Non-prostate cancer tumours: incidence on 18F-DCFPyL PSMA PET/CT and uptake characteristics in 1445 patients (original) (raw)
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PSMA PET-CT in the Diagnosis and Staging of Prostate Cancer
Diagnostics
Prostate cancer is the most common cancer and the second leading cause of cancer death in men. The imaging assessment and treatment of prostate cancer has vastly improved over the past decade. The introduction of PSMA PET-CT has improved the detection of loco-regional and metastatic disease. PSMA PET-CT also has a role in the primary diagnosis and staging, in detecting biochemical recurrence after curative treatment and in metastasis-directed therapy. In this paper we review the role of PSMA PET-CT in prostate cancer.
Journal of Nuclear Medicine, 2019
18 F-PSMA-1007 is a novel prostate-specific membrane antigen (PSMA)-based radiopharmaceutical for imaging prostate cancer (PCa). The aim of this study was to compare the diagnostic accuracy of 18 F-PSMA-1007 with 68 Ga-PSMA-11 PET/CT in the same patients presenting with newly diagnosed intermediate-or high-risk PCa. Methods: Sixteen patients with intermediate-or high-risk PCa underwent 18 F-PSMA-1007 and 68 Ga-PSMA-11 PET/CT within 15 d. PET findings were compared between the 2 radiotracers and with reference-standard pathologic specimens obtained from radical prostatectomy. The Cohen κ-coefficient was used to assess the concordance between 18 F-PSMA-1007 and 68 Ga-PSMA-11 for detection of intraprostatic lesions. The McNemar test was used to assess agreement between intraprostatic PET/CT findings and histopathologic findings. Sensitivity, specificity, positive predictive value, and negative predictive value were reported for each radiotracer. SUV max was measured for all lesions, and tumor-to-background activity was calculated. Areas under receiver-operating-characteristic curves were calculated for discriminating diseased from nondiseased prostate segments, and optimal SUV cutoffs were calculated using the Youden index for each radiotracer. Results: PSMA-avid lesions in the prostate were identified in all 16 patients with an almost perfect concordance between the 2 tracers (κ ranged from 0.871 to 1). Aside from the dominant intraprostatic lesion, similarly detected by both radiotracers, a second less intense positive focus was detected in 4 patients only with 18 F-PSMA-1007. Three of these secondary foci were confirmed as Gleason grade 3 lesions, whereas the fourth was shown on pathologic examination to represent chronic prostatitis. Conclusion: This pilot study showed that both 18 F-PSMA-1007 and 68 Ga-PSMA-11 identify all dominant prostatic lesions in patients with intermediateor high-risk PCa at staging. 18 F-PSMA-1007, however, may detect additional low-grade lesions of limited clinical relevance.
Scripta Scientifica Medica, 2022
INTRODUCTION: Currently 68 Ga-PSMA PET/CT is making a significant shift in the diagnosis, staging and restaging of prostate cancer (PC) patients. Мany questions have been raised concerning the indications and the sensitivity of the method. Most of them are related to the PSA values in biochemical progression, specifically in the low PSA values of up to 2.00 ng/mL. AIM: The aim of this study was to analyze the influence of PSA values in biochemical progression on 68 Ga-PSMA PET/CT sensitivity, detection rate and the association with regional or metastatic lesions incidence in patients after radical prostatectomy (RP) with a focus on the impact of the lower ranges of the PSA values. MATERIAL AND METHODS: We performed a retrospective analysis in 144 consecutive patients with radical prostatectomy (RP) who underwent 68 Ga-PSMA PET/CT from July 2019 to February 2020. The patients were divided into six groups according to the PSA value: 1) ≤0.040 ng/mL; 2) 0.041-0.160 ng/mL; 3) 0.161-0.500 ng/mL; 4) 0.501-1.0 ng/mL; 5) 1.001-2.00 ng/mL; 6) >2.00 ng/mL. RESULTS AND DISCUSSION: The mean age of the patients was 67.3 (7) years and the mean PSA level was 11.0 (52.28) ng/mL. A total of 62 patients (43.1%) showed at least one positive lesion. 68 Ga-PSMA PET/CT detection rate varied into the different groups between 12.0% and 94.0%. There was a significant relationship between the PSA level and the ability of 68 Ga-PSMA PET/CT to detect the lesions. Local recurrence was determined in patients with higher PSA values. Regional metastatic lymph nodes incidence in the 6 groups was between 17.0% and 50.0%. Bone metastases were most commonly diagnosed in patients with low PSA levels. Distant lymph nodes involvement in the studied groups ranged between 0.0% and 75.0%. Distant metastases were detected most commonly in patients with low levels of PSA. The PSA-based assessment of the overall sensitivity and specificity of 68 Ga-PSMA PET/CT was
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.
Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging, 2016
Current standard of care conventional imaging modalities (CIM) such as X-ray computed tomography (CT) and bone scan can be limited for detection of metastatic prostate cancer and therefore improved imaging methods are an unmet clinical need. We evaluated the utility of a novel second-generation low molecular weight radiofluorinated prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) radiotracer, [(18)F]DCFPyL, in patients with metastatic prostate cancer. Nine patients with suspected prostate cancer recurrence, eight with CIM evidence of metastatic prostate cancer and one with biochemical recurrence, were imaged with [(18)F]DCFPyL PET/CT. Eight of the patients had contemporaneous CIM for comparison. A lesion-by-lesion comparison of the detection of suspected sites of metastatic prostate cancer was carried out between PET and CIM. Statistical analysis for estimated proportions of inter-modality agreement for detection of metastatic disease was calcula...
Clinical Impact of 68Ga-PSMA PET/CT in a Patient With Biochemical Recurrence of Prostate Cancer
Clinical nuclear medicine, 2016
A 64-year-old man with history of prostate adenocarcinoma underwent radical prostatectomy in 2003. He remained with undetectable prostate-specific antigen (PSA) levels until 2014, when he then presented rising serum PSA levels and performed a Tc-MDP bone scan that was negative for metastases. In August 2015, his PSA was 4.89 ng/dL, and restaging images with pelvic MR and F-FDG PET/CT were both negative. Therefore, the patient underwent a Ga-PSMA PET/CT that showed marked tracer uptake in a single mediastinal lymph node. Histopathology demonstrated metastatic adenocarcinoma secondary to prostate cancer, altering patient management to hormone therapy instead of pelvic radiotherapy.
Cancers
PSMA-PET/CT is a suitable replacement for conventional imaging in the primary staging of PCa. The aim of this retrospective study was to assess the correlation between parameters discovered by PSMA PET/CT in primary staging and either prostate histopathology (pT) findings or PSMA-IHC expression in a cohort of biopsy-proven high-risk PCa candidates for surgery. Clinical information (age, iPSA-value, and grading group) and PSMA-PET/CT parameters (SUVmax, PSMA tumor volume [PSMA-TV], and total lesion [PSMA-TL]) were compared with pT (including histologic pattern, Gleason grade, and lymphovascular invasion [LVI]) and PSMA-IHC features, including visual quantification (VS) with a four-tiered score (0 = negative, 1+ = weak, 2+ = moderate, 3+ = strong), growth pattern (infiltrative vs expansive), and visual pattern (cytoplasmic vs membranous). In total, 44 patients were enrolled, with a median age of 67 (IQR 57-77); the median iPSA was 9.4 ng/dL (IQR 12.5-6.0). One patient (3%) was grading...
