Is there any additional value to 68Ga-PSMA PET/CT in patients with suspicion of prostate cancer despite negative MRI and systematic biopsy?

Heetman, Joris G.; Lavalaye, Jules; Selm, Sandrine van; Hoeven, Erik Jrj van der; Melick, H.; Bergh, R.C. Van Den

doi:10.23736/s0393-2249.20.03722-4

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…In accordance with a recent case series by Heetman et al. [26] the clinical impact of PSMA PET/CT in addition to mpMRI in our cohort seems low. However, in our study, only six patients underwent PSMA PET/CT in addition to MRI and therefore these results should be interpreted with caution and are only hypothesis‐generating.…”

Section: Discussionsupporting

confidence: 92%

“…Based on the current literature it seems unlikely that patients with low PSA levels and lower-grade tumours will benefit from PSMA screening, especially since higher PSA levels also correlate with the likelihood of positive PSMA imaging [24,25]. In accordance with a recent case series by Heetman et al [26] the clinical impact of PSMA PET/CT in addition to mpMRI in our cohort seems low. However, in our study, only six patients underwent PSMA PET/CT in addition to MRI and therefore these results should be interpreted with caution and are only hypothesis-generating.…”

Section: Discussionsupporting

confidence: 74%

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Incidence of significant prostate cancer after negative MRI and systematic biopsy in the FUTURE trial

et al. 2022

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Objectives To assess the proportion of clinically significant (cs) prostate cancer (PCa) found during follow‐up in patients with negative systematic biopsy (SB) followed by non‐suspicious multiparametric magnetic resonance imaging (mpMRI) and persistent clinical suspicion of PCa compared to the general population. Patients and Methods A prospective study in a subgroup of patients from a multicentre randomized controlled trial was conducted between 2014 and 2017, including 665 men with prior negative SB with a persistent elevated prostate‐specific antigen and/or suspicious digital rectal examination undergoing mpMRI. All patients with negative SB and Prostate Imaging‐Reporting and Data System (PI‐RADS) ≤2 on mpMRI entered biochemical follow‐up. Follow‐up data until December 2021 were collected by reviewing institutional hospital records and the Dutch Pathology Registry (PALGA). The primary outcome was the observed number of csPCa (Gleason ≥3 + 4/International Society of Urological Pathology grade group ≥2) cases during follow‐up compared to the expected number in the general population (standardized incidence ratio [SIR]). Results In total, 431 patients had non‐suspicious mpMRI and entered biochemical follow‐up. After a median (interquartile range) follow‐up of 41 (23–57) months, 38 patients were diagnosed with PCa, of whom 13 (3.0%) had csPCa. The SIR for csPCa was 4.3 (95% confidence interval 2.3–7.4; total excess of eight cases). A higher risk of a positive biopsy for (cs)PCa based on the European Randomized Study of Screening for Prostate Cancer risk calculator and a suspicious repeat MRI (PI‐RADS ≥3) were significant predictive factors for csPCa. Conclusion After negative prior biopsy and non‐suspicious mpMRI the risk of csPCa is low. However, compared to the general population, the risk of csPCa is increased despite the high negative predictive value of mpMRI. More research focusing on biochemical and image‐guided risk‐adapted diagnostic surveillance strategies is warranted.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 74%

Incidence of significant prostate cancer after negative MRI and systematic biopsy in the FUTURE trial

et al. 2022

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“…A fairly strict list on what will be the standards for comparison to determine the prognostic or predictive ability of the chosen MB regarding risk-groups categorization and response to treatment has been devised for oncoming studies. Interestingly, while PSMA-PET was not considered amongst the recommended tests for comparison as still subject to accessibility issues and pendent of validation [24][25][26][27][28] , it is increasingly used in a treatment-naïve context and was felt of interest.…”

Section: Future/potential Role Of Mb In the Context Of Ft For Pcamentioning

confidence: 99%

Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society

Marra¹,

Laguna²,

Walz³

et al. 2022

Minerva Urol Nephrol

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Background: Focal Therapy (FT) for Prostate Cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localised PCa. Materials and Methods: A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, i) the current/present role; ii) the potential/future role; iii) the recommended features for future studies. Consensus was defined using a 70% agreement threshold. Results: Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (n=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (n=3), a consensus on a partial agreement (n=1), and a consensus on uncertainty (n=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localised PCa. Research efforts in this field should be considered a priority. Conclusion: The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.

