68Ga-PSMA PET/CT tumour intensity pre-operatively predicts adverse pathological outcomes and progression-free survival in localised prostate cancer

Roberts, Matthew J.; Morton, Anthony; Donato, Peter; Kyle, Samuel; Pattison, David A.; Thomas, Paul; Coughlin, Geoff; Esler, Rachel; Dunglison, Nigel; Gardiner, Robert A.; Doi, Suhail A.R.; Emmett, Louise; Yaxley, John

doi:10.1007/s00259-020-04944-2

Cited by 76 publications

(89 citation statements)

References 10 publications

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“…For primary PCa, patients with higher GS tend to have stronger PSMA expression 12 . Consistent with PSMA expression by immunohistochemistry (IHC), the SUV max of 68 Ga-PSMA PET/CT is also closely correlated with GS 13 - 16 . In a segment analysis of patients with PCa, 68 Ga-PSMA PET/CT showed a high detection rate, and the SUV max values of the segments with GS = 7-10 were significantly higher than those of their nearby normal prostate (PN) tissues 13 .…”

Section: Introductionmentioning

confidence: 68%

Establishment and prospective validation of an SUV_max cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by ⁶⁸Ga-PSMA PET/CT: a real-world study

Jiao¹,

Kang²,

Zhang³

et al. 2021

Theranostics

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Background and Aims: The aims of this study were to establish a maximum standardized uptake value (SUV max ) cutoff to discriminate clinically significant prostate cancer (csPCa) from benign prostate disease (BPD) by 68 Ga-labeled prostate-specific membrane antigen ( 68 Ga-PSMA-11) positron emission tomography/computed tomography (PET/CT) in patients with suspected prostate cancer (PCa), and to perform a prospective real-world validation of this cutoff value. Methods: The study included a training cohort to identify an SUV max cutoff value and a prospective real-world cohort to validate it. A retrospective analysis assessed 135 patients with suspected PCa in a large tertiary care hospital in China who underwent 68 Ga-PSMA-11 PET/CT. All patients were suspected of having PCa based on symptoms, digital rectal examination (DRE), total prostate-specific antigen (tPSA) level, and multiparameter magnetic resonance imaging (mpMRI). The 68 Ga-PSMA PET/CT results were evaluated using histopathological results from transrectal ultrasound-guided 12-core biopsy with necessary targeted biopsy as references. Patients with Gleason scores (GS) ≥7 from the biopsy results were diagnosed with csPCa, and patients with negative biopsy and follow-up results were diagnosed with BPD. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal SUV max cutoff value. The cutoff value was prospectively validated in 58 patients with suspected PCa. The diagnostic benefits of the cutoff value for clinical decision making were also evaluated. Results: According to ROC curve analysis, the most appropriate SUV max cutoff value for discriminating csPCa from BPD was 5.30 (sensitivity, 85.85%; specificity, 86.21%; area under the curve [AUC], 0.893). The cutoff achieved a sensitivity of 83.33%, a specificity of 81.25%, a positive predictive value (PPV) of 92.11%, a negative predictive value (NPV) of 65.00%, and an accuracy of 82.76% in the prospective validation cohort. Metastases were used as an indicator to reduce false negative results in patients with SUV max ≤ 5.30. In patients without metastases, an SUV max value of 5.30 was also the best cutoff to diagnose localized csPCa (sensitivity, 80.43%; specificity, 86.21%; AUC, 0.852). The cutoff discriminated localized csPCa from BPD with a sensitivity of 76.19%, a specificity of 81.25%, a PPV of 84.21%, an NPV of 72.22%, and an accuracy of 78.38% in the prospective validation cohort. The cutoff, combined with metastases, achieved an accuracy of 89.12% in all patients, increasing accuracy by 8.29% and reducing equivocal results compared with manual reading. There was a strong correlation between SUV max and PSMA expression ( r s ...

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Section: Introductionmentioning

confidence: 68%

Establishment and prospective validation of an SUV_max cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by ⁶⁸Ga-PSMA PET/CT: a real-world study

Jiao¹,

Kang²,

Zhang³

et al. 2021

Theranostics

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“…We have shown that the miT stage is an independent predictor of BCR, and we observed a widely varying prognosis in the miT2 stage patients. Similarly, a recent study has revealed that high intraprostatic 68 Ga-PSMA-11 uptake (SUV max >8) predicts short progression-free survival rate among patients with GS 3+4 on biopsy [35]. The signi cant difference in BCR-free survival rate has been con rmed in IA and IB stage groups.…”

Section: Discussionmentioning

confidence: 83%

PSMA-Ligand Uptake Can Serve as a Novel Biomarker in Primary Prostate Cancer to Predict Outcome After Radical Prostatectomy

