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IMAGING IN 2018

Practice changing for prostate cancer: a vision of the future

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

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    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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Correspondence to Tobias Maurer.

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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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