https://doi.org/10.4081/aiua.2023.11322

68Ga-PSMA PET/CT evaluation in men enrolled in prostate cancer Active Surveillance

Vol. 95 No. 2 (2023)
Submitted: March 18, 2023
Accepted: March 28, 2023
Published: May 22, 2023
Prostate cancer, 68Ga-PSMA PET/CT, Active Surveillance, PCa
Abstract Views: 1105
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Authors

Pietro Pepe
piepepe@hotmail.com
Urology Unit, Cannizzaro Hospital, Catania, Italy.
Ludovica Pepe
Urology Unit, Cannizzaro Hospital, Catania, Italy.
Marinella Tamburo
Radiotherapy Unit, Cannizzaro Hospital, Catania, Italy.
Giulia Marletta
Radiotherapy Unit, Cannizzaro Hospital, Catania, Italy.
Francesco Savoca
Urology Unit, Cannizzaro Hospital, Catania, Italy.
Michele Pennisi
Urology Unit, Cannizzaro Hospital, Catania, Italy.
Filippo Fraggetta
Pathology Unit, Cannizzaro Hospital, Catania, Italy.

Introduction: To evaluate the accuracy of 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the diagnosis of clinically significant prostate cancer (csPCa: Grade Group ≥ 2) in men enrolled in Active Surveillance (AS) protocol. Materials and methods: From May 2013 to December 2021 200 men aged between 52 and 74 years (median age 63) with very low risk PCa were enrolled in an AS protocol study. During the follow up 48/200 (24%) men were upgraded and 10/200 (5%) decided to leave the AS protocol. After five years from confirmatory biopsy (range: 48-60 months) 40/142 (28.2%) consecutive patients were submitted to mpMRI and 68Ga-PSMA PET/CT imaging examinations before scheduled repeated biopsy. All the mpMRI (PI-RADS ≥ 3) and 68Ga-PET/TC standardized uptake value (SUVmax) ≥ 5 index lesions underwent targeted cores (mpMRI-TPBx and PSMA-TPBx) combined with transperineal saturation prostate biopsy (SPBx: median 20 cores). Results: Multiparametric MRI and 68Ga-PSMA PET/CT showed 18/40 (45%) and 9/40 (22.5%) lesions suspicious for PCa. In 3/40 (7.5%) men a csPCa (GG2) was found; 68Ga-PSMA-TPBx vs. mpMRI-TPBx vs. SPBx diagnosed 2/3 (66.6%) vs. 2/3 (66.6%) vs. 3/3 (100%) csPCa, respectively. In detail, mpMRI and 68Ga-PSMA PET/TC demonstrated 16/40 (40%) vs. 7/40 (17.5%) false positive and 1 (33.3%) vs. 1 (33.3%) false negative results. Conclusion: Although 68PSMA PET/CT did not improve the detection for csPCa of SPBx (1 false negative result equal to 33.3% of the cases), at the same time, would have spared 31/40 (77.5%) scheduled biopsies showing a better diagnostic accuracy in comparison with mpMRI (83.3% vs. 70.2%).

