Potential synergy between PSMA uptake and tumour blood flow for prediction of human prostate cancer aggressiveness

Abstract Background Both prostate-specific membrane antigen (PSMA) uptake and tumour blood flow (TBF) correlate with International Society of Urological Pathology (ISUP) Grade Group (GG) and hence prostate cancer (PCa) aggressiveness. The aim of the present study was to evaluate the potential synergistic benefit of combining the two physiologic parameters for separating significant PCa from insignificant findings. Methods From previous studies of [82Rb]Rb positron emission tomography (PET) TBF in PCa, the 43 patients that underwent clinical [68Ga]Ga-PSMA-11 PET were selected for this retrospective study. Tumours were delineated on [68Ga]Ga-PSMA-11 PET or magnetic resonance imaging. ISUP GG was recorded from 52 lesions. Results [68Ga]Ga-PSMA-11 maximum standardized uptake value (SUVmax) and [82Rb]Rb SUVmax correlated moderately with ISUP GG (rho = 0.59 and rho = 0.56, both p < 0.001) and with each other (r = 0.65, p < 0.001). A combined model of [68Ga]Ga-PSMA-11 and [82Rb]Rb SUVmax separated ISUP GG > 2 from ISUP GG 1–2 and benign with an area-under-the-curve of 0.85, 96% sensitivity, 74% specificity, and 95% negative predictive value. The combined model performed significantly better than either tracer alone did (p < 0.001), primarily by reducing false negatives from five or six to one (p ≤ 0.025). Conclusion PSMA uptake and TBF provide complementary information about tumour aggressiveness. We suggest that a combined analysis of PSMA uptake and TBF could significantly improve the negative predictive value and allow non-invasive separation of significant from insignificant PCa.

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Tumour blood flow for prediction of human prostate cancer aggressiveness: a study with Rubidium-82 PET, MRI and Na+/K+-ATPase-density

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-020-04998-2 ◽

2020 ◽

Author(s):

Mads Ryø Jochumsen ◽

Jens Sörensen ◽

Bodil Ginnerup Pedersen ◽

Jens Randel Nyengaard ◽

Søren Rasmus Palmelund Krag ◽

...

Keyword(s):

Prostate Cancer ◽

Blood Flow ◽

Human Prostate ◽

Human Prostate Cancer ◽

Tumour Blood Flow ◽

Cancer Aggressiveness ◽

Rubidium 82 ◽

Tumour Blood

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Multiparametric Prostate MRI in Biopsy-Naïve Men: A Prospective Evaluation of Performance and Biopsy Strategies

Frontiers in Oncology ◽

10.3389/fonc.2021.745657 ◽

2021 ◽

Vol 11 ◽

Author(s):

Brage Krüger-Stokke ◽

Helena Bertilsson ◽

Sverre Langørgen ◽

Torill Anita Eidhammer Sjøbakk ◽

Tone Frost Bathen ◽

...

Keyword(s):

Prostate Cancer ◽

Negative Predictive Value ◽

Predictive Value ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Gleason Grade ◽

Grade Group ◽

Detection Rates ◽

Prostate Mri ◽

Multiparametric Prostate Mri

ObjectivesThis study aims to prospectively estimate the diagnostic performance of multiparametric prostate MRI (mpMRI) and compare the detection rates of prostate cancer using cognitive targeted transrectal ultrasound (TRUS) guided biopsies, targeted MR-guided in-bore biopsies (MRGB), or both methods combined in biopsy-naïve men.MethodsThe biopsy-naïve men referred for mpMRI (including T2-weighted, diffusion-weighted and dynamic contrast enhanced MRI) due to prostate cancer suspicion (elevated prostate-specific antigen or abnormal digital rectal examination) were eligible for inclusion. The images were scored according to Prostate Imaging Reporting and Data System (PI-RADS) v2, and men with PI-RADS 1–2 lesions were referred for routine systematic TRUS, while those with PI-RADS 3–5 lesions were randomized to MRGB or cognitive targeted TRUS. Men randomized to MRGB were referred to a secondary TRUS 2 weeks after MRGB. Gleason grade group ≥2 was defined as clinically significant prostate cancer. The performance of mpMRI was estimated using prostate cancer detected by any biopsy method as the reference test.ResultsA total of 210 men were included. There was no suspicion of prostate cancer after mpMRI (PI-RADS 1–2) in 48% of the men. Among these, significant and insignificant prostate cancer was diagnosed in five and 11 men, respectively. Thirty-five men who scored as PI-RADS 1–2 did not undergo biopsy and were therefore excluded from the calculation of diagnostic accuracy. The overall sensitivity, specificity, negative predictive value, and positive predictive value of mpMRI for the detection of significant prostate cancer were 0.94, 0.63, 0.92, and 0.67, respectively. In patients with PI-RADS 3–5 lesions, the detection rates for significant prostate cancer were not significantly different between cognitive targeted TRUS (68.4%), MRGB (57.7%), and the combination of the two biopsy methods (64.4%). The median numbers of biopsy cores taken per patient undergoing systematic TRUS, cognitive targeted TRUS, and MRGB were 14 [8-16], 12 [6-17], and 2 [1-4] respectively.ConclusionsmpMRI, in a cohort of biopsy-naïve men, has high negative predictive value, and our results support that it is safe to avoid biopsy after negative mpMRI. Furthermore, MRGB provides a similar diagnosis to the cognitive targeted TRUS but with fewer biopsies.

