https://doi.org/10.4081/aiua.2024.12358
Negative biopsy histology in men with PI-RADS score 5: is it useful PSMA PET/CT evaluation?
Submitted: February 5, 2024
Accepted: February 18, 2024
Published: June 27, 2024
Accepted: February 18, 2024
Abstract Views: 1295
PDF: 294
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Introduction: To evaluate the accuracy of PSMA PET/CT in men with mpMRI PI-RADS score 5 negative biopsy histology.
Materials and methods: From January 2011 to January 2023, 180 men with PI-RADS score 5 underwent systematic plus mpMRI/TRUS biopsy; 25/180 (13.9%) patients had absence of cancer and six months from biopsy were submitted to: digital rectal examination, PSA and PSA density exams, mpMRI and 68GaPSMA PET/CT evaluation (standardized uptake value “SUVmax” was reported).
Results: In 24/25 (96%) patients PSA and PSA density significantly decreased, moreover, the PI-RADS score was downgraded resulting < 3; in addition, median SUVmax was 7.5. Only 1/25 (4%) man had an increased PSA value (from 10.5 to 31 ng/ml) with a confirmed PI-RADS score 5, SUVmax of 32 and repeated prostate biopsy demonstrating a Gleason score 9/ISUP Grade Group 5 PCa.
Conclusions: The strict follow up of men with PI-RADS score 5 and negative histology reduce the risk of missing csPCa especially if PSMA PET/CT evaluation is in agreement with downgrading of mpMRI (PI-RADS score < 3).
Lin Y, Yilmaz EC, Belue MJ, Turkbey B. Prostate MRI and image Quality: It is time to take stock. Eur J Radiol 2023; 161:110757.
DOI: https://doi.org/10.1016/j.ejrad.2023.110757
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: 1249-1253.
DOI: https://doi.org/10.1007/s00345-015-1749-3
Rosenkrantz AB, Verma S, Choyke P, et al. Prostate Magnetic Resonance Imaging and Magnetic Resonance Imaging Targeted Biopsy in Patients with a Prior Negative Biopsy: A Consensus Statement by AUA and SAR. J Urol 2016; 196:1613-1618.
DOI: https://doi.org/10.1016/j.juro.2016.06.079
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.
DOI: https://doi.org/10.1080/21681805.2017.1313310
Filson CP, Natarajan S, Margolis DJ, et al. Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: The role of systematic and targeted biopsies. Cancer 2016; 15:884-892.
DOI: https://doi.org/10.1002/cncr.29874
Pepe P, Garufi A, Priolo GD, et al. Is it Time to Perform Only Magnetic Resonance Imaging Targeted Cores? Our Experience with 1,032 Men Who Underwent Prostate Biopsy. J Urol 2018; 200:774-778.
DOI: https://doi.org/10.1016/j.juro.2018.04.061
Westphalen AC, Fazel F, Nguyen H, et al. Detection of clinically significant prostate cancer with PIRADS v2 scores, PSA density, and ADC values in regions with and without mpMRI visible lesions. Int Braz J Urol 2019; 45:713-723.
DOI: https://doi.org/10.1590/s1677-5538.ibju.2018.0768
Otti VC, Miller C, Powell RJ, et al. The diagnostic accuracy of multiparametric magnetic resonance imaging before biopsy in the detection of prostate cancer. BJU Int 2019; 123:82-90.
DOI: https://doi.org/10.1111/bju.14420
Aragona F, Pepe P, Motta M, et al. Incidence of prostate cancer in Sicily: results of a multicenter case-findings protocol. Eur Urol 2005; 47:569-574.
DOI: https://doi.org/10.1016/j.eururo.2004.11.007
Fandella A, Scattoni V, Galosi A, et al. Italian Prostate Biopsies Group: 2016 Updated Guidelines Insights. Anticancer Res 2017; 37:413-424.
DOI: https://doi.org/10.21873/anticanres.11333
Pepe P, Pennisi M. Morbidity following transperineal prostate biopsy: Our experience in 8.500 men. Arch Ital Urol Androl 2022; 94:155-159.
DOI: https://doi.org/10.4081/aiua.2022.2.155
Moore CM, Kasivisvanathan V, Eggener S, et al. START Consortium. Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol 2013; 64:544-552.
DOI: https://doi.org/10.1016/j.eururo.2013.03.030
Pepe P, Garufi A, Priolo G, Pennisi M. Transperineal Versus Transrectal MRI/TRUS Fusion Targeted Biopsy: Detection Rate of Clinically Significant Prostate Cancer. Clin Genitourin Cancer. 2017;15:e33-e36.
