMA-based probes that have appeared so far in the literature, the present work focuses the attention on radiopharmaceuticals with increasing clinical application, highlighting advantages and disadvantages in terms of different metabolization and excretion processes, pharmacokinetic, binding affinity and variable internalization rate, tumor-to-background ratio, residence times and toxicity profile.
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Affiliation(s)
- Giuseppe Capasso
- ITEL TELECOMUNICAZIONI S.r.l - Radiopharmaceutical Division, Italy.
| | - Azzurra Stefanucci
- Department of Pharmacy, Università degli Studi "G. d'Annunzio" Chieti, Pescara, Italy.
| | - Anna Tolomeo
- ITEL TELECOMUNICAZIONI S.r.l - Radiopharmaceutical Division, Italy.
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10
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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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11
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Exterkate L, Hermsen R, Küsters-Vandevelde HVN, Prette JF, Baas DJH, Somford DM, van Basten JPA. Head-to-Head Comparison of 18F-PSMA-1007 Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging with Whole-mount Histopathology as Reference in Localisation and Staging of Primary Prostate Cancer. Eur Urol Oncol 2023; 6:574-581. [PMID: 37230883 DOI: 10.1016/j.euo.2023.04.006] [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: 09/18/2022] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Accurate local staging is critical for treatment planning and prognosis in prostate cancer (PCa). Although multiparametric magnetic resonance imaging (mpMRI) has high specificity for detection of extraprostatic extension (EPE) and seminal vesicle invasion (SVI), its sensitivity remains limited. 18F-PSMA-1007 positron emission tomography/computed tomography (PET/CT) may be more accurate in determining T stage. OBJECTIVE To assess the diagnostic performance of 18F-PSMA-1007 PET/CT in comparison to mpMRI for intraprostatic tumour localisation and detection of EPE and SVI in men with primary PCa undergoing robot-assisted radical prostatectomy (RARP). DESIGN, SETTING, AND PARTICIPANTS Between February 2019 and October 2020, 105 treatment-naïve patients with biopsy-proven intermediate- or high-risk PCa undergoing mpMRI and 18F-PSMA-1007 PET/CT before RARP were prospectively enrolled. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The diagnostic accuracy of 18F-PSMA-1007 PET/CT and mpMRI for intraprostatic tumour localisation and detection of EPE and SVI was assessed via histopathological examination of whole-mount RP specimens. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated. The McNemar test was used to compare outcomes between imaging modalities. RESULTS AND LIMITATIONS In 80 RP specimens, 129 PCa lesions were found, of which 96 were clinically significant PCa (csPCa). Per-lesion sensitivity for localisation of overall PCa was 85% (95% confidence interval [CI] 77-90%) with PSMA PET/CT and 62% (95% CI 53-70%) with mpMRI (p < 0.001). Per-lesion sensitivity for csPCa was 95% (95% CI 88-98%) with PSMA PET/CT and 73% (95% CI 63-81%) with mpMRI (p < 0.001). The diagnostic accuracy of PSMA PET/CT and mpMRI for detection of EPE per lesion did not significantly differ (sensitivity 45%, 95% CI 31-60% vs 55%, 95% CI 40-69%; p = 0.3; specificity 85%, 95% CI 75-92% vs 90%, 95% CI 81-86%; p = 0.5). The sensitivity and specificity of PSMA PET/CT and mpMRI for detection of SVI did not significantly differ (sensitivity 47%, 95% CI 21-73% vs 33%, 95% CI 12-62; p = 0.6; specificity 94%, 95% CI 88-98% vs 96%, 95% CI 90-99%; p = 0.8). CONCLUSIONS 18F-PSMA-1007 is a promising imaging modality for localising intraprostatic csPCa but did not show additional value in assessing EPE and SVI in comparison to mpMRI. PATIENT SUMMARY A new imaging technique called PET/CT (positron emission tomography/computed tomography) with the radioactive tracer 18F-PSMA-1007 shows promise in identifying the location of clinically significant prostate cancer. However, it does not seem to be of additional value over magnetic resonance imaging (MRI) for determining the local tumour stage.
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Affiliation(s)
- Leonie Exterkate
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
| | - Rick Hermsen
- Department of Nuclear Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Jeroen F Prette
- Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Diederik J H Baas
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
| | - Jean-Paul A van Basten
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
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12
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Luo L, Zheng A, Chang R, Li Y, Gao J, Wang Z, Duan X. Evaluating the value of 18F-PSMA-1007 PET/CT in the detection and identification of prostate cancer using histopathology as the standard. Cancer Imaging 2023; 23:108. [PMID: 37924154 PMCID: PMC10623763 DOI: 10.1186/s40644-023-00627-x] [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: 07/04/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Prostate-specific membrane antigen (PSMA) PET/CT is a highly regarded radionuclide imaging modality for prostate cancer (PCa). This study aimed to evaluate the diagnostic performance of 18F-PSMA-1007 PET/CT in detecting intraprostatic lesions of PCa using radical prostatectomy (RP) specimens as a reference standard and to establish an optimal maximum standardized uptake value (SUVmax) cutoff for distinguishing between PCa and non-PCa lesions. METHODS We retrospectively collected 117 patients who underwent 18F-PSMA-1007 PET/CT before RP. The uptake of the index tumor and contralateral non-PCa lesion was assessed. Histopathology of RP specimens was used as the gold standard. Kappa test was used to evaluate the consistency of preoperative PSMA PET/CT staging and postoperative pathological staging. Finally, an SUVmax cutoff value was identified by receiver operating characteristic (ROC) curve analysis to distinguish PCa lesions from non-PCa lesions. A prospective cohort including 76 patients was used to validate the results. RESULTS The detection rate of 18F-PSMA-1007 PET/CT for prostate cancer was 96.6% (113/117). 18F-PSMA-1007 had a sensitivity of 91.2% and a positive predictive value (PPV) of 89.8% for the identification of intraprostatic lesions. The consistency test (Kappa = 0.305) indicated poor agreement between the pathologic T-stage and PSMA PET/CT T-stage. Based on ROC curve analysis, the appropriate SUVmax to diagnose PCa lesions was 8.3 (sensitivity of 71.3% and specificity 96.8%) with an area under the curve (AUC) of 0.93 (P < 0.001). This SUVmax cutoff discriminated PCa lesions from non-PCa lesions with a sensitivity of 74.4%, a specificity of 95.8% in the prospective validation group. CONCLUSIONS 18F-PSMA-1007 PET/CT demonstrated excellent performance in detecting PCa. An optimal SUVmax threshold (8.3) could be utilized to identify lesions of PCa by 18F-PSMA-1007 PET/CT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04521894, Registered: August 17, 2020.
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Affiliation(s)
- Liang Luo
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Anqi Zheng
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Ruxi Chang
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Yunxuan Li
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Jungang Gao
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Zhuonan Wang
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China.
| | - Xiaoyi Duan
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China.
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13
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Holzschuh JC, Mix M, Ruf J, Hölscher T, Kotzerke J, Vrachimis A, Doolan P, Ilhan H, Marinescu IM, Spohn SKB, Fechter T, Kuhn D, Bronsert P, Gratzke C, Grosu R, Kamran SC, Heidari P, Ng TSC, Könik A, Grosu AL, Zamboglou C. Deep learning based automated delineation of the intraprostatic gross tumour volume in PSMA-PET for patients with primary prostate cancer. Radiother Oncol 2023; 188:109774. [PMID: 37394103 PMCID: PMC10862258 DOI: 10.1016/j.radonc.2023.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE With the increased use of focal radiation dose escalation for primary prostate cancer (PCa), accurate delineation of gross tumor volume (GTV) in prostate-specific membrane antigen PET (PSMA-PET) becomes crucial. Manual approaches are time-consuming and observer dependent. The purpose of this study was to create a deep learning model for the accurate delineation of the intraprostatic GTV in PSMA-PET. METHODS A 3D U-Net was trained on 128 different 18F-PSMA-1007 PET images from three different institutions. Testing was done on 52 patients including one independent internal cohort (Freiburg: n = 19) and three independent external cohorts (Dresden: n = 14 18F-PSMA-1007, Boston: Massachusetts General Hospital (MGH): n = 9 18F-DCFPyL-PSMA and Dana-Farber Cancer Institute (DFCI): n = 10 68Ga-PSMA-11). Expert contours were generated in consensus using a validated technique. CNN predictions were compared to expert contours using Dice similarity coefficient (DSC). Co-registered whole-mount histology was used for the internal testing cohort to assess sensitivity/specificity. RESULTS Median DSCs were Freiburg: 0.82 (IQR: 0.73-0.88), Dresden: 0.71 (IQR: 0.53-0.75), MGH: 0.80 (IQR: 0.64-0.83) and DFCI: 0.80 (IQR: 0.67-0.84), respectively. Median sensitivity for CNN and expert contours were 0.88 (IQR: 0.68-0.97) and 0.85 (IQR: 0.75-0.88) (p = 0.40), respectively. GTV volumes did not differ significantly (p > 0.1 for all comparisons). Median specificity of 0.83 (IQR: 0.57-0.97) and 0.88 (IQR: 0.69-0.98) were observed for CNN and expert contours (p = 0.014), respectively. CNN prediction took 3.81 seconds on average per patient. CONCLUSION The CNN was trained and tested on internal and external datasets as well as histopathology reference, achieving a fast GTV segmentation for three PSMA-PET tracers with high diagnostic accuracy comparable to manual experts.
