Improved specificity with 68Ga PSMA PET/CT to detect clinically significant lesions “invisible” on multiparametric MRI of the prostate: a single institution comparative analysis with radical prostatectomy histology

Donato, Peter; Roberts, Matthew J.; Morton, Anthony; Kyle, Samuel; Coughlin, Geoff; Esler, Rachel; Dunglison, Nigel; Gardiner, Robert A.; Yaxley, John

doi:10.1007/s00259-018-4160-7

Cited by 87 publications

(95 citation statements)

References 42 publications

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“…Intraprostatic tumor localization has been investigated in some recent studies . In one study, gross tumor volume detection of mp‐MRI and Ga‐68 PSMA PET/CT were compared with histopathology and both of the modalities showed high sensitivity and specificity in detection of primary PCa .…”

Section: Discussionmentioning

confidence: 99%

“…PI‐RADS (Prostate Imaging—Reporting And Data System) scores were determined according to the second version, PI‐RADS v2 of the American College of Radiology (ACR) . PI‐RADS 4 and 5 scans were considered a likely result, PI‐RADS 3 was considered equivocal and PI‐RADS 2 result was defined as an unlikely result . Extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI) were also reported visually as positive or negative.…”

Section: Methodsmentioning

confidence: 99%

“…Histopathology reports were structured according to the 2014 ISUP Gleason Grading guidelines . Diseases were defined as Gleason 3 + 3 or greater, while other pathological characteristics (tumor grade/stage, location of dominant and nondominant tumor nodules, presence of EPE, SVI, BNI, and margin status) and also if LN dissection was made, metastatic LNs were recorded . Pelvic nodal involvement was done in accordance with the classification of TNM staging system for dissected material postoperatively.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of preoperative locoregional Ga‐68 PSMA‐11 PET‐CT and mp‐MRI results with postoperative histopathology of prostate cancer

Yılmaz¹,

Türkay

Çolakoğlu

et al. 2019

The Prostate

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Background: Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology. Materials and Methods:Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities.Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/ CT had strong results for appropriate tumor localization in the gland. Conclusion: Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning. K E Y W O R D S extraprostatic extension, Gallium-68 prostate-specific membrane antigen-11 positron emission tomography/computed tomography, lymph node, multiparametric magnetic resonance imaging, prostate cancer, seminal vesicle The Prostate. 2019;79:1007-1017. wileyonlinelibrary.com/journal/pros

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Comparison of preoperative locoregional Ga‐68 PSMA‐11 PET‐CT and mp‐MRI results with postoperative histopathology of prostate cancer

Yılmaz¹,

Türkay

Çolakoğlu

et al. 2019

The Prostate

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“…Another retrospective study revealed 58 patients who underwent MRI with 68 Ga-PSMA PET/CT followed by radical prostatectomy. 68 Ga-PSMA PET/CT correctly detected more foci (78%, AUC 0.817) than mpMRI (69%, AUC 0.729) [22]. 68 Ga-PSMA PET/CT may better reflect the histopathology of radical prostatectomy compared to mpMRI when considering multifocal and bilateral disease.…”

Section: Diagnostic Performance Of 68 Ga-psma Petmentioning

confidence: 97%

Current status of radioligand therapy and positron-emission tomography with prostate-specific membrane antigen

et al. 2020

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Prostate-specific membrane antigen (PSMA) is a transmembrane glycoprotein highly expressed by prostate cancer cells. PSMA-based radioligand therapy (RLT) emerged as a promising therapeutic option for prostate cancer in the early 2000s, and has been clinically validated with great enthusiasm during these past two decades. Last year, the European Association of Nuclear Medicine (EANM) published the procedure guidelines for the safe clinical practice of Lutetium-177 (177Lu)-labelled PSMA RLT. In addition, PSMA RLT with alpha-ray-emitting radioisotopes has been also developed recently. Following the clinical use of 177Lu-PSMA RLT, PSMA-targeted positron-emission tomography (PET) with Gallium-68 (68Ga) has been performed inevitably for “theranostics” for the last decade; prostate cancer is going to be treated with PSMA-RLT based on the diagnosis by PSMA-PET. Furthermore, the diagnostic usefulness of 68Ga-PSMA PET has been documented in various diseases beyond prostate cancer more recently. Regrettably, Japan is behind European countries and the United States in this field, and has just made a belated start of their clinical trials. In this review article, we briefly overviewed the current status of PSMA RLT and PSMA PET. We hope that this topic will be a particular focus of attention for most ANM readers in Japan, and that our efforts will help to facilitate the early approval of PSMA RLT and PSMA PET by the Japanese government even if only slightly.