Wang

Amiel

Würnschimmel

et al. 2021

Preprint

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BackgroundThe prostate-specific membrane antigen (PSMA) is a relevant target in prostate cancer and immunohistochemistry studies showed associations with outcome. PSMA-ligand positron emission tomography (PET) is increasingly used for primary prostate cancer staging and the molecular imaging TNM classification (miTNM) standardizes its reporting. We aimed to investigate the potential of PET-imaging to serve as a noninvasive imaging biomarker to predict disease outcome in primary prostate cancer after radical prostatectomy (RP).MethodsIn this retrospective analysis, 186 primary prostate cancer patients treated with RP who had undergone a 68Ga-PSMA-11 PET up to three months prior to the surgery were included. Maximum standardized uptake value (SUVmax), SUVmean, tumor volume (TV) and total lesion (TL) were collected from PET-imaging. Moreover, clinicopathological information, including age, serum prostate-specific antigen (PSA) level, and pathological characteristics were assessed for disease outcome prediction. A stage group system for PET-imaging findings based on the miTNM framework was developed. ResultsAt a median follow-up after RP of 38 months (interquartile range (IQR): 22-53), biochemical recurrence (BCR) was observed in 58 patients during the follow-up period. A significant association between a positive surgical margin and miN status (miN1 vs. miN0, odds ratio (OR): 5.428, p=0.004) was detected. miT status (miT≥3a vs. miT<3, OR: 2.696, p=0.003) was identified as an independent predictor for Gleason score (GS)≥8. Multivariate Cox regression analysis indicated that PSA level (hazard ratio (HR): 1.024, p=0.014), advanced GS (GS≥8 vs. GS<8, HR: 3.253, p<0.001) and miT status (miT≥3a vs. miT<3, HR: 1.941, p=0.035) were independent predictors for BCR. For stage I disease as determined by PET-imaging a shorter BCR-free survival was observed in the patients with higher SUVmax (IA vs. IB stage, log-rank, p=0.022).ConclusionPreoperative miTNM classification from 68Ga-PSMA-11 PET correlates with postoperative GS, surgical margin status and time to BCR. The association between miTNM staging and outcome proposes 68Ga-PSMA-11 PET as a novel non-invasive imaging biomarker and potentially serves for ancillary pre-treatment stratification. Prospective studies with larger cohort are necessary to fully determine its use including primary prostate cancer patients with different treatments and risk categories and late-stage patients.

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“…Besides the genomic biomarkers, several advanced examinations could also predict the prognosis of PCa. As an example, the PSMA PET/CT could predict progression-free survival in localized PCa (Roberts et al, 2020) and could even guide the use of salvage treatments such as radiotherapy (Emmett et al, 2020). However, due to the limitation of the dataset, the role of this kind of technique was unable to be adjusted in our study.…”

Section: Discussionmentioning

confidence: 96%

Identification of a DNA Repair Gene Signature and Establishment of a Prognostic Nomogram Predicting Biochemical-Recurrence-Free Survival of Prostate Cancer

Long

Ouyang

Zhang

et al. 2021

Front. Mol. Biosci.

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Background: The incidence of prostate cancer (PCa) is high and increasing worldwide. The prognosis of PCa is relatively good, but it is important to identify the patients with a high risk of biochemical recurrence (BCR) so that additional treatment could be applied.Method: Level 3 mRNA expression and clinicopathological data were obtained from The Cancer Genome Atlas (TCGA) to serve as training data. The GSE84042 dataset was used as a validation set. Univariate Cox, lasso Cox, and stepwise multivariate Cox regression were applied to identify a DNA repair gene (DRG) signature. The performance of the DRG signature was assessed based on Kaplan–Meier curve, receiver operating characteristic (ROC), and Harrell’s concordance index (C-index). Furtherly, a prognostic nomogram was established and evaluated likewise.Results: A novel four DRG signature was established to predict BCR of PCa, which included POLM, NUDT15, AEN, and HELQ. The ROC and C index presented good performance in both training dataset and validation dataset. The patients were stratified by the signature into high- and low-risk groups with distinct BCR survival. Multivariate Cox analysis revealed that the DRG signature is an independent prognostic factor for PCa. Also, the DRG signature high-risk was related to a higher homologous recombination deficiency (HRD) score. The nomogram, incorporating the DRG signature and clinicopathological parameters, was able to predict the BCR with high efficiency and showed superior performance compared to models that consisted of only clinicopathological parameters.Conclusion: Our study identified a DRG signature and established a prognostic nomogram, which were reliable in predicting the BCR of PCa. This model could help with individualized treatment and medical decision making.

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68Ga-PSMA PET/CT tumour intensity pre-operatively predicts adverse pathological outcomes and progression-free survival in localised prostate cancer

Cited by 76 publications

References 10 publications

Establishment and prospective validation of an SUV_max cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by ⁶⁸Ga-PSMA PET/CT: a real-world study

Establishment and prospective validation of an SUV_max cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by ⁶⁸Ga-PSMA PET/CT: a real-world study

PSMA-Ligand Uptake Can Serve as a Novel Biomarker in Primary Prostate Cancer to Predict Outcome After Radical Prostatectomy

Identification of a DNA Repair Gene Signature and Establishment of a Prognostic Nomogram Predicting Biochemical-Recurrence-Free Survival of Prostate Cancer

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68Ga-PSMA PET/CT tumour intensity pre-operatively predicts adverse pathological outcomes and progression-free survival in localised prostate cancer

Cited by 76 publications

References 10 publications

Establishment and prospective validation of an SUVmax cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by 68Ga-PSMA PET/CT: a real-world study

Establishment and prospective validation of an SUVmax cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by 68Ga-PSMA PET/CT: a real-world study

PSMA-Ligand Uptake Can Serve as a Novel Biomarker in Primary Prostate Cancer to Predict Outcome After Radical Prostatectomy

Identification of a DNA Repair Gene Signature and Establishment of a Prognostic Nomogram Predicting Biochemical-Recurrence-Free Survival of Prostate Cancer

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Establishment and prospective validation of an SUV_max cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by ⁶⁸Ga-PSMA PET/CT: a real-world study

Establishment and prospective validation of an SUV_max cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by ⁶⁸Ga-PSMA PET/CT: a real-world study