Prostate cancer

Prostate biopsy

Prostate-specific antigen

Radiology

Tomography

Standardized uptake value

Internal medicine

Prostate

Prospective cohort study

Glutamate carboxypeptidase II

Positron Emission Tomography-Computed Tomography

Positron emission

Medicine

Nuclear medicine

Cancer

Magnetic resonance imaging

Positron emission tomography

Pathology

The Journal of Urology

No AccessJournal of UrologyAdult Urology1 Jul 201868Ga-PSMA Positron Emission Tomography/Computerized Tomography for Primary Diagnosis of Prostate Cancer in Men with Contraindications to or Negative Multiparametric Magnetic Resonance Imaging: A Prospective Observational Study Egesta Lopci, Alberto Saita, Massimo Lazzeri, Giovanni Lughezzani, Piergiuseppe Colombo, Nicolò Maria Buffi, Rodolfo Hurle, Katia Marzo, Roberto Peschechera, Alessio Benetti, Silvia Zandegiacomo, Luisa Pasini, Giuliana Lista, Pasquale Cardone, Angelo Castello, Davide Maffei, Luca Balzarini, Arturo Chiti, Giorgio Guazzoni, and Paolo Casale Egesta LopciEgesta Lopci Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Alberto SaitaAlberto Saita Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Massimo LazzeriMassimo Lazzeri Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Giovanni LughezzaniGiovanni Lughezzani Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Piergiuseppe ColomboPiergiuseppe Colombo Pathology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Rodolfo HurleRodolfo Hurle Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Katia MarzoKatia Marzo Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Roberto PeschecheraRoberto Peschechera Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Alessio BenettiAlessio Benetti Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Silvia ZandegiacomoSilvia Zandegiacomo Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Luisa PasiniLuisa Pasini Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Giuliana ListaGiuliana Lista Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Pasquale CardonePasquale Cardone Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Angelo CastelloAngelo Castello Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Davide MaffeiDavide Maffei Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Luca BalzariniLuca Balzarini Radiology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author , Arturo ChitiArturo Chiti Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy Pathology Department, Humanitas Clinical and Research Hospital, Milan, Italy Radiology Department, Humanitas Clinical and Research Hospital, Milan, Italy Humanitas University, Milan, Italy More articles by this author , Giorgio GuazzoniGiorgio Guazzoni Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy Pathology Department, Humanitas Clinical and Research Hospital, Milan, Italy Radiology Department, Humanitas Clinical and Research Hospital, Milan, Italy Humanitas University, Milan, Italy More articles by this author , and Paolo CasalePaolo Casale Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.01.079AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography may represent the most promising imaging modality to identify and risk stratify prostate cancer in patients with contraindications to or negative multiparametric magnetic resonance imaging. Materials and Methods: In this prospective observational study we analyzed 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography in a select group of patients with persistently elevated prostate specific antigen and/or Prostate Health Index suspicious for prostate cancer, negative digital rectal examination and at least 1 negative biopsy. The cohort comprised men with equivocal multiparametric magnetic resonance imaging (Prostate Imaging-Reporting and Data System, version 2 score of 2 or less), or an absolute or relative contraindication to multiparametric magnetic resonance imaging. Sensitivity, specificity and CIs were calculated compared to histopathology findings. ROC analysis was applied to determine the optimal cutoff values of 68Ga labeled prostate specific membrane antigen uptake to identify clinically significant prostate cancer (Gleason score 7 or greater). Results: A total of 45 patients with a median age of 64 years were referred for 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography between January and August 2017. The 25 patients (55.5%) considered to have positive positron emission tomography results underwent software assisted fusion biopsy. We determined the uptake values of regions of interest, including a median maximum standardized uptake value of 5.34 (range 2.25 to 30.41) and a maximum-to-background standardized uptake value ratio of 1.99 (range 1.06 to 14.42). Mean and median uptake values on 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography (ie the maximum standardized uptake value or the maximum-to-background standardized uptake value ratio) were significantly higher for Gleason score 7 lesions than for Gleason score 6 or benign lesions (p <0.001). On ROC analysis a maximum standardized uptake value of 5.4 and a maximum-to-background standardized uptake value ratio of 2 discriminated clinically relevant prostate cancer with 100% overall sensitivity in each case, and 76% and 88% specificity, respectively. Conclusions: Our findings support the use of 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography for primary detection of prostate cancer in a specific subset of men. References 1 : Global cancer statistics. CA Cancer J Clin2011; 61: 69. Google Scholar 2 : Prostate cancer. Lancet2016; 387: 70. Google Scholar 3 : Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy. Eur Urol2015; 68: 438. Google Scholar 4 : Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology. 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Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 200Issue 1July 2018Page: 95-103 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsglutamate carboxypeptidase IIdiagnostic imagingprostatic neoplasmshumanbiopsypositron emission tomography computed tomographyMetricsAuthor Information Egesta Lopci Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Alberto Saita Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Massimo Lazzeri Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Giovanni Lughezzani Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Piergiuseppe Colombo Pathology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Nicolò Maria Buffi Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Rodolfo Hurle Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Katia Marzo Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Roberto Peschechera Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Alessio Benetti Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Silvia Zandegiacomo Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Luisa Pasini Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Giuliana Lista Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Pasquale Cardone Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Angelo Castello Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Davide Maffei Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Luca Balzarini Radiology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Arturo Chiti Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Milan, Italy Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy Pathology Department, Humanitas Clinical and Research Hospital, Milan, Italy Radiology Department, Humanitas Clinical and Research Hospital, Milan, Italy Humanitas University, Milan, Italy More articles by this author Giorgio Guazzoni Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy Pathology Department, Humanitas Clinical and Research Hospital, Milan, Italy Radiology Department, Humanitas Clinical and Research Hospital, Milan, Italy Humanitas University, Milan, Italy More articles by this author Paolo Casale Urology Department, Humanitas Clinical and Research Hospital, Milan, Italy More articles by this author Expand All Advertisement PDF downloadLoading ...

<sup>68</sup> Ga-PSMA Positron Emission Tomography/Computerized Tomography for Primary Diagnosis of Prostate Cancer in Men with Contraindications to or Negative Multiparametric Magnetic Resonance Imaging: A Prospective Observational Study

68 Ga-PSMA Positron Emission Tomography/Computerized Tomography for Primary Diagnosis of Prostate Cancer in Men with Contraindications to or Negative Multiparametric Magnetic Resonance Imaging: A Prospective Observational Study

⁶⁸ Ga-PSMA Positron Emission Tomography/Computerized Tomography for Primary Diagnosis of Prostate Cancer in Men with Contraindications to or Negative Multiparametric Magnetic Resonance Imaging: A Prospective Observational Study