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Affiliation(s)
- Julius C Holzschuh
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Faculty of Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.
| | - Michael Mix
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Tobias Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alexis Vrachimis
- Department of Nuclear Medicine, German Oncology Center - University Hospital of the European University, Limassol, Cyprus
| | - Paul Doolan
- Department of Radiation Oncology, German Oncology Center - University Hospital of the European University, Limassol, Cyprus
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital - Ludwig-Maximilians-Universität, Munich, Germany
| | - Ioana M Marinescu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Simon K B Spohn
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Faculty of Medicine - University of Freiburg, Berta-Ottenstein-Programme, Freiburg, Germany
| | - Tobias Fechter
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dejan Kuhn
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Peter Bronsert
- Department of Pathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Radu Grosu
- Cyber-Physical Systems Division, Institute of Computer Engineering and Faculty of Informatics, Technical University of Vienna, Vienna, Austria; Department of Computer Science, State University of New York at Stony Brook, NY, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital - Harvard Medical School, Boston, USA
| | - Pedram Heidari
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, USA
| | - Thomas S C Ng
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, USA; Joint Program in Nuclear Medicine, Brigham and Women's Hospital - Harvard Medical School, Boston, USA; Department of Imaging, Dana-Farber Cancer Institute - Harvard Medical School, Boston, USA
| | - Arda Könik
- Joint Program in Nuclear Medicine, Brigham and Women's Hospital - Harvard Medical School, Boston, USA; Department of Imaging, Dana-Farber Cancer Institute - Harvard Medical School, Boston, USA
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Oncology Center, European University of Cyprus, Limassol, Cyprus
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14
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Huang R, Li Y, Wu H, Liu B, Zhang X, Zhang Z. 68Ga-PSMA-11 PET/CT versus 68Ga-PSMA-11 PET/MRI for the detection of biochemically recurrent prostate cancer: a systematic review and meta-analysis. Front Oncol 2023; 13:1216894. [PMID: 37645433 PMCID: PMC10461474 DOI: 10.3389/fonc.2023.1216894] [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: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose Our aim was to conduct a meta-analysis and systematic review in order to compare the diagnostic efficacy of 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI in patients with biochemically recurrent after radical prostatectomy and biochemically recurrent prostate cancers (BCR) after hybrid RT and RP. Methods Up until February 2023, we searched PubMed, Embase, and Web of Science for pertinent papers. Studies examining the utility of 68Ga-PSMA-11 PET/CT or PET/MRI as a screening tool for biochemically recurrent prostate cancer were included. To measure heterogeneity, we employed the I2 statistic. In cases of substantial heterogeneity (I2 > 50%), we used the random effect model to produce a forest plot. In other cases, we utilized the fixed model. Furthermore, we assessed the quality of the studies included using the Quality Assessment of Diagnostic Performance Studies (QUADAS-2) method. Results In total, 37 studies involving 8409 patients were examined. For 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI, the combined total detection rate was 0.70 (95% CI: 0.65-0.75) and 0.71 (95% CI:0.67-0.75), respectively. 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI did not substantially differ in terms of the overall detection rate for BCR (P = 0.58). The detection rate was unaffected by the PSA values (all P > 0.05). Conclusion The diagnostic efficacy of 68Ga-PSMA-11 PET/CT appears to be equivalent to that of 68Ga-PSMA-11 PET/MRI in detecting biochemically recurrent prostate cancer. Nonetheless, it should be noted that not all studies have used pathological biopsies as the gold standard. Therefore, additional larger prospective studies are needed to address this issue. Systematic review registration identifier CRD42023410039.
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Affiliation(s)
| | | | | | | | | | - Zhongxi Zhang
- The First Clinical College, Changsha Medical University, Changsha, China
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15
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Wang YF, Lo CY, Chen LY, Chang CW, Huang YT, Huang YY, Huang YH. Comparing the Detection Performance Between Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen PET/CT in Patients With Localized Prostate Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2023; 48:e321-e331. [PMID: 37145456 DOI: 10.1097/rlu.0000000000004646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68 Ga-PSMA-11, 18 F-DCFPyL, and 18 F-PSMA-1007 applied PET/CT imaging was an emerging diagnostic tool in prostate cancer patients for staging or posttreatment follow-up, even early detecting. Many studies have used PSMA PET for comparison with mpMRI to test the diagnostic ability for early prostate cancer. Unfortunately, these studies have shown conflicting results. This meta-analysis aimed to compare the differences in diagnostic performance between PSMA PET and mpMRI for detecting and T staging localized prostatic tumors. METHODS This meta-analysis involved a systematic literature search of PubMed/MEDLINE and Cochrane Library databases. The pooling sensitivity and specificity of PSMA and mpMRI verified by pathological analysis were calculated and used to compare the differences between the 2 imaging tools. RESULTS Overall, 39 studies were included (3630 patients in total) from 2016 to 2022 in the current meta-analysis and found that the pooling sensitivity values for localized prostatic tumors and T staging T3a and T3b of PSMA PET were 0.84 (95% confidence interval [CI], 0.83-0.86), 0.61 (95% CI, 0.39-0.79), and 0.62 (95% CI, 0.46-0.76), respectively, whereas those of mpMRI were found to be 0.84 (95% 0.78-0.89), 0.67 (95% CI, 0.52-0.80), and 0.60 (95% CI, 0.45-0.73), respectively, without significant differences ( P > 0.05). However, in a subgroup analysis of radiotracer, the pooling sensitivity of 18 F-DCFPyL PET was higher than mpMRI (relative risk, 1.10; 95% CI, 1.03-1.17; P < 0.01). CONCLUSIONS This meta-analysis found that whereas 18 F-DCFPyL PET was superior to mpMRI at detecting localized prostatic tumors, the detection performance of PSMA PET for localized prostatic tumors and T staging was comparable to that of mpMRI.
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Tang Y, Ji X, Lin Q, Huang H, Zhu H, Huang X, Xie H, Chen W, Zhuang Y. Status of 18F-PSMA-1007-PET/CT compared with multiparametric MRI in preoperative evaluation of prostate cancer. World J Urol 2023; 41:1017-1024. [PMID: 36932282 DOI: 10.1007/s00345-023-04345-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
PURPOSE Treatment of primary prostate cancer extremely depends on preoperative stage. The role of 18F-1007-PSMA-PET/CT in preoperative staging has not been well defined. Our aim was to compare the diagnostic performance of 18F-1007-PEMA-PET/CT, mpMRI, and mpMRI + PEMA-PET/CT in local progression and lymph node invasion of prostate cancer using histopathology as the gold standard. MATERIALS AND METHODS In this retrospective study, all patients with prostate cancer who underwent mpMRI and 18F-PSMA-1007-PET/CT before operation were included. The role of preoperative imaging was evaluated by predicting the sensitivity and specificity of EPE (extraprostatic extension), SVI (seminal vesicle invasion), and lymph node invasion results. RESULTS Ultimately, 130 patients were included in this study. In the preoperative judgment of EPE and SVI, mpMRI + PSMA-PET/CT had higher sensitivity and specificity. When predicting lymph node metastasis, PSMA-PET/CT was the best choice. The accuracy of mpMRI + PSMA-PET/CT and PSMA-PET/CT in the T and N stages, respectively, was affected by the least factors. CONCLUSIONS Based on the combined results of mpMRI and 18F-1007-PSMA-PET/CT, the accuracy of the preoperative judgment of prostatic capsule invasion can be improved, which may be conducive to developing intra-fascial technology while ensuring no tumor-touch isolation. PSMA-PET/CT has the advantages over mpMRI alone in terms of lymph node positivity. Compared with PSMA-PET/CT alone, the combined results can improve the sensitivity, but reduce specificity. Therefore, it is recommended to focus on PSMA-PET/CT to decide whether lymph node dissection should be performed.
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Affiliation(s)
- Yufan Tang
- Department of Urology, Jiashan County First People's Hospital, Jiaxing, China
| | - Xiaowei Ji
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qi Lin
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hang Huang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Honghui Zhu
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xixi Huang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui Xie
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Wei Chen
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Yuandi Zhuang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Huo H, Shen S, He D, Liu B, Yang F. Head-to-head comparison of 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI in the detection of biochemical recurrence of prostate cancer: summary of head-to-head comparison studies. Prostate Cancer Prostatic Dis 2023; 26:16-24. [PMID: 35931759 DOI: 10.1038/s41391-022-00581-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Our meta-analysis aimed to evaluate the diagnostic performance of 68Ga-PSMA-11 PET/CT vs. 68Ga-PSMA-11 PET/MRI for biochemical recurrence of prostate cancer. METHODS We searched for relevant articles in PubMed and Embase until February 2022. Studies evaluating head-to-head comparison of 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI in men with prostate cancer biochemical recurrence were included. The quality of each study was assessed using the Quality Assessment of Diagnostic Performance Studies-2 (QUADAS-2) tool. RESULTS A total of 5 studies with 219 patients were included in the analysis. The pooled overall detection rates of 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI in detecting recurrent PCa after definitive treatment were 0.89 (95% CI: 0.65-1.00), 0.92 (95% CI: 0.77-1.00), while the detection rates were 0.20 (95% CI: 0.05-0.41) and 0.29 (95% CI: 0.10-0.53) in local recurrence, 0.51 (95% CI: 0.33-0.69) and 0.52 (95% CI: 0.44-0.61) in lymph node metastasis, 0.18 (95% CI: 0.07-0.33) and 0.20 (95% CI: 0.09-0.35) in bone metastasis. There was no significant difference between the two imaging modalities in the overall detection rate (P = 0.82). In addition, detection rates were also not significantly different in local recurrence, lymph node metastasis, or bone metastasis (P = 0.54, 1.00, 0.82). CONCLUSIONS 68Ga-PSMA-11 PET/CT and 68Ga-PSMA-11 PET/MRI seem to have equivalent performance in detecting biochemical recurrence in prostate cancer. However, the results of the meta-analysis were drawn from studies with small samples. Further larger studies in this setting are warranted.
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Affiliation(s)
- Huasong Huo
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shurui Shen
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ding He
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Bin Liu
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Fuwei Yang
- Department of neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China.
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18
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Ucar T, Gunduz N, Demirci E, Culpan M, Gunel H, Kir G, Atis RG, Yildirim A. Comparison of 68Ga-PSMA PET/CT and mp-MRI in regard to local staging for prostate cancer with histopathological results: A retrospective study. Prostate 2022; 82:1462-1468. [PMID: 35915579 DOI: 10.1002/pros.24420] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Imaging modalities are used to diagnose and clinical grading of clinically significant prostate cancer. In this study, 68Ga-PSMA PET/CT (PSMA) and multiparametric prostate MRI (mp-MRI) were compared in regard to locating intraprostatic tumor and locoregional staging. METHODS After ethics committee approval, a total of 49 patients with prostate cancer who had mp-MRI and PSMA before radical prostatectomy were included. Preoperative and postoperative PSA, transrectal ultrasound-guided prostate biopsy (TRUS-Bx) ISUP grade, radical prostatectomy ISUP grade, body mass index (BMI), TRUS prostate volume, mp-MRI tumor mapping, PSMAtumor mapping, pathologic tumor mapping, extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node invasion (LNI), and bladder neck invasion (BNI)were retrospectively evaluated. Index tumor was located by uroradiologist, nuclear medicine specialist, and uropathologist on a 12-sector prostate pathology map and compared with each other in terms of accuracy and locoregional clinical staging. RESULTS Mean age of the patients was 66.18 ± 6.67 years and the mean of preoperative PSA results was 21.11 ± 32.56 ng/ml. Nearly half of the patients' (44.9%) pathology was reported as ISUP grade 4 and 5% and 18.4% of patients were surgical margin positive. According to the pathological findings, 362 out of 588 sectors were tumor-positive, 174 out of 362 sectors were tumor-positive in mp-MRI, and 175 out of 362 sectors were tumor-positive in PSMA. Both PSMA and mp-MRI were comparable (p = 0.823) and accurate to detect the location of the intraprostatic index tumor (AUC = 0.66 vs. 0.69 respectively, p = 0.82). The sensitivity and the specificity of the PSMA and mp-MRI for localizing intraprostatic index tumors were 42.5% versus 49.5% and 90.7% versus 88.6% respectively. mp-MRI was more accurate than PSMA in terms of EPE (AUC = 0.8 vs. AUC = 0.57 respectively, p = 0.027) and both methods were comparable in terms of SVI (AUC = 0.75 vs. AUC = 0.75, p = 0.886) and BNI (AUC = 0.51 vs. AUC = 0.59, p = 0.597). PSMA and mp-MRI were comparable in terms of LNI (AUC = 0.76 vs. AUC = 0.64, p = 0.39). CONCLUSION mp-MRI should be considered for its high accuracy in the diagnosis of EPE, especially before decision-making for nerve-sparing surgery in high-risk patients. Both imaging modalities were accurate for localizing intraprostatic index tumor. PSMA is accurate for detecting LNI.
