68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography-Computed Tomography-Based Primary Staging and Histological Correlation after Extended Pelvic Lymph Node Dissection in Intermediate-Risk Prostate Cancer

Objective: The objective of this study is to evaluate prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET/CT)-based primary staging in exclusively D′Amico intermediate-risk prostate cancer (PCa) patients. Patients and Methods: We relied on the Braunschweig institutional database and retrospectively identified D′Amico intermediate-risk PCa patients who were administered to 68Ga-PSMA PET/CT-based primary staging prior to consecutive radical prostatectomy and extended lymph node dissection. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of lymph node metastases were analyzed per-patient (n = 39), per-pelvic side (n = 78), and per-anatomic-region (external iliac artery and vein left/right vs. obturator fossa left/right vs. internal iliac artery left/right) (n = 203), respectively. Results: Sensitivity, specificity, PPV, and NPV per-patient were 20.0, 94.1, 33.3, and 88.9%, respectively. Sensitivity, specificity, PPV, and NPV per-pelvic-side were 16.7, 97.2, 33.3, and 93.3%, respectively. Sensitivity, specificity, PPV, and NPV per-anatomic-region were 16.7, 99.0, 33.3, and 97.5%, respectively. Conclusions: We recorded high rates of specificity and NPV for 68Ga-PSMA PET/CT-based primary staging in D′Amico intermediate-risk PCa patients. Conversely, the sensitivity and PPV were lower than anticipated. Larger and favorably prospective trials are needed to verify our results and to unravel possible bias from such smaller studies.

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How accurate is 68Gallium-prostate specific membrane antigen positron emission tomography / computed tomography (68Ga-PSMA PET/CT) on primary lymph node staging before radical prostatectomy in intermediate and high risk prostate cancer? A study of patient- and lymph node- based analyses

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.07.006 ◽

2021 ◽

Author(s):

Selcuk Erdem ◽

Duygu Has Simsek ◽

Enes Degirmenci ◽

Resat Aydin ◽

Sidar Bagbudar ◽

...

Keyword(s):

Lymph Node ◽

Emission Tomography ◽

Lymph Node Staging ◽

High Risk Prostate Cancer ◽

Positron Emission ◽

Psma Pet ◽

Pet Ct ◽

Risk Prostate Cancer ◽

Primary Lymph Node ◽

Specific Membrane

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Changing Threshold-Based Segmentation Has No Relevant Impact on Semi-Quantification in the Context of Structured Reporting for PSMA-PET/CT

Cancers ◽

10.3390/cancers14020270 ◽

2022 ◽

Vol 14 (2) ◽

pp. 270

Author(s):

Patrick W. Mihatsch ◽

Matthias Beissert ◽

Martin G. Pomper ◽

Thorsten A. Bley ◽

Anna K. Seitz ◽

...

Keyword(s):

Tumor Volume ◽

Bone Lesions ◽

Primary Staging ◽

Standardized Uptake Values ◽

Positron Emission ◽

Diagnostic Certainty ◽

Psma Pet ◽

Pet Ct ◽

The Stability ◽

Specific Membrane

Prostate-specific membrane antigen (PSMA)-directed positron emission tomography/computed tomography (PET/CT) is increasingly utilized for staging of men with prostate cancer (PC). To increase interpretive certainty, the standardized PSMA reporting and data system (RADS) has been proposed. Using PSMA-RADS, we characterized lesions in 18 patients imaged with 18F-PSMA-1007 PET/CT for primary staging and determined the stability of semi-quantitative parameters. Six hundred twenty-three lesions were categorized according to PSMA-RADS and manually segmented. In this context, PSMA-RADS-3A (soft-tissue) or -3B (bone) lesions are defined as being indeterminate for the presence of PC. For PMSA-RADS-4 and -5 lesions; however, PC is highly likely or almost certainly present [with further distinction based on absence (PSMA-RADS-4) or presence (PSMA-RADS-5) of correlative findings on CT]. Standardized uptake values (SUVmax, SUVpeak, SUVmean) were recorded, and volumetric parameters [PSMA-derived tumor volume (PSMA-TV); total lesion PSMA (TL-PSMA)] were determined using different maximum intensity thresholds (MIT) (40 vs. 45 vs. 50%). SUVmax was significantly higher in PSMA-RADS-5 lesions compared to all other PSMA-RADS categories (p ≤ 0.0322). In particular, the clinically challenging PSMA-RADS-3A lesions showed significantly lower SUVmax and SUVpeak compared to the entire PSMA-RADS-4 or -5 cohort (p < 0.0001), while for PSMA-RADS-3B this only applies when compared to the entire PSMA-RADS-5 cohort (p < 0.0001), but not to the PSMA-RADS-4 cohort (SUVmax, p = 0.07; SUVpeak, p = 0.08). SUVmean (p = 0.30) and TL-PSMA (p = 0.16) in PSMA-RADS-5 lesions were not influenced by changing the MIT, while PSMA-TV showed significant differences when comparing 40 vs. 50% MIT (p = 0.0066), which was driven by lymph nodes (p = 0.0239), but not bone lesions (p = 0.15). SUVmax was significantly higher in PSMA-RADS-5 lesions compared to all other PSMA-RADS categories in 18F-PSMA-1007 PET/CT. As such, the latter parameter may assist the interpreting molecular imaging specialist in assigning the correct PSMA-RADS score to sites of disease, thereby increasing diagnostic certainty. In addition, changes of the MIT in PSMA-RADS-5 lesions had no significant impact on SUVmean and TL-PSMA in contrast to PSMA-TV.

