Evaluating F-18-PSMA-1007-PET in primary prostate cancer and comparing it to multi-parametric MRI and histopathology (original) (raw)
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2021
Purpose: The aim of the present study is to investigate the synergic role of 68Ga-PSMA PET/MRI and 68Ga-DOTA-RM2 PET/MRI in PCa staging. Methods: Fifteen patients with biopsy-proven PCa underwent both 68Ga-PSMA PET/MRI and 68Ga-DOTA-RM2 PET/MRI within one month. TNM classification based on image findings was performed and semi-quantitative PET and quantitative MRI parameters were collected for each scan. Finally, DICE score between regions of interest manually segmented on the primary tumor on 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and on T2 MRI was computed. Results: All imaging modalities detected the primary PCa in 15 patients, with slight differences regarding the multifocality of intra-prostatic findings. Two patients presented seminal vesicles involvement on MRI, one of these was also detected by 68Ga-PSMA, with no uptake on 68Ga-DOTA-RM2 images. Regarding extra prostatic disease, 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and MRI resulted positive in 6, 2 and 4 patients at lymph-nodal level,...
Diagnostics
The aim of the present study is to investigate the synergic role of 68Ga-PSMA PET/MRI and 68Ga-DOTA-RM2 PET/MRI in prostate cancer (PCa) staging. We present pilot data on twenty-two patients with biopsy-proven PCa that underwent 68Ga-PSMA PET/MRI for staging purposes, with 19/22 also undergoing 68Gaa-DOTA-RM2 PET/MRI. TNM classification based on image findings was performed and quantitative imaging parameters were collected for each scan. Furthermore, twelve patients underwent radical prostatectomy with the availability of histological data that were used as the gold standard to validate intraprostatic findings. A DICE score between regions of interest manually segmented on the primary tumour on 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and on T2 MRI was computed. All imaging modalities detected the primary PCa in 18/19 patients, with 68Ga-DOTA-RM2 PET not detecting any lesion in 1/19 patients. In the remaining patients, 68Ga-PSMA and MRI were concordant. Seven patients presented seminal ves...
Purpose: In this retrospective study, we compared the diagnostic value of 68Gallium prostate specific membrane antigen positron emission tomography computed tomography ([68Ga]PSMA PET/CT) in primary staging of patients with high-risk prostate cancer (PCa), in comparison to CT, magnetic resonance imaging (MRI), and bone scans, and we explored its overall impact on patients’ management plan. Procedures: Patients with pathological confirmation of PCa with high-risk disease were included in this study. Information on patient demographics, clinical and histopathological findings with Gleason score and initial prostate specific antigen PSA levels, and radiological findings for CT, MRI, bone scan, and [68Ga]PSMA PET/CT were retrieved. We stratified the concordance and discordance of each imaging modality on per-patient and per-lesion-site bases. Results: Twenty-one patients with high-risk disease were included in this study. [68Ga]PSMA PET/CT revealed a significantly higher concordance rate (90%) compared to the concordance rates of bone scan (75%), MRI (73%), and CT (60%). [68Ga]PSMA PET/CT had a similar accuracy to MRI in detecting prostate lesions but a higher accuracy for suspicious pelvic lymph nodes (95.2% vs. 80%). It also superseded CT scan in detecting suspicious pelvic lymph nodes (95.2% vs. 75%) and extra-pelvic lymph nodes (100% vs. 75%), as well as bone lesions via bone scan (100% vs. 62.5%). [68Ga]PSMA PET/CT changed the management in 11 patients (52%). Conclusions: [68Ga]PSMA PET/CT is an invaluable imaging modality in the assessment of primary high-risk PCa with great potential for the detection of lymph node spread and bone metastases that would impact the management plan.
