Investigating PSMA-PET/CT to resolve prostate MRI PIRADS4-5 and negative biopsy discordance

Springer Science and Business Media LLC - Tập 41 - Trang 463-469 - 2023
Lih-Ming Wong1,2,3, Samantha Koschel1,2, Thomas Whish-Wilson1,2, Matthew Farag2,3, Damien Bolton2,3, Homi Zargar2,4, Niall Corcoran2,4, Nathan Lawrentschuk2,4, Alexandar Christov1, Lauren Thomas5, Elisa Perry5,6, Stefan Heinze7, Kim Taubman5, Tom Sutherland5,6
1Department of Urology, St Vincent’s Health Melbourne, Melbourne, Australia
2Department of Surgery, University of Melbourne, Melbourne, Australia
3Department of Urology, Austin Health, Melbourne, Australia
4Department of Urology, Melbourne Health, Melbourne, Australia
5Department of Radiology, St Vincent’s Health Melbourne, Melbourne, Australia
6Department of Medicine, University of Melbourne, Melbourne, Australia
7Department of Radiology, Melbourne Health, Melbourne, Australia

Tóm tắt

To determine the utility of diagnostic 18F-DCPyL PSMA-PET/CT to aid management of men with highly suspicious multiparametric MRI prostate (PIRAD 4–5 lesions) and discrepant negative prostate biopsy. A multicentre prospective consecutive case series was conducted (2018–2021), recruiting men with prior mpMRI prostate PIRADS 4–5 lesions and negative prostate biopsy. All men had 18F-DCPyL PSMA-PET/CT with subsequent management based on the concordance between MRI and PET: (1) Concordant lesions were biopsied using in-bore MRI targeting; (2) PSMA-PET/CT avidity without MRI correlate were biopsied using cognitive/software targeting with ultrasound guidance and (3) Patients with negative PET/CT were returned to standard of care follow-up. 29 patients were recruited with 48% (n = 14) having concordant MRI/PET abnormalities. MRI targeted biopsy found prostate cancer in six patients, with grade groups GG3 (n = 1), GG2 (n = 1), GG1 (n = 4) found. Of the 20 men who PSMA-PET/CT avidity and biopsy, analysis showed higher SUVmax (20.1 vs 6.8, p = 0.036) predicted prostate cancer. Of patients who had PSMA-PET avidity without MRI correlate, and those with no PSMA-PET avidity, only one patient was subsequently found to have prostate cancer (GG1). The study is limited by small size and short follow-up of 17 months (IQR 12.5–29.9). PSMA-PET/CT is useful in this group of men but requires further investigation. Avidity (higher SUVmax) that correlates to the mpMRI prostate lesion should be considered for targeted biopsy.

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