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Clinical research

Diagnostic ability of Ga-68 PSMA PET to detect dominant and non-dominant tumors, upgrading and adverse pathology in patients with PIRADS 4–5 index lesions undergoing radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 24, pages 202–209 (2021)Cite this article

Subjects

Abstract

Background

To evaluate the additive role of Ga-68 PSMA PET as a primary staging tool in patients bearing prostate cancer in single PIRADS 4 or 5 index lesions.

Methods

Eighty-one biopsy-naive patients with preoperative mpMRI and Ga-68 PSMA PET who underwent radical prostatectomy (RP) were evaluated retrospectively. Forty-nine patients had PIRADS 4 and 32 had PIRADS 5 index lesions. The localization, grade, and volumetric properties of dominant (DT) and non-dominant tumors (NDT) in RP were compared to the index lesions of mpMRI and Ga-68 PSMA PET.

Results

The median age and PSA level were 62 (IQR; 59–69) years and 7 (IQR; 2–8) ng/ml, respectively. Ga-68 PSMA PET detected DTs in 100% of the patients including 13 patients in whom mpMR failed. In 45 patients an NDT was reported in RP. Ga-68 PSMA PET accurately detected NDT in 24 of 45 (53.3%) patients. Six patients (12.2%) in PIRADS 4 and 8 (25%) in PIRADS 5 group showed upgrading. In PIRADS 4, Ga-68 PSMA PET localized DT in all patients with upgraded tumors whereas mpMRI missed exact location in 2 of 6 (33.3%). In PIRADS 5 both mpMRI and Ga-68 PSMA PET accurately located all DTs. Overall detection rates of extracapsular extension (ECE) and seminal vesicle invasion (SVI) by mpMRI were 51.1% and 53.8%, respectively. Ga-68 PSMA PET detected ECE and SVI in 27.9% and 30.7%, respectively. When mpMRI and Ga-68 PSMA PET were used in combination detection rates of ECE and SVI increased to 65.1 and 61.5%. Ga-68 PSMA PET-detected six of ten patients with positive lymph nodes whereas mpMRI could not identify any.

Conclusions

Ga-68 PSMA PET has a better diagnostic accuracy in detecting DT, NDT, upgrading, adverse pathology in patients with PIRADS 4 index lesions. However, mpMRI better predicted ECE and SVI than Ga-68 PSMA PET.

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References

  1. Mottet N, van den Bergh RCN, Briers E, Cornford P, Santis M, Fanti S, et al. EAU-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer 2020. European Association of Urology Guidelines 2020 edition. Presented at the EAU Annual Congress Amsterdam 2020. European Association of Urology Guidelines Office: Arnhem, The Netherlands; 2020.

  2. Esen T, Kilic M, Seymen H, Acar O, Demirkol MO. Can Ga-68 PSMA PET/CT replace conventional imaging modalities for primary lymph node and bone staging of prostate cancer? Eur Urol Focus. 2020;6:218–20.

    Article  Google Scholar 

  3. Berger I, Annabattula C, Lewis J, Shetty DV, Kam J, Maclean F. et al. (68)Ga-PSMA PET/CT vs. mpMRI for locoregional prostate cancer staging: correlation with final histopathology. Prostate Cancer Prostatic Dis. 2018;21:204–11.

    Article  CAS  Google Scholar 

  4. Rhee H, Thomas P, Shepherd B, Gustafson S, Vela I, Russell PJ, et al. Prostate specific membrane antigen positron emission tomography may improve the diagnostic accuracy of multiparametric magnetic resonance imaging in localized prostate cancer. J Urol. 2016;196:1261–7.

    Article  CAS  Google Scholar 

  5. Demirci E, Kabasakal L, Sahin OE, Akgun E, Gultekin MH, Doganca T, et al. Can SUVmax values of Ga-68-PSMA PET/CT scan predict the clinically significant prostate cancer? Nucl Med Commun. 2019;40:86–91.

    Article  Google Scholar 

  6. Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet. 2020;395:1208–16.

    Article  CAS  Google Scholar 

  7. de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol. 2016;70:233–45.

