https://doi.org/10.4081/aiua.2022.3.274
Targeted prostate biopsy: 68Ga-PSMA PET/CT vs. mpMRI in the diagnosis of prostate cancer
Submitted: July 21, 2022
Accepted: August 6, 2022
Published: September 26, 2022
Accepted: August 6, 2022
Abstract Views: 2247
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Introduction: To evaluate the diagnostic accuracy of 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomog-raphy (PET/CT) vs. multiparametric magnetic resonance imaging (mpMRI) targeted biopsy (TPBx) in the diagnosis of clinical-ly significant prostate cancer (csPCa: Grade Group ≥ 2).
Materials and methods: From January 2021 to June 2022, 100 patients (median age: 66 years) with negative digital rectal examination underwent transperineal prostate biopsy for abnor-mal PSA values (median 7.5 ng/ml). Before prostate biopsy, all patients underwent mpMRI and 68Ga-PET/CT examinations and mpMRI (PI-RADS version 2 ≥ 3) or 68Ga-PET/CT index lesions suspicious for cancer (SUVmax > 5 g/ml) underwent cognitive targeted cores (mpMRI-TPBx and PSMA-TPBx: four cores) combined with extended systematic prostate biopsy (eSPBx: median 18 cores). The procedure was performed transperineally using a tru-cut 18-gauge needle under sedation and antibiotic prophylaxis.
Results: PCa was found in 58/100 (58.0%) men; in detail, 44/58 (75.9%) were csPCa; mpMRI and 68Ga-PSMA showed 66/100 (66%) and 62/100 (60%) lesions suspicious for PCa, respectively. 68Ga-PSMA-TPBx vs. mpMRI-TPBx vs. eSPBx diagnosed 42 (95.4%) vs. 36 (81.8%) vs. 30 (68.2%) csPCa, respectively; mpMRI-TPBx vs. 68Ga-PSMA-TPBx showed a diagnostic accuracy of 76.9% vs. 84.9% in diagnosing csPCa.
Conclusions: 68GaPSMA PET/CT TPBx demonstrated good accuracy in the diagnosis of csPCa, which was not inferior to mpMRI TPBx (84.9% vs. 76.9%) improving the detection rate for cancer of systematic biopsy.
Panebianco V, Barchetti G, Simone G, et al. Negative multipara-metric magnetic resonance imaging for prostate cancer: what’s next?Eur Urol. 2018; 74: 48-54.
DOI: https://doi.org/10.1016/j.eururo.2018.03.007
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.
DOI: https://doi.org/10.21873/anticanres.15785
Sheikhbahaei S, Afshar-Oromieh A, Eiber M, et al. Pearls and pit-falls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging. Eur J Nucl Med Mol Imaging 2017; 44:2117-2136.
DOI: https://doi.org/10.1007/s00259-017-3780-7
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; 11:3473.
DOI: https://doi.org/10.3390/jcm11123473
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.
DOI: https://doi.org/10.1016/j.eururo.2019.01.049
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.
DOI: https://doi.org/10.1038/s41391-020-00292-2
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; 44:941-49.
DOI: https://doi.org/10.1007/s00259-017-3631-6
Emmett L, Buteau J, Papa N, et al. The additive diagnostic value of prostate-specific membrane antigen positron emission tomography computed tomography to multiparametric magnetic resonance imag-ing triage in the diagnosis of prostate cancer (PRIMARY): a prospec-tive multicentre study. Eur Urol. 2021; 80:682-689.
DOI: https://doi.org/10.1016/j.eururo.2021.08.002
Eiber M, Weirich G, Holzapfel K, et al. Simultaneous 68GaPSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol 2016; 70: 829-836.
DOI: https://doi.org/10.1016/j.eururo.2015.12.053
Pepe P, Pennisi M: Should 68Ga-PSMA PET/CT replace CT and bone scan in clinical staging of high-risk prostate cancer? Anticancer Research. 2022; 42:1495-1498.
DOI: https://doi.org/10.21873/anticanres.15621
Carvalho J, Nunes P, Da Silva ET, et al. [68Ga] Ga-PSMA-11 PET-CT: Local preliminary experience in prostate cancer biochemical recurrence patients. Arch Ital Urol Androl. 2021; 93:21-25.
DOI: https://doi.org/10.4081/aiua.2021.1.21
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; 40:244-252.