DOI: https://doi.org/10.1016/j.clgc.2016.07.007
Pepe P, Pennisi M, Fraggetta F. How Many Cores Should be Obtained During Saturation Biopsy in the Era of Multiparametric Magnetic Resonance? Experience in 875 Patients Submitted to Repeat Prostate Biopsy. Urology 2020; 137:133-137.
DOI: https://doi.org/10.1016/j.urology.2019.11.016
Pepe P, Dibenedetto G, Pennisi M, et al. Detection rate of anterior prostate cancer in 226 patients submitted to initial and repeat transperineal biopsy. Urol Int 2014; 93:189-192.
DOI: https://doi.org/10.1159/000358494
Epstein JI, Egevad L, Amin MB, et al. Grading Committee. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016; 40:244-52.
DOI: https://doi.org/10.1097/PAS.0000000000000530
Dindo D, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a Cohort of 6336 patients and results of survey. Ann Surg 2004; 2:205-213.
DOI: https://doi.org/10.1097/01.sla.0000133083.54934.ae
Pepe P, Pennisi M. Targeted Biopsy in Men High Risk for Prostate Cancer: 68Ga-PSMA PET/CT Versus mpMRI. Clin Genitourin Cancer 2023; 21:639-642.
DOI: https://doi.org/10.1016/j.clgc.2023.06.007
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.
DOI: https://doi.org/10.4081/aiua.2022.3.274
Faria R, Soares MO, Spackman E, et al. Optimising the Diagnosis of Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging: A Cost-effectiveness Analysis Based on the Prostate MR Imaging Study (PROMIS). Eur Urol 2018; 73:23-30.
DOI: https://doi.org/10.1016/j.eururo.2017.08.018
Pepe P, Pepe G, Pepe L, et al. Cost-effectiveness of Multiparametric MRI in 800 Men Submitted to Repeat Prostate Biopsy: Results of a Public Health Model. Anticancer Res 2018; 38:2395-2398.
DOI: https://doi.org/10.21873/anticanres.12489
Pepe P, Pepe L, Pennisi M, Fraggetta F. Confirmatory transperineal saturation prostate biopsy combined with mpMRI decrease the reclassification rate in men enrolled in Active Surveillance: Our experience in 100 men submitted to eight-years scheduled biopsy. Arch Ital Urol Androl 2022; 94:270-273.
DOI: https://doi.org/10.4081/aiua.2022.3.270
Kim H, Pak S, Park KJ, et al. Utility of Multiparametric Magnetic Resonance Imaging With PI-RADS, Version 2, in Patients With Prostate Cancer Eligible for Active Surveillance: Which Radiologic Characteristics Can Predict Unfavorable Disease? Clin Genitourin Cancer 2020; 18:50-55.
DOI: https://doi.org/10.1016/j.clgc.2019.09.018
Cecchini S, Castellani D, Fabbietti P, et al. Combination of Multiparametric Magnetic Resonance Imaging With Elastic-fusion Biopsy Has a High Sensitivity in Detecting Clinically Significant Prostate Cancer in Daily Practice. Clin Genitourin Cancer. 2020;18:e501-e509.
DOI: https://doi.org/10.1016/j.clgc.2020.02.006
Westhoff N, Siegel FP, Hausmann D, et al. Precision of MRI/ultrasound-fusion biopsy in prostate cancer diagnosis: an ex vivo comparison of alternative biopsy techniques on prostate phantoms. World J Urol 2017; 35:1015-1022.
DOI: https://doi.org/10.1007/s00345-016-1967-3
Pepe P, Pennisi M. Negative Biopsy Histology in Men With PIRADS Score 5 in Daily Clinical Practice: Incidence of Granulomatous Prostatitis. Clin Genitourin Cancer 2020; 18:e684-e687.
DOI: https://doi.org/10.1016/j.clgc.2020.04.001
Arabi A, Deebajah M, Yaguchi G, et al. Systematic Biopsy Does Not Contribute to Disease Upgrading in Patients Undergoing Targeted Biopsy for PI-RADS 5 Lesions Identified on Magnetic Resonance Imaging in the Course of Active Surveillance for Prostate Cancer. Urology 2019; 134:168-172.
DOI: https://doi.org/10.1016/j.urology.2019.08.035
Li JL, Phillips D, Towfighi S, et al. Second-opinion reads in prostate MRI: added value of subspecialty interpretation and review at multidisciplinary rounds. Abdom Radiol (NY). 2022; 47:827-837.
