Skip to main content

Advertisement

SpringerLink
Log in

Can 68Ga-PSMA-11 PET/CT predict pathological upgrading of prostate cancer from MRI-targeted biopsy to radical prostatectomy?

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Prostate-specific membrane antigen (PSMA) positron emission tomography (PSMA-PET) is an ideal tool for staging and restaging of prostate cancer (PCa). This study was designed to investigate the prognostic role of preoperative 68Ga-PSMA-11 PET/CT in predicting pathological upgrading from multiparametric magnetic resonance imaging–targeted biopsy (mpMRI-TB) to final radical prostatectomy (RP) specimens in patients with localized PCa.

Methods

A total of 67 biopsy-confirmed localized PCa patients with mpMRI and 68Ga-PSMA-11 PET/CT prior to RP were included. Clinical and imaging characteristics derived from mpMRI and PET/CT were compared in patients with or without pathological upgrading. Predictors for pathological upgrading were evaluated by using univariate and multivariable analyses. A prediction model was developed based on the identified parameters and validated using internal validation.

Results

Pathological upgrading from mpMRI-TB to final RP specimens occurred in 38.8% (26/67) of the patients. Multivariable logistic regression analysis showed SUVmax (OR: 1.223, 95% CI 1.068–1.399, p = 0.003); highest tumor grade at mpMRI-TB, ISUP grade group (ISUP GG) 1 vs. 4 (OR: 0.11, 95% CI 0.000–0.452, p = 0.018) and ISUP GG 2 vs. 4 (OR: 0.16, 95% CI 0.001–0.252, p = 0.003); and multifocality on PET/CT (OR: 9.821, 95% CI 1.438–67.085, p = 0.02) were independent risk factors for pathological upgrading. Our developed prediction model based on the identified parameter showed good calibration at internal validation (mean absolute error = 0.033).

Conclusion

68Ga-PSMA-11 PET/CT was found to be an ideal biomarker for the prediction of pathological upgrading from mpMRI-TB to RP, especially for patients with lower tumor grade at mpMRI-TB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer. Part II-2020 update: treatment of relapsing and metastatic prostate cancer. Eur Urol. 2020. doi:https://doi.org/10.1016/j.eururo.2020.09.046.

  2. Brockman JA, Alanee S, Vickers AJ, Scardino PT, Wood DP, Kibel AS, et al. Nomogram predicting prostate cancer-specific mortality for men with biochemical recurrence after radical prostatectomy. Eur Urol. 2015;67:1160–7. https://doi.org/10.1016/j.eururo.2014.09.019.

    Article  PubMed  Google Scholar 

  3. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018;378:1767–77. https://doi.org/10.1056/NEJMoa1801993.

    Article  PubMed  Google Scholar 

  4. Cohen MS, Hanley RS, Kurteva T, Ruthazer R, Silverman ML, Sorcini A, et al. Comparing the Gleason prostate biopsy and Gleason prostatectomy grading system: the Lahey Clinic Medical Center experience and an international meta-analysis. Eur Urol. 2008;54:371–81. https://doi.org/10.1016/j.eururo.2008.03.049.

    Article  PubMed  Google Scholar 

  5. van der Leest M, Cornel E, Israel B, Hendriks R, Padhani AR, Hoogenboom M, et al. Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naive men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol. 2019;75:570–8. https://doi.org/10.1016/j.eururo.2018.11.023.

    Article  PubMed  Google Scholar 

  6. Ahdoot M, Wilbur AR, Reese SE, Lebastchi AH, Mehralivand S, Gomella PT, et al. MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med. 2020;382:917–28. https://doi.org/10.1056/NEJMoa1910038.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet. 2020;395:1208–16. https://doi.org/10.1016/S0140-6736(20)30314-7.

    Article  CAS  PubMed  Google Scholar 

  8. Lopci E, Piccardo A, Lazzeri M. Prostate cancer imaging and therapeutic alternatives with highly specific molecular 'probes'. BJU Int. 2019;124:188–9. https://doi.org/10.1111/bju.14713.