DOI: https://doi.org/10.1097/PAS.0000000000000530
Aragona F, Pepe P, Motta M, et al. Incidence of prostate cancer in Sicily: results of a multicenter case-findings protocol. Eur Urol. 2005; 47:569-74.
DOI: https://doi.org/10.1016/j.eururo.2004.11.007
Pepe P, Panella P, Savoca F, et al. Prevalence and clinical signifi-cance of prostate cancer among 12,682 men with normal DRE, low PSA (≤ 4 ng/mL) and %fPSA cut-off of 15% and 20%. Urologia Internationalis. 2007; 78:308-312.
DOI: https://doi.org/10.1159/000100833
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.
DOI: https://doi.org/10.1016/j.juro.2018.04.061
Pepe P, Pennisi M, Fraggetta F. How many cores should be obtained during saturation biopsy in the ra of multiparametric mag-netic 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, Pennisi M. Prostate cancer diagnosis and management accross twenty years of clinical practice: a songle-center experience on 2,500 cases. Anticancer Res. 2019; 39:1397-1401.
DOI: https://doi.org/10.21873/anticanres.13254
Moore CM, Kasivisvanathan V, Eggener S, et al., and START con-sortium 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
Dindo D, Demartines N, 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, Garufi A, Priolo G, Pennisi M. Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evalua-tion 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 res-onance 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
Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospec-tive, randomised, multicentre study. Lancet. 2020; 395:1208-1216.
DOI: https://doi.org/10.1016/S0140-6736(20)30314-7
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.
DOI: https://doi.org/10.1016/j.prnil.2020.07.008
Franklin A, Yaxley WJ, Raveenthiran S, et al. Histological com-parison between predictive value of preoperative 3-T multiparamet-ric 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.
DOI: https://doi.org/10.1111/bju.15134
Ma L, Wan-Chun Zhang WC, Ya-Xin Hao YX. Current state of prostate-specific membrane antigen PET/CT imaging-targeted biop-sy techniques for detection of clinically significant prostate cancer J Med Imaging Radiat Oncol. 2022; 66:776-780.
DOI: https://doi.org/10.1111/1754-9485.13369
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 immunohistochem-ical PSMA expression patterns. Eur J Nucl Med Mol Imaging. 2021; 48:4042-53.
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 com-pared with transrectal ultrasound guided biopsy: a prospective ran-domized 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 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.
DOI: https://doi.org/10.3389/fonc.2021.612157
Kalapara AA, Nzenza T, Pan HYC, et al. Detection and localisation of primary prostate cancer using 68gallium prostate-specific membrane antigen positron emission tomography/computed tomography compared with multiparametric magnetic resonance imaging and radical prosta-tectomy specimen pathology. BJU Int. 2020; 126:83-90.
DOI: https://doi.org/10.1111/bju.14858
Xue AL, Kalapara AA, Ballok ZE, et al. 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography maximum stan-dardized uptake value as a predictor of Gleason pattern 4 and patho-logical upgrading in intermediate-risk prostate cancer. 2022; 207:341-349.
DOI: https://doi.org/10.1097/JU.0000000000002254
Ferraro DA, Becker AS, Kranzbühler B, et al. Diagnostic per-formance of 68Ga-PSMA-11 PET/MRI-guided biopsy in patients with suspected prostate cancer: a prospective single-center study. Eur J Nucl Med Mol Imaging. 2021; 48:3315-3324.
DOI: https://doi.org/10.1007/s00259-021-05261-y
Pepe P, Dibenedetto G, Pepe L, Pennisi M. Multiparametric MRI vs Select MDX accuracy in the diagnosis of clinically significant PCa in men enrolled in Active Surveillance. In vivo. 2020; 34:393-396.
DOI: https://doi.org/10.21873/invivo.11786
Roscigno M, Stabile A, Lughezzani G, et al. The use of multipara-metric 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.
DOI: https://doi.org/10.1016/j.clgc.2020.04.006
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
How to Cite
Pepe, P., Pepe, L., Tamburo, M., Marletta, G., Pennisi, M., & Fraggetta, F. (2022). Targeted prostate biopsy: 68Ga-PSMA PET/CT vs. mpMRI in the diagnosis of prostate cancer. Archivio Italiano Di Urologia E Andrologia, 94(3), 274–277. https://doi.org/10.4081/aiua.2022.3.274
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