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European Journal of Nuclear Medicine and Molecular Imaging

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01-07-2020 | Prostate Cancer | Original Article

⁶⁸Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is ⁶⁸Ga-PSMA PET/CT guided biopsy the future?

Authors: Peter Donato, Andrew Morton, John Yaxley, Sachinka Ranasinghe, Patrick E. Teloken, Samuel Kyle, Geoff Coughlin, Rachel Esler, Nigel Dunglison, Robert A Gardiner, Matthew J Roberts

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 8/2020

Abstract

Background

68Ga prostate specific membrane antigen PET/CT (68Ga-PSMA PET/CT) may be superior to multiparametric MRI (mpMRI) for localisation of prostate cancer tumour foci, however the concordance and differences between 68Ga-PSMA PET/CT and mpMRI when applied to all biopsied patients and potential benefit in patients with negative mpMRI is unclear.

Methods

Retrospective analysis of patients undergoing mpMRI, prostate biopsy and 68Ga-PSMA PET/CT over a 3-year period. Diagnostic performance of 68Ga-PSMA PET/CT and mpMRI were assessed using biopsy histopathology for the entire cohort and radical prostatectomy specimen in a subset of patients. Lesion concordance and additional detection of each modality were determined, including in a dedicated cohort of patients with mpMRI PIRADS 2 scans.

Results

A total of 144 patients were included in the study. Index lesion/foci detection was similar between 68Ga-PSMA PET/CT and mpMRI (sensitivity 83.1% vs 90.1%; p = 0.267), however lesions missed by mpMRI were larger (1.66 cm³ vs 0.72 cm³; p = 0.034). Lesion detection rates were similar across the biopsy histopathology and radical prostatectomy specimen subset, with a high concordance for index (80.1%) and a moderate concordance for total (67%) lesions between the 2 imaging modalities. The additional detection yield favoured 68Ga-PSMA PET/CT over mpMRI for index (13.5% vs 4.3%) and total (18.2% vs 5.4%) lesions; both modalities missed 2.1% and 12.3% of index and total lesions, respectively. 68Ga-PSMA PET/CT identified 9 of 11 patients with PIRADS 2 mpMRI but subsequently diagnosed with Gleason ≥ 3 + 4 disease.

Conclusions

Despite high concordance rates, 68Ga-PSMA PET/CT incrementally improved tumour localisation compared with mpMRI. These results suggest that 68Ga-PSMA PET/CT may have an incremental value to that of mpMRI in the diagnostic process for prostate.

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Title: 68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is 68Ga-PSMA PET/CT guided biopsy the future?
Authors: Peter Donato
Andrew Morton
John Yaxley
Sachinka Ranasinghe
Patrick E. Teloken
Samuel Kyle
Geoff Coughlin
Rachel Esler
Nigel Dunglison
Robert A Gardiner
Matthew J Roberts
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Prostatectomy
Prostatectomy
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 8/2020
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-019-04620-0

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⁶⁸Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is ⁶⁸Ga-PSMA PET/CT guided biopsy the future?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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