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Dual-tracer PET/CT-targeted, mpMRI-targeted, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer: a pilot study

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Abstract

Purpose

Growing evidence proved the efficacy of multi-parametric MRI (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-guided targeted biopsy (TB) in prostate cancer (PCa) diagnosis, but there is no direct comparison between mpMRI-TB and PSMA PET/CT-TB. Gastrin-releasing peptide receptor (GRPR) is highly expressed in PCa, which can compensate for the unstable expression of PSMA in PCa. Therefore, we designed a study to compare the efficiency of mpMRI-TB, dual-tracer (GRPR and PSMA) PET/CT-TB, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer.

Methods

One hundred twelve suspicious PCa patients were enrolled from September 2020 to June 2021. Patients with anyone of positive dual-tracer PET/CT or mpMRI underwent TB, and all enrolled patients underwent systematic biopsy (SB) after TB. The primary outcome was the detection rates of PCa in different biopsy strategies. Secondary outcomes were the performance of three imaging methods, omission diagnostic rates, and upgrading and downgrading of biopsy samples relative to those of prostatectomy specimens in different biopsy strategies. McNemar’s tests and Bonferroni correction in multiple comparisons were used to compare the primary and secondary outcomes.

Results

In 112 men, clinically significant PCa (grade group[GG] ≥ 2) accounted for 34.82% (39/112), and nonclinically significant PCa (GG = 1) accounted for 4.46% (5/112). 68 Ga-PSMA PET/CT-TB achieved higher PCa detection rate (69.77%) and positive ratio of biopsy cores (0.44) compared with SB (39.29% and 0.12) and mpMRI-TB (36.14% and 0.23), respectively (P < 0.005). Dual-tracer PET/CT screen out patients for avoiding 52.67% (59/112) unnecessary biopsy, whereas dual-tracer PET/CT-TB plus SB achieved high detection rate (77.36%) without misdiagnosis of csPCa.

Conclusion

Dual-tracer PET/CT might screen patients for avoiding unnecessary biopsy. Dual-tracer PET/CT-TB plus SB might be a more effective and promising strategy for the definite diagnosis of clinically significant PCa than mpMRI-TB.

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Data availability

The individual participant data study protocol, statistical analysis plan, analytical code text, tables, figure, and appendices will all be available. Data will be available between 9 and 36 months after the article publication. All related data is available for analyses that achieve the aims of the approved proposal. Requests for data should be directed by email to Yi Cai. Data requestors will need to sign a data access agreement first to obtain data.

Abbreviations

TB :

Targeted biopsy

SB :

Systematic biopsy

mpMRI :

Multi-parametric magnetic resonance imaging

PSMA :

Prostate-specific membrane antigen

GRPR :

Gastrin-releasing peptide receptor

PET/CT :

Positron emission tomography/computed tomography

GG :

Grade group

PCa :

Prostate cancer

csPCa :

Clinically significant prostate cancers

ncsPCa :

Nonclinically significant prostate cancers

RP :

Radical prostatectomy

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Acknowledgements

We thank everyone who provided support for this study. We thank the support from the Key Research and Development Program of Hunan Province (2021SK2014), the National Natural Science Foundation of China (91859207), the National Natural Science Foundation of China (81800590, 81902858, 81902606), and the Natural Science Foundation of Hunan Province (2020JJ5882, 2020JJ5949, 2020JJ5891).

Funding

This investigation was sponsored by the Key Research and Development Program of Hunan Province (2021SK2014), the National Natural Science Foundation of China (91859207), the National Natural Science Foundation of China (81800590, 81902858, 81902606), and the Natural Science Foundation of Hunan Province (2020JJ5882, 2020JJ5949, 2020JJ5891).

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  1. Dong-Xu Qiu and Jian Li contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People’s Republic of China

    Dong-Xu Qiu, Min-Feng Chen, Yu Gan, Gui-Lin Wang, Xiong-Bing Zu & Yi Cai

  2. Department of PET Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People’s Republic of China

    Jian Li, Yong-Xiang Tang & Shuo Hu

  3. Department of Radiology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People’s Republic of China

    Jin-Wei Zhang & Xiao-Ping Yi

  4. Department of Pathology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People’s Republic of China

    Xiao-Mei Gao & Hong-ling Yin

  5. Department of Oncology, NHC Key Laboratory of Cancer Proteomics, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People’s Republic of China

    Ye Zhang

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  1. Dong-Xu Qiu
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Correspondence to Shuo Hu or Yi Cai.

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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 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local ethic committee (201909253).

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

Key points

Question:Although several prostate biopsy strategies are known, the most effective and accurate approach to diagnose PCa, especially for clinically significant prostate cancer (csPCa), remains unestablished.

Pertinent findings: In this prospective and comparative effectiveness study involving 112 patients, the use of dual-tracer PET/CT (68 Ga-GRPR + 68 Ga-PSMA) was recommended to screen patients from unnecessary biopsy. Dual-tracer PET/CT-TB plus SB achieved a significantly higher PCa detection rate (77.36%) without misdiagnosis of csPCa when compared with the application outcomes of mpMRI-TB and mpMRI-TB + SB.

Implications for patient care: Dual-tracer PET/CT-TB plus SB may be a more effective and promising strategy for accurately diagnosing PCa than mpMRI-TB and mpMRI-TB + SB.

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Qiu, DX., Li, J., Zhang, JW. et al. Dual-tracer PET/CT-targeted, mpMRI-targeted, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer: a pilot study. Eur J Nucl Med Mol Imaging 49, 2821–2832 (2022). https://doi.org/10.1007/s00259-021-05636-1

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