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

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A Correction to this article was published on 12 September 2020

This article has been updated

Abstract

Purpose

Prostate-specific membrane antigen (PSMA) positron emission tomography (PSMA-PET) improves prostate cancer staging. Intraprostatic PSMA intensity may predict clinically relevant oncological outcomes. The aim of this study was to investigate the relationship between intraprostatic PSMA intensity and adverse pathology outcomes, including biochemical progression-free survival (PFS) after radical prostatectomy.

Methods

This is a cohort study of 71 patients with MRI-guided, biopsy-proven prostate cancer and pre-operative 68Ga-PSMA-11 PET/CT prior to radical prostatectomy (RP). Intraprostatic PSMA intensity was correlated to adverse pathology outcomes (Gleason score and upgrading from biopsy, pathological stage) and PFS using multivariate statistical analysis.

Results

68Ga-PSMA-11 PET/CT intensity in vivo predicted all of Gleason score on RP, upgrading from biopsy to RP histopathology, pathological stage, positive surgical margins and PFS. 74.6% (53/71) of patients were free from progression at a median follow-up of 19.5 months (0.4–48 months). Predictive accuracy was particularly enhanced by PSMA among patients with biopsy Gleason score ≤ 3 + 4 (n = 39) as the most significant predictor of PFS according to Cox-proportional hazards regression. Cox-regression adjusted survival analysis predicted a 5.48-fold increase in hazard for Gleason score ≤ 3 + 4 patients with high (SUVmax > 8) compared with low (SUVmax < 8) PSMA intensity.

Conclusion

Intraprostatic 68Ga-PSMA-11 intensity is prognostic and may be a valuable new biomarker in localised prostate cancer, especially in men with biopsy-proven Gleason 3 + 4 disease considering an initial approach of active surveillance or focal therapy.

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Fig. 1
Fig. 2

Change history

  • 12 September 2020

    Figure 2b is incorrect in the original paper.

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Acknowledgements

MJR is supported by a Clinician Research Fellowship from the Metro North Office of Research, Queensland Health, and a Doctor in Training Research Scholarship from Avant Mutual Group Pty Ltd.

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Authors and Affiliations

  1. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Matthew J. Roberts, Peter Donato, Geoff Coughlin, Rachel Esler, Nigel Dunglison, Robert A. Gardiner & John Yaxley

  2. Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Australia

    Matthew J. Roberts & Robert A. Gardiner

  3. Department of Urology, Redcliffe Hospital, Brisbane, Australia

    Matthew J. Roberts

  4. Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia

    Matthew J. Roberts, Andrew Morton, Peter Donato, Samuel Kyle, David A. Pattison, Paul Thomas & John Yaxley

  5. Department of Nuclear Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Samuel Kyle, David A. Pattison & Paul Thomas

  6. Griffith University, Brisbane, Queensland, Australia

    Robert A. Gardiner

  7. Edith Cowan University, Joondalup, Western Australia

    Robert A. Gardiner

  8. Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar

    Suhail A. Doi

  9. Department of Theranostics and Nuclear Medicine, St Vincent’s Hospital, Sydney, Australia

    Louise Emmett

  10. Faculty of Medicine, University of New South Wales, Sydney, Australia

    Louise Emmett

Authors
  1. Matthew J. Roberts
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  2. Andrew Morton
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  3. Peter Donato
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  4. Samuel Kyle
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  7. Geoff Coughlin
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  8. Rachel Esler
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  9. Nigel Dunglison
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  10. Robert A. Gardiner
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  11. Suhail A. Doi
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  12. Louise Emmett
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  13. John Yaxley
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Corresponding author

Correspondence to Matthew J. Roberts.

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The authors declare that they have no conflict of interest.

Ethics approval

The study received ethical approval from the Royal Brisbane and Women’s Hospital (RBWH) Human Research Ethics Committee (Approval Number HREC/17/QRBW/644).

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The original version of this article was revised. Figure 2 is updated.

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

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Roberts, M.J., Morton, A., Donato, P. et al. 68Ga-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 48, 477–482 (2021). https://doi.org/10.1007/s00259-020-04944-2

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