    Article  PubMed  Google Scholar 

  9. Fendler WP, Calais J, Eiber M, Flavell RR, Mishoe A, Feng FY, et al. Assessment of 68Ga-PSMA-11 PET accuracy in localizing recurrent prostate cancer: a prospective single-arm clinical trial. JAMA Oncol. 2019;5:856–63. https://doi.org/10.1001/jamaoncol.2019.0096.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lopci E, Lughezzani G, Castello A, Saita A, Colombo P, Hurle R, et al. Prospective evaluation of (68)Ga-labeled prostate-specific membrane antigen ligand positron emission tomography/computed tomography in primary prostate cancer diagnosis. Eur Urol Focus. 2020. https://doi.org/10.1016/j.euf.2020.03.004.

  11. Lopci E, Guazzoni G, Lazzeri M. (68)Ga prostate-specific membrane antigen PET/CT for primary diagnosis of prostate cancer: complementary or alternative to multiparametric MR imaging. Radiology. 2018;287:725–6. https://doi.org/10.1148/radiol.2017172607.

    Article  PubMed  Google Scholar 

  12. Lopci E, Saita A, Lazzeri M, Lughezzani G, Colombo P, Buffi NM, et al. (68)Ga-PSMA positron emission tomography/computerized tomography for primary diagnosis of prostate cancer in men with contraindications to or negative multiparametric magnetic resonance imaging: a prospective observational study. J Urol. 2018;200:95–103. doi:https://doi.org/10.1016/j.juro.2018.01.079.

  13. Chen M, Zhang Q, Zhang C, Zhao X, Marra G, Gao J, et al. Combination of (68)Ga-PSMA PET/CT and multiparametric MRI improves the detection of clinically significant prostate cancer: a lesion-by-lesion analysis. J Nucl Med. 2019;60:944–9. https://doi.org/10.2967/jnumed.118.221010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Zamboglou C, Carles M, Fechter T, Kiefer S, Reichel K, Fassbender TF, et al. Radiomic features from PSMA PET for non-invasive intraprostatic tumor discrimination and characterization in patients with intermediate- and high-risk prostate cancer - a comparison study with histology reference. Theranostics. 2019;9:2595–605. https://doi.org/10.7150/thno.32376.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cysouw MCF, Jansen BHE, van de Brug T, Oprea-Lager DE, Pfaehler E, de Vries BM, et al. Machine learning-based analysis of [(18)F]DCFPyL PET radiomics for risk stratification in primary prostate cancer. Eur J Nucl Med Mol Imaging. 2020. https://doi.org/10.1007/s00259-020-04971-z.

  16. Chen M, Qiu X, Zhang Q, Zhang C, Zhou Y, Zhao X, et al. PSMA uptake on [68Ga]-PSMA-11-PET/CT positively corrects with prostate cancer aggressiveness. Q J Nucl Med Mol Imaging. 2019. doi:https://doi.org/10.23736/S1824-4785.19.03172-8.

  17. Roberts MJ, Morton A, Donato P, Kyle S, Pattison DA, Thomas P, et al. (68)Ga-PSMA PET/CT tumour intensity pre-operatively predicts adverse pathological outcomes and progression-free survival in localised prostate cancer. Eur J Nucl Med Mol Imaging. 2020. doi:https://doi.org/10.1007/s00259-020-04944-2.

  18. Koseoglu E, Kordan Y, Kilic M, Sal O, Seymen H, Kiremit MC, et al. Diagnostic ability of Ga-68 PSMA PET to detect dominant and non-dominant tumors, upgrading and adverse pathology in patients with PIRADS 4-5 index lesions undergoing radical prostatectomy. Prostate Cancer Prostatic Dis. 2020. https://doi.org/10.1038/s41391-020-00270-8.

