Anouk C de Jong1,2, Minke Smits3, Job van Riet1,4, Jurgen J Fütterer5, Tessa Brabander2, Paul Hamberg6, Inge M van Oort7, Ronald de Wit1, Martijn P Lolkema1, Niven Mehra3, Marcel Segbers2, Astrid A M van der Veldt8,2. 1. Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. 2. Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands. 3. Department of Medical Oncology, Radboud UMC, Nijmegen, The Netherlands. 4. Cancer Computational Biology Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. 5. Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands. 6. Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands; and. 7. Department of Urology, Radboud UMC, Nijmegen, The Netherlands. 8. Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands a.vanderveldt@erasmusmc.nl.
Abstract
For individual treatment decisions in patients with metastatic prostate cancer (mPC), molecular diagnostics are increasingly used. Bone metastases are frequently the only source for obtaining metastatic tumor tissue. However, the success rate of CT-guided bone biopsies for molecular analyses in mPC patients is approximately only 40%. PET using 68Ga prostate-specific membrane antigen (68Ga-PSMA) is a promising tool to improve the harvest rate of bone biopsies for molecular analyses. The aim of this study was to determine the success rate of 68Ga-PSMA-guided bone biopsies for molecular diagnostics in mPC patients. Methods: Within a prospective multicenter whole-genome sequencing trial (NCT01855477), 69 mPC patients underwent 68Ga-PSMA PET/CT before bone biopsy. The primary endpoint was the success rate (tumor percentage ≥ 30%) of 68Ga-PSMA-guided bone biopsies. At biopsy sites, 68Ga-PSMA uptake was quantified using rigid-body image registration of 68Ga-PSMA PET/CT and interventional CT. Actionable somatic alterations were identified. Results: The success rate of 68Ga-PSMA-guided biopsies for molecular analyses was 70%. At biopsy sites categorized as positive, inconclusive, or negative for 68Ga-PSMA uptake, 70%, 64%, and 36% of biopsies were tumor-positive (≥30%), respectively (P = 0.0610). In tumor-positive biopsies, 68Ga-PSMA uptake was significantly higher (P = 0.008), whereas radiodensity was significantly lower (P = 0.006). With an area under the curve of 0.84 and 0.70, both 68Ga-PSMA uptake (SUVmax) and radiodensity (mean Hounsfield units) were strong predictors for a positive biopsy. Actionable somatic alterations were detected in 73% of the sequenced biopsies. Conclusion: In patients with mPC, 68Ga-PSMA PET/CT improves the success rate of CT-guided bone biopsies for molecular analyses, thereby identifying actionable somatic alterations in more patients. Therefore, 68Ga-PSMA PET/CT may be considered for guidance of bone biopsies in both clinical practice and clinical trials.
For individual treatment decisions in patients with metastatic prostate cancer (mPC), molecular diagnostics are increasingly used. Bone metastases are frequently the only source for obtaining metastatic tumor tissue. However, the success rate of CT-guided bone biopsies for molecular analyses in mPCpatients is approximately only 40%. PET using 68Ga prostate-specific membrane antigen (68Ga-PSMA) is a promising tool to improve the harvest rate of bone biopsies for molecular analyses. The aim of this study was to determine the success rate of 68Ga-PSMA-guided bone biopsies for molecular diagnostics in mPCpatients. Methods: Within a prospective multicenter whole-genome sequencing trial (NCT01855477), 69 mPCpatients underwent 68Ga-PSMA PET/CT before bone biopsy. The primary endpoint was the success rate (tumor percentage ≥ 30%) of 68Ga-PSMA-guided bone biopsies. At biopsy sites, 68Ga-PSMA uptake was quantified using rigid-body image registration of 68Ga-PSMA PET/CT and interventional CT. Actionable somatic alterations were identified. Results: The success rate of 68Ga-PSMA-guided biopsies for molecular analyses was 70%. At biopsy sites categorized as positive, inconclusive, or negative for 68Ga-PSMA uptake, 70%, 64%, and 36% of biopsies were tumor-positive (≥30%), respectively (P = 0.0610). In tumor-positive biopsies, 68Ga-PSMA uptake was significantly higher (P = 0.008), whereas radiodensity was significantly lower (P = 0.006). With an area under the curve of 0.84 and 0.70, both 68Ga-PSMA uptake (SUVmax) and radiodensity (mean Hounsfield units) were strong predictors for a positive biopsy. Actionable somatic alterations were detected in 73% of the sequenced biopsies. Conclusion: In patients with mPC, 68Ga-PSMA PET/CT improves the success rate of CT-guided bone biopsies for molecular analyses, thereby identifying actionable somatic alterations in more patients. Therefore, 68Ga-PSMA PET/CT may be considered for guidance of bone biopsies in both clinical practice and clinical trials.
Authors: Thomas S C Ng; Xin Gao; Keyan Salari; Dimitar V Zlatev; Pedram Heidari; Sophia C Kamran Journal: Front Oncol Date: 2021-07-28 Impact factor: 6.244
Authors: Ricardo Donners; Nicos Fotiadis; Ines Figueiredo; Matthew Blackledge; Daniel Westaby; Christina Guo; Maria de Los Dolores Fenor de la Maza; Dow-Mu Koh; Nina Tunariu Journal: Eur Radiol Date: 2022-07-26 Impact factor: 7.034