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“…Thus, nowadays, mpMRI remain the pivotal exam to guide surgeons or radiotherapist during the treatment. Maybe, during the diagnostic process, PSMA PET/CT can have a role in specific, difficult cases 5 CT is useful to stratify high-risk PCa patients with better performance compared to conventional imaging. Interestingly, the authors underline a clinical impact on patient management of roughly 20-30%, thus justifying the routinely adoption of PSMA PET/CT: how many patients would be shifted from radical prostatectomy to radiotherapy or systemic treatments?…”

mentioning

confidence: 99%

PSMA PET/CT to stage high-risk prostate cancer: is already the time to replace conventional imaging?

Schiavina¹,

Bianchi²,

Bunocilla³

2021

Minerva Urol Nephrol

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MiNerVa Urology aNd Nephrology 135leTTerS To The ediTor spatial resolution, suggesting one single whole-body examination;• systemic staging. The assessment of nodal and bone metastases is of leading interest since it may influence the choice between locoregional vs. systemic treatment. 6 Unfortunately, for this purpose, current guidelines still suggest conventional imaging (CT/ Bone scan), which present very low spatial resolution. Currently, for lymph-node staging, the sole accurate method remains surgical assessment, which is not devoid of complications and it has no proven effect on disease control. 7 Furthermore, milestone studies such as Chaarted and Latitude was still using conventional imaging for risk stratification, which is not more acceptable in the era of modern imaging. Since early 2000, PET/CT with specific tracers such as choline and fluciclovine, has been largely investigated with mild to moderate improvement in the detection of the metastases, but a concrete cost-effective turning point has not been proven for preoperative staging. Recently, the introduction of pSMa both for restaging and staging proposal has gained surprising interest: emerging data report very high sensitivity for early detection of metastatic relapse suggesting a potential significant change of direction of diagnostic and therapeutic approaches. 8 But the question is: are we really facing with an adequate, one-step exam for the systemic staging of high-risk patients? Some retrospective papers reported that PSMA PET/CT has significantly higher performance compared to conventional imaging to detect nodal involvement. However, taking together data form meta-analyses reported in the current review, the range of sensitivity for nodal metastases vary from 25% to 70%, which is very wide, despite high specificity (>90%). Data concerning detection of bone metastases are scarce but the diagnostic performance of PSMA PET/CT seems to overcome limitations of conventional imaging. 2 Even if we haven't found the "panacea" yet for preoperative staging, this evidence suggests that PSMA PET/CT could replace conventional imaging.Another important question is whenever PSMA PET/CT can be cost effective. The prospective randomized trial ProPSMA proved superior accuracy (92% vs. 65%) and positive cost-effect (around 1000 dollars/patient saved) over combined findings of CT and BS, suggesting a possible shift even for current guidelines. 9 In the current clinical practice, PSMA PET/CT is not devoid from limitations: except for the cost, wide range of reported results, availability, false positive results and limited spatial resolution (5 mm) are still a matter of discussion. Moreover, despite large success of pSMa imaging, we should consider that a significant proportion of patients (approximately 10%) do not express PSMA receptors. Further investigation on immunohistochemical expression of pSMa on biopsy specimen would be helpful to selects patients with high-risk disease and high pSMa expression.

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Is there any additional value to 68Ga-PSMA PET/CT in patients with suspicion of prostate cancer despite negative MRI and systematic biopsy?

Cited by 6 publications

References 5 publications

Incidence of significant prostate cancer after negative MRI and systematic biopsy in the FUTURE trial

Incidence of significant prostate cancer after negative MRI and systematic biopsy in the FUTURE trial

Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society

PSMA PET/CT to stage high-risk prostate cancer: is already the time to replace conventional imaging?

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