⁶⁸Ga-PSMA PET/CT Combined with PET/Ultrasound-Guided Prostate Biopsy Can Diagnose Clinically Significant Prostate Cancer in Men with Previous Negative Biopsy Results

Abstract

parameters to predict the outcome of repeat prostate biopsy. Results: The median age of patients was 65 years (range 53-81), and the median PSA level was 18.0 ng/ml (range 5.48-49.77 ng/ml). Prostate cancer was detected in 15/31 patients (48.4%) and 12/31 patients (38.7%) had clinically significant disease. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 68 Ga-PSMA PET/CT in the diagnosis of clinically significant prostate cancer were 100.0%, 68.4%, 66.7%, 100.0% and 80.6%, respectively. The detection rate of prostate cancer increased with the increase of miPSMA-ES score. The detection rate of clinically significant prostate cancer in miPSMA-ES 0-1, 2 and 3 groups were 0%, 54.5% and 85.7% respectively. Semi-quantitative analysis of 68 Ga-PSMA PET/CT images showed that predictive models based on maximum standardized uptake value (SUVmax), tumor-to-background normal prostate SUV (SUVT/BGp) and tumor-to-background normal liver SUV (SUVratio) could effectively predict clinically significant prostate cancer; area under the curves were 0.930, 0.877, and 0.956, respectively. Conclusion: This study preliminarily confirmed that 68 Ga-PSMA PET/CT imaging combined with PET-ultrasound fusion image-guided prostate biopsy can effectively detect clinically significant prostate cancer. Prebiopsy 68 Ga-PSMA PET/CT has predictive value for clinically significant cancer in the studied patient population.

Clinical Utility of 18F-PSMA-1007 Positron Emission Tomography/Magnetic Resonance Imaging in Prostate Cancer: A Single-Center Experience

“…All patients underwent PSMA PET-ultrasound fusion image-guided biopsy. Imaging was positive in 18 patients, and csPCa was detected in 12 of 31 patients (38.7%) ( 14 ). Lopci et al.…”

64Cu-PSMA-BCH: A New Radiotracer for Delayed PET Imaging of Prostate Cancer

“…Not only for detecting tumors, delayed PSMA PET/CT imaging of 64 Cu-PSMA-BCH may have more application in clinic. Our group had reported a study that performed PSMA PET/CT prior to biopsy and then PSMA PET-ultrasound fusion targeted biopsies, which improved the detection rate and decrease possibility of repeated biopsies [3]. As shown in Figures 4 and 6 .…”

“…After imaging at 24 h p.i., the images were reconstructed and analyzed, then the patients were performed classic ultrasound-guided biopsies with visual fusion of PET images according to PROMISE criteria (version 1.0) as reported [19,3].…”

A Pilot Study of 18F-DCFPyL PET/CT or PET/MRI and Ultrasound Fusion Targeted Prostate Biopsy for Intra-Prostatic PET-Positive Lesions

“…Some studies have validated the performance of PSMA PET/CT to define the gross tumor volume (GTV) through comparison with histology and have reported good results with high sensitivity and specificity in the detection of primary prostate cancer ( 19 – 21 ). In a recent study, 31 patients with previously negative prostate biopsy, but persistently elevated serum PSA, were imaged with 68 Ga-labeled PSMA PET/CT and then underwent both standard systematic biopsy and PET/CT-US fusion targeted biopsy ( 9 ): Among the 13 patients who were negative on PSMA PET imaging, none were diagnosed with clinically significant cancer; in the 18 patients positive by PSMA PET imaging, PET/CT-US fusion targeted biopsy detected all 12 patients with clinically significant cancer while standard systematic biopsy detected only 10 patients. These preliminary results suggest that PSMA PET might be a useful tool to identify and define malignant lesions prior to prostate biopsy.…”

“…Analyzed biopsy features include the total number of biopsy cores, percentage of cores involving adenocarcinoma, and the number of positive biopsy cores. In our study, clinically significant prostate cancer was defined as the presence of a single biopsy core indicating disease of Gleason score 3 + 4 (Gleason sum of 7) or greater (the Gleason score is composed of a primary [most predominant] grade plus a secondary [highest non-predominant] grade); the range for a primary or secondary grade is from 3 to 5, with the Gleason sum ranging from 6 to 10 ( 3 , 9 – 12 ).…”