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Affiliation(s)
- Taha Ucar
- Department of Urology, Nigde Omer Halis Demir University Research and Training Hospital, Nigde, Turkey
| | - Nesrin Gunduz
- Department of Radiology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Emre Demirci
- Department of Nuclear Medicine, Yeditepe University, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Humeyra Gunel
- Department of Pathology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Gozde Kir
- Department of Pathology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Ramazan Gokhan Atis
- Department of Urology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
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Huang YT, Tseng NC, Chen YK, Huang KH, Lin HY, Huang YY, Hwang TIS, Ou YC. The Detection Performance of 18 F-Prostate-Specific Membrane Antigen-1007 PET/CT in Primary Prostate Cancer : A Systemic Review and Meta-analysis. Clin Nucl Med 2022; 47:755-762. [PMID: 35452013 DOI: 10.1097/rlu.0000000000004228] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Multiple tools are now available to determine the requirement for a biopsy to diagnose prostate cancer, and PET/CT with radiolabeled prostate-specific membrane antigen (PSMA)-targeting radiotracers has been recommended for detecting primary prostate cancer. Particularly, the radiotracer 18 F-PSMA-1007 was found to be more favorable for primary tumors compared with other PSMA-targeting radiotracers because of its low clearance via the urinary tract and better image resolution. Thus, we performed a systematic review and meta-analysis to more accurately evaluate the detection performance of 18 F-PSMA-1007 PET/CT in primary prostate cancer patients. METHODS An update on the databases of PubMed/MEDLINE, EMBASE, and Cochrane Library for comprehensive literature search was performed on September 30, 2021. The pooling detection rate was calculated on a per-patient basis. The pooling median of the SUV max was analyzed from the included studies. Furthermore, the positive predictive value of 18 F-PSMA-1007 PET/CT with pathologic lesions was analyzed using the criterion standard. RESULTS Twelve studies (540 patients total) were included in the meta-analysis. The overall pooling detection rate of 18 F-PSMA-1007 per patient was 94%, and the pooling median of SUV max located at the intraprostate tumor was 16 (range, 3.7-77.7). The positive predictive value of 18 F-PSMA-1007 per lesion with histopathological validation was 0.90, detecting regional lymph node metastasis was 0.94, and detecting localized prostatic tumors was 0.84. CONCLUSIONS In the current meta-analysis, we revealed the excellent performance of 18 F-PSMA-1007 to detect localized prostatic tumor lesions and regional lymph node metastasis. Moreover, the uptake of localized tumors in primary prostate cancer was nearly liver uptake and may be considered a suspicious malignancy if it was equal to or greater than the liver uptake.
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20
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Primary Staging of Prostate Cancer Patients with [18F]PSMA-1007 PET/CT Compared with [68Ga]Ga-PSMA-11 PET/CT. J Clin Med 2022; 11:jcm11175064. [PMID: 36078994 PMCID: PMC9457380 DOI: 10.3390/jcm11175064] [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: 07/29/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Hybrid imaging with prostate-specific membrane antigen (PSMA) is gaining importance as an increasingly meaningful tool for prostate cancer (PC) diagnostics and as a guide for therapy decisions. This study aims to investigate and compare the performance of [18F]PSMA-1007 (18F-PSMA) and [68Ga]Ga-PSMA-11 positron emission tomography/computed tomography (68Ga-PSMA) in the initial staging of PC patients. Methods: The data of 88 biopsy-proven patients were retrospectively evaluated. PSMA-avid lesions were compared with the histopathologic Gleason Score (GS) for prostate biopsies, and the results were plotted by receiver operating characteristic (ROC)-curve. Optimal maximum standardized uptake value (SUVmax) cut-off values were rated using the Youden index. Results: 18F-PSMA was able to distinguish GS ≤ 7a from ≥7b with a sensitivity of 62%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 67% for a SUVmax of 8.95, whereas sensitivity was 54%, specificity 91%, PPV 93%, and accuracy 66% for 68Ga-PSMA (SUVmax 8.7). Conclusions: Both methods demonstrated a high concordance of detected PSMA-avid lesions with histopathologically proven PC. 18F-PSMA and 68Ga-PSMA are both suitable for the characterization of primary PC with a comparable correlation of PSMA-avid lesions with GS. Neither method showed a superior advantage. Our calculated SUVmax thresholds may represent valuable parameters in clinical use to distinguish clinically significant PC (csPC) from non-csPC.
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21
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Ingvar J, Hvittfeldt E, Trägårdh E, Simoulis A, Bjartell A. Assessing the accuracy of [ 18F]PSMA-1007 PET/CT for primary staging of lymph node metastases in intermediate- and high-risk prostate cancer patients. EJNMMI Res 2022; 12:48. [PMID: 35943665 PMCID: PMC9363552 DOI: 10.1186/s13550-022-00918-7] [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: 05/18/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background [18F]PSMA-1007 is a promising tracer for integrated positron emission tomography and computed tomography (PET/CT).
Objective Our aim was to assess the diagnostic accuracy of [18F]PSMA-1007 PET/CT for primary staging of lymph node metastasis before robotic-assisted laparoscopy (RALP) with extended lymph node dissection (ePLND). Design, Setting and Participants The study was a retrospective cohort in a tertiary referral center. Men with prostate cancer that underwent surgical treatment for intermediate- or high-risk prostate cancer between May 2019 and August 2021 were included. Interventions [18F]PSMA-1007 PET/CT for initial staging followed by RALP and ePLND. Outcome measurements and statistical analyses Sensitivity and specificity were calculated both for the entire cohort and for patients with lymph node metastasis ≥ 3 mm. Positive (PPV) and negative (NPV) predictive values were calculated. Results and limitations Among 104 patients included in the analyses, 26 patients had lymph node metastasis based on pathology reporting and metastases were ≥ 3 mm in size in 13 of the cases (50%). In the entire cohort, the sensitivity and specificity of [18F]PSMA-1007 were 26.9% (95% confidence interval (CI); 11.6–47.8) and 96.2% (95% CI; 89.2–99.2), respectively. The sensitivity and specificity of [18F]PSMA-1007 to detect a lymph node metastasis ≥ 3 mm on PET/CT were 53.8% (95% CI; 25.1–80.8) and 96.7% (95% CI; 90.7–99.3), respectively. PPV was 70% and NPV 93.6%. Conclusions In primary staging of intermediate- and high-risk prostate cancer, [18F]PSMA-1007 PET/CT is highly specific for prediction of lymph node metastases, but the sensitivity for detection of metastases smaller than 3 mm is limited. Based on our results, [18F]PSMA-1007 PET/CT cannot completely replace ePLND. Patient summary This study investigated the use of an imaging method based on a prostate antigen-specific radiopharmaceutical tracer to detect lymph node prostate cancer metastasis. We found that it is unreliable to discover small metastasis.
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Affiliation(s)
- Jacob Ingvar
- Department of Urology, Skåne University Hospital, Malmö, Sweden. .,Department of Translational Medicine, Faculty of Medicine, Lund University, Jan Waldenströmsgata 5, 205 02, Malmö, Sweden.
| | - Erland Hvittfeldt
- Department of Translational Medicine, Faculty of Medicine, Lund University, Jan Waldenströmsgata 5, 205 02, Malmö, Sweden.,Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Elin Trägårdh
- Department of Translational Medicine, Faculty of Medicine, Lund University, Jan Waldenströmsgata 5, 205 02, Malmö, Sweden.,Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Athanasios Simoulis
- Department of Translational Medicine, Faculty of Medicine, Lund University, Jan Waldenströmsgata 5, 205 02, Malmö, Sweden.,Department of Pathology, Skåne University Hospital and Lund University, Malmö, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Faculty of Medicine, Lund University, Jan Waldenströmsgata 5, 205 02, Malmö, Sweden
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22
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Liu X, Jiang T, Gao C, Liu H, Sun Y, Zou Q, Tang R, Zeng W. Detection rate of fluorine-18 prostate-specific membrane antigen-1007 PET/CT for prostate cancer in primary staging and biochemical recurrence with different serum PSA levels: A systematic review and meta-analysis. Front Oncol 2022; 12:911146. [PMID: 35936732 PMCID: PMC9353183 DOI: 10.3389/fonc.2022.911146] [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: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background We performed a systematic review and meta-analysis to evaluate the detection rate (DR) of fluoro-prostate-specific membrane antigen (18F-PSMA-1007) PET/CT in patients with different serum prostate-specific antigen (PSA) levels in the setting of primary staging of prostate cancer (PCa) or biochemically recurring PCa. Methods A comprehensive electronic literature search of the PubMed, Embase, and Cochrane Library databases was conducted in accordance with the PRISMA statement. This study was registered in the PROSPERO database (registration number: CRD42022331595). We calculated the DR of 18F-PSMA-1007 PET/CT in PCa. Results The final analysis included 15 studies that described 1,022 patients and 2,034 lesions with 18F-PSMA-1007 PET/CT in PCa. The DR of 18F-PSMA-1007 PET/CT in patients with PCa in primary staging ranged from 90% to 100%, with a pooled estimate of 94% (95% CI: 92%–96%). The DR of 18F-PSMA-1007 PET/CT in patients with PCa in BCR ranged from 47% to 100%, with a pooled estimate of 86% (95% CI: 76%–95%). The DRs of PSA levels >2.0, 1.1–2.0, 0.51–1.0, and ≤0.5 ng/ml detected by 18F-PSMA-1007 PET/CT in a patient-based analysis were 97% (95% CI: 93%–99%), 95% (95% CI: 88%–99%), 79% (95% CI: 68%–88%), and 68% (95% CI: 58%–78%), respectively. Conclusion This meta-analysis concluded that 18F-PSMA-1007 PET/CT had a high application value for prostate cancer, including primary tumors and biochemical recurrence. The DR of 18F-PSMA-1007 PET/CT was slightly higher in primary prostate tumors than in biochemical recurrence. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022331595.