    Article  Google Scholar 

  8. Futterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, et al. Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol. 2015;68:1045–53.

    Article  Google Scholar 

  9. Giesel FL, Sterzing F, Schlemmer HP, Holland-Letz T, Mier W, Rius M, et al. Intra-individual comparison of (68)Ga-PSMA-11-PET/CT and multi-parametric MR for imaging of primary prostate cancer. Eur J Nucl Med Mol Imaging. 2016;43:1400–6.

    Article  CAS  Google Scholar 

  10. Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA, et al. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013;40:486–95.

    Article  CAS  Google Scholar 

  11. Maurer T, Eiber M, Schwaiger M, Gschwend JE. Current use of PSMA-PET in prostate cancer management. Nat Rev Urol. 2016;13:226–35.

    Article  CAS  Google Scholar 

  12. Kalapara AA, Nzenza T, Pan HY, Ballok Z, Ramdave S, O’Sullivan R, et al. Detection and localisation of primary prostate cancer using (68) Ga-PSMA PET/CT compared with mpMRI and radical prostatectomy specimens. BJU Int. 2020;126:83–90.

    Article  CAS  Google Scholar 

  13. Amin A, Blazevski A, Thompson J, Scheltema MJ, Hofman MS, Murphy D, et al. Protocol for the PRIMARY clinical trial, a prospective, multicentre, cross-sectional study of the additive diagnostic value of gallium-68 prostate-specific membrane antigen positron-emission tomography/computed tomography to multiparametric magnetic resonance imaging in the diagnostic setting for men being investigated for prostate cancer. BJU Int. 2020;125:515–24.

    Article  CAS  Google Scholar 

  14. Bahler CD, Green M, Hutchins GD, Cheng L, Magers MJ, Fletcher J, et al. Prostate specific membrane antigen targeted positron emission tomography of primary prostate cancer: assessing accuracy with whole mount pathology. J Urol. 2020;203:92–9.

    Article  Google Scholar 

  15. Stabile A, Giganti F, Rosenkrantz AB, Taneja SS, Villeirs G, Gill IS, et al. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol. 2020;17:41–61.

    Article  Google Scholar 

  16. Schieda N, Quon JS, Lim C, El-Khodary M, Shabana W, Singh V, et al. Evaluation of the European Society of Urogenital Radiology (ESUR) PI-RADS scoring system for assessment of extra-prostatic extension in prostatic carcinoma. Eur J Radiol. 2015;84:1843–8.

    Article  Google Scholar 

  17. Roethke MC, Lichy MP, Jurgschat L, Hennenlotter J, Vogel U, Schilling D, et al. Tumorsize dependent detection rate of endorectal MRI of prostate cancer—a histopathologic correlation with whole-mount sections in 70 patients with prostate cancer. Eur J Radiol. 2011;79:189–95.

    Article  Google Scholar 

  18. Zamboglou C, Drendel V, Jilg CA, Rischke HC, Beck TI, Schultze-Seemann W, et al. Comparison of (68)Ga-HBED-CC PSMA-PET/CT and multiparametric MRI for gross tumour volume detection in patients with primary prostate cancer based on slice by slice comparison with histopathology. Theranostics. 2017;7:228–37.

    Article  CAS  Google Scholar 

  19. Woythal N, Arsenic R, Kempkensteffen C, Miller K, Janssen JC, Huang K, et al. Immunohistochemical validation of PSMA expression measured by (68)Ga-PSMA PET/CT in primary prostate cancer. J Nucl Med. 2018;59:238–43.

    Article  CAS  Google Scholar 

  20. Koerber SA, Utzinger MT, Kratochwil C, Kesch C, Haefner MF, Katayama S. et al. (68)Ga-PSMA-11 PET/CT in newly diagnosed carcinoma of the prostate: correlation of intraprostatic PSMA uptake with several clinical parameters. J Nucl Med. 2017;58:1943–8.

    Article  CAS  Google Scholar 

  21. Uprimny C, Kroiss AS, Decristoforo C, Fritz J, von Guggenberg E, Kendler D. et al. (68)Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Med Mol Imaging. 2017;44:941–9.

