68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is 68Ga-PSMA PET/CT guided biopsy the future?

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

doi:10.1007/s00259-019-04620-0

Cited by 75 publications

(93 citation statements)

References 36 publications

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“…These results are in line with previous published studies. Kalapara et al showed a sensitivity of 94% for both 68Ga-PSMA-PET/CT and mpMRI [18], and Donato et al showed a sensitivity of 94% for 68Ga-PSMA-PET/CT with lower detection rate for mpMRI [14]. Specificity in our study was 67%, this is lower than in the study of Donato et al (90%) and could be dependent on population composition.…”

Section: Discussioncontrasting

confidence: 73%

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Detection and Local Staging of Prostate Cancer by 68Ga-PSMA-PET/CT, Comparison with mpMRI and Histopathology

Intema¹,

Kooistra²,

Vermeulen³

et al. 2020

AMI

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Introduction: 68Ga-PSMA-PET/CT has proven its value in prostate cancer with high positive predictive value for lymph node metastasis and superior detection of distant metastasis. There is growing evidence that 68Ga-PSMA-PET/CT has high sensitivity for detection of tumor lesions in the prostate as well. Studies thus far have mainly been performed in patients prior to prostatectomy. Aim of this study is to evaluate diagnostic accuracy in a mixed population of men with increased risk of prostate cancer and evaluate diagnostic possibilities with respect to extra-capsular extension and seminal vesicle invasion. Methods: The population consisted of a retrospectively included sequential cohort of 69 patients with 68Ga-PSMA-PET/CT and mpMRI available. 68Ga-PSMA-PET/CT was re-evaluated by two readers blinded for mpMRI and clinical information. Likelihood of tumour presence, extra-prostatic extension and seminal vesicle invasion was scored on 5-point Likert scale and localized schematically. Results were compared with mpMRI. Available pathological outcome served as gold standard. SUVmax of index lesions was measured and correlated to index tumor Gleason grade. Results: Clinically significant prostate cancer (Gleason ≥ 3 + 4) was detected in 57 (83%) of 69 patients. Diagnostic accuracy was 89% for PET reader 1, 93% for PET reader 2 and 86% for mpMRI. Lesion concordance of 68Ga-PSMA-PET/CT and mpMRI was 97%. SUVmax of the index lesion correlated to Gleason grade.

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Section: Discussioncontrasting

confidence: 73%

“…Several studies have shown beneficial results for the PSMA-PET/CT compared to mpMRI in primary tumor detection in a high risk population with proven prostate cancer [14] [15] [16] [17] [18]. Better delineation of tumor volume has been shown which could be relevant for planning of radiation therapy [19].…”

Section: Introductionmentioning

confidence: 99%

Detection and Local Staging of Prostate Cancer by 68Ga-PSMA-PET/CT, Comparison with mpMRI and Histopathology

Intema¹,

Kooistra²,

Vermeulen³

et al. 2020

AMI

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“…A high true positive rate is becoming more important in clinical practice, both for the detection of metastases (e.g. due to the emergence of strategies like local, metastasis-directed therapy) as well as the primary tumors [48]. Therefore, the purpose of this study was to evaluate 18 F-DCFPyL PET-detected lesions in patients with BCR and identify clinical/imaging characteristics that increase diagnostic certainty regarding the malignant nature of PSMA-avid lesions.…”

Section: Discussionmentioning

confidence: 99%

Clinical verification of 18F-DCFPyL PET-detected lesions in patients with biochemically recurrent prostate cancer

et al. 2020

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Radiolabeled Prostate-Specific Membrane Antigen (PSMA) PET/CT is the current standard-of-care for lesion detection in patients with biochemically recurrent (BCR) prostate cancer (PCa). However, rigorous verification of detected lesions is not always performed in routine clinical practice. To aid future 18 F-radiolabeled PSMA PET/CT interpretation, we aimed to identify clinical/imaging characteristics that increase the likelihood that a PSMAavid lesion is malignant. Materials and methods 262 patients with BCR, who underwent 18 F-DCFPyL PSMA PET/CT, were retrospectively analyzed. The malignant nature of 18 F-DCFPyL PET-detected lesions was verified through any of the following metrics: (1) positive histopathological examination; (2) additional positive imaging; (3) a �50% decrease in Prostate-Specific Antigen (PSA) following irradiation of the lesion(s). Results In 226/262 PET scans (86.3%) at least one lesion suspicious for recurrent PCa was detected ('positive scan'). In 84/226 positive scans (37.2%), at least one independent verification metric was available. PSMA PET-detected lesions were most often confirmed to be malignant (PCa) in the presence of a CT-substrate (96.5% vs. 55.6% without CT-substrate), with SUV peak �3.5 (91.4% vs. 60.0% with SUV peak <3.5), in patients with a PSA-level �2.0

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“…Another study also found PSMA PET–CT to have greater sensitivity, specificity, negative predictive value and positive predictive value in intermediate grade cancers (ISUP grade 2–3) compared with multiparametric MRI; a combination of the two modalities increased accuracy slightly 62 . Comparing the concordance between biopsy and radical prostatectomy histology in 144 men, PSMA PET–CT was found to incrementally improve tumour location compared with multiparametric MRI 63 …”

Section: Prostate‐specific Membrane Antigen Positron Emission Tomogramentioning

confidence: 92%

Understanding the diagnosis of prostate cancer

Ong

Bagguley

Yaxley

et al. 2020

Medical Journal of Australia

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Summary Prostate cancer continues to be the most commonly diagnosed cancer, and the second leading cause of cancer death among Australian men. Prostate‐specific antigen testing is personalised (not dichotomous in nature) and its interpretation should take into account the patient's age, symptoms, previous results and medication (eg, 5‐α reductase inhibitors such as dutasteride). Multiparametric magnetic resonance imaging of the prostate has been proven to have a 93% sensitivity for detecting clinically significant prostate cancer. It has the potential to decrease unnecessary prostate biopsies by around 27%. International Society of Urological Pathology (ISUP) grade 1 (Gleason score 6) has been shown to have very little, if any, risk of metastasis ISUP grade 1 (Gleason score 3 +3 = 6) and low percentage ISUP grade 2 (Gleason score 3 + 4 [< 10%] = 7) can be offered active surveillance. The goal of active surveillance is to defer treatment but is still curative when required. With better imaging (magnetic resonance imaging and emerging prostate‐specific membrane antigen positron emission tomography–computed tomography) and transperineal prostate biopsy, more men can be offered screening after discussion of risks and benefits, knowing that overdiagnosis has been minimised and radical treatment is reserved for only the most aggressive disease.

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68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is 68Ga-PSMA PET/CT guided biopsy the future?

Cited by 75 publications

References 36 publications

Detection and Local Staging of Prostate Cancer by 68Ga-PSMA-PET/CT, Comparison with mpMRI and Histopathology

Detection and Local Staging of Prostate Cancer by 68Ga-PSMA-PET/CT, Comparison with mpMRI and Histopathology

Clinical verification of 18F-DCFPyL PET-detected lesions in patients with biochemically recurrent prostate cancer

Understanding the diagnosis of prostate cancer

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