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Can 68Ga-prostate specific membrane antigen positron emission tomography/computerized tomography provide an accurate lymph node staging for patients with medium/high risk prostate cancer? A diagnostic meta-analysis

Radiation Oncology ◽

10.1186/s13014-020-01675-4 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Lei Peng ◽

Jinze Li ◽

Chunyang Meng ◽

Jinming Li ◽

Chengyu You ◽

...

Keyword(s):

Prostate Cancer ◽

Positron Emission Tomography ◽

Lymph Node ◽

High Risk ◽

Meta Analysis ◽

Diagnostic Value ◽

Emission Tomography ◽

Positron Emission ◽

Psma Pet ◽

Pet Ct

Abstract Objective This article aims to evaluate the diagnostic value of 68Gallium-PSMA positron emission tomography/computerized tomography (68Ga-PSMA PET/CT) for lymph node (LN) staging in patients with prostate cancer (PCa) by a meta-analysis of diagnostic tests. Methods We systematically retrieved articles from Web of Science, EMBASE, Cochrane Database, PubMed. The time limit is from the creation of the database until June 2019, and Stata 15 was used for calculation and statistical analyses. Results Sensitivity, specificity, positive and negative likelihood ratio (PLR, NLR), diagnostic odds ratio (DOR) and 95% confidence intervals (CI) be used to evaluate the diagnostic value. A total of 10 studies were included in our meta-analysis, which included 701 individuals. The results of each consolidated summary are as follows: sensitivity of 0.84 (95% CI 0.55–0.95), specificity of 0.95 (95% CI 0.87–0.98), PLR and NLR was 17.19 (95% CI 6.27, 47.17) and 0.17 (95% CI 0.05–0.56), respectively. DOR of 100 (95% CI 18–545), AUC of 0.97 (95% CI 0.95–0.98). Conclusion Our study demonstrates that 68Ga-PSMA PET/CT has a high overall diagnostic value for LN staging in patients with moderate and high-risk PCa. But our conclusions still require a larger sample size, multi-center prospective randomized controlled trial to verify.

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Prediction of postoperative histology in patients with prostate cancer using preoperative Ga-68-PSMA-PET/CT.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.144 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 144-144

Author(s):

Martin Boegemann ◽

Axel Semjonow ◽

Hans-Joerg Breyholz ◽

Andres Jan Schrader ◽

Laura-Maria Krabbe ◽

...

Keyword(s):

