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Is Cribriform Pattern in Prostate Biopsy a Risk Factor for Metastatic Disease on 68Ga-PSMA-11 PET/CT? - Beyond the Abstract

The cribriform growth pattern (CP) in prostate cancer (PCa) has been associated with various unfavorable oncological outcomes. In this study, we conducted an analysis to determine if CP in prostate cancer biopsies serves as an independent risk factor for metastatic disease, as indicated by PSMA PET/CT scans. We enrolled patients with an ISUP Grade Group of 2 or higher from 2020 to 2021.

The study included 401 patients, with CP reported in 252 (63%) patients, accounting for 63% of the total participants. CP in prostate biopsies was not an independent risk factor for metastatic disease when visualized on the 68Ga-PSMA PET/CT (p = 0.14). ISUP grade groups 4 and 5, higher PSA level groups per 10ng/ml up to >50, and the presence of clinical extraprostatic extension (EPE) were all identified as independent risk factors.

The research extended into subgroups defined by different ISUP grade groups (GG 2 and GG 3), the intermediate-risk group, and the high-risk group. Consistently, in all these subgroups, CP in biopsies failed to demonstrate its influence as an independent risk factor for metastatic disease on the 68Ga-PSMA PET/CT.

Furthermore, we analyzed the impact of strictly adhering to the European Association of Urology (EAU) guideline recommendations for performing metastatic screenings. If these guidelines were employed as the threshold for PSMA PET/CT imaging, metastatic disease would have been missed in 9 (2%) patients. On the upside, this approach would have resulted in 18% fewer PSMA PET/CT scans performed.

Limitations of this study include its retrospective design, lack of MRI information for many patients, varied biopsy protocols, and the absence of a central pathology review.

In conclusion, the CP pattern in prostate cancer biopsies does not independently contribute to the risk of metastatic disease, as identified by 68Ga-PSMA PET/CT scans. This knowledge is valuable for refining our understanding of metastatic risk factors in prostate cancer and for the more effective use of PSMA PET/CT.

Written by: J. G. Heetman,1 R. Versteeg,2 L. Wever,2,3 L. J. Paulino Pereira,2 T. F. W. Soeterik,2-5 J. Lavalaye,4 P. C. de Bruin,5 R. C. N. van den Bergh,2 H. H. E. van Melick2

  1. Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands.
  2. Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands.
  3. Department of Urology, Canisius Wilhelmina Hospital, Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands.
  4. Department of Pathology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands.
  5. Department of Nuclear Medicine, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands.

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