  19. Zhang Q, Wang W, Zhang B, Shi J, Fu Y, Li D, et al. Comparison of free-hand transperineal mpMRI/TRUS fusion-guided biopsy with transperineal 12-core systematic biopsy for the diagnosis of prostate cancer: a single-center prospective study in China. Int Urol Nephrol. 2017;49:439–48. https://doi.org/10.1007/s11255-016-1484-8.

    Article  PubMed  Google Scholar 

  20. Zhang Q, Zang S, Zhang C, Fu Y, Lv X, Zhang Q, et al. Comparison of (68)Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer. J Transl Med. 2017;15:230. https://doi.org/10.1186/s12967-017-1333-2.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. Prostate Imaging Reporting and Data System Version 2.1: 2019 update of Prostate Imaging Reporting and Data System Version 2. Eur Urol. 2019;76:340–51. https://doi.org/10.1016/j.eururo.2019.02.033.

    Article  PubMed  Google Scholar 

  22. Donati OF, Mazaheri Y, Afaq A, Vargas HA, Zheng J, Moskowitz CS, et al. Prostate cancer aggressiveness: assessment with whole-lesion histogram analysis of the apparent diffusion coefficient. Radiology. 2014;271:143–52. https://doi.org/10.1148/radiol.13130973.

    Article  PubMed  Google Scholar 

  23. Fanti S, Goffin K, Hadaschik BA, Herrmann K, Maurer T, MacLennan S, et al. Consensus statements on PSMA PET/CT response assessment criteria in prostate cancer. Eur J Nucl Med Mol Imaging. 2020. https://doi.org/10.1007/s00259-020-04934-4.

  24. Marra G, Zhuang J, Beltrami M, Calleris G, Zhao X, Marquis A, et al. Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases. BJU Int. 2021;127:122–30. https://doi.org/10.1111/bju.15121.

    Article  CAS  PubMed  Google Scholar 

  25. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA, et al. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016;40:244–52. https://doi.org/10.1097/PAS.0000000000000530.

    Article  PubMed  Google Scholar 

  26. Bakavicius A, Daniunaite K, Zukauskaite K, Barisiene M, Jarmalaite S, Jankevicius F. Urinary DNA methylation biomarkers for prediction of prostate cancer upgrading and upstaging. Clin Epigenetics. 2019;11:115. https://doi.org/10.1186/s13148-019-0716-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kerr KF, Brown MD, Zhu K, Janes H. Assessing the clinical impact of risk prediction models with decision curves: guidance for correct interpretation and appropriate use. J Clin Oncol. 2016;34:2534–40. https://doi.org/10.1200/JCO.2015.65.5654.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Xu N, Wu YP, Li XD, Lin MY, Zheng QS, Chen SH, et al. Risk of upgrading from prostate biopsy to radical prostatectomy pathology: is magnetic resonance imaging-guided biopsy more accurate? J Cancer. 2018;9:3634–9. https://doi.org/10.7150/jca.26791.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Shoag JE, Cai PY, Gross MD, Gaffney C, Li D, Mao J, et al. Impact of prebiopsy magnetic resonance imaging on biopsy and radical prostatectomy grade concordance. Cancer. 2020;126:2986–90. https://doi.org/10.1002/cncr.32821.

    Article  PubMed  Google Scholar 

  30. Calio BP, Sidana A, Sugano D, Gaur S, Maruf M, Jain AL, et al. Risk of upgrading from prostate biopsy to radical prostatectomy pathology-does saturation biopsy of index lesion during multiparametric magnetic resonance imaging-transrectal ultrasound fusion biopsy help? J Urol. 2018;199:976–82. https://doi.org/10.1016/j.juro.2017.10.048.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mesko S, Marks L, Ragab O, Patel S, Margolis DA, Demanes DJ, et al. Targeted prostate biopsy Gleason score heterogeneity and implications for risk stratification. Am J Clin Oncol. 2018;41:497–501. https://doi.org/10.1097/COC.0000000000000308.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Demirci E, Kabasakal L, Sahin OE, Akgun E, Gultekin MH, Doganca T, et al. Can SUVmax values of Ga-68-PSMA PET/CT scan predict the clinically significant prostate cancer? Nucl Med Commun. 2019;40:86–91. https://doi.org/10.1097/MNM.0000000000000942.