The Journal of Urology, 2018
INTRODUCTION AND OBJECTIVES: Current standard of care for prostate cancer detection is multiparametric MRI (mpMRI) and biopsy prior to active treatment. In recent years, prostate-specific membrane antigen (PSMA) ligands have been used in positron emission tomography (PET) to target prostate cancer cells for detection, however guidelines on its use are limited by its infancy. PSMA PET is a highly sensitive and specific scan that has been primarily used in detecting prostate cancer recurrence. PSMA PET may be combined with computed tomography (CT) or MRI, although few centres have access to PET/MRI machines. There is a growing role for PSMA PET/CT in primary staging. We aimed to examine how PSMA PET/CT could contribute to current standards of care by comparing mpMRI and PSMA PET/CT to prostatectomy histopathology. METHODS: We conducted a chart review from February 2015 to January 2017 of 50 male patients staged for prostate cancer using PSMA PET/CT and mpMRI who then underwent radical prostatectomy. Pre-operative PSMA PET/CT and mpMRI were paired with their corresponding histological tumor. RESULTS: A total of 50 male patients were included in this study, with a mean age of 64.9 years (AE 5.6), and PSA of 10.6 (AE 8.1). The median time between PSMA PET/CT and surgery was 5 weeks (range 0-21 weeks), and the median time between mpMRI and surgery was 18 weeks (IQR 13-25 weeks). The median time between mpMRI and PSMA PET/CT was 12 weeks (IQR 3-12.25 weeks). A total of 81 lesions were confirmed by histopathology. Fifty index lesions were confirmed by histopathology, all of which were detected by PSMA PET/ CT and 47 by mpMRI (100% vs. 94%). Thirty-one secondary lesions were confirmed by histopathology, 29 of which were detected by PSMA PET/CT and 16 by mpMRI (93.5% vs. 51.6%). PSMA had better sensitivity for index lesion localization than mpMRI (81.1% vs. 64.8%). Specificity was similar for PSMA PET/CT and mpMRI (84.6% vs. 82.7%). Forty-five patients (90%) were found to have multifocal disease on histopathology. PSMA predicted multifocal disease in 43 (86%) of patients (88.9% sensitivity, 40.0% specificity); mpMRI predicted multifocal disease poorly (10% sensitivity, 10% specificity). CONCLUSIONS: PSMA-PET/CT provided superior detection of prostate cancer lesions with better sensitivity than mpMRI. PSMA-PET/ CT can be used to enhance locoregional mpMRI to provide improved detection and characterization of lesions.
Prostate Cancer and Prostatic Diseases, 2018
Background Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) can be used to locate lesions based on PSMA avidity, however guidelines on its use are limited by its infancy. We aimed to compare multiparametric magnetic resonance imaging (mpMRI) and PSMA PET/CT to prostatectomy histopathology. Methods We conducted a chart review from February 2015 to January 2017 of 50 male patients staged for prostate cancer using PSMA PET/CT and mpMRI who then underwent radical prostatectomy. Pre-operative PSMA PET/CT and mpMRI were paired with corresponding histopathology. Correlations, sensitivity, and specificity were used for comparisons. Results A total of 81 lesions were confirmed by histopathology. Fifty index lesions were detected by histopathology, all of which were detected by PSMA PET/CT (100% detection), and 47 by mpMRI (94% detection). Thirty-one histologically confirmed secondary lesions were detected, 29 of which were detected by PSMA PET/CT (93.5% detection), and 16 by mpMRI (51.6% detection). PSMA had better sensitivity for index lesion localization than mpMRI (81.1 vs. 64.8%). Specificity was similar for PSMA PET/CT and mpMRI (84.6 vs. 82.7%). SUV max of index lesions ranged from 2.9 to 39.6 (M = 9.27 ± 6.41). Index lesion SUV max was positively correlated with PSA (rho = 0.48, p < 0.001) and ISUP grade (rho = 0.51, p < 0.001). Conclusions PSMA-PET/CT provided superior detection of prostate cancer lesions with better sensitivity than mpMRI. PSMA-PET/CT can be used to enhance locoregional mpMRI to provide improved detection and characterization of lesions.
The Journal of Urology, 2018
, we selected those who performed an early scan for the detection of prostate fossae recurrences and had a PSA levels <2 ng/mL at PET time. 75 subjects met the inclusion criteria. All these patients underwent an early static (after 2 minutes from the FCH injection; 1 bed; 5 minutes/bed) and late whole-body (after 60 minutes from FCH injection; 7 beds; 3 minutes/ bed) PET/CT acquisition. A correlation among terapeutic factors, Gleason Score, PSA levels, PSA doubling time (PSAdt), PSA velocity (PSA vel) and early PET/CT findings were assessed by using the chisquare test and Mann-Whitney test. The agreement between early and late PET/CT acquisitions was studied by K-statistic. ROC analysis was used to evaluate the optimal cutoff point for PSA able to distinguish positive and negative PET/CT finding. A p<0.05 was considered statistically significant. RESULTS: PET/CT showed a pathological tracer uptake in 25 patients (33.3%); in 15 cases confined to the prostatic bed, in 4 to lymph nodes, in 4 to the bone, in 2 to both prostatic fossae and lymph nodes and in 3 to both bone and lymph nodes. Therefore, the detection rate of PET/CT was higher for local recurrences (18/25; 72%). PSA values increased in patients with a positive PET/CT finding compared to subjects with a negative scan. Similarly, PSAdt and PSAvel values were different between patients with a positive and a negative PET/CT scan (6.9 versus 10.2 mo and 0.6 versus 0.4 ng/mL/year, respectively). 15 patients had positive early scans and only 4/15 were positive for both early and late PET/CT acquisition (Kappa value ¼ 0.368; p< 0.001). No correlation was found between the PSAdt or PSAvel and positive or negative early PET/CT images. At ROC analysis a PSA value of 0.67 ng/mL showed a sensitivity and specificity of 69% and 64%, respectively, to distinguish patients with positive or negative PET findings. Using this cutoff value, FCH PET/CT was positive in 23% of patients with PSA < 0.67 ng/mL; 12% of patients had a positive early PET/CT and therefore 88% had negative early scans. CONCLUSIONS: From this study emerges that, in patients with PSA < 2 ng/mL, local recurrence is more often detect by FCH PET/CT finding. An early PET acquisition is able to improve the detection rate, expecially in prostatic fossae, and we reported in this study that local findings were increased to 70%. Our results suggest that the selection of patients ungergoing a "dual phase" PET/CT should be based not only on PSA value but also on PSA kinetic.
