Egesta Lopci1, Alberto Saita2, Massimo Lazzeri3, Giovanni Lughezzani2, Piergiuseppe Colombo4, Nicolò Maria Buffi2, Rodolfo Hurle2, Katia Marzo1, Roberto Peschechera2, Alessio Benetti2, Silvia Zandegiacomo2, Luisa Pasini2, Giuliana Lista2, Pasquale Cardone2, Angelo Castello1, Davide Maffei2, Luca Balzarini5, Arturo Chiti6, Giorgio Guazzoni7, Paolo Casale2. 1. Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy. 2. Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy. 3. Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy. Electronic address: massimo.lazzeri@humanitas.it. 4. Pathology Department, Humanitas Clinical and Research Hospital, Milan, Italy. 5. Radiology Department, Humanitas Clinical and Research Hospital, Milan, Italy. 6. Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy; Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy; Pathology Department, Humanitas Clinical and Research Hospital, Milan, Italy; Radiology Department, Humanitas Clinical and Research Hospital, Milan, Italy; Humanitas University, Milan, Italy. 7. Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy; Pathology Department, Humanitas Clinical and Research Hospital, Milan, Italy; Radiology Department, Humanitas Clinical and Research Hospital, Milan, Italy; Humanitas University, Milan, Italy.
Abstract
PURPOSE: 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography may represent the most promising imaging modality to identify and risk stratify prostate cancer in patients with contraindications to or negative multiparametric magnetic resonance imaging. MATERIALS AND METHODS: In this prospective observational study we analyzed 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography in a select group of patients with persistently elevated prostate specific antigen and/or Prostate Health Index suspicious for prostate cancer, negative digital rectal examination and at least 1 negative biopsy. The cohort comprised men with equivocal multiparametric magnetic resonance imaging (Prostate Imaging-Reporting and Data System, version 2 score of 2 or less), or an absolute or relative contraindication to multiparametric magnetic resonance imaging. Sensitivity, specificity and CIs were calculated compared to histopathology findings. ROC analysis was applied to determine the optimal cutoff values of 68Ga labeled prostate specific membrane antigen uptake to identify clinically significant prostate cancer (Gleason score 7 or greater). RESULTS: A total of 45 patients with a median age of 64 years were referred for 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography between January and August 2017. The 25 patients (55.5%) considered to have positive positron emission tomography results underwent software assisted fusion biopsy. We determined the uptake values of regions of interest, including a median maximum standardized uptake value of 5.34 (range 2.25 to 30.41) and a maximum-to-background standardized uptake value ratio of 1.99 (range 1.06 to 14.42). Mean and median uptake values on 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography (ie the maximum standardized uptake value or the maximum-to-background standardized uptake value ratio) were significantly higher for Gleason score 7 lesions than for Gleason score 6 or benign lesions (p <0.001). On ROC analysis a maximum standardized uptake value of 5.4 and a maximum-to-background standardized uptake value ratio of 2 discriminated clinically relevant prostate cancer with 100% overall sensitivity in each case, and 76% and 88% specificity, respectively. CONCLUSIONS: Our findings support the use of 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography for primary detection of prostate cancer in a specific subset of men.
PURPOSE: 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography may represent the most promising imaging modality to identify and risk stratify prostate cancer in patients with contraindications to or negative multiparametric magnetic resonance imaging. MATERIALS AND METHODS: In this prospective observational study we analyzed 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography in a select group of patients with persistently elevated prostate specific antigen and/or Prostate Health Index suspicious for prostate cancer, negative digital rectal examination and at least 1 negative biopsy. The cohort comprised men with equivocal multiparametric magnetic resonance imaging (Prostate Imaging-Reporting and Data System, version 2 score of 2 or less), or an absolute or relative contraindication to multiparametric magnetic resonance imaging. Sensitivity, specificity and CIs were calculated compared to histopathology findings. ROC analysis was applied to determine the optimal cutoff values of 68Ga labeled prostate specific membrane antigen uptake to identify clinically significant prostate cancer (Gleason score 7 or greater). RESULTS: A total of 45 patients with a median age of 64 years were referred for 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography between January and August 2017. The 25 patients (55.5%) considered to have positive positron emission tomography results underwent software assisted fusion biopsy. We determined the uptake values of regions of interest, including a median maximum standardized uptake value of 5.34 (range 2.25 to 30.41) and a maximum-to-background standardized uptake value ratio of 1.99 (range 1.06 to 14.42). Mean and median uptake values on 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography (ie the maximum standardized uptake value or the maximum-to-background standardized uptake value ratio) were significantly higher for Gleason score 7 lesions than for Gleason score 6 or benign lesions (p <0.001). On ROC analysis a maximum standardized uptake value of 5.4 and a maximum-to-background standardized uptake value ratio of 2 discriminated clinically relevant prostate cancer with 100% overall sensitivity in each case, and 76% and 88% specificity, respectively. CONCLUSIONS: Our findings support the use of 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography for primary detection of prostate cancer in a specific subset of men.
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Authors: Massimo Lazzeri; Vittorio Fasulo; Giovanni Lughezzani; Alessio Benetti; Giulia Soldà; Rosanna Asselta; Ilaria De Simone; Marco Paciotti; Pier Paolo Avolio; Roberto Contieri; Cesare Saitta; Alberto Saita; Rodolfo Hurle; Giorgio Guazzoni; Nicolò Maria Buffi; Paolo Casale Journal: Front Oncol Date: 2022-09-06 Impact factor: 5.738