The role of histopathological and biochemical parameters for predicting metastatic disease on ⁶⁸Ga‐PSMA‐11 PET in prostate cancer

Abstract

Background: The aim of this study was to evaluate the role of histopathological and biochemical parameters in the prediction of the presence and number of PSMA positive lesions consistent with the metastatic spread of prostate cancer on 68 Ga-PSMA PET images.Methods: Biochemical, histopathological and imaging data of 302 prostate cancer patients who underwent 68 Ga-PSMA-11 PET/CT or PET/MR imaging for primary staging were retrospectively analyzed. Patients were divided into two groups as "PET positive" and "PET negative" according to the presence of pathologic extraprostatic PSMA involvement. "PET positive" patients were additionally divided into two groups: oligometastatic (1-3 metastatic lesion) and multimetastatic (>3 metastatic lesions).Results: The mean age of patients was 66.8 ± 7.6 years. Imaging modality was PET/ MR in 223 (73.8%) and PET/CT in 79 (26.2%) of patients. Total PSA, PSA density (PSAD), ALP, and tumor ratio in biopsy specimens were found to be significantly higher in "PET positive" group compared to "PET negative" group and in multimetastatic group compared to oligometastatic group. PET positivity was observed in 3.8% of the low-intermediate risk groups (ISUP 1-3 and total PSA ≤ 20 ng/ml and PSAD < 0.15 ng/ml/cc). This ratio was 46% in the high-risk group (ISUP 4-5 or total PSA > 20 ng/ml or PSAD ≥ 0.15 ng/ml/cc) with a relative risk of 12 (p < .001). The prediction models to predict the PET positivity and the presence of distant metastasis had AUCs of 0.901 and 0.925, respectively; with ALP, total PSA, and tumor ratio in needle biopsy specimen as significant independent predictors (p < .05).Conclusions: In this study, 68 Ga-PSMA-11 PET positivity was significantly higher in the high-risk patient group than in the low-intermediate risk groups. The prediction models used for predicting the PET positivity and the presence of distant metastasis on PET imaging were successful with high discriminatory powers. In addition to total

The Diagnostic Value of PSMA PET/CT in Men with Newly Diagnosed Unfavorable Intermediate-Risk Prostate Cancer

“…Along with the radiologic tumor stage, the proportion of positive prostate biopsies was associated with the presence of metastatic disease on PSMA PET/CT in our study. This is equally the case for the proportion of ISUP GG3 in prostate biopsies and in line with preexisting literature (27). The presence of these associations may be explained by potential improper grading at the time of biopsy.…”

Development and validation of a nomogram for predicting the likelihood of metastasis in prostate cancer patients undergoing Ga-68 PSMA PET/CT due to biochemical recurrence

“…In a study by Bluemel et al, Ga-68 PSMA PET/CT positivity showed a significant correlation with PSA level and PSA increase rate in recurring prostate cancer patients with negative F-18 Choline PET/CT [20]. Similarly, Aydos et al showed that total PSA and ISUP group were associated with metastatic spread of prostate cancer on Ga-68 PSMA PET images [21]. However, there is no consensus on the exact level of PSA for referring patients to the PET scan [22].…”

“…Similarly, Aydos et al . showed that total PSA and ISUP group were associated with metastatic spread of prostate cancer on Ga-68 PSMA PET images [21]. However, there is no consensus on the exact level of PSA for referring patients to the PET scan [22].…”

Optimization of prostate cancer patient lymph node staging via the integration of neutrophil–lymphocyte ratios, platelet–lymphocyte ratios, and 68Ga‐PSMA‐PET‐derived SUVmax values

“…O'Rourke et al 29 further found that a SUVmax > 3.0 could be similarly used to aid in the diagnosis of supraclavicular lymph nodes in esophageal cancer patients. Given that we employed a PSMA‐specific tracer in the present study, which has a promising comparative noise ratio and superior specificity for prostate cancer cells, 31 this may explain the observed diagnostic value of a lower SUVmax cutoff value in the context of LNM detection in PCa patients.…”