Prostate Cancer ◽

Standard Uptake Value ◽

Whole Body ◽

Diagnostic Tools ◽

Likelihood Ratios ◽

Psma Pet ◽

Pet Ct ◽

Detect Prostate Cancer ◽

Sensitivity Specificity ◽

Specific Membrane

144 Background: Recently developed 68Ga labeled prostate specific membrane antigen (PSMA) ligands were introduced as diagnostic tools to detect prostate cancer (PCa), PCa relapse and metastases with high accuracy. In this study we assessed the usability of preoperative PSMA-PET/CT information on congruency of spread of PCA compared with postoperative PCa-maps derived from radical prostatectomy (RPE) specimens. Methods: We referred 6 patients with biopsy proven high risk PCa to PSMA-PET/CT prior to RPE. Whole body PET/CT (Biograph mCT with 128 slice CT, Siemens) was performed 62±8 minutes after injection of 160±31 MBq [68Ga]-PSMA-HBED-CC (DKFZ-Ga-PSMA-11) as described by routine acquisition protocol. After RPE, prostate specimens were processed in the local pathology department. Topographical analysis of extension of PCa was reconstructed from representative slides on a schematic diagram resulting in a PCa-map of the prostate. After aligning the cutting planes of the PSMA-PET/CT to the PCa-map we defined 20 segments of the prostate and the seminal vesicles. We measured the maximum standard uptake value (SUV) of PSMA activity of the respective segments and compared the concordance of PSMA-positive and -negative areas with those of PCa and no PCa on the PCa-maps. We calculated sensitivity, specificity, positive and negative likelihood ratios (LR) taking available segments into account. Results: 106/112 segments were analyzed. 8 segments were excluded due to spillover of PSMA-activity in bladder urine. All but 3 segments with no PCa on the PCa-maps showed no uptake in PSMA-PET/CT (Specificity = 92%). The sensitivity of PSMA-PET/CT for showing PCa areas was equally 92%. The positive and negative LR for PSMA-PET/CT detecting or ruling out PCa was 11.5 and 0.09, respectively. Conclusions: This preliminary proof of concept study shows that prediction of later pathologic results in RPE-specimens could be estimated by preoperative PSMA-PET/CT. With optimized acquisition protocols it may be possible to improve our preliminary results. Perspectively PSMA-PET/CT may be helpful for identifying PCa suspicious lesions prior to prostate biopsy and support decision making prior to RPE or radiation therapy.

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Comparison of 68Ga-PSMA PET/CT and Multiparametric MRI for the Detection of Low- and Intermediate-risk Prostate Cancer

10.21203/rs.3.rs-995707/v1 ◽

2021 ◽

Author(s):

Chuanchi Zhou ◽

Yongxiang Tang ◽

Zhihe Deng ◽

Jinhui Yang ◽

Ming Zhou ◽

...

Keyword(s):

Detection Rate ◽

Specific Antigen ◽

Multiparametric Mri ◽

Intermediate Risk ◽

Diagnostic Confidence ◽

Prostate Imaging ◽

Psma Pet ◽

Pet Ct ◽

Risk Prostate Cancer ◽

Stratified Analysis

Abstract Purpose: To provide a direct comparison between mpMRI and 68Ga-PSMA PET/CT for the detection of low- and intermediate-risk PCa and to determine which of low- or intermediate-risk PCa is more likely to be detected by 68Ga-PSMA PET/CT.Methods: We conducted a retrospective analysis of patients who had undergone a prostate biopsy and/or radical prostatectomy, and who were scanned with 68Ga-PSMA PET/CT and mpMRI between June 2019 and March 2021. The mpMRI images were scored with the Prostate Imaging-Reporting and Data System Version 2.1 (PI-RADS) and were classified as either negative (PI-RADS 1-3) or positive (PI-RADS 4-5). Suspicious 68Ga-PSMA PET/CT lesions were reviewed for each relevant patient and classified by double-trained board-certified nuclear medicine physicians. The results were evaluated with the histopathological outcome. All patients were classified according to the D’Amico classification, and the clinical data were combined for stratified analysis.Result: 101 patients who were pathologically diagnosed with PCa were analyzed. Of the 101 patients, 88 (80.6%) patients presented with a pathologic mpMRI, and 85 (79.1%) with a pathologic 68Ga-PSMA PET/CT. In the high-risk PCa cohort, 68Ga-PSMA PET/CT was positive in 64/66 (97.0%) patients and yielded a higher detection rate than that for the mpMRI patients (58/66, 87.9%: p<0.05). However, mpMRI provided superior diagnostic confidence in identifying low- and intermediate-risk PCa (30/35, 85.7% vs. 21/35,60.0%; p<0.05). When the age threshold exceeded 62.5 years and the serum prostate specific antigen (PSA) threshold exceeded 9.4 ng/ml, a higher uptake of PSMA was more likely to occur in the lesions of low- and intermediate-risk PCa.Conclusion: In the initial diagnosis of low- and intermediate-risk PCa, we found that mpMRI showed a higher diagnostic accuracy than 68Ga-PSMA PET/CT did. Low- and intermediate-risk PCa patients with PSA≥9.4 ng/ml and age≥62.5 years were more likely to have a positive 68Ga-PSMA PET/CT result.

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