Abdominal Radiology, 2020
Objectives To compare the ability of 68 Ga-PSMA PET/CT (PSMA PET/CT) and multiparametric MRI (mpMRI) to exclude lymph node invasion (LNI) in patients who undergo radical prostatectomy (RP). Materials and methods A multicenter cohort of patients who underwent PSMA PET/CT and pelvic mpMRI prior to RP with pelvic lymph node dissection (PLND) was analyzed. Increased Ga68-PSMA uptake on PET/CT and enlarged (> 10 mm) or abnormal lymph nodes on mpMRI were considered positive findings. The final surgical pathology served as the standard of reference. The negative predictive value (NPV) was calculated for each modality separately, as well as the combined value. Results Included were 89 patients with D'Amico intermediate (45%) or high-risk (55%) prostate cancer. The median number of extracted LN was 9 (IQR 6-14). LNI was found in 12 (13.5%) patients. The NPV of mpMRI, PSMA PET/CT, and the two tests combined were 87%, 89%, and 90%, in the entire cohort, 95%, 97%, and 97% in patients with intermediate-risk disease, and 80%, 82%, and 83% in patients with high-risk disease, respectively. The median diameter of LN missed by both imaging and the median intranodal tumor diameter was 5.5 (IQR 3-10) mm and 1 (IQR 1-3) mm, respectively. Conclusions PSMA PET/CT and mpMRI demonstrated similar performance in excluding pelvic LNI with NPV of approximately 90%. The combination of both tests does not improve NPV significantly. Therefore, even in the era of advanced imaging, PLND is still recommended for accurate staging, especially in the high-risk population.
International braz j urol
To the editor, Prostate cancer (PC) has a highly variable clinic. It can remain for an extended period of time without any findings, as well as shows an aggressive course. Early diagnosis is very important. The most important diagnostic methods used in the PC are digital rectal examination, transrectal ultrasonography and prostate specific antigen (PSA) values. The exact diagnosis is made by histopathology (1). The correct staging of the PC is very important as it directly affects the treatment decision and patient management. Currently, staging tests are not recommended since the risk of metastasis is low in patients with low risk compared to D'Amico risk classification. It is recommended that patients in the middle-high risk group be performed by abdominal computer tomography (CT) or magnetic resonance imaging (MRI) with bone scintigraphy for staging (2-4). Since the 1980s, MRI has been used in the evaluation of the prostate gland and its surrounding structures among radiological diagnostic methods. It was originally used for staging in patients with PC diagnosis, and for determining invasion and lymph node metastases. Conventional MRI examinations (especially T2-weighted examinations) are the basic method for detecting PC, but they have high sensitivity but low specificity (2). In recent years, new software and techniques in MRI technique have made progress in anatomical, functional and physiological evaluation. Thus, the evaluation has increased sensitivity and specificity. In addition to high-resolution T2A examinations, dynamic, diffusion and MRI spectroscopies have been added to the diagnosis of PC. The MRI technique performed by adding at least two functional MRIs to the T2A sequences is called Multiparametric MRI (Mp-MRI). This method is the most commonly used technique for prostate imaging today. It is especially recommended to use MRI device with 3 Tesla main magnet power in imaging. Compared to 1.5T tesla devices, the signal-to-noise ratio, temporal and spatial resolution are higher in 3T devices. Biopsies can be taken from the lesion described in the light of Mp-MRI, and this reduces false negative rates (4-6). One of the most important benefits of Mp-MRI is its extraprostatic extension and local recurrence. Because the extension outside the capsule and the seminal vesicle involvement counted in the extraprostatic extension criterion are independent pathological criteria that increase the risk of local recurrence, progression and death. The probability of local recurrence in these cases considered high risk is 40-50% (6, 7). According to the meta-analysis of 5681 cases by de Rooij et al; in extracapsular invasion, MRI sensitivity and specificity were found to be 57% and 91%, respectively (2). In a study by Pokorny et al. they compared transrectal ultrasound guided biopsy and MP-MRI guided biopsy. They found that the MP-MRI examination reduced the biopsy requirement by 51%. They also reported that the MP-MRI examination reduced the clinical significance of low prostate cancer by 89.4% and increased the detection of medium / high risk prostate cancer by 17.7%. (3). In a review, it is stated that Mp-MRI is found to be highly specific and highly sensitive in detecting local recurrences and in the diagnosis of