Egesta Lopci1, Giovanni Lughezzani2, Angelo Castello3, Alberto Saita2, Piergiuseppe Colombo4, Rodolfo Hurle2, Roberto Peschechera2, Alessio Benetti2, Silvia Zandegiacomo2, Luisa Pasini2, Paolo Casale2, Diana Pietro2, Giulio Bevilacqua2, Luca Balzarini5, Nicolò Maria Buffi6, Giorgio Guazzoni6, Massimo Lazzeri2. 1. Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy. Electronic address: egesta.lopci@gmail.com. 2. Urology Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy. 3. Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy. 4. Pathology Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy. 5. Radiology Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy. 6. Urology Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Pathology Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Radiology Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas University, Pieve Emanuele, Milan, Italy.
Abstract
BACKGROUND: Positron emission tomography (PET)/computed tomography (CT) with 68Ga-labeled prostate-specific membrane antigen ligand (68Ga-PSMA) may represent the most promising alternative to multiparametric magnetic resonance imaging (mpMRI) for prostate cancer (PCa) diagnosis. OBJECTIVE: To test the diagnostic performance of 68Ga-PSMA PET/CT in this clinical context. DESIGN, SETTING, AND PARTICIPANTS: From January 2017 to December 2018 we prospectively enrolled 97 patients with persistently elevated prostate-specific antigen and/or Prostate Health Index score, negative digital rectal examination, and previous negative biopsy. We also included patients with either negative mpMRI or contraindications to or positive mpMRI but previous negative biopsy. INTERVENTION: Patients underwent 68Ga-PSMA PET/CT with additional pelvic reconstruction. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint of the study was the diagnostic performance of 68Ga-PSMA PET/CT in detecting malignant lesions and clinically significant PCa (Gleason score [GS] ≥7). RESULTS AND LIMITATIONS: 68Ga-PSMA PET/transrectal ultrasound fusion biopsy was performed in 64 of 97 patients (66%) for 114 regions of interest (ROIs). Forty patients (41%) had already undergone mpMRI with either a negative result for PCa (n = 15; 22 ROIs) or a positive mpMRI result but a previous negative biopsy. According to pathology, 23 patients (36%) had evidence of PCa: eight (16 ROIs) with GS 6, 13 (21 ROIs) with GS 7 (3 + 4 or 4 + 3), one (2 ROIs) with GS 8, and one (2 ROIs) with GS 10. Clinically significant PCa was identified in four patients with previous negative mpMRI (25%). PET/CT demonstrated PCa in seven patients (14 ROIs) with previous positive mpMRI and negative biopsy. The median maximum standardized uptake value (SUVmax) and median SUV ratio were significantly higher for PCa lesions than for benign lesions (p < 0.001). Optimal cutoff points obtained for SUVmax (>5.4) and SUV ratio (>2.2) could identify clinically significant PCa with accuracy of 81% and 90%, respectively. CONCLUSIONS: In our cohort of patients with high suspicion of cancer,68Ga-PSMA PET/CT was capable of detecting malignancy and accurately identifying clinically relevant PCa. PATIENT SUMMARY: Positron emission tomography/computed tomography with a 68Ga-labeled ligand for prostate-specific membrane antigen is capable of detecting prostate cancer in patients with a high suspicion of cancer and a previous negative biopsy.
BACKGROUND: Positron emission tomography (PET)/computed tomography (CT) with 68Ga-labeled prostate-specific membrane antigen ligand (68Ga-PSMA) may represent the most promising alternative to multiparametric magnetic resonance imaging (mpMRI) for prostate cancer (PCa) diagnosis. OBJECTIVE: To test the diagnostic performance of 68Ga-PSMA PET/CT in this clinical context. DESIGN, SETTING, AND PARTICIPANTS: From January 2017 to December 2018 we prospectively enrolled 97 patients with persistently elevated prostate-specific antigen and/or Prostate Health Index score, negative digital rectal examination, and previous negative biopsy. We also included patients with either negative mpMRI or contraindications to or positive mpMRI but previous negative biopsy. INTERVENTION: Patients underwent 68Ga-PSMA PET/CT with additional pelvic reconstruction. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint of the study was the diagnostic performance of 68Ga-PSMA PET/CT in detecting malignant lesions and clinically significant PCa (Gleason score [GS] ≥7). RESULTS AND LIMITATIONS: 68Ga-PSMA PET/transrectal ultrasound fusion biopsy was performed in 64 of 97 patients (66%) for 114 regions of interest (ROIs). Forty patients (41%) had already undergone mpMRI with either a negative result for PCa (n = 15; 22 ROIs) or a positive mpMRI result but a previous negative biopsy. According to pathology, 23 patients (36%) had evidence of PCa: eight (16 ROIs) with GS 6, 13 (21 ROIs) with GS 7 (3 + 4 or 4 + 3), one (2 ROIs) with GS 8, and one (2 ROIs) with GS 10. Clinically significant PCa was identified in four patients with previous negative mpMRI (25%). PET/CT demonstrated PCa in seven patients (14 ROIs) with previous positive mpMRI and negative biopsy. The median maximum standardized uptake value (SUVmax) and median SUV ratio were significantly higher for PCa lesions than for benign lesions (p < 0.001). Optimal cutoff points obtained for SUVmax (>5.4) and SUV ratio (>2.2) could identify clinically significant PCa with accuracy of 81% and 90%, respectively. CONCLUSIONS: In our cohort of patients with high suspicion of cancer,68Ga-PSMA PET/CT was capable of detecting malignancy and accurately identifying clinically relevant PCa. PATIENT SUMMARY: Positron emission tomography/computed tomography with a 68Ga-labeled ligand for prostate-specific membrane antigen is capable of detecting prostate cancer in patients with a high suspicion of cancer and a previous negative biopsy.
Authors: E Lopci; G Lughezzani; A Castello; P Colombo; P Casale; A Saita; N M Buffi; G Guazzoni; A Chiti; M Lazzeri Journal: Clin Transl Oncol Date: 2020-05-23 Impact factor: 3.405
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
Authors: Daniel Eberli; Irene A Burger; Daniela A Ferraro; Anton S Becker; Benedikt Kranzbühler; Iliana Mebert; Anka Baltensperger; Konstantinos G Zeimpekis; Hannes Grünig; Michael Messerli; Niels J Rupp; Jan H Rueschoff; Ashkan Mortezavi; Olivio F Donati; Marcelo T Sapienza Journal: Eur J Nucl Med Mol Imaging Date: 2021-02-23 Impact factor: 9.236