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Affiliation(s)
- Xue Liu
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Tao Jiang
- Department of Nuclear Medicine, The First People’s Hospital of Huaihua City, Hunan, China
| | - CaiLiang Gao
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - HuiTing Liu
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Yu Sun
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Qiao Zou
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Rui Tang
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - WenBing Zeng
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
- *Correspondence: WenBing Zeng,
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Kubihal V, Kundra V, Lanka V, Sharma S, Das P, Nayyar R, Das CJ. Prospective evaluation of PI-RADS v2 and quantitative MRI for clinically significant prostate cancer detection in Indian men – East meets West. Arab J Urol 2022; 20:126-136. [PMID: 35935908 PMCID: PMC9354636 DOI: 10.1080/2090598x.2022.2072141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Vijay Kubihal
- Department of Radiodiagnosis and Interventional Radiology, Urology All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kundra
- Department of diagnostic radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Vivek Lanka
- Department of Radiodiagnosis and Interventional Radiology, Urology All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radiodiagnosis and Interventional Radiology, Urology All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Radiodiagnosis and Interventional Radiology, Urology All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Nayyar
- Department of Radiodiagnosis and Interventional Radiology, Urology All India Institute of Medical Sciences, New Delhi, India
| | - Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, Urology All India Institute of Medical Sciences, New Delhi, India
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Liu W, Loblaw A, Laidley D, Fakir H, Mendez L, Davidson M, Kassam Z, Lee TY, Ward A, Thiessen J, Bayani J, Conyngham J, Bailey L, Andrews JD, Bauman G. Imaging Biomarkers in Prostate Stereotactic Body Radiotherapy: A Review and Clinical Trial Protocol. Front Oncol 2022; 12:863848. [PMID: 35494042 PMCID: PMC9043802 DOI: 10.3389/fonc.2022.863848] [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: 01/27/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Advances in imaging have changed prostate radiotherapy through improved biochemical control from focal boost and improved detection of recurrence. These advances are reviewed in the context of prostate stereotactic body radiation therapy (SBRT) and the ARGOS/CLIMBER trial protocol. ARGOS/CLIMBER will evaluate 1) the safety and feasibility of SBRT with focal boost guided by multiparametric MRI (mpMRI) and 18F-PSMA-1007 PET and 2) imaging and laboratory biomarkers for response to SBRT. To date, response to prostate SBRT is most commonly evaluated using the Phoenix Criteria for biochemical failure. The drawbacks of this approach include lack of lesion identification, a high false-positive rate, and delay in identifying treatment failure. Patients in ARGOS/CLIMBER will receive dynamic 18F-PSMA-1007 PET and mpMRI prior to SBRT for treatment planning and at 6 and 24 months after SBRT to assess response. Imaging findings will be correlated with prostate-specific antigen (PSA) and biopsy results, with the goal of early, non-invasive, and accurate identification of treatment failure.
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Affiliation(s)
- Wei Liu
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, ON, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre and Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - David Laidley
- Division of Nuclear Medicine, St. Joseph's Health Centre and Western University, London, ON, Canada
| | - Hatim Fakir
- Department of Oncology and Department of Medical Biophysics, London Health Sciences Centre and Western University, London, ON, Canada
| | - Lucas Mendez
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, ON, Canada
| | - Melanie Davidson
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre and Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care and Western University, London, ON, Canada
| | - Ting-Yim Lee
- Department of Medical Biophysics, Western University and Lawson Health Research Institute, London, ON, Canada
| | - Aaron Ward
- Department of Medical Biophysics, Western University and Lawson Health Research Institute, London, ON, Canada
| | - Jonathan Thiessen
- Department of Medical Biophysics, Western University and Lawson Health Research Institute, London, ON, Canada
| | - Jane Bayani
- Ontario Institute for Cancer Research and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Laura Bailey
- Clinical Research Unit, London Regional Cancer Program, London, ON, Canada
| | - Joseph D Andrews
- Clinical Research Unit, London Regional Cancer Program, London, ON, Canada
| | - Glenn Bauman
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, ON, Canada
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Kim JK, Song YS, Lee WW, Lee HJ, Hwang SI, Hong SK. Diagnostic accuracy of F-18-fluorocholine PET/CT and multiparametric MRI for prostate cancer. Prostate Int 2022; 10:152-157. [PMID: 36225289 PMCID: PMC9520420 DOI: 10.1016/j.prnil.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
- Corresponding author. Seoul National University Bundang Hospital, Seongnam, Korea 173-82, Gumi-Ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.
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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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Liu FY, Sheng TW, Tseng JR, Yu KJ, Tsui KH, Pang ST, Wang LJ, Lin G. Prostate-specific membrane antigen (PSMA) fusion imaging in prostate cancer: PET-CT vs PET-MRI. Br J Radiol 2022; 95:20210728. [PMID: 34767482 PMCID: PMC8978229 DOI: 10.1259/bjr.20210728] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate whether PET-CT or PET-MRI is more appropriate for imaging prostate cancer, in terms of primary tumor detection, local staging and recurrence, as well as lymph nodes and distant metastases. METHODS A systematic literature search was conducted on Embase, PubMed/MEDLINE, and the Cochrane Library database. Studies evaluating the diagnostic performance of PET-CT vs PET-MRI in prostate cancer patients were emphasized. RESULTS We reviewed 57 original research articles during the period 2016-2021: 14 articles regarding the radiotracer PSMA; 18 articles regarding the primary tumor detection, local tumor staging, managing local recurrence; 17 articles for managing lymph node metastases; and eight articles for managing bone and other distant metastases. PSMA PET could be complementary to mpMRI for primary prostate cancer localization and is particularly valuable for PI-RADS three lesions. PET-MRI is better than PET-CT in local tumor staging due to its specific benefit in predicting extracapsular extension in MRI-occult prostate cancer patients. PET-MRI is likely superior as compared with PET-CT in detecting local recurrence, and has slightly higher detection rates than PET-CT in lymph node recurrence. PET-CT and PET-MRI seem to have equivalent performance in detecting distant bony or visceral metastases. CONCLUSION In conclusion, PET-MRI is suitable for local and regional disease, either primary staging or restaging, whereas PET-CT is valuable for managing distant bony or visceral metastasis. ADVANCES IN KNOWLEDGE We reviewed the emerging applications of PET-MRI and PET-CT in clinical aspects. Readers will gain an objective overview on the strength and shortfalls of PET-MRI or PET-CT in the management of prostate cancer.
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Affiliation(s)
- Feng-Yuan Liu
- Department of Nuclear Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Ting-Wen Sheng
- Department of Medical Imaging and Intervention, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Jing-Ren Tseng
- Department of Nuclear Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Kai-Jie Yu
- Department of Urology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Ke-Hong Tsui
- Department of Urology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Se-Tong Pang
- Department of Urology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Wang
- Department of Medical Imaging and Intervention, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
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28
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Diagnostic value of integrated 18F-PSMA-1007 PET/MRI Compared with that of Biparametric MRI for the detection of Prostate Cancer. Prostate Int 2022; 10:108-116. [PMID: 35510079 PMCID: PMC9052074 DOI: 10.1016/j.prnil.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Materials and methods Results Conclusion
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Risk of metastatic disease using [ 18F]PSMA-1007 PET/CT for primary prostate cancer staging. EJNMMI Res 2021; 11:128. [PMID: 34928437 PMCID: PMC8688644 DOI: 10.1186/s13550-021-00869-5] [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: 08/11/2021] [Accepted: 11/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Accurate prostate cancer imaging is critical for patient management. Multiple studies have demonstrated superior diagnostic accuracy of [68Ga]-PSMA-11 PET/CT over conventional imaging for disease detection, with validated clinical and biochemical predictors of disease detection. More recently [18F]PSMA-1007 offers theoretical imaging advantages, but there is limited evidence of clinical and biochemical predictors of scan findings in the staging population. This study investigates the association of clinical variables with imaging characteristics among patients who underwent [18F]PSMA-1007 PET/CT for primary staging of men with histopathologically confirmed prostate carcinoma. A retrospective review of 194 consecutive patients imaged between May 2019 to May 2020 was performed. Association between imaging variables (presence and distribution of metastatic disease, primary tumour SUVmax) and clinical variables (EAU risk criteria) were assessed using descriptive statistics, logistic regression model and ROC analysis. RESULTS The median age, PSA level and ISUP grade were 70 years, 10 ng/mL and ISUP grade 3, respectively. There were 36.6% of patients with intermediate-risk and 60.8% of patients with high-risk disease. ISUP grade was associated with the presence of metastasis overall (p = 0.008) as well as regional nodal (p = 0.003), non-regional nodal (p = 0.041) and bone (p = 0.006) metastases. PSA level was associated with metastatic disease overall (p = 0.001), regional (p = 0.001) and non-regional nodal metastases (p = 0.004), but not with bone metastases (p = 0.087). There were too few visceral metastases for meaningful analysis. SUVmax of the primary prostatic tumour was associated with ISUP grade (p = 0.004), PSA level (p < 0.001) and AJCC stage (p = 0.034). PSA > 20 ng/mL and ISUP grade > 3 had a specificity of 85% (95% CI 78-91%) and 60% (95% CI 50-68%) and a sensitivity of 36% (95% CI 25-49%) and 62% (95% CI 49-74%), respectively, for detection of metastatic disease. CONCLUSION Metastatic disease according to [18F]PSMA-1007 PET/CT was associated with ISUP grade and PSA level. This is the largest study using [18F]PSMA-1007 PET/CT to confirm a positive correlation of PSA level, ISUP grade and stage with primary prostate tumour SUVmax.