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“…Studies generally show PSMA-PET has improved sensitivity for detecting intraprostatic cancer lesions over MRI (74-92% vs. 53-73%). [9][10][11][12][13] Most studies are retrospective by design and report improved detection for PSMA-PET over mpMRI for both primary and secondary prostate cancer lesions. 9,12,14 Also, most studies have focused on high-risk prostate cancer with few intermediate risk cancers (grade group ≤3) being studied.…”

Section: Introductionmentioning

confidence: 99%

Prostate Specific Membrane Antigen Targeted Positron Emission Tomography of Primary Prostate Cancer: Assessing Accuracy with Whole Mount Pathology

et al. 2020

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To evaluate what lesions are detected and missed on [ 68 Ga]Ga-PSMA-11 PET scanning in primary prostate cancer Materials and Methods Patients undergoing radical prostatectomy were enrolled in this prospective observational study. Patients received a [ Ga]Ga-PSMA-11 PET/CT or PET/MRI scan prior to surgery, and were dosed with [ 68 Ga]Ga-PSMA-11 intraoperatively for PET scanning of extirpated specimens. Whole mount pathology was performed with a lesion and intra-lesion-based analysis to determine characteristics of lesions detected or not detected by PSMA-PET. Lesion volume was determined by planimetry and "clinically significant lesion volume" was calculated (lesion volume x fraction Pattern 4/5). Results Thirty cancer lesions were found in 15 patients on whole-mount analysis as follows: 4 Grade Group (GG)-1, 15 GG-2, 4 GG-3, 1 GG-4, and 6 GG-5. PSMA-PET detected 100% of primary/index lesions and 82% (8/11) of secondary lesions. All GG-3-5 lesions were detected versus 12/15 GG-2 lesions. When comparing GG-2 versus 3-5, lesion size was similar (p=0.48), but the SUVmax was lower for Grade Group 2 vs. 3-5 (5.3 vs. 7.9, p=0.03). The three missed lesions were of ≤10% Pattern 4 and had a volume of Gleason Pattern 4/5 of <0.1 cm 3. Conclusions PSMA-PET detected 100% of primary/index lesions in this study. The three missed secondary lesions were of small size and low percentage Pattern 4. This argues for further study to better understand what defines a clinically significant prostate cancer lesion, which would assist in determining whether small lesions, that become challenging to detect with [ 68 Ga]Ga-PSMA-11 PET, confer a risk to the patient.

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Improved specificity with 68Ga PSMA PET/CT to detect clinically significant lesions “invisible” on multiparametric MRI of the prostate: a single institution comparative analysis with radical prostatectomy histology

Abstract: Ga-PSMA PET/CT may better reflect RP histopathology compared to mpMRI when considering multifocal and bilateral disease. These findings may influence surgical planning, targeted biopsy and focal therapy strategies and require further research.

Cited by 87 publications

References 42 publications

Comparison of preoperative locoregional Ga‐68 PSMA‐11 PET‐CT and mp‐MRI results with postoperative histopathology of prostate cancer

Comparison of preoperative locoregional Ga‐68 PSMA‐11 PET‐CT and mp‐MRI results with postoperative histopathology of prostate cancer

Current status of radioligand therapy and positron-emission tomography with prostate-specific membrane antigen

Prostate Specific Membrane Antigen Targeted Positron Emission Tomography of Primary Prostate Cancer: Assessing Accuracy with Whole Mount Pathology

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