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. 2024 Apr:133 Suppl 4:14-22.
doi: 10.1111/bju.16207. Epub 2023 Nov 8.

Prostate-specific membrane antigen positron emission tomography in addition to multiparametric magnetic resonance imaging and biopsies to select prostate cancer patients for focal therapy

Bart Geboers  1   2   3 , Dennie Meijer  4 , William Counter  5 , Alexandar Blazevski  1   2 , James Thompson  1   2   6 , Paul Doan  1   2 , William Gondoputro  1   2 , Athos Katelaris  1   2 , Anne-Maree Haynes  1 , Warick Delprado  7 , Gordon O'Neill  8 , Carlo Yuen  8 , Andre N Vis  4 , Pim J van Leeuwen  9 , Bao Ho  5 , Victor Liu  5 , Jonathan Lee  5 , Maarten L Donswijk  10 , Daniela Oprea-Lager  3 , Matthijs J Scheltema  1   2   4 , Louise Emmett  5 , Phillip D Stricker  2   8
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Prostate-specific membrane antigen positron emission tomography in addition to multiparametric magnetic resonance imaging and biopsies to select prostate cancer patients for focal therapy

Bart Geboers et al. BJU Int. 2024 Apr.

Abstract

Objective: To evaluate the additional value of prostate-specific membrane antigen positron emission tomography (PSMA-PET) to conventional diagnostic tools to select patients for hemi-ablative focal therapy (FT).

Patients and methods: We performed a retrospective analysis on a multicentre cohort (private and institutional) of 138 patients who underwent multiparametric magnetic resonance imaging (mpMRI), PSMA-PET, and systematic biopsies prior to radical prostatectomy between January 2011 and July 2021. Patients were eligible when they met the consensus criteria for FT: PSA <15 ng/mL, clinical/radiological T stage ≤T2b, and International Society of Urological Pathology (ISUP) grade 2-3. Clinically significant prostate cancer (csPCa) was defined as ISUP grade ≥2, extracapsular extension >0.5 mm or seminal vesicle involvement at final histopathology. The diagnostic accuracy of mpMRI, systematic biopsies and PSMA-PET for csPCa (separate and combined) was calculated within a four-quadrant prostate model by receiver-operating characteristic and 2 × 2 contingency analysis. Additionally, we assessed whether the diagnostic tools correctly identified patients suitable for hemi-ablative FT.

Results: In total 552 prostate quadrants were analysed and 272 (49%) contained csPCa on final histopathology. The area under the curve, sensitivity, specificity, positive predictive value and negative predictive value for csPCa were 0.79, 75%, 83%, 81% and 77%, respectively, for combined mpMRI and systematic biopsies, and improved after addition of PSMA-PET to 0.84, 87%, 80%, 81% and 86%, respectively (P < 0.001). On final histopathology 46/138 patients (33%) were not suitable for hemi-ablative FT. Addition of PSMA-PET correctly identified 26/46 (57%) non-suitable patients and resulted in 4/138 (3%) false-positive exclusions.

Conclusions: Addition of PSMA-PET to the conventional work-up by mpMRI and systematic biopsies could improve selection for hemi-ablative FT and guide exclusion of patients for whom whole-gland treatments might be a more suitable treatment option.

Keywords: PSMA‐PET; biopsy; focal therapy; mpMRI; prostate cancer.

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Conflict of interest statement

Phillip D. Stricker is a paid consultant for Angio Dynamics. Matthijs J. Scheltema, Alexandar Blazevski and Bart Geboers received research funding from Angio Dynamics. Louise Emmett reports grants from Movember, Cancer Institute New South Wales, St Vincent's Curran and Clinic Foundations, non-financial support from Astellas and Endocyte/AAA, and personal fees from Janssen, Astrazeneca, Astellas, Telix, Mundipharma, Bayer and Amgen. Dennie Meijer, William Counter, Paul Doan, Anne-Maree Haynes, William Gondoputro, Athos Katelaris, James Thompson, Andre N. Vis, Pim J. van Leeuwen, Bao Ho, Jonathan Lee, Victor Liu, Maarten L. Donswijk, Daniela Oprea-Lager, Gordon O’Neill, Warick Delprado and Carlo Yuen have no relevant competing interests to declare.

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References

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