To evaluate the additional value of prostate-specific membrane antigen - positron emission tomography (PSMA-PET) to conventional diagnostic tools to select patients for hemi-ablative Focal Therapy (FT).
We performed a retrospective analysis on a multi-center cohort (private and institutional) of 138 patients that underwent multi-parametric MRI (mpMRI), PSMA-PET, and systematic biopsies prior to Radical Prostatectomy (RP) between January 2011 to July 2021. Patients were eligible when they met the consensus criteria for FT: PSA <15 ng/mL, clinical/radiological T stage ≤T2b, and international society of pathology (ISUP) grade 2-3. CsPCa was defined as ISUP grade ≥2, extra capsular extension >0.5mm or seminal vesicle involvement at final histopathology. The diagnostic accuracy of mpMRI, systematic biopsies and PSMA-PET for csPCa (separate and combined) was calculated within a 4-quadrant prostate model by receiver-operating characteristic and 2x2 contingency analysis. Additionally, it was assessed whether the diagnostic tools correctly identified patients suitable for hemi-ablative FT.
In total 552 prostate quadrants were analyzed and 272 (49%) contained csPCa on final histopathology. The AUC, sensitivity, specificity, PPV, and NPV for csPCa were 0.79, 75%, 83%, 81%, and 77% for combined mpMRI and systematic biopsies, and improved after addition of PSMA-PET to 0.84, 87%, 80%, 81%, and 86% respectively (p<0.001). On final histopathology 46/138 (33%) patients were not suitable for hemi-ablative FT. Addition of PSMA-PET correctly identified 26/46 (57%) non-suitable patients and resulted in 4/138 (3%) false positive exclusions.
Addition of PSMA-PET to the conventional workup by mpMRI and systematic biopsies could improve selection for hemi-ablative FT and guide exclusion of patients for whom whole gland treatments might be a more suitable treatment option.
BJU international. 2023 Oct 19 [Epub ahead of print]
Bart Geboers, Dennie Meijer, William Counter, Alexandar Blazevski, James Thompson, Paul Doan, William Gondoputro, Athos Katelaris, Anne-Maree Haynes, Warick Delprado, Gordon O'Neill, Carlo Yuen, Andre N Vis, Pim J Van Leeuwen, Bao Ho, Victor Liu, Jonathan Lee, Maarten L Donswijk, Daniela Oprea-Lager, Matthijs J Scheltema, Louise Emmett, Phillip D Stricker
Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia., Amsterdam UMC (location VUmc), Department of Urology, Amsterdam, The Netherlands., St. Vincent's hospital, Department of Theranostics and Nuclear medicine, Darlinghurst, Sydney, NSW, Australia., Douglas Hanly Moir Pathology, Sydney, NSW, Australia., St. Vincent's Hospital and Private Clinic, Department of Urology, Darlinghurst, Sydney, NSW, Australia., Antoni van Leeuwenhoek - Netherlands Cancer Institute, Department of Urology, Amsterdam, the Netherlands., Antoni van Leeuwenhoek - Netherlands Cancer Institute, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands., Amsterdam UMC (location VUmc), Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands., St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia.