Prediction of clinically significant prostate cancer by [68 Ga]Ga-PSMA-11 PET/CT: a potential tool for selecting patients for active surveillance

Akcay, Kaan; Kibar, Ali; Sahin, Onur Erdem; Demirbilek, Muhammet; Beydagi, Gamze; Asa, Sertac; Aghazada, Fuad; Toklu, Turkay; Selcuk, Nalan Alan; Onal, Bulent; Kabasakal, Levent

doi:10.1007/s00259-023-06556-y

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…This improvement may be attributed to the correlation between PI-RADS scores and adverse pathology, as well as the more accurate pathology obtained through MRI-targeted biopsy. Previous studies have shown that [ 68 Ga]Ga-PSMA PET/CT is a more accurate predictor of adverse pathological outcomes compared to mpMRI [ 15 , 34 ]. In addition, previous literatures have proved that PSMA PET-targeted biopsy, combined with the technique of intraoperative quantification of PSMA PET uptake in core biopsies, could improve the detection rate of csPCa compared with systematic biopsy and reduce the need for saturation biopsy [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Up to 25% of patients with biopsy GGG 1–2 PCa may qualify for AS but harbour adverse pathology (AP: pT3 and/or N1 and/or GGG ≥ 3) at radical prostatectomy (RP) [ 12 , 13 ]. By enrolling these patients in AS, they may miss the opportunity for curative treatment due to disease progression [ 14 , 15 ]. Additionally, the inflexibility of risk categories may limit the number of patients with pathologically indolent PCa who qualify for AS, increasing the risk of overtreatment [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have demonstrated a strong positive correlation between the maximal standardized uptake value (SUVmax) of [ 68 Ga]Ga-PSMA PET and GGG for primary prostate tumors, indicating its potential to predict pathological upgrade from biopsy to RP [ 22 ]. The implementation of this novel molecular imaging technique could prove more advantageous than mpMRI in the patient screening process for AS [ 15 ]. In recent years, the field of radiomics has rapidly progressed, offering the ability to extract valuable quantitative data from digitally encrypted medical images, thereby providing additional information on lesions [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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[68Ga]Ga‑PSMA‑617 PET-based radiomics model to identify candidates for active surveillance amongst patients with GGG 1–2 prostate cancer at biopsy

Yang,

Xiao,

Zhou

et al. 2024

Cancer Imaging

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Purpose To develop a radiomics-based model using [68Ga]Ga-PSMA PET/CT to predict postoperative adverse pathology (AP) in patients with biopsy Gleason Grade Group (GGG) 1–2 prostate cancer (PCa), assisting in the selection of patients for active surveillance (AS). Methods A total of 75 men with biopsy GGG 1–2 PCa who underwent radical prostatectomy (RP) were enrolled. The patients were randomly divided into a training group (70%) and a testing group (30%). Radiomics features of entire prostate were extracted from the [68Ga]Ga-PSMA PET scans and selected using the minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator regression model. Logistic regression analyses were conducted to construct the prediction models. Receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curve were employed to evaluate the diagnostic value, clinical utility, and predictive accuracy of the models, respectively. Results Among the 75 patients, 30 had AP confirmed by RP. The clinical model showed an area under the curve (AUC) of 0.821 (0.695–0.947) in the training set and 0.795 (0.603–0.987) in the testing set. The radiomics model achieved AUC values of 0.830 (0.720–0.941) in the training set and 0.829 (0.624–1.000) in the testing set. The combined model, which incorporated the Radiomics score (Radscore) and free prostate-specific antigen (FPSA)/total prostate-specific antigen (TPSA), demonstrated higher diagnostic efficacy than both the clinical and radiomics models, with AUC values of 0.875 (0.780–0.970) in the training set and 0.872 (0.678–1.000) in the testing set. DCA showed that the net benefits of the combined model and radiomics model exceeded those of the clinical model. Conclusion The combined model shows potential in stratifying men with biopsy GGG 1–2 PCa based on the presence of AP at final pathology and outperforms models based solely on clinical or radiomics features. It may be expected to aid urologists in better selecting suitable patients for AS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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[68Ga]Ga‑PSMA‑617 PET-based radiomics model to identify candidates for active surveillance amongst patients with GGG 1–2 prostate cancer at biopsy

Yang,

Xiao,

Zhou

et al. 2024

Cancer Imaging

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“…Furthermore, [ 68 Ga]Ga-PSMA PET/CT could serve as a non-invasive diagnostic tool for csPCa and for monitoring patients under active surveillance (Fig. 1) [11]. However, since the PRIMARY score's data encompasses all cancer grades, its diagnostic performance and reproducibility are potentially inflated.…”

