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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 28-04-2022 | Prostate Cancer | Short Communication

Assessment of malignancy and PSMA expression of uncertain bone foci in [¹⁸F]PSMA-1007 PET/CT for prostate cancer—a single-centre experience of PET-guided biopsies

Authors: Bernd Vollnberg, Ian Alberts, Vera Genitsch, Axel Rominger, Ali Afshar-Oromieh

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2022

Abstract

Purpose

Uncertain focal bone uptake (UBU) with intensive radiopharmaceutical avidity are frequently observed in patients undergoing [¹⁸F]PSMA-1007 PET/CT for the detection of prostate cancer (PC). Such foci can pose diagnostic conundrums and risk incorrect staging. The aim of this short communication is to share the results of PET-guided biopsies of such foci.

Methods

A retrospective analysis revealed 10 patients who were referred to our department for PET-guided biopsy of UBU visible in a previous [¹⁸F]PSMA-1007 PET/CT. [¹⁸F]-PSMA-1007 PET-guided biopsy was conducted for 11 PSMA-avid bone foci in these 10 patients. The biopsy materials were analysed for tissue typing, and immunohistochemistry (IHC) was performed for prostate-specific-membrane-antigen (PSMA) expression. The scans were analysed by two experienced physicians in a consensus read for clinical characteristics and radiopharmaceutical uptake of foci.

Results

One out of 11 (9.1%) of the foci biopsied was confirmed as bone metastasis of PC with intense PSMA-expression, while 10/11 (90.9%) foci were revealed to be unremarkable bone tissue without evidence of PSMA expression at IHC. Amongst all bone foci assessed by biopsy, eight were visually classified as being at high risk of malignancy in the PET/CT (SUVmean 12.0 ± 8.1; SUVmax 18.8 ± 13.1), three as equivocal (SUVmean 4.6 ± 2.1; SUVmax 7.2 ± 3.0) and zero as low risk. No UBU had any CT correlate.

Conclusions

This cohort biopsy revealed that a small but relevant number of UBU are true metastases. For those confirmed as benign, no PSMA expression at IHC was observed, suggesting a non-PSMA mediated cause for intensive [¹⁸F]PSMA-1007 uptake of which the reason remains unclear. Readers must interpret such foci with caution in order to reduce the risk of erroneous staging and subsequent treatment. PET-guided biopsy, particularly in the absence of morphological changes in the CT, can be a useful method to clarify such foci.

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Title: Assessment of malignancy and PSMA expression of uncertain bone foci in [18F]PSMA-1007 PET/CT for prostate cancer—a single-centre experience of PET-guided biopsies
Authors: Bernd Vollnberg
Ian Alberts
Vera Genitsch
Axel Rominger
Ali Afshar-Oromieh
Publication date: 28-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2022
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-022-05745-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment of malignancy and PSMA expression of uncertain bone foci in [¹⁸F]PSMA-1007 PET/CT for prostate cancer—a single-centre experience of PET-guided biopsies

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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