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Evaluating F-18-PSMA-1007-PET in primary prostate cancer and comparing it to multi-parametric MRI and histopathology

Prostate Cancer and Prostatic Diseases volume 24, pages 423–430 (2021)Cite this article

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Abstract

Background

PSMA-PET is a novel imaging modality for the staging of prostate cancer (PCa). While there are several PSMA ligands available, F-18-PSMA-1007 is particularly of interest as it is not renally excreted and therefore does not impair the imaging of the pelvic area. Hence, this study aimed to investigate the F-18-PSMA-1007-PET for the primary staging of PCa and compared it to multi-parametric (mp) MRI and histopathology.

Methods

A retrospective study was performed of men with intermediate and high-risk PCa patients that underwent a F-18-PSMA-1007-PET after mpMRI with subsequent MR-guided target biopsy (MRGB). Suspicious mpMRI lesions and F-18-PSMA-1007-PET were simultaneously reviewed on both a per patient and per-lesion basis. Results were subsequently evaluated with histopathological outcome of MRGB, and if performed, the radical prostatectomy specimen.

Results

A total of 66 suspicious mpMRI lesions were identified in 53 patients and underwent MRGB. Two lesions had a maximum standardized uptake value (SUVmax) less than the mean SUVmax of healthy prostate tissue and were considered as non-PSMA-expressing. All PSMA avid tumors had higher SUVmax than the mean SUVmean of the bladder/urine, therefore all lesions were clearly distinguishable in the pelvic area. Twenty-three patients received a radical prostatectomy of which the histopathology specimens were evaluated. F-18-PSMA-1007-PET/CT correctly staged seminal vesicle invasion (i.e. pT3b) more often than mpMRI (90 vs. 76%), whereas mpMRI more accurately detected extracapsular extension (i.e. pT3a) compared to F-18-PSMA-1007-PET (90% vs 57%).

Conclusions

The present study of a selected cohort suggest that dual imaging with mpMRI and F-18-PSMA-1007-PET may improve staging of primary PCa. F-18-PSMA-1007-PET/CT had low renal clearance, which could assist the evaluation of tumors in proximity of the bladder.

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Fig. 1: SUVmax and ADC stratified for biopsy ISUP grades.
Fig. 2: Concordance of the tumor stage on mpMRI and F-18-PSMA-PET after histopathologic evaluation.
Fig. 3: pT2 (a–c) and a pT3b (d–f) tumor on mpMRI and F-18-PSMA-PET.

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Data availability

Data are available on request.

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Author notes

  1. These authors contributed equally: Bastiaan Privé, Bas Israël

  2. These authors jointly supervised this work: Inge van Oort, Prof James Nagarajah

Authors and Affiliations

  1. Department of Radiology & Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

    Bastiaan M. Privé, Bas Israël, Melline G. M. Schilham, Patrik Zámecnik, Fred Verzijlbergen, Marcel J. R. Janssen, Martin Gotthardt, Jelle O. Barentsz & James Nagarajah

  2. Department of Urology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

    Constantijn H. J. Muselaers, Peter F. A. Mulders, J. Alfred Witjes, Michiel Sedelaar & Inge M. van Oort

  3. Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands

    Niven Mehra

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Correspondence to Bastiaan M. Privé.

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Privé, B.M., Israël, B., Schilham, M.G.M. et al. Evaluating F-18-PSMA-1007-PET in primary prostate cancer and comparing it to multi-parametric MRI and histopathology. Prostate Cancer Prostatic Dis 24, 423–430 (2021). https://doi.org/10.1038/s41391-020-00292-2

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