Detection of prostate cancer with 18F-DCFPyL PET/CT compared to final histopathology of radical prostatectomy specimens: is PSMA-targeted biopsy feasible? The DeTeCT trial

Abstract Purpose In primary prostate cancer (PCa) patients, accurate staging and histologic grading are crucial to guide treatment decisions. 18F-DCFPyL (PSMA)-PET/CT has been successfully introduced for (re)staging PCa, showing high accuracy to localise PCa in lymph nodes and/or osseous structures. The diagnostic performance of 18F-DCFPyL-PET/CT in localizing primary PCa within the prostate gland was assessed, allowing for PSMA-guided targeted-prostate biopsy. Methods Thirty patients with intermediate-/high-risk primary PCa were prospectively enrolled between May 2018 and May 2019 and underwent 18F-DCFPyL-PET/CT prior to robot-assisted radical prostatectomy (RARP). Two experienced and blinded nuclear medicine physicians assessed tumour localisation within the prostate gland on PET/CT, using a 12-segment mapping model of the prostate. The same model was used by a uro-pathologist for the RARP specimens. Based on PET/CT imaging, a potential biopsy recommendation was given per patient, based on the size and PET-intensity of the suspected PCa localisations. The biopsy recommendation was correlated to final histopathology in the RARP specimen. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for clinically significant PCa (csPCa, Gleason score ≥ 3 + 4 = 7) were assessed. Results The segments recommended for potential targeted biopsy harboured csPCA in 28/30 patients (93%), and covered the highest Gleason score PCa segment in 26/30 patient (87%). Overall, 122 of 420 segments (29.0%) contained csPCa at final histopathological examination. Sensitivity, specificity, PPV and NPV for csPCa per segment using 18F-DCFPyL-PET/CT were 61.4%, 88.3%, 68.1% and 84.8%, respectively. Conclusions When comparing the PCa-localisation on 18F-DCFPyL-PET/CT with the RARP specimens, an accurate per-patient detection (93%) and localisation of csPCa was found. Thus, 18F-DCFPyL-PET/CT potentially allows for accurate PSMA-targeted biopsy.

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Letter to the Editor BJUI in response to Montorsi et al .: Histological comparison between predictive value of preoperative 3‐T multiparametric MRI and 68 Ga‐PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer

BJU International ◽

10.1111/bju.15377 ◽

2021 ◽

Vol 127 (6) ◽

pp. 747-747

Author(s):

John Yaxley

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Radical Prostatectomy ◽

Predictive Value ◽

Multiparametric Mri ◽

Pelvic Lymph Node Dissection ◽

Node Dissection ◽

Psma Pet ◽

Pet Ct ◽

Pet Ct Scan

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Clinical accuracy of detecting recurrent prostate cancer lesions with F-18-Fluoroethylcholine or Ga-68-PSMA-HBED-CC PET/CT.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.218 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 218-218

Author(s):

David J. K. P. Pfister ◽

Daniel Porres ◽

Axel Heidenreich ◽

Florian Behrendt ◽

Frederik Verburg

Keyword(s):

Prostate Cancer ◽

Predictive Value ◽

Recurrent Prostate Cancer ◽

Retroperitoneal Lymphadenectomy ◽

Imaging Results ◽

Psma Pet ◽

Pet Ct ◽

Study Results ◽

Clinical Accuracy ◽

Sensitivity Specificity

218 Background: Ga-68-PSMA-HBED-CC (PSMA) is a novel and promising tracer for highly sensitive PET/CT diagnosis in recurrent prostate cancer (PCA). The aim of the present work was to assess the sensitivity, specificity, positive and negative predictive value (PPV/NPV) per lesion as well as the positive predictive value per patient of PSMA PET/CT in patients with recurrent prostate cancer referred for surgery after a positive PET/CT and to compare this with a collective of patients scanned using the current de-facto PET/CT standard tracer F-18-Fluoroethylcholine (FEC). Methods: In this retrospective study results of PET/CTs and post-surgical histological analysis were compared. 38 patients had FEC and 27 patients had PSMA. We performed a pelvic and/or retroperitoneal lymphadenectomy, if necessary supplemented by resection of locally recurrent lesions in accordance with imaging results. Results: In 30/38 FEC and 22/27 PSMA patients at least one focus of PCA was identified in postsurgical histology, leading to a PPV of 78.9% for FEC and 81.5% for PSMA. In FEC and PSMA patients a total of 378 and 308 lymph nodes and local lesions were removed, respectively. For FEC and PSMA the respective sensitivity was 71.2% and 86.9%, specificity 86.9% and 93.1%, PPV 67.3% and 75.7% and NPV 88.8% and 96.6%. Conclusions: In the present series PSMA PET/CT shows a somewhat better performance than the current de-facto PET/CT standard tracer FEC. Due to the very high NPV of PSMA PET/CT a selective locoregional lymphadenectomy involving only the regions affected on imaging can be discussed.

