Investigating PSMA-PET/CT to resolve prostate MRI PIRADS4-5 and negative biopsy discordance

• DOI: 10.1007/s00345-022-04243-5
• Publication Date: 2023-01-05T15:03:55Z
• Authors: Lih-Ming Wong; Samantha Koschel; Thomas Whish-Wilson; Matthew Farag; Damien Bolton; Homi Zargar; Niall Corcoran; Nathan Lawrentschuk; Alexandar Christov; Lauren Thomas; Elisa Perry; Stefan Heinze; Kim Taubman; Tom Sutherland
• Keywords: Male; Biopsy; Prostate; Prostatic Neoplasms; Magnetic Resonance Imaging; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Positron Emission Tomography Computed Tomography; Humans; Prospective Studies; Radiopharmaceuticals

To determine the utility of diagnostic 18F-DCPyL PSMA-PET/CT to aid management of men with highly suspicious multiparametric MRI prostate (PIRAD 4-5 lesions) and discrepant negative prostate biopsy.A multicentre prospective consecutive case series was conducted (2018-2021), recruiting men with prior mpMRI prostate PIRADS 4-5 lesions and negative prostate biopsy. All men had 18F-DCPyL PSMA-PET/CT with subsequent management based on the concordance between MRI and PET: (1) Concordant lesions were biopsied using in-bore MRI targeting; (2) PSMA-PET/CT avidity without MRI correlate were biopsied using cognitive/software targeting with ultrasound guidance and (3) Patients with negative PET/CT were returned to standard of care follow-up.29 patients were recruited with 48% (n = 14) having concordant MRI/PET abnormalities. MRI targeted biopsy found prostate cancer in six patients, with grade groups GG3 (n = 1), GG2 (n = 1), GG1 (n = 4) found. Of the 20 men who PSMA-PET/CT avidity and biopsy, analysis showed higher SUVmax (20.1 vs 6.8, p = 0.036) predicted prostate cancer. Of patients who had PSMA-PET avidity without MRI correlate, and those with no PSMA-PET avidity, only one patient was subsequently found to have prostate cancer (GG1). The study is limited by small size and short follow-up of 17 months (IQR 12.5-29.9).PSMA-PET/CT is useful in this group of men but requires further investigation. Avidity (higher SUVmax) that correlates to the mpMRI prostate lesion should be considered for targeted biopsy.