Standardised uptake values as determined on prostate‐specific membrane antigen positron emission tomography/computed tomography is associated with oncological outcomes in patients with prostate cancer

Abstract

Objectives To investigate the association between intraprostatic, intratumoral maximum standardised uptake values (SUVmax) on prostate‐specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer (PCa) prior to robot‐assisted radical prostatectomy (RARP) and pathology outcomes, including pathological International Society of Urological Pathology score (pISUP) and lymph node (LN) status (pN0/pN1). Patients and Methods A bi‐centric, secondary analysis of two previous, prospective cohort studies was performed in 318 patients with biopsy confirmed PCa and who were scheduled for RARP. Before surgery, patients received a PSMA PET/CT with either 68Ga‐PSMA‐11 (59% of the patients) or 18F‐PSMA (DCFPyL; 41%) as radiotracer. PET/CT images were analysed both visually and semi‐quantitatively by measuring the SUVmax of the most intense suspect lesion in the prostate. The association between the SUVmax of the primary tumour and pre‐ and postoperative variables was analysed. Results The SUVmax was associated with clinical and biopsy preoperative variables, as well as with pISUP score and pathological tumour stage. Patients with a pISUP of ≤2 showed significantly lower SUVmax compared to patients with a pISUP of >2 for both tracers (SUVmax 18F‐PSMA: median 5.1 vs 9.6, P = 0.002; SUVmax 68Ga‐PSMA‐11: 6.6 vs 8.6, P = 0.003). Moreover, patients with pN1 had significantly higher median SUVmax than those with pN0/pNx for both tracers (SUVmax 18F‐PSMA: 7.9 vs 12.3, P = 0.04; SUVmax 68Ga‐PSMA‐11: 7.6 vs 12.0, P < 0.001). On multivariable logistic regression analysis, the intraprostatic SUVmax was an independent predictor of pN1 for both 68Ga‐PSMA‐11 (per doubling: odds ratio [OR] 1.96, 95% confidence interval [CI] 1.27–3.01)) and 18F‐PSMA (per doubling: OR 1.79, 95% CI 1.06–3.03). Conclusion Intraprostatic, intratumoral PSMA intensity on PET/CT, as semi‐quantitatively expressed by SUVmax, may be a valuable innovative biomarker in patients with localised PCa, as it is highly associated with known conventional prognostic factors, such as pISUP and LN status.

18F-JK-PSMA-7 PET/CT for staging intermediate- or high-risk prostate cancer patients before radical prostatectomy: a pilot study

“…These high SUVmax values might represent important biomarkers highly associated with conventional prognostic factors such as ISUP or lymph node status as recently suggested also by Bodar et al (Bodar et al 2022 ).…”

Higher Preoperative Maximum Standardised Uptake Values (SUVmax) Are Associated with Higher Biochemical Recurrence Rates after Robot-Assisted Radical Prostatectomy for [68Ga]Ga-PSMA-11 and [18F]DCFPyL Positron Emission Tomography/Computed Tomography

“…In line with the European Association of Nuclear Medicine (EANM) standardised reporting guidelines for PSMA-PET (E-PSMA), the semi-quantitative measurement of PSMA tracer uptake, expressed as maximum Standardised Uptake Values (SUV max ), is one important element when interpreting PET/CT scans [9,10]. Previous studies suggest that the SUV max of the primary prostate tumour may predict unfavourable disease outcomes, such as a higher pathological International Society of Urological Pathology Grade Group (pISUP), pathological tumour stage (pT) and lymph node involvement [11][12][13]. Furthermore, research showed that the SUV max in the primary staging of PCa represents an independent predictor for disease recurrence with the radiotracer [ 68 Ga]Ga-PSMA-11 [11,14,15].…”

Re: ‘Prostate‐specific membrane antigen positron emission tomography in addition to multiparametric magnetic resonance imaging and biopsies to select prostate cancer patients for focal therapy’

“…Notwithstanding these limitations, the authors' have the merit of evaluating the possible role of PSMA-PET as a diagnostic tool for PCa and particularly to select best candidates for FT [2]. However, we believe that, despite the increasing claim of PSMA-PET as a more accurate method, it suffers from excess sensitivity, and its use should be directed towards patients with a high risk of metastatic PCa, particularly when the traditional imaging is controversial or in doubt.…”

“…Being aware of the authors' good intention to make the treatment for PCa increasingly minimally invasive, thus reducing side-effects associated with radical treatment and improve quality of life, we have some concern about the following points according to the current evidence [2].…”