    Article  CAS  Google Scholar 

  22. Qi F, Zhu K, Cheng Y, Hua L, Cheng G. How to pick out the “Unreal” gleason 3 + 3 patients: a nomogram for more precise active surveillance protocol in low-risk prostate cancer in a Chinese population. J Invest Surg. 2019;6:1–8.

    Article  Google Scholar 

  23. Vellekoop A, Loeb S, Folkvaljon Y, Stattin P. Population based study of predictors of adverse pathology among candidates for active surveillance with Gleason 6 prostate cancer. J Urol. 2014;191:350–7.

    Article  Google Scholar 

  24. Druskin SC, Liu JJ, Young A, Feng Z, Dianat SS, Ludwig WW, et al. Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status. Res Rep Urol. 2017;9:55–63.

    PubMed  PubMed Central  Google Scholar 

  25. Rocco B, Sighinolfi MC, Sandri M, Eissa A, Elsherbiny A, Zoeir A, et al. Is extraprostatic extension of cancer predictable? A review of predictive tools and an external validation based on a large and a single center cohort of prostate cancer patients. Urology. 2019;129:8–20.

    Article  Google Scholar 

  26. von Klot CJ, Merseburger AS, Boker A, Schmuck S, Ross TL, Bengel FM. et al. (68)Ga-PSMA PET/CT imaging predicting intraprostatic tumor extent, extracapsular extension and seminal vesicle invasion prior to radical prostatectomy in patients with prostate cancer. Nucl Med Mol Imaging. 2017;51:314–22.

    Article  Google Scholar 

  27. Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C. et al. (68)Ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer. Eur Urol. 2016;70:553–7.

    Article  CAS  Google Scholar 

  28. Budaus L, Leyh-Bannurah SR, Salomon G, Michl U, Heinzer H, Huland H, et al. Initial experience of (68)Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol. 2016;69:393–6.

    Article  Google Scholar 

  29. Hope TA, Goodman JZ, Allen IE, Calais J, Fendler WP, Carroll PR. Metaanalysis of (68)Ga-PSMA-11 PET accuracy for the detection of prostate cancer validated by histopathology. J Nucl Med. 2019;60:786–93.

    Article  CAS  Google Scholar 

  30. van Leeuwen PJ, Emmett L, Ho B, Delprado W, Ting F, Nguyen Q, et al. Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU Int. 2017;119:209–15.

    Article  Google Scholar 

  31. Hovels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008;63:387–95.

    Article  CAS  Google Scholar 

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Author notes

  1. These authors contributed equally: Mehmet Onur Demirkol, Tarik Esen

Authors and Affiliations

  1. Department of Urology, Koç University Hospital, Istanbul, Turkey

    Ersin Koseoglu

  2. Department of Urology, School of Medicine, Koç University, Istanbul, Turkey

    Yakup Kordan, Murat Can Kiremit, Abdullah Erdem Canda, Derya Balbay & Tarik Esen

  3. Department of Urology, VKF American Hospital, Istanbul, Turkey

    Mert Kilic, Derya Balbay & Tarik Esen

  4. School of Medicine, Koç University, Istanbul, Turkey

    Oguzhan Sal

  5. Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Koç University, Istanbul, Turkey

    Hulya Seymen, Okan Falay & Mehmet Onur Demirkol

  6. Department of Pathology, School of Medicine, Koç University, Istanbul, Turkey

    Ayse Armutlu & Dilek Ertoy Baydar

  7. Department of Radiology, School of Medicine, Koç University, Istanbul, Turkey

    Emre Altinmakas

  8. Department of Radiology, VKF American Hospital, Istanbul, Turkey

    Metin Vural

  9. Department of Nuclear Medicine and Molecular Medicine, VKF American Hospital, Istanbul, Turkey

    Mehmet Onur Demirkol

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Koseoglu, E., Kordan, Y., Kilic, M. et al. Diagnostic ability of Ga-68 PSMA PET to detect dominant and non-dominant tumors, upgrading and adverse pathology in patients with PIRADS 4–5 index lesions undergoing radical prostatectomy. Prostate Cancer Prostatic Dis 24, 202–209 (2021). https://doi.org/10.1038/s41391-020-00270-8

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