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. 2021 Mar;9(1):54-59.
doi: 10.1016/j.prnil.2020.07.007. Epub 2020 Aug 13.

The role of 68Gallium-prostate-specific membrane antigen positron emission tomography on staging of high-risk localized prostate cancer: for all high-risk patients or would it be better to select them?

Fernando Sabino M Monteiro  1   2   3 , Juçara Motta Serafim Eliam  2 , Rafaela Gomes de Jesus  1 , Pedro Cavalcante  4 , Gustavo do Vale Gomes  4 , Bruno Hochhegger  5 , Vinicius K Gonçalves  3 , Laura Von Wallwitz Freitas  3 , Diego H Roman  5 , Andre Poisl Fay  1   5   3
Affiliations

The role of 68Gallium-prostate-specific membrane antigen positron emission tomography on staging of high-risk localized prostate cancer: for all high-risk patients or would it be better to select them?

Fernando Sabino M Monteiro et al. Prostate Int. 2021 Mar.

Abstract

Background: According to pathologico-clinical features, patients diagnosed with localized prostate cancer (PCa) are stratified into distinct risk groups (low-risk, intermediate-risk or high-risk). Data have demonstrated that 68Gallium-prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET/CT) is superior to conventional radiological exams (CT or MRI and bone scintigraphy) in the primary staging of high-risk localized PCa. However, it is still unknown if in a population of high-risk PCa, there would be a subgroup of patients with a higher probability of identifying metastatic disease by the 68Ga-PSMA PET/CT.

Materials and methods: Data from patients with localized PCa who underwent 68GA-PSMA PET/CT for primary staging from four institutions were retrospectively collected. We selected patients with at least one D'Amico classification risk factor (International Society of Urological Pathology ≥ IV and/or prostate-specific antigen > 20 ng/ml). To detect an association between extent of disease and number of risk factors as well as International Society of Urological Pathology prostate cancer grade, contingency tables were used, and Fisher Exact Test was performed.

Results: Between 2016 and 2020, 60 patients underwent a 68GA-PSMA PET/CT for primary staging of high-risk localized PCa. Regarding the number of risk factors, 37 patients (62%) had one risk factor, and 23 (38%) had two risk factors. In the subgroup of patients with metastatic disease (n = 22), those with two risk factors had higher incidence of metastatic disease, and it was statistically significant (p = 0.011).

Conclusion: This retrospective analysis demonstrated that 68GA-PSMA PET/CT was able to identify advanced disease in more than one-third of patients with high-risk disease especially those with two adverse risk factors.

Keywords: 68GA-PSMA; PET/CT; high-risk; localized prostate cancer; primary staging.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
68Ga-PSMA PET/CT scans identification and selection. 68Ga-PSMA PET/CT, 68Gallium-prostate-specific membrane antigen positron emission tomography; ISUP, International Society of Urological Pathology.
Fig. 2
Fig. 2
Association between D'Amico risk factors and metastatic disease. ISUP, International Society of Urological Pathology; PSA, prostrate-specific antigen.
Fig. 3
Fig. 3
Association between ISUP prostate cancer grade and metastatic disease. ISUP, International Society of Urological Pathology.
See this image and copyright information in PMC

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