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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: 5] [Impact Index Per Article: 1.7] [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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Darr C, Fragoso Costa P, Kesch C, Krafft U, Püllen L, Harke NN, Hess J, Szarvas T, Haubold J, Reis H, Fendler WP, Herrmann K, Radtke JP, Hadaschik BA, Tschirdewahn S. Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging-utilization of a short-pass filter to reduce technical pitfalls. Transl Androl Urol 2021; 10:3972-3985. [PMID: 34804840 PMCID: PMC8575587 DOI: 10.21037/tau-20-1141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background Intraoperative Cerenkov luminescence imaging (CLI) is a novel technique to assess surgical margins in patients undergoing nerve sparing radical prostatectomy (RP). Here, we analyze the efficacy of a 550-nm optical short-pass filter (OF) to improve its performance. Methods In this prospective single-center feasibility study ten patients with prostate cancer (PC) were included between December 2019 and April 2020, including three patients without tracer injection as a control group. After preoperative injection of 68-Ga-prostate-specific membrane antigen (PSMA)-11 followed by RP, CLI of the excised prostate and the incised index lesion was performed to visualize the primary tumor lesion. We compared the findings on intraoperative CLI to postoperative histopathology. Furthermore, CLI-intensities determined as tumor to background ratio (TBR) and contrast to noise ratio (CNR) were measured. Results Histopathology proved positive surgical margins (PSM) in 3 patients with corresponding findings in CLI. After magnetic resonance imaging (MRI)-informed incision above the index lesion 2 out of 3 prostates demonstrated elevated CLI signals with histopathological confirmation of PC cells. The use of the OF enabled a significant reduction of the area of the regions of interest from a median of 1.80 to 0.15 cm2 (reduction by 85%, P=0.005) leading to increased specificity. Signals due to PSMs were not suppressed by the 550-nm OF. The median TBR was reduced from 3.33 to 2.10. In all three patients of the control group elevated CLI intensities were detected at locations with diathermal energy deposition during surgery. After application of the 550-nm OF these were almost totally suppressed with a TBR of 1.10. Measurements of Cerenkov luminescence intensity with the 550-nm OF showed a significant Pearson's correlation of 0.82 between PSM and the elevated TBR (P=0.003) and a significant Pearson's correlation of 0.66 between PSM and elevated CNR (P=0.04). Measurements without the OF did not correlate significantly. Conclusions Intraoperative 68-Ga-PSMA CLI in PC is a tool that warrants further investigation to visualize PSM especially in intermediate and high-risk PC. Intraoperative CLI benefits from usage of a 550-nm OF to reduce false-positive signals.
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Affiliation(s)
- Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Pedro Fragoso Costa
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Ulrich Krafft
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Lukas Püllen
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Nina Natascha Harke
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Jochen Hess
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Tibor Szarvas
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Institute of Diagnostics and Radiology, University Hospital Essen, Essen, Germany
| | - Henning Reis
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Institute of Pathology, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang Peter Fendler
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Boris Alexander Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Stephan Tschirdewahn
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
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32
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Bodar YJL, Zwezerijnen BGJC, van der Voorn PJ, Jansen BHE, Smit RS, Kol SQ, Meijer D, de Bie K, Yaqub M, Windhorst BAD, Hendrikse HNH, Vis AN, Oprea-Lager DE. Prospective analysis of clinically significant prostate cancer detection with [ 18F]DCFPyL PET/MRI compared to multiparametric MRI: a comparison with the histopathology in the radical prostatectomy specimen, the ProStaPET study. Eur J Nucl Med Mol Imaging 2021; 49:1731-1742. [PMID: 34725727 PMCID: PMC8940822 DOI: 10.1007/s00259-021-05604-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/22/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Multiparametric magnetic resonance imaging (mpMRI) is a well-established imaging method for localizing primary prostate cancer (PCa) and for guiding targeted prostate biopsies. [18F]DCFPyL positron emission tomography combined with MRI (PSMA-PET/MRI) might be of additional value to localize primary PCa. The aim of this study was to assess the diagnostic performance of [18F]DCFPyL-PET/MRI vs. mpMRI in tumour localization based on histopathology after robot-assisted radical-prostatectomy (RARP), also assessing biopsy advice for potential image-guided prostate biopsies. METHODS Thirty prospectively included patients with intermediate to high-risk PCa underwent [18F]DCFPyL-PET/MRI and mpMRI prior to RARP. Two nuclear medicine physicians and two radiologists assessed tumour localization on [18F]DCFPyL-PET/MRI and on mpMRI respectively, and gave a prostate biopsy advice (2 segments) using a 14-segment model of the prostate. The uro-pathologist evaluated the RARP specimen for clinically significant PCa (csPCa) using the same model. csPCa was defined as any PCa with Grade Group (GG) ≥ 2. The biopsy advice based on imaging was correlated with the final histology in the RARP specimen for a total-agreement analysis. An additional near-agreement correlation was performed to approximate clinical reality. RESULTS Overall, 142 of 420 (33.8%) segments contained csPCa after pathologic examination. The segments recommended for targeted biopsy contained the highest GG PCa segment in 27/30 patients (90.0%) both for [18F]DCFPyL-PET/MRI and mpMRI. Areas under the receiver operating characteristics curves (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the total-agreement detection of csPCa per segment using [18F]DCFPyL-PET/MRI were 0.70, 50.0%, 89.9%, 71.7%, and 77.9%, respectively. These results were 0.75, 54.2%, 94.2%, 82.8%, and 80.1%, respectively, for mpMRI only. CONCLUSION Both [18F]DCFPyL-PET/MRI and mpMRI were only partly able to detect csPCa on a per-segment basis. An accurate detection (90.0%) of the highest GG lesion at patient-level was observed when comparing both [18F]DCFPyL-PET/MRI and mpMRI biopsy advice with the histopathology in the RARP specimen. So, despite the finding that [18F]DCFPyL-PET/MRI adequately detects csPCa, it does not outperform mpMRI.
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Affiliation(s)
- Yves J L Bodar
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands. .,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands. .,Prostate Cancer Network, Amsterdam, the Netherlands.
| | - Ben G J C Zwezerijnen
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Patrick J van der Voorn
- Department of Pathology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Bernard H E Jansen
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Prostate Cancer Network, Amsterdam, the Netherlands
| | - Ruth S Smit
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Sabrine Q Kol
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Dennie Meijer
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Prostate Cancer Network, Amsterdam, the Netherlands
| | - Katelijne de Bie
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Bert A D Windhorst
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Harry N H Hendrikse
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - André N Vis
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Prostate Cancer Network, Amsterdam, the Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
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Manafi-Farid R, Ranjbar S, Jamshidi Araghi Z, Pilz J, Schweighofer-Zwink G, Pirich C, Beheshti M. Molecular Imaging in Primary Staging of Prostate Cancer Patients: Current Aspects and Future Trends. Cancers (Basel) 2021; 13:5360. [PMID: 34771523 PMCID: PMC8582501 DOI: 10.3390/cancers13215360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/19/2022] Open
Abstract
Accurate primary staging is the cornerstone in all malignancies. Different morphological imaging modalities are employed in the evaluation of prostate cancer (PCa). Regardless of all developments in imaging, invasive histopathologic evaluation is still the standard method for the detection and staging of the primary PCa. Magnetic resonance imaging (MRI) and computed tomography (CT) play crucial roles; however, functional imaging provides additional valuable information, and it is gaining ever-growing acceptance in the management of PCa. Targeted imaging with different radiotracers has remarkably evolved in the past two decades. [111In]In-capromab pendetide scintigraphy was a new approach in the management of PCa. Afterwards, positron emission tomography (PET) tracers such as [11C/18F]choline and [11C]acetate were developed. Nevertheless, none found a role in the primary staging. By introduction of the highly sensitive small molecule prostate-specific membrane antigen (PSMA) PET/CT, as well as recent developments in MRI and hybrid PET/MRI systems, non-invasive staging of PCa is being contemplated. Several studies investigated the role of these sophisticated modalities in the primary staging of PCa, showing promising results. Here, we recapitulate the role of targeted functional imaging. We briefly mention the most popular radiotracers, their diagnostic accuracy in the primary staging of PCa, and impact on patient management.
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Affiliation(s)
- Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran 1411713135, Iran;
| | - Shaghayegh Ranjbar
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Zahra Jamshidi Araghi
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Julia Pilz
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Gregor Schweighofer-Zwink
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Christian Pirich
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Mohsen Beheshti
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
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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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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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Pattison DA, Debowski M, Gulhane B, Arnfield EG, Pelecanos AM, Garcia PL, Latter MJ, Lin CY, Roberts MJ, Ramsay SC, Thomas PA. Prospective intra-individual blinded comparison of [ 18F]PSMA-1007 and [ 68 Ga]Ga-PSMA-11 PET/CT imaging in patients with confirmed prostate cancer. Eur J Nucl Med Mol Imaging 2021; 49:763-776. [PMID: 34383089 DOI: 10.1007/s00259-021-05520-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION [18F]PSMA-1007 has potential advantages over [68 Ga]Ga-PSMA-11, although limited prospective data evaluating diagnostic performance exist. The aims of this study are to describe the concordance of [18FPSMA-1007 and [68 Ga]Ga-PSMA-11 for TNM with the American Joint Committee on Cancer (AJCC) prognostic stage and assess differences in tracer uptake. METHODS Fifty men (mean age 71.8) were imaged with [68 Ga]Ga-PSMA-11 and [18F]PSMA-1007 < 4 weeks apart. Images were independently reported according to TNM by two experienced nuclear medicine specialists blinded to the other scan and prior imaging. Discordant results were resolved by a third independent nuclear medicine specialist. Quantitative analysis of lesion uptake and physiologic tissue for each tracer was performed by one experienced reader. RESULTS Scan indications were initial staging (n = 12), biochemical recurrence (n = 27) and metastatic disease evaluation (n = 11). Most patients had ISUP grade group 3 or higher. Median PSA value was 2.7 ng/ml (IQR 0.7-12.0), and a minority of patients (28%) were currently treated with androgen deprivation therapy. [18F]PSMA-1007 uptake was significantly higher than [68Ga]Ga-PSMA-11 in local recurrence, nodal and distant metastases and most physiologic sites (including bone) except for urinary bladder which was significantly lower. [18F]PSMA-1007 upstaged local prostate staging in 5/17 patients, local recurrence in 3/33 patients, regional nodal disease in 3/50 patients and 1 distant metastasis (bladder). [68Ga]Ga-PSMA-11 upstaged regional nodal disease in 1/50 patients and distant metastasis in one patient (right adrenal). Overall AJCC prognostic stage was concordant in 46/50 (92%) patients, with two patients upstaged for both [18F]PSMA-1007 and [68Ga]Ga-PSMA-11. [18F]PSMA-1007 had more equivocal results (one regional node; six equivocal bone lesions, one of which was subsequently confirmed metastatic) than [68Ga]Ga-PSMA-11 (one equivocal local recurrence). CONCLUSION Overall AJCC prognostic stage was similar (92%) between [18F]PSMA-1007 and [68Ga]Ga-PSMA-11. [18F]PSMA-1007 demonstrates higher uptake within involved nodes and distant metastases and most physiologic sites except urinary bladder which aided [18F]PSMA-1007 local staging of the prostate primary/local recurrence and regional nodal disease adjacent ureters. However, [18F]PSMA-1007 liver uptake obscured a solitary right adrenal metastasis, and more equivocal bone lesions were identified. Trial registration The study was registered with Australia New Zealand Clinical Trials Registry (ACTRN12618000665235) on 24 April 2018.