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541 Investigation of Suspected Prostate Cancer In UK; Evaluation of Local Practice and Feasibility of Moving Towards MRI As First Line Investigation – Re-Audit Following Change of Radiology Staffing

British Journal of Surgery ◽

10.1093/bjs/znab134.449 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Lee ◽

A Luk ◽

Y Kailash ◽

B Chaplin

Keyword(s):

Prostate Cancer ◽

Negative Predictive Value ◽

Predictive Value ◽

Gleason Grade ◽

First Line ◽

Grade Group ◽

Prostate Mri ◽

Radiology Service ◽

Group 2 ◽

Significant Disease

Abstract Introduction NICE recommends MRI as first-line investigation for suspected clinically localised prostate cancer (PCa); previous local audit findings suggest this to be safe and feasible to implement. Recent retirement of radiology staffing however had resulted in MRIs being reported by teleconsultation radiology service. There were concerns on whether this may lead to more missed significant PCa. We performed a re-audit on our prostate MRI and biopsy to assess if this is indeed the case. Method All patients with suspected PCa who have had prostate MRI and biopsy simultaneously from April-August 2019 were retrospectively analysed. Results 222 men were included. 36% of patients with negative MRI had positive biopsies; within this group 25% had significant disease (Gleason grade group ≥2). Compared with our previous audit, specificity for significant PCa has increased (from 34% to 46%), but with a reduced negative predictive value (from 97% to 91%). Conclusions If we are to implement MRI as first-line triage for potential subsequent biopsy, it would result in more men not going for a biopsy (from 18% to 25%), a reduction in diagnosis of non-significant PCa (from 21% to 36%), but at an expense of increase in missed significant PCa (from 3% to 9%).

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Multicentric Evaluation of the True Negative Predictive Value of Multiparametric MRI for the Detection of Prostate Cancer Using Cystoprostatectomy Specimen as Reference

Case Medical Research ◽

10.31525/ct1-nct03960112 ◽

2019 ◽

Author(s):

Keyword(s):

Prostate Cancer ◽

Negative Predictive Value ◽

Predictive Value ◽

Multiparametric Mri ◽

True Negative

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Arterial spin labelling and diffusion-weighted magnetic resonance imaging in differentiation of recurrent head and neck cancer from post-radiation changes

The Journal of Laryngology & Otology ◽

10.1017/s0022215118001743 ◽

2018 ◽

Vol 132 (10) ◽

pp. 923-928 ◽

Cited By ~ 19

Author(s):

A A K Abdel Razek

Keyword(s):

Blood Flow ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Arterial Spin Labelling ◽

Tumour Blood Flow ◽

Apparent Diffusion ◽

Post Radiation ◽

Recurrent Head ◽

Tumour Blood

AbstractObjectiveTo assess arterial spin labelling and diffusion-weighted imaging in the differentiation of recurrent head and neck cancer from post-radiation changes.MethodsA retrospective study was conducted of 47 patients with head and neck cancer, treated with radiotherapy, who underwent magnetic resonance arterial spin labelling and diffusion-weighted magnetic resonance imaging. Tumour blood flow and apparent diffusion co-efficient of the lesion were calculated.ResultsThere was significant difference (p= 0.001) in tumour blood flow between patients with recurrent head and neck cancer (n= 31) (47.37 ± 16.3 ml/100 g/minute) and those with post-radiation changes (n= 16) (18.80 ± 2.9 ml/100 g/minute). The thresholds of tumour blood flow and apparent diffusion co-efficient used for differentiating recurrence from post-radiation changes were more than 24.0 ml/100 g/minute and 1.21 × 10−3mm2/second or less, with area under the curve values of 0.94 and 0.90, and accuracy rates of 88.2 per cent and 88.2 per cent, respectively. The combined tumour blood flow and apparent diffusion co-efficient values used for differentiating recurrence from post-radiation changes had an area under the curve of 0.96 and an accuracy of 90.2 per cent.ConclusionCombined tumour blood flow and apparent diffusion co-efficient can differentiate recurrence from post-radiation changes.

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