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Carlsson S, Benfante N, Alvim R, et al. Long-Term Outcomes of Active Surveillance for Prostate Cancer: The Memorial Sloan Kettering Cancer Center Experience. J Urol 2020; 203:1122-1127.
Briganti A, Fossati N, Catto JWF, et al. Active Surveillance for Low-risk Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018; 74:357-368.
Pepe P, Cimino S, Garufi A, et al. Confirmatory biopsy of men under active surveillance: extended versus saturation versus multiparametric magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy. Scand J Urol 2017; 51:260-263.
Pepe P, Pepe L, Pennisi M, Fraggetta F. Which Prostate Biopsy in Men Enrolled in Active Surveillance? Experience in 110 Men Submitted to Scheduled Three-Years Transperineal Saturation Biopsy Combined With Fusion Targeted Cores. Clin Genitourin Cancer 2021; 19:305-308.
Pepe P, Garufi A, Priolo GD, et al. Is it time to perform only MRI targeted biopsy? Our experience in 1032 men submitted to prostate biopsy. J Urol 2018; 200:774-778.
Caglic I, Sushentsev N, Gnanapragasam VJ, et al. MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance. Eur Radiol 2021; 31:2696-2705.
Perera M, Papa N, Roberts M, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: A systematic review and meta-analysis. Eur Urol 2020; 77:403-417.
Privé BM, Israël B, Schilham MGM, et al. Evaluating F-18-PSMA-1007-PET in primary prostate cancer and comparing it to multi-parametric MRI and histopathology. Prostate Cancer Prostatic Dis. 2021; 24:423-430.
Uprimny C, Kroiss AS, Decristoforo C, et al. 68Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Mol Imaging 2017; 44:941-949.
Zhang Q, Zang SM, Zhang CE, et al. Comparison of 68Ga-PSMA11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer. J Transl Med 2017; 15:230-38.
Pepe P, Pepe L, Cosentino S, et al. Detection Rate of 68Ga-PSMA PET/CT vs. mpMRI Targeted Biopsy for Clinically Significant Prostate Cancer. Anticancer Research 2022; 42:3011-3015.
Raveenthiran S, Yaxley WJ, Franklin T, et al. Findings in 1,123 Men with Preoperative 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography/Computerized Tomography and Multiparametric Magnetic Resonance Imaging Compared to Totally Embedded Radical Prostatectomy Histopathology: Implications for the Diagnosis and Management of Prostate Cancer. J Urol 2022;207:573-580.
Pepe P, Pepe L, Tamburo M, et al. Targeted prostate biopsy: 68Ga-PSMA PET/CT vs. mpMRI in the diagnosis of prostate cancer. Arch Ital Urol Androl 2022; 94:274-277.
Pepe P, Roscigno M, Pepe L, et al. Could 68Ga-PSMA PET/CT evaluation reduce the number of scheduled prostate biopsy in men enrolled in active surveillance protocols? J Clin Med 2022; 16:3473.
Pepe P, Pennisi M, Fraggetta F. How many cores should be obtained during saturation biopsy in the ra of multiparametric magnetic resonance? Experience in 875 patients submitted to repeat prostate-biopsy. Urology 2020; 137:133-37.
Pepe P, Garufi A, Priolo G, Pennisi M. Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance? World J Urol 2016; 34:1249-53.
Roscigno M, Stabile A, Lughezzani G, et al. The Use of Multiparametric Magnetic Resonance Imaging for Follow-up of Patients Included in Active Surveillance Protocol. Can PSA Density Discriminate Patients at Different Risk of Reclassification? Clin Genitourin Cancer. 2020; 18:e698-e704.
Roscigno M, Stabile A, Lughezzani G, et al. Multiparametric magnetic resonance imaging and clinical variables: Which is the best combination to predict reclassification in active surveillance patients? Prostate Int 2020; 8:167-172.
Pepe P, Dibenedetto G, Pepe L, Pennisi M. Multiparametric MRI Versus SelectMDx Accuracy in the Diagnosis of Clinically Significant PCa in Men Enrolled in Active Surveillance. In Vivo 2020; 34:393-396.
Pepe P, Pennisi M. Should 68Ga-PSMA PET/CT Replace CT and Bone Scan in Clinical Staging of High-risk Prostate Cancer? Anticancer Res. 2022; 42:1495-1498.
Kwan TN, Spremo S, Teh AYM, et al. Performance of Ga-68 PSMA PET/CT for diagnosis and grading of local prostate cancer. Prostate International 2021; 9:107-112.
Ma L, Zhang WC, Ya-Xin Hao YX, Hao YX. Current state of prostate-specific membrane antigen PET/CT imaging-targeted biopsy techniques for detection of clinically significant prostate cancer J Med Imaging Radiat Oncol 2022; 66:776-780.
Perera M, Papa N, Roberts M, et al. Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer-Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate-specific Membrane Antigen-avid Lesions: A Systematic Review and Meta-analysis. Eur Urol 2020;77:403-417.
Demirci E, Kabasakal L, Sahin OE, et al. Can SUVmax values of Ga-68-PSMA PET/CT scan predict the clinically significant prostate cancer? Nucl Med Commun 2019; 40:86-91.
Rüschoff JH, Ferraro DA, Muehlematter UJ, et al. What's behind 68Ga-PSMA-11 uptake in primary prostate cancer PET? Investigation of histopathological parameters and immunohistochemical PSMA expression patterns. Eur J Nucl Med Mol Imaging 2021; 48:4042-4053.
Franklin A, Yaxley WJ, Raveenthiran S, et al. Histological comparison between predictive value of preoperative 3-T multiparametric MRI and 68Ga-PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer. BJU Int 2021; 127:71-79.
Liu Y, Yu H, Liu J, et al. A Pilot Study of 18 F-DCFPyL PET/CT or PET/MRI and Ultrasound Fusion Targeted Prostate Biopsy for Intra-Prostatic PET-Positive Lesions. Front Oncol 2021; 11:612157.
Kalapara AA, Nzenza T, Pan HYC, et al. Detection and localisation of primary prostate cancer using 68 gallium prostate-specific membrane antigen positron emission tomography/computed tomography compared with multiparametric magnetic resonance imaging and radical prostatectomy specimen pathology. BJU Int 2020;126:83-90.
Xue AL, Kalapara AA, Ballok ZE, et al. 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography Maximum Standardized Uptake Value as a Predictor of Gleason Pattern 4 and Pathological Upgrading in Intermediate-Risk Prostate Cancer. J Urol 2022: 207:341-349.
Bhanji Y, Rowe SP, Pavlovich CP. New imaging modalities to consider for men with prostate cancer on active surveillance. World J Urol World J Urol 2022; 40:51-59.

How to Cite

Pepe, P., Pepe, L., Tamburo, M., Marletta, G., Savoca, F., Pennisi, M., & Fraggetta, F. (2023). 68Ga-PSMA PET/CT evaluation in men enrolled in prostate cancer Active Surveillance. Archivio Italiano Di Urologia E Andrologia, 95(2). https://doi.org/10.4081/aiua.2023.11322
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