PSMA PET-targeted Biopsy for Prostate Cancer Diagnosis: Initial Experience From a Multicenter Cohort - 29/10/24

Doi : 10.1016/j.urology.2024.10.026

Enrico Checcucci ^a,^{^{1
Enrico Checcucci and Matteo Bauckneht contributed equally to the first Authorship},}^⁎ , Matteo Bauckneht ^b,^c,^{^{1
Enrico Checcucci and Matteo Bauckneht contributed equally to the first Authorship}}, Edoardo Cisero ^d, Gabriele Volpi ^a, Alessio Rizzo ^e, Fabio Zattoni ^f, Lorenzo Bianchi ^g, Mario De Angelis ^h, Danilo Cangemi ^g, Joris Heetman ⁱ, Andrea Farolfi ^j, Federico Piramide ^d, Sabrina De Cillis ^d, Daniele Amparore ^d, Stefano De Luca ^d, Michele Di Dio ^k, Fabrizio Dal Moro ^f, Stefano Fanti ^j, Riccardo Schiavina ^g, Alberto Briganti ^h, Cristian Fiori ^d, Giorgio Gandaglia ^h,^{^{2
Giorgio Gandaglia and Francesco Porpiglia contributed equally to the senior Authorship}}, Francesco Porpiglia ^d,^{^{2
Giorgio Gandaglia and Francesco Porpiglia contributed equally to the senior Authorship}}
^a Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
^b Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
^c Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
^d Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO)
^e Department of Nuclear Medicine, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Turin, Italy
^f Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
^g Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Università degli studi di Bologna, Bologna, Italy
^h Division of Oncology/Unit of Urology, Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
ⁱ Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, Netherlands
^j Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
^k Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy

^⁎Address correspondence to: Enrico Checcucci, M.D., Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3,95 Candiolo, Turin 10060, Italy.Department of Surgery, Candiolo Cancer Institute, FPO-IRCCSStrada Provinciale 142, km 3,95 CandioloTurin10060Italy

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 29 October 2024

Résumé

Objective

To describe the initial experience with PSMA-PET/CT-guided biopsy in European referral centres.

Methods

This multicenter observational cohort study was endorsed by the Young Academic Urologist (YAU) Prostate Cancer Group of the EAU and conducted across 6 tertiary-level European centres. PSMA-guided biopsies were carried out in a cognitive/fusion manner for all the recruited patients with or without MRI-guided biopsies and/or standard biopsy (SB). PCa and clinical significant PCa (csPCA) detection rate (DR) at prostate biopsy was assessed. Uni- and multivariable models were employed to identify features related to csPCA.

Results

Overall, 72 patients were recruited. The topographic location of the dominant lesion depicted by PSMA PET/CT was significantly associated with the location of csPCa, especially in the biopsy naïve cohort. The DR for PCa and csPCa of PSMA-PET/CT-guided biopsies was significantly higher than SB (0.40 ± 0.43 vs 0.23 ± 0.29, and 0.36 ± 0.44 vs 0.21 ± 0.30, respectively, both P <.05) but did not surpass MRI-guided biopsies (0.40 ± 0.43 vs 0.47 ± 0.44, and 0.36 ± 0.44 vs 0.47 ± 0.34, respectively, both P >.05). PSMA-PET/CT-guided biopsy performed better in the biopsy naïve than in the repeated biopsy setting. A SUVmax cut-off value equal to 4.8 provided the best results for detecting csPCa.

Conclusion

Our real-world data illustrate the potentialities of PSMA-PET/CT-guided biopsy in diagnosing PCa. Specifically, in biopsy naïve patients with suspicion of high-risk disease, the use of PSMA-PET/CT-targeted biopsy can be considered. Additionally, in the context of repeated biopsies, a PSMA-PET/CT target biopsy might be advisable over the SB.

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