Journal of Nuclear Medicine, 2020
Bone is the most common site of distant metastatic spread in prostate adenocarcinoma. Prostatespecific membrane antigen uptake has been described in both benign and malignant bone lesions, which can lead to false-positive findings on 68 Ga-prostate-specific membrane antigen-11 positron emission tomography (68 Ga-PSMA-11 PET). The purpose of this study was to evaluate the diagnostic accuracy of 68 Ga-PSMA-11 PET for osseous prostate cancer metastases and improve bone uptake interpretation using semi-quantitative metrics. METHODS. 56 prostate cancer patients (18 pre-prostatectomy, 38 biochemical recurrence) who underwent 68 Ga-PSMA-11 PET/MRI or PET/CT examinations with osseous PSMA-ligand uptake were included in the study. Medical records were reviewed retrospectively by boardcertified nuclear radiologists to determine true or false positivity based on a composite endpoint. For each avid osseous lesion, biological volume, size, PSMA-RADS rating, maximum standardized uptake value (SUVmax), and ratio of lesion SUVmax to liver, blood pool, and background bone SUVmax were measured. Differences between benign and malignant lesions were evaluated for statistical significance, and cutoff values for these parameters were determined to maximize diagnostic accuracy. RESULTS. Among 56 participants, 13 patients (22.8%) had false-positive osseous 68 Ga-PSMA-11 findings and 43 patients (76.8%) had true-positive osseous 68 Ga-PSMA-11 findings. Twentytwo patients (39%) had 1 osseous lesion, 18 (32%) had 2-4 lesions, and 16 (29%) had 5 or more lesions. Cutoff values resulting in statistically significant (p<0.005) differences between benign and malignant lesions were: PSMA-RADS ≥4, SUVmax ≥4.1, SUVmax ratio of lesion to blood pool ≥2.11, to liver ≥0.55, and to bone ≥4.4. These measurements corresponded to lesion-based 68 Ga-PSMA-11 PET lesion detection rate for malignancy of 80%, 93%, 89%, 21%, 89%, and a specificity of 73%, 73%, 73%, 93%, 60%, respectively. CONCLUSION. PSMA-RADS rating, SUVmax, and SUVmax ratio of lesion to blood pool can help differentiate benign from malignant lesions on 68 Ga-PSMA-11 PET. SUVmax ratio to blood pool above 2.2 is a reasonable parameter to support image interpretation and presented superior lesion detection rate and specificity when compared to visual interpretation by PSMA RADS. These parameters hold clinical value by improving diagnostic accuracy for metastatic prostate cancer on 68 Ga-PSMA-11 PET/MRI and PET/CT.
Nuclear Medicine Review, 2023
Background: Our aim is to determine the accuracy of [ 68 Ga]Ga-PSMA PET/CT in showing PSMA expression in primary prostate cancer and to investigate the relationship between SUVmax and immunohistochemical PSMA expression, Gleason score, and PSA value. Material and methods: We retrospectively analyzed 66 male patients who were diagnosed with primary prostate adenocarcinoma, underwent pre-treatment [ 68 Ga]Ga-PSMA PET/CT examination for staging, and performed radical prostatectomy between March 2018-August 2020. Immunohistochemical staining was applied to the radical prostatectomy specimens of all patients to detect PSMA expression. The results were evaluated as an immunoreactive score (IRS) and a modified IRS was obtained. Gleason score groups and prostate-specific antigen (PSA) serum values of the patients were obtained from the patient files. Results: The high SUVmax of primary prostate tumors was significantly correlated with a high modified IRS score (score 2; 3), high PSA value, high Gleason score, and metastasis. In correlation analysis, a positive correlation was found between SUVmax and PSA value and modified IRS score (r = 0.69, p = 0.001; r = 0.39, p = 0.001). In addition, there was a statistically significant weak correlation between PSA serum concentration and modified IRS scores (r = 0.267; p = 0.03). In regression analysis, the percentage of positive cells had a statistically significant and increasing effect on SUVmax (p = 0.031; std beta = 0.268; 95% CI = 0.231-4.596). Conclusions: In prostate adenocarcinoma, SUVmax of the primary tumor in [ 68 Ga]Ga-PSMA PET/CT correlates with immunohistochemical PSMA expression. In addition, high SUVmax is associated with markers of poor prognoses, such as high PSMA expression, PSA value, and Gleason score.
18F-DCFBC PET/CT for PSMA-based Detection and Characterization of Primary Prostate Cancer
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2015
We previously demonstrated the ability to detect metastatic prostate cancer using (18)F-DCFBC (DCFBC), a low-molecular-weight radiotracer that targets the prostate-specific membrane antigen (PSMA). PSMA has been shown to be associated with higher Gleason grade and more aggressive disease. An imaging biomarker able to detect clinically significant high-grade primary prostate cancer reliably would address an unmet clinical need by allowing for risk-adapted patient management. We enrolled 13 patients with primary prostate cancer who were imaged with DCFBC PET prior to scheduled prostatectomy, with 12 of these patients also undergoing pelvic prostate MRI. Prostate DCFBC PET was correlated with MRI and histological and immunohistochemical (IHC) analysis on a prostate segment (12 regions) and dominant lesion basis. There were no incidental extraprostatic findings on PET suspicious for metastatic disease. MRI was more sensitive than DCFBC PET for detection of primary prostate cancer on a p...