Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 2/2021

Open Access 01-02-2021 | Prostate Cancer | Original Article

68Ga-PSMA PET/CT targeted biopsy for the diagnosis of clinically significant prostate cancer compared with transrectal ultrasound guided biopsy: a prospective randomized single-centre study

Authors: Le-Le Zhang, Wen-Cheng Li, Zheng Xu, Nan Jiang, Shi-Ming Zang, Lu-Wei Xu, Wen-Bing Huang, Feng Wang, Hong-Bin Sun

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 2/2021

Login to get access

Abstract

Purpose

68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is valuable for detecting primary and recurrent prostatic lesions. This study aimed to evaluate the efficacy of 68Ga-PSMA-11 PET/CT as a triage tool for prostate biopsy (PSMA-TB) and compare with transrectal ultrasound-guided biopsy (TRUS-GB) for the diagnosis of clinically significant prostate cancer (csPCa).

Methods

This single-centre study randomly allocated 120 patients with elevated serum prostate-specific antigen (PSA) levels (> 4 ng/ml) to PSMA-PET or TRUS group. Patients with PSMA-avid lesions (SUVmax ≥ 8.0) underwent PSMA-TB via a single-puncture percutaneous transgluteal approach (n = 25), whilst patients with negative PSMA-PET underwent systematic TRUS-GB (n = 35). All patients in the TRUS group underwent TRUS-GB directly (n = 60).

Results

PCa and csPCa were detected in 26/60 (43.3%) and 24/60 (40.0%) patients in the PSMA-PET group and 19/60 (31.6%) and 15/60 (25.0%) in the TRUS group, respectively. In the PSMA-PET group, the detection rate of PCa and csPCa were significantly higher in PSMA-PET-positive than negative patients (PCa, 23/25 (92.0%) vs 3/35 (8.6%), P < 0.01; csPCa, 22/25 (88.0%) vs 2/35 (5.7%), P < 0.01). PSMA-TB detected significantly more PCa and csPCa than TRUS-GB in the TRUS controls (PCa, 21/25 (84.0%) vs 19/60 (31.6%), P < 0.01; csPCa, 20/25 (80.0%) vs 15/60 (25.0%), P < 0.01). PSMA-PET detected significantly more cases of csPCa amongst patients with PSA 4.0–20.0 ng/ml than TRUS (27.02% vs 8.82%, P < 0.05). No haematuria, urinary retention or pelvic infection was observed after PSMA-TB compare with TRUS-GB.