Section: Mpmri Pathwaymentioning

confidence: 99%

Incorporating the [68Ga]Ga-PSMA PET/CT PRIMARY score into the selection criteria for prostate cancer patients eligible for active surveillance

Kabasakal,

Turkay,

Onal

2024

Eur J Nucl Med Mol Imaging

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Active surveillance (AS) has become a preferred strategy to minimize overtreatment in patients with low-risk prostate cancer (PCa) who do not present with severe lower urinary tract symptoms. Identifying candidates for AS and monitoring them effectively is crucial to mitigate the risk of undertreating localized disease. Currently, the selection of patients for AS is based on a combination of digital rectal examination (DRE) results, prostate-specific antigen (PSA) levels, Gleason score from prostate biopsies, and the rate of tumor-positive biopsy cores. Some protocols also incorporate PSA density, the rate of cancer in biopsy cores, and multiparametric prostate magnetic resonance imaging (mpMRI) to enhance predictive accuracy. Despite these measures, the absence of universally accepted selection standards leads to inconsistencies in identifying appropriate AS candidates. These inconsistencies may result in unnecessary curative treatments, such as radical prostatectomy or radiotherapy for patients suitable for AS, or conversely, a missed opportunity for timely intervention in high-risk patients.Follow-up protocols typically recommend an annual DRE, biannual PSA tests, and repeat biopsies at least once every 1 to 3 years. However, the invasive nature of prostate biopsies, which can cause discomfort and risks such as infections leading to sepsis, hematuria, hematospermia, and dysuria, often dissuades patients from undergoing repeat procedures [1,2]. Adherence to the AS protocol is paramount for its success. The PRIAS study indicated that 40% of patients deviated from the protocol, opting for definitive treatments for reasons outside of the guidelines [3,4]. Consequently, there is a pressing need for new, reliable, and preferably non-invasive diagnostic tools.

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“…Biomarkers for early risk/benefit susceptibility/stratification could be imaged to distinguish patients with high-response from those with medium- or low-response and determine a patient cohort who is suitable for active surveillance or early intervention 128 . In radiopharmaceutical therapies, baseline PET or SPECT scans using biomarker-specific probes provide essential information for selecting patients who are eligible for peptide receptor radionuclide therapy 129 , 130 .…”

Section: Biomarker-driven Molecular Imaging Probes In Radiotherapy Wo...mentioning

confidence: 99%

Biomarker-driven molecular imaging probes in radiotherapy

Li,

Gong,

Luo

2024

Theranostics

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Background: Biomarker-driven molecular imaging has emerged as an integral part of cancer precision radiotherapy. The use of molecular imaging probes, including nanoprobes, have been explored in radiotherapy imaging to precisely and noninvasively monitor spatiotemporal distribution of biomarkers, potentially revealing tumor-killing mechanisms and therapy-induced adverse effects during radiation treatment. Methods: We summarized literature reports from preclinical studies and clinical trials, which cover two main parts: 1) Clinically-investigated and emerging imaging biomarkers associated with radiotherapy, and 2) instrumental roles, functions, and activatable mechanisms of molecular imaging probes in the radiotherapy workflow. In addition, reflection and future perspectives are proposed. Results: Numerous imaging biomarkers have been continuously explored in decades, while few of them have been successfully validated for their correlation with radiotherapeutic outcomes and/or radiation-induced toxicities. Meanwhile, activatable molecular imaging probes towards the emerging biomarkers have exhibited to be promising in animal or small-scale human studies for precision radiotherapy. Conclusion: Biomarker-driven molecular imaging probes are essential for precision radiotherapy. Despite very inspiring preliminary results, validation of imaging biomarkers and rational design strategies of probes await robust and extensive investigations. Especially, the correlation between imaging biomarkers and radiotherapeutic outcomes/toxicities should be established through multi-center collaboration involving a large cohort of patients.

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Prediction of clinically significant prostate cancer by [68 Ga]Ga-PSMA-11 PET/CT: a potential tool for selecting patients for active surveillance

Cited by 8 publications

References 28 publications

[68Ga]Ga‑PSMA‑617 PET-based radiomics model to identify candidates for active surveillance amongst patients with GGG 1–2 prostate cancer at biopsy

[68Ga]Ga‑PSMA‑617 PET-based radiomics model to identify candidates for active surveillance amongst patients with GGG 1–2 prostate cancer at biopsy

Incorporating the [68Ga]Ga-PSMA PET/CT PRIMARY score into the selection criteria for prostate cancer patients eligible for active surveillance

Biomarker-driven molecular imaging probes in radiotherapy

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