Head-to-head comparison of 68Ga-PSMA-11 PET/CT and mpMRI in the detection, intra-prostatic localization, and local extension of primary prostate cancer: A single-center imaging study with histopathology gold-standard.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 193-193
Author(s):  
Ida Sonni ◽  
Ely Felker ◽  
Andrew Thomas Lenis ◽  
Anthony E Sisk ◽  
Shadfar Bahri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Imaging Modality ◽  
Imaging Study ◽  
Imaging Modalities ◽  
Detection Rates ◽  
Local Extension ◽  
Primary Prostate Cancer ◽  
Psma Pet ◽  
Pet Ct ◽  
Local Staging

193 Background: The local staging of prostate cancer relies on systematic or targeted biopsies and multiparametric magnetic resonance imaging (mpMRI). The role of prostate-specific membrane antigen (PSMA)-targeted PET in the evaluation of intraprostatic cancer foci and T-staging assessment is not well defined. The goal of this analysis was to compare the diagnostic performance of PSMA PET/CT, mpMRI and the combination of the two (PSMA PET/CT+mpMRI) in the detection, intra-prostatic localization and local extension of primary prostate cancer with histopathology as the gold standard.Methods: Patients with intermediate- or high-risk prostate cancer underwent a PSMA PET/CT scan and mpMRI prior to intended radical prostatectomy. Each imaging modality was interpreted by 3 blinded independent readers. A majority rule was applied (2:1). A standardized approach was used to assess presence, location and size of prostate cancer foci within the prostate. The analysis was conducted on a lesion- and segment-level. Whole mount pathology was interpreted by a Genito-Urinary pathologist using the same standardized method described above. Accuracy in determining the location, extra-capsular extension (ECE) and seminal vesicle invasion (SVI) of prostate cancer foci were assessed using receiver operating characteristic (ROC) analysis. A “raw-stringent” and “neighboring” approach were used to define imaging/pathology correlation for the detection of individual prostate cancer foci. Results: The final analysis included 74 patients. Detection rate was 75%, 79% and 82% using the “raw-stringent” approach, 86%, 83% and 87% using the “neighboring” approach for PSMA PET/CT, mpMRI and PSMA PET/CT+mpMRI, respectively. Differences in detection rates between PSMA PET/CT, mpMRI and PSMA PET/CT+mpMRI were not statistically significant. The two imaging modalities performed similarly (AUC = 0.70 vs 0.73, p = 0.09; AUC = 0.77 for the two together) in localizing prostate cancer. ΔAUC between PSMA PET/CT+mpMRI and the two imaging modalities alone was statistically significant (p < 0.001), but not between PSMA PET/CT and mpMRI (p = 0.093). mpMRI performed better than PSMA PET/CT in the T-staging assessment: ECE (AUC = 0.79 vs 0.59, p = 0.002) and SVI (AUC = 0.84 vs 0.63, p = 0.001). Conclusions: PSMA PET/CT and mpMRI have similar diagnostic accuracy in the detection and intra-prostatic localization of prostate cancer foci while mpMRI performs better in the assessment of ECE and SVI. The combination of the two imaging modalities improves performance of the two modalities alone, but this does not reach statistically significant levels on a lesion-level and might not justify changes in the current practices for local staging of prostate cancer.

OC-0208: Comparison between 68Ga-PSMA-PET/CT and mpMRI for radiotherapy planning in primary prostate cancer

2020 ◽  
Vol 152 ◽  
pp. S104
Author(s):  
S. Spohn ◽  
C. Jaegle ◽  
A.S. Bettermann ◽  
S. Kiefer ◽  
C.A. Jilg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiotherapy Planning ◽  
Primary Prostate Cancer ◽  
Psma Pet ◽  
Pet Ct

Comparison of 68Ga-PSMA PET CT and multi-parametric MRI in the evaluation of tumor extension of primary prostate cancer

2019 ◽  
Vol 18 (1) ◽  
pp. e214
Author(s):  
X. Qiu ◽  
M. Chen ◽  
Z. Qing ◽  
J. Gao ◽  
C. Zhang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Tumor Extension ◽  
Primary Prostate Cancer ◽  
Psma Pet ◽  
Pet Ct

scholarly journals Immunohistochemical Validation of PSMA Expression Measured by 68Ga-PSMA PET/CT in Primary Prostate Cancer

2017 ◽  
Vol 59 (2) ◽  
pp. 238-243 ◽  
Author(s):  
Nadine Woythal ◽  
Ruza Arsenic ◽  
Carsten Kempkensteffen ◽  
Kurt Miller ◽  
Jan-Carlo Janssen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Primary Prostate Cancer ◽  
Psma Pet ◽  
Pet Ct ◽  
Psma Expression

scholarly journals The Diagnostic Role of 18F-Choline, 18F-Fluciclovine and 18F-PSMA PET/CT in the Detection of Prostate Cancer With Biochemical Recurrence: A Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Rang Wang ◽  
Guohua Shen ◽  
Mingxing Huang ◽  
Rong Tian
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Biochemical Recurrence ◽  
Meta Analysis ◽  
Detection Rates ◽  
Psma Pet ◽  
Pet Ct ◽  
Diagnostic Role ◽  
Sensitivity Specificity