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Histological comparison between predictive value of preoperative 3‐T multiparametric MRI and 68 Ga‐PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer

BJU International ◽

10.1111/bju.15134 ◽

2020 ◽

Vol 127 (1) ◽

pp. 71-79

Author(s):

Anthony Franklin ◽

William J. Yaxley ◽

Sheliyan Raveenthiran ◽

Geoff Coughlin ◽

Troy Gianduzzo ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Radical Prostatectomy ◽

Predictive Value ◽

Multiparametric Mri ◽

Pelvic Lymph Node Dissection ◽

Node Dissection ◽

Psma Pet ◽

Pet Ct ◽

Pet Ct Scan

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Re: Histological comparison between predictive value of preoperative 3-T multiparametric MRI and 68Ga-PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer

BJU International ◽

10.1111/bju.15308 ◽

2020 ◽

Author(s):

Francesco Montorsi ◽

Giorgio Gandaglia ◽

Nicola Fossati ◽

Federico Dehò ◽

Alberto Briganti

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Radical Prostatectomy ◽

Predictive Value ◽

Multiparametric Mri ◽

Pelvic Lymph Node Dissection ◽

Node Dissection ◽

Psma Pet ◽

Pet Ct ◽

Pet Ct Scan

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68Ga-PSMA PET/CT imaging predicting intraprostatic tumor extent prior to radical prostatectomy in patients with prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.e632 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. e632-e632

Author(s):

Christoph A. J. von Klot ◽

Axel S. Merseburger ◽

Markus A. Kuczyk ◽

Sebastian Schmuck ◽

Frank M. Bengel ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Seminal Vesicle ◽

Sensitivity And Specificity ◽

Gleason Score ◽

Tnm Stage ◽

Seminal Vesicle Invasion ◽

Psma Pet ◽

Pet Ct ◽

Tumor Extent

e632 Background: The performance of gallium Ga 68 (68Ga)-labeled prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) shows promising results with regard to lymph node detection even at low prostate specific antigen (PSA) levels in patients with biochemical recurrence after curative therapy for prostate cancer. In this study we evaluate the usefulness of PSMA-PET/CT for the evaluation of intraprostatic tumor extent prior to radical prostatectomy. Methods: In total 15 patients with prostate cancer underwent a 68Ga-PSMA-PET/CT before surgical treatment. All patients received either open or laparoscopic radical prostatectomy. Intraprostatic tumor extent was assessed on PET/CT. The peak standardized uptake value (SUV) was correlated with final whole gland histopathology including Gleason grade, lobe infiltration, TNM stage and seminal vesicle invasion. Results: Mean SUV over all patients was 10.64 ±9.19. Median Gleason score was 7. The distribution of TNM stage 2a, 2b, 2c, 3a, 3b, 4 was 0, 2, 6, 5, 2 and 0 patients. Mean intraprostatic SUV for patients with organ confined vs. extraprostatic tumor on histopathology was 6.3 and 15 respectively (p = 0.043). Mean SUV for patients with a Gleason score of ≤ 7a and > 7a was 6.2 and 13.5 (p = 0.046). Sensitivity and specificity for identifying tumor invasion of a prostate lobe was 84.6% and 75% (Positive and negative predictive value (PPV, NPV) for prostate lobe invasion were 95.7% and 42.9%). Sensitivity and specificity for seminal vesicle invasion were 50% and 100% (PPV 100%, NPV 96.6%). Conclusions: These early results need to be further validated in a larger cohort.

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Heterogenous PSMA expression in primary tumor of prostate cancer as a reason for negative 68 Ga-PSMA PET/CT scan? Immunohistochemical validation of 40 patients undergoing radical prostatectomy

10.1055/s-0040-1708334 ◽

2020 ◽

Author(s):

W Cytawa ◽

S Kircher ◽

C Lapa ◽

AK Buck ◽

B Brockhuis ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Ct Scan ◽

Primary Tumor ◽

Psma Pet ◽

Pet Ct ◽

Pet Ct Scan ◽

Psma Expression

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Oligometastatic Disease Detection with 68Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact

Cancers ◽

10.3390/cancers13194982 ◽

2021 ◽

Vol 13 (19) ◽

pp. 4982

Author(s):

Carlos Artigas ◽

Romain Diamand ◽

Qaid Ahmed Shagera ◽

Nicolas Plouznikoff ◽

Fabrice Fokoue ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Predictive Factors ◽

Clinical Management ◽

Biochemical Recurrence ◽

Oligometastatic Disease ◽

Psma Pet ◽

Pet Ct ◽

Hormone Sensitive

Metastasis-directed therapy (MDT) in oligometastatic prostate cancer has the potential of delaying the start of androgen deprivation therapy (ADT) and disease progression. We aimed to analyze the efficacy of PSMA-PET/CT in detecting oligometastatic disease (OMD), to look for predictive factors of OMD, and to evaluate the impact of PSMA-PET/CT findings on clinical management. We retrospectively analyzed a homogeneous population of 196 hormone-sensitive prostate cancer patients (HSPC), considered potential candidates for MDT, with a PSMA-PET/CT performed at biochemical recurrence (BCR) after radical prostatectomy (RP). Multivariable logistic regression analysis was performed based on several clinico-pathological factors. Changes in clinical management before and after PSMA-PET/CT were analyzed. The OMD detection rate was 44% for a total positivity rate of 60%. PSMA-PET/CT positivity was independently related to PSA (OR (95%CI), p) (1.7 (1.3–2.3), p < 0.0001) and PSAdt (0.4 (0.2–0.8), p = 0.013), and OMD detection was independently related to PSA (1.6 (1.2–2.2), p = 0.001) and no previous salvage therapy (0.3 (0.1–0.9), p = 0.038). A treatment change was observed in 58% of patients, mostly to perform MDT after OMD detection (60% of changes). This study showed that PSMA-PET/CT is an excellent imaging technique to detect OMD early in HSPC patients with BCR after RP, changing therapeutic management mostly into MDT.

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