    Article  PubMed  Google Scholar 

  33. Gallina A, Maccagnano C, Suardi N, Capitanio U, Abdollah F, Raber M, et al. Unilateral positive biopsies in low risk prostate cancer patients diagnosed with extended transrectal ultrasound-guided biopsy schemes do not predict unilateral prostate cancer at radical prostatectomy. BJU Int. 2012;110:E64–8. https://doi.org/10.1111/j.1464-410X.2011.10762.x.

    Article  PubMed  Google Scholar 

  34. Le JD, Tan N, Shkolyar E, Lu DY, Kwan L, Marks LS, et al. Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology. Eur Urol. 2015;67:569–76. https://doi.org/10.1016/j.eururo.2014.08.079.

    Article  PubMed  Google Scholar 

  35. Bratan F, Niaf E, Melodelima C, Chesnais AL, Souchon R, Mege-Lechevallier F, et al. Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. Eur Radiol. 2013;23:2019–29. https://doi.org/10.1007/s00330-013-2795-0.

    Article  PubMed  Google Scholar 

  36. Sawicki LM, Kirchner J, Buddensieck C, Antke C, Ullrich T, Schimmoller L, et al. Prospective comparison of whole-body MRI and (68)Ga-PSMA PET/CT for the detection of biochemical recurrence of prostate cancer after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2019;46:1542–50. https://doi.org/10.1007/s00259-019-04308-5.

    Article  CAS  PubMed  Google Scholar 

  37. Afshar-Oromieh A, Vollnberg B, Alberts I, Bahler A, Sachpekidis C, Dijkstra L, et al. Comparison of PSMA-ligand PET/CT and multiparametric MRI for the detection of recurrent prostate cancer in the pelvis. Eur J Nucl Med Mol Imaging. 2019;46:2289–97. https://doi.org/10.1007/s00259-019-04438-w.

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by grants from the Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Key Medical Discipline (Laboratory) (ZDXKB2016014).

Author information

Author notes

  1. Haoli Yin, Mengxia Chen and Xuefeng Qiu contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China

    Haoli Yin, Mengxia Chen, Xuefeng Qiu, Jie Gao, Danyan Li, Haifeng Huang, Qing Zhang & Hongqian Guo

  2. Institute of Urology, Nanjing University, Nanjing, China

    Haoli Yin, Mengxia Chen, Xuefeng Qiu, Jie Gao, Danyan Li, Haifeng Huang, Qing Zhang & Hongqian Guo

  3. Department of Math, College of Art and Science, The Ohio State University, Columbus, OH, 43210, USA

    Li Qiu

  4. Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China

    Danyan Li

  5. Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China

    Yao Fu

  6. School of Artificial Intelligence, Nanjing University, Nanjing, 210093, China

    Suhan Guo

  7. Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210003, China

    Shuyue Ai & Feng Wang

Authors
  1. Haoli Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mengxia Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xuefeng Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jie Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Danyan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yao Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Haifeng Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Suhan Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Qing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shuyue Ai
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Feng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hongqian Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Feng Wang or Hongqian Guo.

Ethics declarations

Ethics approval

This study was approved by the Ethics Committee of the Drum Tower Hospital (2017-147-01). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Oncology - Genitourinary.

Supplementary information

ESM 1

(DOCX 452 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yin, H., Chen, M., Qiu, X. et al. Can 68Ga-PSMA-11 PET/CT predict pathological upgrading of prostate cancer from MRI-targeted biopsy to radical prostatectomy?. Eur J Nucl Med Mol Imaging 48, 3693–3701 (2021). https://doi.org/10.1007/s00259-021-05217-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-021-05217-2

Keywords

Search

Navigation