Evaluating F-18-PSMA-1007-PET in primary prostate cancer and comparing it to multi-parametric MRI and histopathology

• Published in: Prostate cancer and prostatic diseases Vol. 24; no. 2; pp. 423 - 430
• Main Authors: Privé, Bastiaan M, Israël, Bas, Schilham, Melline G M, Muselaers, Constantijn H J, Zámecnik, Patrik, Mulders, Peter F A, Witjes, J Alfred, Sedelaar, Michiel, Mehra, Niven, Verzijlbergen, Fred, Janssen, Marcel J R, Gotthardt, Martin, Barentsz, Jelle O, van Oort, Inge M, Nagarajah, James
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.06.2021
• Subjects: Aged; Biopsy; Bladder; Cancer surgery; Comparative analysis; Computed tomography; Fluorine isotopes; Fluorodeoxyglucose F18 - metabolism; Follow-Up Studies; Histochemistry; Histopathology; Humans; Lesions; Magnetic resonance imaging; Male; Medical imaging; Middle Aged; Multiparametric Magnetic Resonance Imaging; Niacinamide - analogs & derivatives; Niacinamide - metabolism; Oligopeptides - metabolism; PET imaging; Positron emission; Positron Emission Tomography Computed Tomography; Prognosis; Prostate cancer; Prostatectomy; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Radioisotopes; Radiopharmaceuticals - metabolism; Retrospective Studies; Seminal vesicle; Tomography; Tumors; Netherlands
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/s41391-020-00292-2

PSMA-PET is a novel imaging modality for the staging of prostate cancer (PCa). While there are several PSMA ligands available, F-18-PSMA-1007 is particularly of interest as it is not renally excreted and therefore does not impair the imaging of the pelvic area. Hence, this study aimed to investigate the F-18-PSMA-1007-PET for the primary staging of PCa and compared it to multi-parametric (mp) MRI and histopathology. A retrospective study was performed of men with intermediate and high-risk PCa patients that underwent a F-18-PSMA-1007-PET after mpMRI with subsequent MR-guided target biopsy (MRGB). Suspicious mpMRI lesions and F-18-PSMA-1007-PET were simultaneously reviewed on both a per patient and per-lesion basis. Results were subsequently evaluated with histopathological outcome of MRGB, and if performed, the radical prostatectomy specimen. A total of 66 suspicious mpMRI lesions were identified in 53 patients and underwent MRGB. Two lesions had a maximum standardized uptake value (SUV ) less than the mean SUV of healthy prostate tissue and were considered as non-PSMA-expressing. All PSMA avid tumors had higher SUV than the mean SUV of the bladder/urine, therefore all lesions were clearly distinguishable in the pelvic area. Twenty-three patients received a radical prostatectomy of which the histopathology specimens were evaluated. F-18-PSMA-1007-PET/CT correctly staged seminal vesicle invasion (i.e. pT3b) more often than mpMRI (90 vs. 76%), whereas mpMRI more accurately detected extracapsular extension (i.e. pT3a) compared to F-18-PSMA-1007-PET (90% vs 57%). The present study of a selected cohort suggest that dual imaging with mpMRI and F-18-PSMA-1007-PET may improve staging of primary PCa. F-18-PSMA-1007-PET/CT had low renal clearance, which could assist the evaluation of tumors in proximity of the bladder.