(UroToday.com) The 2022 American Urological Association (AUA) Annual Meeting included a session on detection and screening of prostate cancer and a presentation by Dr. Hyeok Kwon discussing the value of [F-18] FlorastaminR PSMA PET/CT at initial diagnosis of prostate cancer compared with mpMRI. The prevalence rate of prostate cancer is increasing and accurate diagnosis tools are becoming more important. Recently, multi-parametric magnetic resonance imaging (mpMRI) has become the most commonly used imaging modality for assisting with diagnosis, however, its accuracy is not perfect. This study compared PSMA PET/CT with mpMRI for detecting accuracy of clinically significant prostate cancer (≥ Gleason score 7 (3+4)) and detecting accuracy of cancer location correlation with biopsy results.
There were 82 patients with suspicion of prostate cancer (abnormal DRE or PSA >3.0 ng/ml) were recruited for this study. After [F-18] FlorastaminR PET/CT and mpMRI was performed, a saturation perineal (20 core) biopsy was completed. The positive criteria of MRI were more than PI-RADs score 3, and all results were evaluated by the urologist who did the prostate biopsy, including referrence to the standards for [F-18] PSMA PET/CT (higher than background level, unrelated to physiological uptake, or known pitfall). As follows are example cases of PSMA PET/CT (+), MRI (+), biopsy (+), as well as PSMA PET/CT (+), MRI (-), biopsy (+):
Four scenarios were created by Dr. Kwon and colleagues, as follows:
Of the 82 patients, 27 were diagnosed with clinically significant prostate cancer and mpMRI showed accuracy of 69.5%. Positive scenario and worst scenario showed the same accuracy of 72.0% but negative scenario and best scenario showed the same accuracy of 79.3%. Positive scenario and worst scenario showed the same accuracy of 72.0% but negative scenario and best scenario showed the same accuracy of 79.3%. The following table shows accuracy of [F-18] FlorastaminR PSMA PET/CT:
Dr. Kwon concluded his presentation discussing the value of [F-18] FlorastaminR PSMA PET/CT at initial diagnosis of prostate cancer compared with mpMRI with the following take home messages:
- This is the first study to use [F-18] Florastamin PET/CT as an initial diagnostic tool of prostate cancer
- The result shows that clinically significant prostate cancer detection accuracy of PSMA PET/CT is higher than MRI, and location detection accuracy is also higher
- There was no clinically significant prostate cancer that both PSMA PET/CT and mpMRI did not detect
- Perineal biopsy for prostate cancer may be more accurate when mpMRI and [F-18] Florastamin PET/CT are used together
Presented by: Hyeok J. Kwon, MD, St. Mary’s Hospital, Seoul, Republic of Korea
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.