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Affiliation(s)
- David A Pattison
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, 2006, Australia. .,School of Medicine, University of Queensland, Brisbane, Australia.
| | - Maciej Debowski
- Department of Medical Imaging, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Brook Gulhane
- Department of Medical Imaging, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Evyn G Arnfield
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, 2006, Australia
| | - Anita M Pelecanos
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Peter L Garcia
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, 2006, Australia
| | - Melissa J Latter
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, 2006, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Charles Y Lin
- School of Medicine, University of Queensland, Brisbane, Australia.,Department of Radiation Oncology, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Urology, Redcliffe Hospital, Redcliffe, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Stuart C Ramsay
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, 2006, Australia.,School of Medicine, James Cook University, Townsville, Australia
| | - Paul A Thomas
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, 2006, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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[Positron emission tomography with computed tomography/magnetic resonance imaging for primary staging of prostate cancer]. Radiologe 2021; 61:818-824. [PMID: 34351430 DOI: 10.1007/s00117-021-00895-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/25/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE Prostate cancer is the most common malignancy and the second leading cause of cancer-related death in men. Accurate imaging diagnosis and staging are crucial for patient management and treatment. The role of nuclear medicine in the diagnosis of prostate cancer has evolved rapidly in recent years due to the availability of hybrid imaging with radiopharmaceuticals targeting the prostate-specific membrane antigen (PSMA). STANDARD RADIOLOGICAL PROCEDURES Hybrid imaging provides higher diagnostic accuracy compared to conventional imaging and has a significant impact on clinical management. Numerous radiotracers have been used in clinical applications, with PSMA ligands being the most commonly used. METHODOLOGICAL INNOVATIONS Hybrid imaging provides higher diagnostic accuracy for lymph node and bone metastases compared to conventional imaging and has a significant impact on clinical management. PERFORMANCE The high accuracy for primary staging in high-risk prostate cancer using PSMA ligands has led to the inclusion of PSMA positron emission tomography (PET)/computed tomography (CT) in the new German S3 guideline for primary staging of prostate cancer. PURPOSE The aim of this article is to provide an overview of the use of PET imaging in the primary diagnosis of prostate cancer, to present the most commonly used radiotracers, and to highlight the results of recent studies.
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[ 68Ga]Ga-PSMA-11: The First FDA-Approved 68Ga-Radiopharmaceutical for PET Imaging of Prostate Cancer. Pharmaceuticals (Basel) 2021; 14:ph14080713. [PMID: 34451810 PMCID: PMC8401928 DOI: 10.3390/ph14080713] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 12/12/2022] Open
Abstract
For the positron emission tomography (PET) imaging of prostate cancer, radiotracers targeting the prostate-specific membrane antigen (PSMA) are nowadays used in clinical practice. Almost 10 years after its discovery, [68Ga]Ga-PSMA-11 has been approved in the United States by the Food and Drug Administration (FDA) as the first 68Ga-radiopharmaceutical for the PET imaging of PSMA-positive prostate cancer in 2020. This radiopharmaceutical combines the peptidomimetic Glu-NH-CO-NH-Lys(Ahx)-HBED-CC with the radionuclide 68Ga, enabling specific imaging of tumor cells expressing PSMA. Such a targeting approach may also be used for therapy planning as well as potentially for the evaluation of treatment response.
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Scobioala S, Kittel C, Wolters H, Huss S, Elsayad K, Seifert R, Stegger L, Weckesser M, Haverkamp U, Eich HT, Rahbar K. Diagnostic efficiency of hybrid imaging using PSMA ligands, PET/CT, PET/MRI and MRI in identifying malignant prostate lesions. Ann Nucl Med 2021; 35:628-638. [PMID: 33742373 PMCID: PMC8079339 DOI: 10.1007/s12149-021-01606-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess the accuracy of 68Ga-PSMA-11 PET/MRI, 18F-PSMA-1007 PET/CT, 68Ga-PSMA-11 PET/CT, and multiparametric (mp)MRI for the delineating of dominant intraprostatic lesions (IPL). MATERIALS AND METHODS 35 patients with organ-confined prostate cancer who were assigned to definitive radiotherapy (RT) were divided into three groups based on imaging techniques: 68Ga-PSMA-PET/MRI (n = 9), 18F-PSMA-PET/CT (n = 16) and 68Ga-PSMA-PET/CT (n = 10). All patients without PSMA-PET/MRI received an additional mpMRI. PSMA-PET-based automatic isocontours and manual contours of the dominant IPLs were generated for each modality. The biopsy results were then used to validate whether any of the prostate biopsies were positive in the marked lesion using Dice similarity coefficient (DSC), Youden index (YI), sensitivity and specificity. Factors that can predict the accuracy of IPLs contouring were analysed. RESULTS Diagnostic performance was significantly superior both for manual and automatic IPLs contouring using 68Ga-PSMA-PET/MRI (DSC/YI SUV70%-0.62/0.51), 18F-PSMA-PET/CT (DSC/YI SUV70%-0.67/0.53) or 68Ga-PSMA-PET/CT (DSC/YI SUV70%-0.63/0.51) compared to mpMRI (DSC/YI-0.47/0.41; p < 0.001). The accuracy for delineating IPLs was not improved by combination of PET/CT and mpMRI images compared to PET/CT alone. Significantly superior diagnostic accuracy was found for large prostate lesions (at least 15% from the prostate volume) and higher Gleason score (at least 7b) comparing to smaller lesions with lower GS. CONCLUSION IPL localization was significantly improved when using PSMA-imaging procedures compared to mpMRI. No significant difference for delineating IPLs was found between hybrid method PSMA-PET/MRI and PSMA-PET/CT. PSMA-based imaging technique should be considered for the diagnostics of IPLs and focal treatment modality.
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Affiliation(s)
- Sergiu Scobioala
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
- West German Cancer Center, Muenster and Essen, Germany.
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Heidi Wolters
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Sebastian Huss
- Department of Pathology, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
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Ceci F, Oprea-Lager DE, Emmett L, Adam JA, Bomanji J, Czernin J, Eiber M, Haberkorn U, Hofman MS, Hope TA, Kumar R, Rowe SP, Schwarzenboeck SM, Fanti S, Herrmann K. E-PSMA: the EANM standardized reporting guidelines v1.0 for PSMA-PET. Eur J Nucl Med Mol Imaging 2021; 48:1626-1638. [PMID: 33604691 PMCID: PMC8113168 DOI: 10.1007/s00259-021-05245-y] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/07/2021] [Indexed: 12/13/2022]
Abstract
RATIONALE The development of consensus guidelines for interpretation of Prostate-Specific Membrane Antigen (PSMA)-Positron Emission Tomography (PET) is needed to provide more consistent reports in clinical practice. The standardization of PSMA-PET interpretation may also contribute to increasing the data reproducibility within clinical trials. Finally, guidelines in PSMA-PET interpretation are needed to communicate the exact location of findings to referring physicians, to support clinician therapeutic management decisions. METHODS A panel of worldwide experts in PSMA-PET was established. Panelists were selected based on their expertise and publication record in the diagnosis or treatment of PCa, in their involvement in clinical guidelines and according to their expertise in the clinical application of radiolabeled PSMA inhibitors. Panelists were actively involved in all stages of a modified, nonanonymous, Delphi consensus process. RESULTS According to the findings obtained by modified Delphi consensus process, panelist recommendations were implemented in a structured report for PSMA-PET. CONCLUSIONS The E-PSMA standardized reporting guidelines, a document supported by the European Association of Nuclear Medicine (EANM), provide consensus statements among a panel of experts in PSMA-PET imaging, to develop a structured report for PSMA-PET in prostate cancer and to harmonize diagnostic interpretation criteria.
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Affiliation(s)
- Francesco Ceci
- Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Louise Emmett
- St. Vincent's Clinical School, University of New South Wales, Kensington, NSW, Australia
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Judit A Adam
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamshed Bomanji
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Matthias Eiber
- School of Medicine, Department of Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Steven P Rowe
- Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
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Abstract
Positron emission tomography (PET) is a valuable imaging in evaluating many malignancies. There are various molecular imaging tracers that are currently being utilized with prostate cancer (PC). Several PET agents imaging different molecular processes in PC have reached the clinic. While all of these agents have demonstrated an advantage over conventional imaging, there are considerable differences in the performance of each in staging newly diagnosed PC. In this article, we review the current updates available of different PET tracers, with a strong focus on the emerging role of prostate-specific membrane antigen PET in the management of newly diagnosed PC.
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Trägårdh E, Simoulis A, Bjartell A, Jögi J. Tumor detection of 18F-PSMA-1007 in the prostate gland in patients with prostate cancer using prostatectomy specimens as reference method. J Nucl Med 2021; 62:jnumed.121.261993. [PMID: 33789930 PMCID: PMC8612187 DOI: 10.2967/jnumed.121.261993] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) radiopharmaceuticals used with positron emission tomography/computed tomography (PET-CT) are a promising tool for managing patients with prostate cancer. This study aimed to determine the accuracy of 18F-PSMA-1007 PET-CT for detecting tumors in the prostate gland using radical prostatectomy (RP) specimens as a reference method and to determine whether a correlation exists between 18F-PSMA-1007 uptake and the International Society of Urological Pathology (ISUP) grade and prostate specific antigen (PSA) levels at diagnosis. Methods: Thirty-nine patients referred for 18F-PSMA-1007 PET-CT for initial staging and who underwent RP within four months were retrospectively included. Uptake of 18F-PSMA-1007 indicative of cancer was assessed and maximum standardized uptake values (SUVmax) and total lesion uptake (TLU) were calculated for the index tumor. Histopathology was assessed from RP specimens. True positive, false negative, and false positive lesions were calculated. Results: In 94.9% of patients, the index tumor was correctly identified with PET. SUVmax was significantly higher in the tumors vs normal prostate tissue, but no significant differences were found between different ISUP grades and SUVmax There was a poor correlation between PSA at diagnosis and SUVmax (r=0.23) and moderate agreement between PSA at diagnosis and TLU (r=0.67). When all tumors (also non-index tumors) were considered, many small tumors (approx. 1-2 mm) were not detected with PET. Conclusion: 18F-PSMA-1007 PET-CT performs well in correctly identifying the index tumor in patients with intermediate to high-risk prostate cancer. Approximately 5% of the index tumors were missed by PET, which agrees with previous studies.
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Affiliation(s)
- Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Athanasios Simoulis
- Department of Pathology, Skåne University Hospital and Lund University, Malmö, Sweden; and
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Jonas Jögi
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
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Awenat S, Piccardo A, Carvoeiras P, Signore G, Giovanella L, Prior JO, Treglia G. Diagnostic Role of 18F-PSMA-1007 PET/CT in Prostate Cancer Staging: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11030552. [PMID: 33808825 PMCID: PMC8003688 DOI: 10.3390/diagnostics11030552] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The use of prostate-specific membrane antigen (PSMA)-targeted agents for staging prostate cancer (PCa) patients using positron emission tomography/computed tomography (PET/CT) is increasing worldwide. We performed a systematic review on the role of 18F-PSMA-1007 PET/CT in PCa staging to provide evidence-based data in this setting. Methods: A comprehensive computer literature search of PubMed/MEDLINE and Cochrane Library databases for studies using 18F-PSMA-1007 PET/CT in PCa staging was performed until 31 December 2020. Eligible articles were selected and relevant information was extracted from the original articles by two authors independently. Results: Eight articles (369 patients) evaluating the role of 18F-PSMA-1007 PET/CT in PCa staging were selected. These studies were quite heterogeneous, but, overall, they demonstrated a good diagnostic accuracy of 18F-PSMA-1007 PET/CT in detecting PCa lesions at staging. Overall, higher primary PCa aggressiveness was associated with higher 18F-PSMA-1007 uptake. When compared with other radiological and scintigraphic imaging methods, 18F-PSMA-1007 PET/CT had superior sensitivity in detecting metastatic disease and the highest inter-reader agreement. 18F-PSMA-1007 PET/CT showed similar results in terms of diagnostic accuracy for PCa staging compared with PET/CT with other PSMA-targeted tracers. Dual imaging with multi-parametric magnetic resonance imaging and 18F-PSMA-1007 PET/CT may improve staging of primary PCa. Notably, 18F-PSMA-1007-PET/CT may detect metastatic disease in a significant number of patients with negative standard imaging. Conclusions: 18F-PSMA-1007 PET/CT demonstrated a good accuracy in PCa staging, with similar results compared with other PSMA-targeted radiopharmaceuticals. This method could substitute bone scintigraphy and conventional abdominal imaging for PCa staging. Prospective multicentric studies are needed to confirm these findings.
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Affiliation(s)
- Salam Awenat
- Institute for Radiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany;
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | | | - Giovanni Signore
- Department of Medicine, Università degli studi della Campania “L. Vanvitelli”, 81100 Caserta, Italy;
| | - Luca Giovanella
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Department of Nuclear Medicine, University Hospital Zürich and University of Zürich, 8091 Zürich, Switzerland
| | - John O. Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, 6900 Lugano, Switzerland
- Correspondence: ; Tel.: +0041-918118919
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Cytawa W, Hartrampf P, Lass P, Kircher M, Polat B, Buck AK, Lapa C. PSMA Theranostics: A "Must Have" in Every Prostate Cancer Center. Illustration of Two Clinical Cases and Review of the Literature. Clin Genitourin Cancer 2021; 19:e235-e247. [PMID: 33906800 DOI: 10.1016/j.clgc.2021.03.008] [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: 11/05/2020] [Revised: 02/14/2021] [Accepted: 03/03/2021] [Indexed: 12/20/2022]
Abstract
This manuscript describes the history of 2 patients with prostate cancer (PCa) and the role of prostate-specific membrane antigen (PSMA) theranostics in their clinical management. In the first patient, PSMA-directed positron emission tomography (PET)/computed tomography (CT) imaging was used for primary staging of high-risk PCa before initial therapy. Then after biochemical relapse it was used to plan the scope of further treatment, in which it allowed among others to perform precise target volume delineation for salvage radiotherapy for pathologic lymph nodes. In the second patient with metastatic castration-resistant prostate cancer (mCRPC), PSMA-guided imaging played a key role in the qualification for PSMA-directed radioligand therapy (RLT) with lutetium-177. We also present a review of the current literature concerning PSMA theranostics in the 2 clinical settings, ie, primary staging of PCa and PSMA RLT of mCRPC. In the first part of the review, we report on the diagnostic efficacy of various PSMA imaging radiotracers labeled with gallium-68, fluorine-18, and technetium-99m. In the second part, we describe the limitations and future perspectives of PSMA therapeutic radiopharmaceuticals, including various beta(-) and alpha emitters.
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Affiliation(s)
- Wojciech Cytawa
- Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland; Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
| | - Philipp Hartrampf
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Piotr Lass
- Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Malte Kircher
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Constantin Lapa
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
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The impact of the co-registration technique and analysis methodology in comparison studies between advanced imaging modalities and whole-mount-histology reference in primary prostate cancer. Sci Rep 2021; 11:5836. [PMID: 33712662 PMCID: PMC7954803 DOI: 10.1038/s41598-021-85028-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
Comparison studies using histopathology as standard of reference enable a validation of the diagnostic performance of imaging methods. This study analysed (1) the impact of different image-histopathology co-registration pathways, (2) the impact of the applied data analysis method and (3) intraindividually compared multiparametric magnet resonance tomography (mpMRI) and prostate specific membrane antigen positron emission tomography (PSMA-PET) by using the different approaches. Ten patients with primary PCa who underwent mpMRI and [18F]PSMA-1007 PET/CT followed by prostatectomy were prospectively enrolled. We demonstrate that the choice of the intermediate registration step [(1) via ex-vivo CT or (2) mpMRI] does not significantly affect the performance of the registration framework. Comparison of analysis methods revealed that methods using high spatial resolutions e.g. quadrant-based slice-by-slice analysis are beneficial for a differentiated analysis of performance, compared to methods with a lower resolution (segment-based analysis with 6 or 18 segments and lesions-based analysis). Furthermore, PSMA-PET outperformed mpMRI for intraprostatic PCa detection in terms of sensitivity (median %: 83-85 vs. 60-69, p < 0.04) with similar specificity (median %: 74-93.8 vs. 100) using both registration pathways. To conclude, the choice of an intermediate registration pathway does not significantly affect registration performance, analysis methods with high spatial resolution are preferable and PSMA-PET outperformed mpMRI in terms of sensitivity in our cohort.
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Das C, Kubihal V, Sharma S, Kumar R, Seth A, Kumar R, Kaushal S, Sarangi J, Gupta R. Multiparametric magnetic resonance imaging, 68Ga prostate-specific membrane antigen positron emission tomography–Computed tomography, and respective quantitative parameters in detection and localization of clinically significant prostate cancer in intermediate- and high-risk group patients: An Indian demographic study. Indian J Nucl Med 2021; 36:362-370. [PMID: 35125753 PMCID: PMC8771078 DOI: 10.4103/ijnm.ijnm_80_21] [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: 06/03/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: The objective of this study was to evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) and 68Ga prostate-specific membrane antigen positron emission tomography–computed tomography (PSMA PET-CT) and respective quantitative parameters (Ktrans – influx rate contrast, Kep – efflux rate constant, ADC – apparent diffusion coefficient, and SUVmax ratio – prostate SUVmax to background SUVmax ratio) in detection and localization of clinically significant prostate cancer (CSPCa) in D’Amico intermediate- and high-risk group patients (prostate-specific antigen [PSA] >10 ng/ml). Methodology: The study included thirty-three consecutive adult men with serum prostate specific antigen >10ng/ml, and systematic 12 core prostate biopsy proven prostate cancer. All the 33 patients, were evaluated with mpMRI, and 68Ga PSMA PET-CT. The biopsy specimens and imaging were evaluated for 12 sectors per prostate by a predetermined scheme. Results: MpMRI Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score ≥3 showed higher sensitivity than 68Ga PSMA PET-CT (96.3% vs. 82.4%), with similar specificity (54.5% vs. 54.5%) (n = 33 patients, 396 sectors). Combined use of MRI and 68Ga PSMA PET-CT in parallel increased sensitivity (99.5%) and NPV (98.7%) for detection of CSPCa and combined use of MRI and 68Ga PSMA PET-CT in series increased specificity (71.8%) and PPV (71.5%) (n = 33 patients, 396 sectors). ADC showed a strong negative correlation with Gleason score (r = −0.77), and the highest discriminative ability for detection and localization of CSPCa (area under curve [AUC]: 0.91), followed by Ktrans (r = 0.74; AUC: 0.89), PI-RADS (0.73; 0.86), SUVmax ratio (0.49; 0.74), and Kep (0.24; 0.66). Conclusion: MpMRI PI-RADS v2 score and 68Ga PSMA PET-CT (individually as well as in combination) are reliable tool for detection and localization of CSPCa. Quantitative MRI and 68Ga PSMA PET-CT parameters have potential to predict Gleason score and detect CSPCa.
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47
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Spohn SKB, Kramer M, Kiefer S, Bronsert P, Sigle A, Schultze-Seemann W, Jilg CA, Sprave T, Ceci L, Fassbender TF, Nicolay NH, Ruf J, Grosu AL, Zamboglou C. Comparison of Manual and Semi-Automatic [ 18F]PSMA-1007 PET Based Contouring Techniques for Intraprostatic Tumor Delineation in Patients With Primary Prostate Cancer and Validation With Histopathology as Standard of Reference. Front Oncol 2020; 10:600690. [PMID: 33365271 PMCID: PMC7750498 DOI: 10.3389/fonc.2020.600690] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/04/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Accurate contouring of intraprostatic gross tumor volume (GTV) is pivotal for successful delivery of focal therapies and for biopsy guidance in patients with primary prostate cancer (PCa). Contouring of GTVs, using 18-Fluor labeled tracer prostate specific membrane antigen positron emission tomography ([18F]PSMA-1007/PET) has not been examined yet. PATIENTS AND METHODS Ten Patients with primary PCa who underwent [18F]PSMA-1007 PET followed by radical prostatectomy were prospectively enrolled. Coregistered histopathological gross tumor volume (GTV-Histo) was used as standard of reference. PSMA-PET images were contoured on two ways: (1) manual contouring with PET scaling SUVmin-max: 0-10 was performed by three teams with different levels of experience. Team 1 repeated contouring at a different time point, resulting in n = 4 manual contours. (2) Semi-automatic contouring approaches using SUVmax thresholds of 20-50% were performed. Interobserver agreement was assessed for manual contouring by calculating the Dice Similarity Coefficient (DSC) and for all approaches sensitivity, specificity were calculated by dividing the prostate in each CT slice into four equal quadrants under consideration of histopathology as standard of reference. RESULTS Manual contouring yielded an excellent interobserver agreement with a median DSC of 0.90 (range 0.87-0.94). Volumes derived from scaling SUVmin-max 0-10 showed no statistically significant difference from GTV-Histo and high sensitivities (median 87%, range 84-90%) and specificities (median 96%, range 96-100%). GTVs using semi-automatic segmentation applying a threshold of 20-40% of SUVmax showed no significant difference in absolute volumes to GTV-Histo, GTV-SUV50% was significantly smaller. Best performing semi-automatic contour (GTV-SUV20%) achieved high sensitivity (median 93%) and specificity (median 96%). There was no statistically significant difference to SUVmin-max 0-10. CONCLUSION Manual contouring with PET scaling SUVmin-max 0-10 and semi-automatic contouring applying a threshold of 20% of SUVmax achieved high sensitivities and very high specificities and are recommended for [18F]PSMA-1007 PET based focal therapy approaches. Providing high specificities, semi-automatic approaches applying thresholds of 30-40% of SUVmax are recommend for biopsy guidance.
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Affiliation(s)
- Simon K. B. Spohn
- Department of Radiation Oncology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Maria Kramer
- Department of Radiation Oncology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Selina Kiefer
- Institute for Surgical Pathology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - August Sigle
- Department of Urology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Schultze-Seemann
- Department of Urology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cordula A. Jilg
- Department of Urology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Lara Ceci
- Department of Radiation Oncology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas F. Fassbender
- Department of Nuclear Medicine, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils H. Nicolay
- Department of Radiation Oncology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca L. Grosu
- Department of Radiation Oncology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hong JJ, Liu BL, Wang ZQ, Tang K, Ji XW, Yin WW, Lin J, Zheng XW. The value of 18F-PSMA-1007 PET/CT in identifying non-metastatic high-risk prostate cancer. EJNMMI Res 2020; 10:138. [PMID: 33169183 PMCID: PMC7652971 DOI: 10.1186/s13550-020-00730-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinical management decisions on prostate cancer (PCa) are often based on a determination of risk. 68Ga-prostate-specific membrane antigen (PSMA)-11-positron emission tomography (PET)/computer tomography (CT) is an attractive modality to assess biochemical recurrence of PCa, detect metastatic disease and stage of primary PCa, making it a promising strategy for risk stratification. However, due to some limitation of 68Ga-PSMA-11 the development of alternative tracers is of high interest. In this study, we aimed to investigate the value of 18F-PSMA-1007 in identifying non-metastatic high-risk PCa. METHODS A total of 101 patients with primary non-metastatic PCa who underwent 18F-PSMA-1007 PET/CT were retrospectively analyzed. According to the European Association of Urology guidelines on PCa, patients were classified into intermediate-risk (IR) group or high-risk (HR) group. The maximum standardized uptake values (SUVmax) of the primary prostate tumor were measured on PET/CT images. The diagnostic performance of PET/CT for IR and HR PCa was calculated, and the relationship between the SUVmax of primary prostate tumor, prostate-specific antigen (PSA) level and Gleason score (GS) was analyzed. RESULTS Of all 101 patients, 49 patients were classified into IR group and 52 patients were classified into HR group. There was a significant positive correlation between PSA level/GS and SUVmax (r = 0.561, r = 0.496, P < 0.001, respectively). Tumors with GS 6 and 7a showed significantly lower 18F-PSMA-1007 uptake compared to patients with GS 8 and 9 (P < 0.01). SUVmax in patients of HR was significantly higher than those of IR (median SUVmax: 16.85 vs 7.80; P < 0.001). In receiver operating characteristic curve analysis, the optimal cutoff value of the SUVmax for identifying high-risk PCa was set as 9.05 (area under the curve: 0.829; sensitivity: 90.4%; specificity: 65.3%). CONCLUSION 18F-PSMA-1007 PET/CT showed the powerful diagnosis efficacy for high-risk PCa, which can be used as an objective imaging reference index for clinical reference.
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Affiliation(s)
- Jun-Jie Hong
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Bo-le Liu
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Zhi-Qiang Wang
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Kun Tang
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Xiao-Wei Ji
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Wei-Wei Yin
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jie Lin
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Xiang-Wu Zheng
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China.
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Bodar YJL, Jansen BHE, van der Voorn JP, Zwezerijnen GJC, Meijer D, Nieuwenhuijzen JA, Boellaard R, Hendrikse NH, Hoekstra OS, van Moorselaar RJA, Oprea-Lager DE, Vis AN. Detection of prostate cancer with 18F-DCFPyL PET/CT compared to final histopathology of radical prostatectomy specimens: is PSMA-targeted biopsy feasible? The DeTeCT trial. World J Urol 2020; 39:2439-2446. [PMID: 33079250 PMCID: PMC8332599 DOI: 10.1007/s00345-020-03490-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 11/01/2022] Open
Abstract
PURPOSE In primary prostate cancer (PCa) patients, accurate staging and histologic grading are crucial to guide treatment decisions. 18F-DCFPyL (PSMA)-PET/CT has been successfully introduced for (re)staging PCa, showing high accuracy to localise PCa in lymph nodes and/or osseous structures. The diagnostic performance of 18F-DCFPyL-PET/CT in localizing primary PCa within the prostate gland was assessed, allowing for PSMA-guided targeted-prostate biopsy. METHODS Thirty patients with intermediate-/high-risk primary PCa were prospectively enrolled between May 2018 and May 2019 and underwent 18F-DCFPyL-PET/CT prior to robot-assisted radical prostatectomy (RARP). Two experienced and blinded nuclear medicine physicians assessed tumour localisation within the prostate gland on PET/CT, using a 12-segment mapping model of the prostate. The same model was used by a uro-pathologist for the RARP specimens. Based on PET/CT imaging, a potential biopsy recommendation was given per patient, based on the size and PET-intensity of the suspected PCa localisations. The biopsy recommendation was correlated to final histopathology in the RARP specimen. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for clinically significant PCa (csPCa, Gleason score ≥ 3 + 4 = 7) were assessed. RESULTS The segments recommended for potential targeted biopsy harboured csPCA in 28/30 patients (93%), and covered the highest Gleason score PCa segment in 26/30 patient (87%). Overall, 122 of 420 segments (29.0%) contained csPCa at final histopathological examination. Sensitivity, specificity, PPV and NPV for csPCa per segment using 18F-DCFPyL-PET/CT were 61.4%, 88.3%, 68.1% and 84.8%, respectively. CONCLUSIONS When comparing the PCa-localisation on 18F-DCFPyL-PET/CT with the RARP specimens, an accurate per-patient detection (93%) and localisation of csPCa was found. Thus, 18F-DCFPyL-PET/CT potentially allows for accurate PSMA-targeted biopsy.
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Affiliation(s)
- Y J L Bodar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands. .,Prostate Cancer Network, Amsterdam, The Netherlands.
| | - B H E Jansen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - J P van der Voorn
- Department of Pathology, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - D Meijer
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - J A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - R Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - N H 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
| | - O S Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - R J A van Moorselaar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - D E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - A N Vis
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
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50
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Darr C, Harke NN, Radtke JP, Yirga L, Kesch C, Grootendorst MR, Fendler WP, Costa PF, Rischpler C, Praus C, Haubold J, Reis H, Hager T, Herrmann K, Binse I, Hadaschik B. Intraoperative 68Ga-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy: A Feasibility Study. J Nucl Med 2020; 61:1500-1506. [PMID: 32060212 PMCID: PMC7539648 DOI: 10.2967/jnumed.119.240424] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/05/2020] [Indexed: 11/16/2022] Open
Abstract
Our objective was to assess the feasibility and accuracy of Cerenkov luminescence imaging (CLI) for assessment of surgical margins intraoperatively during radical prostatectomy. Methods: A single-center feasibility study included 10 patients with high-risk primary prostate cancer (PC). 68Ga-prostate-specific membrane antigen (PSMA) PET/CT scans were performed followed by radical prostatectomy and intraoperative CLI of the excised prostate. In addition to imaging the intact prostate, in the first 2 patients the prostate gland was incised and imaged with CLI to visualize the primary tumor. We compared the tumor margin status on CLI to postoperative histopathology. Measured CLI intensities were determined as tumor-to-background ratio. Results: Tumor cells were successfully detected on the incised prostate CLI images as confirmed by histopathology. Three of 10 men had histopathologically positive surgical margins (PSMs), and 2 of 3 PSMs were accurately detected on CLI. Overall, 25 (72%) of 35 regions of interest proved to visualize a tumor signal according to standard histopathology. The median tumor radiance in these areas was 11,301 photons/s/cm2/sr (range, 3,328-25,428 photons/s/cm2/sr), and median tumor-to-background ratio was 4.2 (range, 2.1-11.6). False-positive signals were seen mainly at the prostate base, with PC cells overlaid by benign tissue. PSMA immunohistochemistry revealed strong PSMA staining of benign gland tissue, which impacts measured activities. Conclusion: This feasibility showed that 68Ga-PSMA CLI is a new intraoperative imaging technique capable of imaging the entire specimen's surface to detect PC tissue at the resection margin. Further optimization of the CLI protocol, or the use of lower-energy imaging tracers such as 18F-PSMA, is required to reduce false-positives. A larger study will be performed to assess diagnostic performance.
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Affiliation(s)
- Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Nina N Harke
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Leubet Yirga
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | | | | | - Christine Praus
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostics and Radiology, University Hospital Essen, Essen, Germany
| | - Henning Reis
- Institute of Pathology, University Duisburg-Essen, Essen, Germany; and
| | - Thomas Hager
- Institute of Pathology, University Duisburg-Essen, Essen, Germany; and
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Ina Binse
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
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