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  • Year in Review
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IMAGING IN 2018

Practice changing for prostate cancer: a vision of the future

Nature Reviews Urology volume 16, pages 71–72 (2019)Cite this article

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2018 has been an exciting year for imaging in urology, especially in the field of prostate cancer. In this context, multiparametric MRI and molecular imaging targeting prostate-specific membrane antigen provide practice-changing developments for detection and diagnostic work-up.

Key advances

  • Targeting biopsies in patients with abnormal findings on multiparamentric MRI (mpMRI) is superior to standard ultrasonography-guided biopsy in detecting clinically significant prostate cancer at initial evaluation1.

  • A minority of patients with negative mpMRI develop clinically significant prostate cancer at 4 years. Increasing PSA levels and higher PSA density predict increased likelihood of disease development3.

  • In biochemically recurrent prostate cancer, detection rates by 68Ga-PSMA-PET are ~55% and ~70% for patients with PSA values between 0.2 and 0.5 ng/ml and between 0.5 and 1.0 ng/ml, respectively5.

  • Results from 68Ga-PSMA-PET change management in approximately half of patients with biochemically recurrent prostate cancer6.

  • Novel fluorinated PSMA ligands might replace 68Ga-based PSMA ligands for PET staging of prostate cancer owing to reduced urinary excretion and advantageous pelvic imaging, easier handling and increased availability8.

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Fig. 1: 68Ga-PSMA-PET–CT of a 74-year-old patient with recurrent prostate cancer (initial Gleason score 7) after radical prostatectomy and local salvage radiotherapy with rising serum PSA value (1.76 ng/ml at the time of assessment).

References

  1. Kasivisvanathan, V. et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N. Engl. J. Med. 378, 1767–1777 (2018).

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  2. Ahmed, H. U. et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389, 815–822 (2017).

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  3. Panebianco, V. et al. Negative multiparametric magnetic resonance imaging for prostate cancer: what’s next? Eur. Urol. 74, 48–54 (2018).

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  4. Maurer, T. et al. Current use of PSMA-PET in prostate cancer management. Nat. Rev. Urol. 13, 226–235 (2016).

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  5. Rauscher, I. et al. Efficacy, predictive factors, and prediction nomograms for 68Ga-labeled prostate-specific membrane antigen-ligand positron-emission tomography/computed tomography in early biochemical recurrent prostate cancer after radical prostatectomy. Eur. Urol. 73, 656–661(2018).

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  6. Han, S. et al. Impact of 68Ga-PSMA PET on the management of patients with prostate cancer: a systematic review and meta-analysis. Eur. Urol. 74, 179–190 (2018).

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  7. Maurer, T. et al. 99mTechnetium-based prostate-specific membrane antigen-radioguided surgery in recurrent prostate cancer. Eur. Urol. https://doi.org/10.1016/j.eururo.2018.03.013 (2018).

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  8. Giesel, F. L. et al. Detection efficacy of [18F]PSMA-1007 PET/CT in 251 patients with biochemical recurrence after radical prostatectomy. J. Nucl. Med. https://doi.org/10.2967/jnumed.118.212233 (2018).

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Authors and Affiliations

  1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Tobias Maurer

  2. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Tobias Maurer

  3. Department of Nuclear Medicine, Technical University of Munich, Munich, Germany

    Matthias Eiber

Authors
  1. Tobias Maurer
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  2. Matthias Eiber
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Correspondence to Tobias Maurer.

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All authors declare no competing interests.

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Maurer, T., Eiber, M. Practice changing for prostate cancer: a vision of the future. Nat Rev Urol 16, 71–72 (2019). https://doi.org/10.1038/s41585-018-0134-6

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