Conclusions

68Ga-PSMA-11 PET/CT is a feasible imaging technique that may serve as a triage tool for prostate biopsy, and may improve the detection rate of csPCa compared with TRUS-GB, especially in patients with serum PSA 4.0–20.0 ng/ml.
Literature
1.
Abraham NE, Mendhiratta N, Taneja SS. Patterns of repeat prostate biopsy in contemporary clinical practice. J Urol. 2015;193:1178–84.CrossRef
2.
Ahmed HU, EI-Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389:815–22.CrossRef
3.
Barentsz JQ, Weinreb JC, Nerma S, et al. Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendation for use. Eur Urol. 2016;69:41–9.CrossRef
4.
Siddiqui MM, Rais-Bahrami S, Turkbey B, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 2015;313:390–7.CrossRef
5.
Kasivisvanathan V, Rannikko M, Borghi V, et al. MRI-targeted or standard biopsy for prostate cancer diagnosis. N Engl J Med. 2018;379:589–99.CrossRef
6.
Panebianco V, Barchetti G, Simone G, et al. Negative multiparametric magnetic resonance imaging for prostate cancer: what’s next? Eur Urol. 2018;74:48–54.CrossRef
7.
Paschalis A, Sheehan B, Riisnaes R, et al. Prostate-specific Membrane Antigen Heterogeneity and DNA Repair Defects in Prostate Cancer. Eur Urol. 2019;76:469–78.CrossRef
8.
Sheikhbahaei S, Afshar-Oromieh A, Eiber M, et al. Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging. Eur J Nucl Med Mol Imaging. 2017;44:2117–36.CrossRef
9.
Cristain U, Marlon P, Michael SH, et al. 68Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography in advanced prostate cancer: current state and future trends. Prostate Int. 2017;5:125–9.CrossRef
10.
Perera M, Papa N, Roberts M, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: A systematic review and meta-analysis. Eur Urol. 2019. https://​doi.​org/​10.​1016/​j.​eururo.​2019.​01.​049.
11.
Budäus L, Leyh-Bannurah SR, Salomon G, et al. Initial experience of 68Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol. 2016;69:393–6.CrossRef
12.
Herlemann A, Wenter V, Kretschmer A, et al. 68Ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer. Eur Urol. 2016;70:553–7.CrossRef
13.
Uprimny C, Kroiss AS, Decristoforo C, et al. 68Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Mol Imaging. 2017;44:941–9.CrossRef
14.
Fendler WP, Schmidt DF, Wenter V, et al. 68Ga-PSMA PET/CT detects the location and extent of primary prostate cancer. J Nucl Med. 2016;57:1720–5.CrossRef
15.
Eiber M, Weirich G, Holzapfel K, et al. Simultaneous (68)Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol. 2016;70:829–36.CrossRef
16.
Zang S, Shao G, Cui C, et al. 68Ga-PSMA-11 PET/CT for prostate cancer staging and risk stratification in Chinese patients. Oncotarget. 2017;8:12247–58.CrossRef
17.
Gao J, Zhang C, Zhang Q, et al. Diagnostic performance of 68Ga-PSMA PET/CT for identification of aggressive cribriform morphology in prostate cancer with whole-mount sections. Eur J Nucl Med Mol Imaging. 2019;46:1531–41.CrossRef
18.
Zhang Q, Zang SM, Zhang CE, et al. Comparison of 68Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer. J Transl Med. 2017;15:230–8.CrossRef
19.
20.
Sathekge M, Lengana T, Maes A, et al. (68) Ga-PSMA-11 PET/CT in primary staging of prostate carcinoma: preliminary results on differences between black and white South-Africans. Eur J Nucl Med Mol Imaging. 2018;45:226–34.CrossRef
21.
Kisten B, Peter LC. Advances in prostate-specific membrane antigen PET of prostate cancer. Curr Opin Oncol. 2018;30:189–96.CrossRef
22.
Bailey J, Piert M. Performance of 68Ga-PSMA PET/CT for prostate cancer management at initial staging and time of biochemical recurrence. Curr Urol Rep. 2017;18:84–90.CrossRef
23.
Eichler K, Hempel S, Wilby J, et al. Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review. J Urol. 2006;175:1605–12.CrossRef
24.
Djavan B, Ravery V, Zlotta A, et al. Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol. 2001;166:1679–83.CrossRef
25.
Baowei F, Perter TN, Viraj AM, et al. Molecular imaging and fusion targeted biopsy of the prostate. Clin Transl Imaging. 2017;5:29–43.CrossRef
26.
Simopoulos DN, Natarajan S, Jones TA, et al. Targeted prostate biopsy using 68Gallium PSMA-PET/CT for image guidance. Urol Case Rep. 2017;14:11–4.CrossRef
27.
Fei B, Nieh PT, Schuster DM, Master VA. PET-directed 3D ultrasound-guided prostate biopsy. Diagn Imaging Eur. 2013;29:12–5.PubMedPubMedCentral
28.
Maurer T, Gschwend JE, Rauscher I, et al. Diagnostic efficacy of (68)gallium-PSMA positron emission tomography compared to conventional imaging for lymphnode staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol. 2016;195:1436–43.CrossRef
29.
Mannweiler S, Amersdorfer P, Trajanoski S, Terrett JA, King D, Mehes G. Heterogeneity of prostate-specific membrane antigen (PSMA) expression in prostate carcinoma in distant metastasis. Pathol Oncol Res. 2009;15:162–72.
Metadata
Title
68Ga-PSMA PET/CT targeted biopsy for the diagnosis of clinically significant prostate cancer compared with transrectal ultrasound guided biopsy: a prospective randomized single-centre study
Authors
Le-Le Zhang
Wen-Cheng Li
Zheng Xu
Nan Jiang
Shi-Ming Zang
Lu-Wei Xu
Wen-Bing Huang
Feng Wang
Hong-Bin Sun
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 2/2021
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-020-04863-2

Other articles of this Issue 2/2021

European Journal of Nuclear Medicine and Molecular Imaging 2/2021 Go to the issue

Original Article

Clinical validation of the novel HDAC6 radiotracer [18F]EKZ-001 in the human brain

Image of the Month

18F-FDG PET/CT findings in a rare monomorphic epitheliotropic intestinal T cell lymphoma

Original Article

Thyroglobulin doubling time offers a better threshold than thyroglobulin level for selecting optimal candidates to undergo localizing [18F]FDG PET/CT in non-iodine avid differentiated thyroid carcinoma

Short Communication

18F-FDG brain PET hypometabolism in post-SARS-CoV-2 infection: substrate for persistent/delayed disorders?

Original Article

The deep learning model combining CT image and clinicopathological information for predicting ALK fusion status and response to ALK-TKI therapy in non-small cell lung cancer patients

Original Article

18F-DCFPyL PET/CT for primary staging in 160 high-risk prostate cancer patients; metastasis detection rate, influence on clinical management and preliminary results of treatment efficacy