TY - JOUR
T1 - Using prostate-specific membrane antigen positron-emission tomography to guide prostate biopsies and stage men at high-risk of prostate cancer
AU - Bodar, Yves J. L.
AU - Boevé, Liselotte M. S.
AU - van Leeuwen, Pim J.
AU - Baars, Phillippe C.
AU - Nieuwenhuijzen, Jakko A.
AU - van Haarst, Ernst P.
AU - Oddens, Jorg R.
AU - Donswijk, Maarten L.
AU - van Riel, Luigi A. M. J. G.
AU - Scheltema, Matthijs J.
AU - Meijer, Dennie
AU - Hendrikse, N. Harry
AU - Oprea-Lager, Daniela E.
AU - Vis, André N.
N1 - Publisher Copyright: © 2023 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.
PY - 2023/12
Y1 - 2023/12
N2 - Objective: To assess whether a diagnostic pathway in which prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) is used as a single imaging modality is feasible to guide targeted biopsy and to detect clinically significant prostate cancer (csPCa) in biopsy-naïve men at high-risk of disease. Patients and Methods: A total of 60 men with a prostate-specific antigen (PSA) level of 20–50 ng/mL underwent 18F-PSMA(DCFPyL)-PET/CT prior to prostate biopsies in this prospective, non-randomised cohort study. Magnetic resonance imaging (MRI) was not performed. Using a 12-segment mapping model of the prostate, PSMA-guided targeted biopsy was performed along with systematic biopsies. The detection rate of PCa and csPCa was assessed for combined systematic and targeted biopsy, and for targeted biopsy only. csPCa was defined as a prostate biopsy with an International Society of Uropathology (ISUP) Grade Group ≥2. Results: Lesions suspicious for PCa in the prostate gland were observed on all PSMA-PET/CTs. A total of 27/60 men (45%) already had metastatic disease on staging 18F-PSMA(DCFPyL)-PET/CT. Combined PSMA-guided targeted and systematic biopsies detected PCa in 56/60 (93.3%) patients, with 52 of them (92.9%) having csPCa. PSMA-guided targeted biopsy, if performed as a single biopsy modality, identified PCa in 52/60 men (86.7%) and in 27/27 men (100%) men with metastases. Conclusions: Using the PSMA-driven single imaging modality pathway in biopsy-naïve men at high-risk of PCa, a substantial number of diagnostic MRI scans could be avoided while at the same time obtaining adequate targeting, staging, and detection of csPCa.
AB - Objective: To assess whether a diagnostic pathway in which prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) is used as a single imaging modality is feasible to guide targeted biopsy and to detect clinically significant prostate cancer (csPCa) in biopsy-naïve men at high-risk of disease. Patients and Methods: A total of 60 men with a prostate-specific antigen (PSA) level of 20–50 ng/mL underwent 18F-PSMA(DCFPyL)-PET/CT prior to prostate biopsies in this prospective, non-randomised cohort study. Magnetic resonance imaging (MRI) was not performed. Using a 12-segment mapping model of the prostate, PSMA-guided targeted biopsy was performed along with systematic biopsies. The detection rate of PCa and csPCa was assessed for combined systematic and targeted biopsy, and for targeted biopsy only. csPCa was defined as a prostate biopsy with an International Society of Uropathology (ISUP) Grade Group ≥2. Results: Lesions suspicious for PCa in the prostate gland were observed on all PSMA-PET/CTs. A total of 27/60 men (45%) already had metastatic disease on staging 18F-PSMA(DCFPyL)-PET/CT. Combined PSMA-guided targeted and systematic biopsies detected PCa in 56/60 (93.3%) patients, with 52 of them (92.9%) having csPCa. PSMA-guided targeted biopsy, if performed as a single biopsy modality, identified PCa in 52/60 men (86.7%) and in 27/27 men (100%) men with metastases. Conclusions: Using the PSMA-driven single imaging modality pathway in biopsy-naïve men at high-risk of PCa, a substantial number of diagnostic MRI scans could be avoided while at the same time obtaining adequate targeting, staging, and detection of csPCa.
KW - PSMA
KW - detection
KW - diagnosis
KW - prostate cancer
KW - target biopsy
UR - http://www.scopus.com/inward/record.url?scp=85170694184&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/bju.16167
DO - https://doi.org/10.1111/bju.16167
M3 - Article
C2 - 37620288
SN - 1464-4096
VL - 132
SP - 705
EP - 712
JO - BJU international
JF - BJU international
IS - 6
ER -