Mehmet Onur Demirkol1,2, Tarik Esen3,4, Ersin Koseoglu5, Yakup Kordan3, Mert Kilic4, Oguzhan Sal6, Hulya Seymen1, Murat Can Kiremit3, Ayse Armutlu7, Dilek Ertoy Baydar7, Emre Altinmakas8, Metin Vural9, Okan Falay1, Abdullah Erdem Canda3, Derya Balbay3,4. 1. Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Koç University, Istanbul, Turkey. 2. Department of Nuclear Medicine and Molecular Medicine, VKF American Hospital, Istanbul, Turkey. 3. Department of Urology, School of Medicine, Koç University, Istanbul, Turkey. 4. Department of Urology, VKF American Hospital, Istanbul, Turkey. 5. Department of Urology, Koç University Hospital, Istanbul, Turkey. ekoseoglu@kuh.ku.edu.tr. 6. School of Medicine, Koç University, Istanbul, Turkey. 7. Department of Pathology, School of Medicine, Koç University, Istanbul, Turkey. 8. Department of Radiology, School of Medicine, Koç University, Istanbul, Turkey. 9. Department of Radiology, VKF American Hospital, Istanbul, Turkey.
Abstract
BACKGROUND: To evaluate the additive role of Ga-68 PSMA PET as a primary staging tool in patients bearing prostate cancer in single PIRADS 4 or 5 index lesions. METHODS: Eighty-one biopsy-naive patients with preoperative mpMRI and Ga-68 PSMA PET who underwent radical prostatectomy (RP) were evaluated retrospectively. Forty-nine patients had PIRADS 4 and 32 had PIRADS 5 index lesions. The localization, grade, and volumetric properties of dominant (DT) and non-dominant tumors (NDT) in RP were compared to the index lesions of mpMRI and Ga-68 PSMA PET. RESULTS: The median age and PSA level were 62 (IQR; 59-69) years and 7 (IQR; 2-8) ng/ml, respectively. Ga-68 PSMA PET detected DTs in 100% of the patients including 13 patients in whom mpMR failed. In 45 patients an NDT was reported in RP. Ga-68 PSMA PET accurately detected NDT in 24 of 45 (53.3%) patients. Six patients (12.2%) in PIRADS 4 and 8 (25%) in PIRADS 5 group showed upgrading. In PIRADS 4, Ga-68 PSMA PET localized DT in all patients with upgraded tumors whereas mpMRI missed exact location in 2 of 6 (33.3%). In PIRADS 5 both mpMRI and Ga-68 PSMA PET accurately located all DTs. Overall detection rates of extracapsular extension (ECE) and seminal vesicle invasion (SVI) by mpMRI were 51.1% and 53.8%, respectively. Ga-68 PSMA PET detected ECE and SVI in 27.9% and 30.7%, respectively. When mpMRI and Ga-68 PSMA PET were used in combination detection rates of ECE and SVI increased to 65.1 and 61.5%. Ga-68 PSMA PET-detected six of ten patients with positive lymph nodes whereas mpMRI could not identify any. CONCLUSIONS: Ga-68 PSMA PET has a better diagnostic accuracy in detecting DT, NDT, upgrading, adverse pathology in patients with PIRADS 4 index lesions. However, mpMRI better predicted ECE and SVI than Ga-68 PSMA PET.
BACKGROUND: To evaluate the additive role of Ga-68PSMA PET as a primary staging tool in patients bearing prostate cancer in single PIRADS 4 or 5 index lesions. METHODS: Eighty-one biopsy-naive patients with preoperative mpMRI and Ga-68PSMA PET who underwent radical prostatectomy (RP) were evaluated retrospectively. Forty-nine patients had PIRADS 4 and 32 had PIRADS 5 index lesions. The localization, grade, and volumetric properties of dominant (DT) and non-dominant tumors (NDT) in RP were compared to the index lesions of mpMRI and Ga-68PSMA PET. RESULTS: The median age and PSA level were 62 (IQR; 59-69) years and 7 (IQR; 2-8) ng/ml, respectively. Ga-68PSMA PET detected DTs in 100% of the patients including 13 patients in whom mpMR failed. In 45 patients an NDT was reported in RP. Ga-68PSMA PET accurately detected NDT in 24 of 45 (53.3%) patients. Six patients (12.2%) in PIRADS 4 and 8 (25%) in PIRADS 5 group showed upgrading. In PIRADS 4, Ga-68PSMA PET localized DT in all patients with upgraded tumors whereas mpMRI missed exact location in 2 of 6 (33.3%). In PIRADS 5 both mpMRI and Ga-68PSMA PET accurately located all DTs. Overall detection rates of extracapsular extension (ECE) and seminal vesicle invasion (SVI) by mpMRI were 51.1% and 53.8%, respectively. Ga-68PSMA PET detected ECE and SVI in 27.9% and 30.7%, respectively. When mpMRI and Ga-68PSMA PET were used in combination detection rates of ECE and SVI increased to 65.1 and 61.5%. Ga-68PSMA PET-detected six of ten patients with positive lymph nodes whereas mpMRI could not identify any. CONCLUSIONS:Ga-68PSMA PET has a better diagnostic accuracy in detecting DT, NDT, upgrading, adverse pathology in patients with PIRADS 4 index lesions. However, mpMRI better predicted ECE and SVI than Ga-68PSMA PET.
Authors: Sasha C Druskin; Jen-Jane Liu; Allen Young; Zhaoyong Feng; Seyed S Dianat; Wesley W Ludwig; Bruce J Trock; Katarzyna J Macura; Christian P Pavlovich Journal: Res Rep Urol Date: 2017-04-18
Authors: Gabriele Sorce; Rocco Simone Flammia; Benedikt Hoeh; Francesco Chierigo; Lukas Hohenhorst; Andrea Panunzio; Armando Stabile; Giorgio Gandaglia; Zhe Tian; Derya Tilki; Carlo Terrone; Michele Gallucci; Felix K H Chun; Alessandro Antonelli; Fred Saad; Shahrokh F Shariat; Francesco Montorsi; Alberto Briganti; Pierre I Karakiewicz Journal: Prostate Date: 2022-04-01 Impact factor: 4.012