Prostate Specific Membrane Antigen Targeted Positron Emission Tomography of Primary Prostate Cancer: Assessing Accuracy with Whole Mount Pathology

No AccessJournal of UrologyAdult Urology1 Jan 2020Prostate Specific Membrane Antigen Targeted Positron Emission Tomography of Primary Prostate Cancer: Assessing Accuracy with Whole Mount PathologyThis article is commented on by the following:Editorial Comment Clinton D. Bahler, Mark Green, Gary D. Hutchins, Liang Cheng, Martin J. Magers, James Fletcher, and Michael O. Koch Clinton D. BahlerClinton D. Bahler *Correspondence: Department of Urology, Indiana University School of Medicine, 535 North Barnhill Dr., Suite 420, Indianapolis, Indiana 46202 telephone: 317-944-3458; FAX: 317-944-0174; E-mail Address: [email protected] Departments of Urology, Indiana University, Indianapolis, Indiana , Mark GreenMark Green Departments of Radiology, Indiana University, Indianapolis, Indiana , Gary D. HutchinsGary D. Hutchins Departments of Radiology, Indiana University, Indianapolis, Indiana , Liang ChengLiang Cheng Departments of Pathology, Indiana University, Indianapolis, Indiana , Martin J. MagersMartin J. Magers Departments of Pathology, Indiana University, Indianapolis, Indiana , James FletcherJames Fletcher Departments of Radiology, Indiana University, Indianapolis, Indiana , and Michael O. KochMichael O. Koch Departments of Urology, Indiana University, Indianapolis, Indiana View All Author Informationhttps://doi.org/10.1097/JU.0000000000000501AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated which lesions are detected and missed on [68Ga]Ga-PSMA (prostate specific membrane antigen)-11 positron emission tomography in patients with primary prostate cancer. Materials and Methods: Patients undergoing radical prostatectomy were enrolled in this prospective observational study. Patients underwent [68Ga]Ga-PSMA-11 positron emission tomography/computerized tomography or positron emission tomography/magnetic resonance imaging prior to surgery and received a dose of [68Ga]Ga-PSMA-11 intraoperatively for positron emission tomography of extirpated specimens. Whole mount pathology was performed with lesion and intralesion based analysis to determine the characteristics of lesions detected or not detected by PSMA positron emission tomography. Lesion volume was determined by planimetry and clinically significant lesion volume was calculated as lesion volume × fraction pattern 4/5. Results: On whole mount analysis 30 cancerous lesions were found in a total of 15 patients, including 4, 15, 4, 1 and 6 which were Grade Group 1, 2, 3, 4 and 5, respectively. PSMA-positron emission tomography detected 100% of primary/index lesions and 8 of 11 (82%) secondary lesions. All Grade Group 3-5 lesions were detected vs 12 of 15 Grade Group 2 lesions. When comparing Grade Group 2 vs 3-5, lesion size was similar (p=0.48) but the standardized uptake value was lower for Grade Group 2 vs 3-5 (5.3 vs 7.9, p=0.03). The 3 missed lesions showed 10% or less of pattern 4 and a Gleason pattern 4/5 volume of less than 0.1 cm3. Conclusions: PSMA positron emission tomography detected 100% of primary/index lesions in this study. The 3 missed secondary lesions were small and had a low percent of pattern 4. This argues for further study to better understand what defines clinically significant prostate cancer, which would assist in determining whether small lesions that become challenging to detect by [68Ga]Ga-PSMA-11 positron emission tomography confer a risk to the patient. References 1. : WHO Classification of Tumours of the Urinary System and Male Genital Organs. Lyon, France: International Agency for Research on Cancer 2016. 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Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. ClinicalTrial.gov NCT03213951. Supported by a donation to the Indiana University Foundation prostate cancer research fund by Al Christy, