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Value of Targeted Biopsies and Combined PSMA PET/CT and mp-MRI Imaging in Locally Recurrent Prostate Cancer after Primary Radiotherapy

医学 前列腺癌 活检 放射科 磁共振成像 近距离放射治疗 前列腺 谷氨酸羧肽酶Ⅱ 放射治疗 超声波 正电子发射断层摄影术 癌症 核医学 内科学
作者
M. Rasing,Marieke van Son,Marinus A. Moerland,Bart de Keizer,Frank J. Wessels,Trudy Jonges,S. van de Pol,Wietse S.C. Eppinga,Juus L Noteboom,J J W Lagendijk,Jochem van der Voort van Zijp,Max Peters
出处
期刊:Cancers [Multidisciplinary Digital Publishing Institute]
卷期号:14 (3): 781-781 被引量:15
标识
DOI:10.3390/cancers14030781
摘要

Radiorecurrent prostate cancer is conventionally confirmed using systematic and/or targeted biopsies. The availability of multiparametric (mp) MRI and prostate specific membrane antigen (PSMA) PET/CT has increased diagnostic accuracy. The objective was to determine the positive predictive value (PPV) of combined mp-MRI and PSMA PET/CT and whether pathology verification with MR-targeted biopsies remains necessary for patients with radiorecurrent prostate cancer. Patients with locally recurrent prostate cancer who were referred for 19 Gy single-dose MRI-guided focal salvage high dose rate (HDR) brachytherapy between 2015 and 2018 were included in the current analysis. Patients were selected if they underwent pre-biopsy mp-MRI and PSMA PET/CT. Based on these images, lesions suspect for isolated tumor recurrence were transperineally biopsied using transrectal ultrasound fused with MRI. A total of 41 patients were identified from the database who underwent cognitive targeted (n = 7) or MRI/PSMA-transrectal ultrasound (TRUS) fused targeted (n = 34) biopsies. A total of 40 (97.6%) patients had positive biopsies for recurrent cancer. Five patients initially had negative biopsies (all MRI/PSMA-TRUS fusion targeted), four of whom recurrence was confirmed after a re-biopsy. One (2.4%) patient refused re-biopsy, leading to a positive predictive value (PPV) for combined imaging of 97.6%. Biopsies can therefore safely be withheld when the results of the combined mp-MRI and PSMA PET/CT are conclusive, avoiding an unnecessary invasive and burdensome procedure.
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