To investigate the additive role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) independent from multiparametric magnetic resonance imaging (mpMRI) and clinical-pathological parameters to predict pathological upgrading in patients with ISUP grade group (GG) 1 prostate cancer (PCa) at prostate biopsy.
A total of 41 patients who underwent robotic radical prostatectomy (RP) for GG1 disease at prostate biopsy with preoperative PSMA PET/CT and mpMRI images available for central review were included in the study. Univariate and multivariate logistic regression analyses were performed to determine the independent predictors of pathological upgrading (GG ≥ 2).
Final RP pathology revealed upgrading in 26 patients (65.9%); to GG 2 disease in 25 cases and GG 4 disease in one case. International Society of Urological Pathology (ISUP) upgrading rates for prostate imaging-reporting and data system (PIRADS)-5, PIRADS-4, and PIRADS ≤ 3 lesions were 78%, 74%, and 38%, respectively. Fourteen out of 15 (93.3%) patients with an SUVmax ≥ 5.6 and all patients with an SUVmax ≥ 6.5 (n = 10) had pathological upgrading. The upgrading rate in patients with SUV < 5.6 was 46.2% (12/26). Intraprostatic SUVmax ≥ 5.6 was found as the only independent predictor of pathological upgrading in multivariate analysis.
High prostatic PSMA uptake was found to be a very reliable predictor of pathological upgrading, but low PSMA uptake cannot exclude pathological upgrading. Intraprostatic PSMA uptake along with previously known mpMRI and biopsy-related parameters should be considered when making a treatment decision in patients with GG1 PCa at prostate biopsy.
The Prostate. 2023 Sep 03 [Epub ahead of print]
Baris Esen, Hulya Seymen, Bengi Gurses, Ayse Armutlu, Ersin Koseoglu, Kayhan Tarim, Dilek Ertoy Baydar, Ahmet Furkan Sarikaya, Abdullah Erdem Canda, Derya Balbay, Yakup Kordan, Derya Tilki, Tarik Esen, Mehmet Onur Demirkol
Department of Urology, School of Medicine, Koç University, Istanbul, Turkey., Department of Nuclear Medicine, School of Medicine, Koç University, Istanbul, Turkey., Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey., Department of Pathology, School of Medicine, Koç University, Istanbul, Turkey.