BackgroundDiagnosing the biochemical recurrence (BCR) of prostate cancer (PCa) is a clinical challenge, and early detection of BCR can help patients receive optimal treatment. We conducted a meta-analysis to define the diagnostic accuracy of PET/CT using 18F-labeled choline, fluciclovine, and prostate-specific membrane antigen (PSMA) in patients with BCR.MethodsMultiple databases were searched until March 30, 2021. We included studies investigating the diagnostic accuracy of 18F-choline, 18F-fluciclovine, and 18F-PSMA PET/CT in patients with BCR. The pooled sensitivity, specificity, and detection rate of 18F-labeled tracers were calculated with a random-effects model.ResultsA total of 46 studies met the included criteria; 17, 16, and 13 studies focused on 18F-choline, fluciclovine, and PSMA, respectively. The pooled sensitivities of 18F-choline and 18F-fluciclovine were 0.93 (95% CI, 0.85–0.98) and 0.80 (95% CI, 0.65–0.897), and the specificities were 0.91 (95% CI, 0.73–0.97) and 0.66 (95% CI, 0.50–0.79), respectively. The pooled detection rates of 18F-labeled choline, fluciclovine and PSMA were 66, 74, and 83%, respectively. Moreover, the detection rates of 18F-labeled choline, fluciclovine, and PSMA were 35, 23, and 58% for a PSA level less than 0.5 ng/ml; 41, 46, and 75% for a PSA level of 0.5–0.99 ng/ml; 62, 57, and 86% for a PSA level of 1.0–1.99 ng/ml; 80, 92, and 94% for a PSA level more than 2.0 ng/ml.ConclusionThese three 18F-labeled tracers are promising for detecting BCR in prostate cancer patients, with 18F-choline showing superior diagnostic accuracy. In addition, the much higher detection rates of 18F-PSMA showed its superiority over other tracers, particularly in low PSA levels.Systematic Review RegistrationPROSPERO, identifier CRD42020212531.

scholarly journals Establishing a Provincial Registry for Recurrent Prostate Cancer: Providing Access to PSMA PET/CT in Ontario, Canada

2021 ◽  
Vol 11 ◽  
Author(s):  
Sympascho Young ◽  
Ur Metser ◽  
Golmehr Sistani ◽  
Deanna L. Langer ◽  
Glenn Bauman
Keyword(s):  
Prostate Cancer ◽  
Imaging Modality ◽  
Cancer Recurrence ◽  
Steering Committee ◽  
Primary Therapy ◽  
Psma Pet ◽  
Pet Ct ◽  
Prostate Cancer Recurrence ◽  
Health Canada ◽  
Pet Radiopharmaceuticals

Prostate Specific Membrane Antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is becoming established as a standard of care for the (re)staging of high-risk primary and prostate cancer recurrence after primary therapy. Despite the favorable performance of this imaging modality with high accuracy in disease detection, the availability of PSMA PET/CT varies across jurisdictions worldwide due to variability in the selection of PSMA PET/CT agent, regulatory approvals and funding. In Canada, PSMA based radiopharmaceuticals are still considered investigational new drug (IND), creating limitations in the deployment of these promising imaging agents. While regulatory approval rests with Health Canada, as a single payer health system, funding for Health Canada approved drugs and devices is decided by Provincial Health Ministries. Ontario Health (Cancer Care Ontario) (OH-CCO) is the agency of the Ministry of Health (MOH) in Ontario responsible for making recommendations to the MOH around the organization and funding of cancer services within Ontario (population of 15 million), and the PET Steering Committee of OH-CCO is responsible for providing recommendations on the introduction of new PET radiopharmaceuticals and indications. For Health Canada approved PET radiopharmaceuticals like 18F-FDG, OH-CCO (on behalf of the MOH) provides coverage based on levels of evidence and specific PET Registries are established to aid in real-world evidence collection to inform OH-CCO regarding emerging PET applications. In the case of PSMA PET/CT, adapting this model to an IND PSMA PET/CT agent, 18F-DCFPyL, necessitated the creation of a hybrid Registry-Study model to leverage the existing OH-CCO Registry structure while respecting the need for a Health Canada Clinical Trials Application (CTA) for the deployment of this agent in the province. Within the first 2 years of the registry, over 1700 men have been imaged resulting in a change in management (compared to pre-PET management plans) in over half of the men imaged. In this article, we describe the organization and deployment of the PSMA PET/CT (PREP) Registry throughout the province to provide access for men with suspected prostate cancer recurrence along with key stakeholder perspectives and preliminary results.

scholarly journals Detection rates of recurrent prostate cancer: 68Gallium (Ga)-labelled prostate-specific membrane antigen versus choline PET/CT scans. A systematic review

2019 ◽  
Vol 11 ◽  
pp. 175628721881579 ◽  
Author(s):  
Masood Moghul ◽  
Bhaskar Somani ◽  
Tim Lane ◽  
Nikhil Vasdev ◽  
Brian Chaplin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Ct Scans ◽  
Prostate Specific Membrane Antigen ◽  
Recurrent Prostate Cancer ◽  
Detection Rates ◽  
Psma Pet ◽  
Pet Ct ◽  
Significant Difference ◽  
Specific Membrane

Background: The aim of this work was to assess the use of prostate-specific membrane antigen (PSMA)-labelled radiotracers in detecting the recurrence of prostate cancer. PSMA is thought to have higher detection rates when utilized in positron emission tomography (PET)/computed tomography (CT) scans, particularly at lower prostate-specific antigen (PSA) levels, compared with choline-based scans. Methods: A systematic review was conducted comparing choline and PSMA PET/CT scans in patients with recurrent prostate cancer following an initial curative attempt. The primary outcomes were overall detection rates, detection rates at low PSA thresholds, difference in detection rates and exclusive detection rates on a per-person analysis. Secondary outcome measures were total number of lesions, exclusive detection by each scan on a per-lesion basis and adverse side effects. Results: Overall detection rates were 79.8% for PSMA and 66.7% for choline. There was a statistically significant difference in detection rates favouring PSMA [OR (M–H, random, 95% confidence interval (CI)) 2.27 (1.06, 4.85), p = 0.04]. Direct comparison was limited to PSA < 2 ng/ml in two studies, with no statistically significant difference in detection rates between the scans [OR (M–H, random, 95% CI) 2.37 (0.61, 9.17) p = 0.21]. The difference in detection on the per-patient analysis was significantly higher in the PSMA scans ( p < 0.00001). All three studies reported higher lymph node, bone metastasis and locoregional recurrence rates in PSMA. Conclusions: PSMA PET/CT has a better performance compared with choline PET/CT in detecting recurrent disease both on per-patient and per-lesion analysis and should be the imaging modality of choice while deciding on salvage and nonsystematic metastasis-directed therapy strategies.

Differential expression of PSMA and 18F-fluciclovine transporter genes in metastatic castrate-resistant and treatment-emergent small cell/neuroendocrine prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 24-24
Author(s):  
Carissa Chu ◽  
Mohammed Alshalalfa ◽  
Martin Sjöström ◽  
Shuang Zhao ◽  
Annika Herlemann ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Expression Profiles ◽  
Small Cell ◽  
Imaging Modalities ◽  
Primary Tumors ◽  
Neuroendocrine Prostate Cancer ◽  
Psma Pet ◽  
Pet Ct ◽  
Castrate Resistant ◽  
Psma Expression

24 Background: 18F-fluciclovine (Axumin) PET/CT imaging is recommended by the NCCN in the setting of biochemical recurrence, while prostate-specific membrane antigen (PSMA) PET/CT is preferred by the EAU. The utility of these methods in the post-androgen deprivation therapy (ADT) setting however, is less defined. Our objective was to compare relative gene expression of the molecular targets of these imaging modalities— fluciclovine transporter genes (LAT1-4, ASCT1-2) and PSMA—in metastatic castrate resistant prostate cancer (mCRPC) and treatment-emergent small cell/neuroendocrine prostate cancer (t-SCNC). Methods: Genome-wide expression profiles of five mCRPC cohorts (Aggarwal, Grasso, Kumar, Beltran, Robinson, et al) were used to characterize relative expression of fluciclovine transporter (LAT1-4, ASC1-2) and PSMA (FOLH1) genes. 3 cohorts (Kumar, Beltran, Aggarwal) were enriched with t-SCNC tumors. The GSE35988 cohort included primary tumors and mCRPC. RNA expression profiling methods were consistent within cohorts. Results: 518 mCRPC specimens were included. In the GSE35988 cohort, PSMA expression was downregulated in mCRPC when compared to primary localized tumors (p=0.01). PSMA expression was further depressed in t-SCNC when compared with mCRPC (p<0.001). Of the fluciclovine transporter genes, LAT1 and LAT4 were overexpressed in mCRPC when compared to primary tumors, while ASC2 was less expressed (p<0.001). LAT1 was further overexpressed in t-SCNC when compared to mCRPC, while LAT2 was less expressed (p<0.001). PSMA expression was negatively correlated with LAT1 (p<0.001) but positively correlated with LAT2 (p=0.006). Other fluciclovine transporters were not correlated. Conclusions: Expression of PSMA and a subset of fluciclovine transporter genes are inversely correlated in mCRPC and t-SCNC. These findings suggest that fluciclovine-based imaging may play a role in castrate resistant states. Clinical comparison between PSMA- and fluciclovine-based imaging modalities in mCRPC and t-SCNC is warranted.

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