DOI: https://doi.org/10.1007/s00261-021-03377-1
Salvi M, Caputo A, Balmativola D, Scotto M. Impact of Stain Normalization on Pathologist Assessment of Prostate Cancer: A Comparative Study. Cancers (Basel). 2023; 15:1503..
DOI: https://doi.org/10.3390/cancers15051503
Pepe P, Pepe L, Tamburo M, et al. 68Ga-PSMA PET/CT and Prostate Cancer Diagnosis: Which SUVmax Value? In Vivo 2023;37:1318-1322.
DOI: https://doi.org/10.21873/invivo.13211
Pepe P, Fandella A, Barbera M, et al. Advances in radiology and pathology of prostate cancer: a review for the pathologist. Pathologica. 2024; 116:1-12.
DOI: https://doi.org/10.32074/1591-951X-925
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 Res. 2022; 42:3011-3015.
DOI: https://doi.org/10.21873/anticanres.15785
Pepe P, Roscigno M, Pepe L, et al. Could 68Ga-PSMA PET/CT Evaluation Reduce the Number of Scheduled Prostate Biopsies in Men Enrolled in Active Surveillance Protocols? J Clin Med 2022; 11:3473.
DOI: https://doi.org/10.3390/jcm11123473
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.
DOI: https://doi.org/10.1097/MNM.0000000000000942
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.
DOI: https://doi.org/10.1007/s00259-021-05501-1
Zhang LL, Li WC, Xu Z, et al. 68Ga-PSMA PET/CT targeted biopsy for the diagnosis of clinically significant prostate cancer compared with transrectal ultrasound guided biopsy: a prospective randomized single-centre study. Eur J Nucl Med Mol Imaging 2021;48:483-492.
DOI: https://doi.org/10.1007/s00259-020-04863-2
Liu Y, Yu H, Liu J, et al. A Pilot Study of 18F-DCFPyL PET/CT or PET/MRI and Ultrasound Fusion Targeted Prostate Biopsy for Intra Prostatic PET-Positive Lesions. Front Oncol 2021; 11:612157.
DOI: https://doi.org/10.3389/fonc.2021.612157
Rais-Bahrami S, Nix JW, Turkbey B, et al. Clinical and multiparametric MRI signatures of granulomatous prostatitis. Abdom Radiol (NY) 2017; 42:1956-1962.
DOI: https://doi.org/10.1007/s00261-017-1080-0
Chatterjee A, Thomas S, Oto A Prostate MR: Pitfalls and benign lesions Abdom Radiol (NY) 2020; 45:2154-2164.
DOI: https://doi.org/10.1007/s00261-019-02302-x
Gordetsky JB, Ullman D, Schultz L, et al. Histologic findings associated with false-positive multiparametric magnetic resonance imaging performed for prostate cancer detection. Hum Pathol 2019; 83:159-165.
DOI: https://doi.org/10.1016/j.humpath.2018.08.021
Kawada H, Kanematsu M, Goshima S, et al. Multiphase contrast-enhanced magnetic resonance imaging features of Bacillus Calmette-Guérin-induced granulomatous prostatitis in five patients. Korean J Radiol 2015; 16:342-348.
DOI: https://doi.org/10.3348/kjr.2015.16.2.342
Pepe P, Pepe L, Curduman M, et al. Ductal prostate cancer staging: Role of PSMA PET/CT. Arch Ital Urol Androl. 2024; 96:12132.
DOI: https://doi.org/10.4081/aiua.2024.12132
Gottlieb J, Princenthal R, Cohen MI. Multi-parametric MRI findings of granulomatous prostatitis developing after intravesical bacillus calmette-guérin therapy. Abdom Radiol (NY) 2017; 42:1963-1967.
DOI: https://doi.org/10.1007/s00261-017-1081-z
Wong LM, Koschel S, Whish-Wilson T, et al. Investigating PSMAPET/CT to resolve prostate MRI PIRADS4-5 and negative biopsy discordance. World J Urol 2023; 463-469.
DOI: https://doi.org/10.1007/s00345-022-04243-5
How to Cite
Pepe, P., Pepe, L., & Pennisi, M. (2024). Negative biopsy histology in men with PI-RADS score 5: is it useful PSMA PET/CT evaluation?. Archivio Italiano Di Urologia E Andrologia, 96(2). https://doi.org/10.4081/aiua.2024.12358
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.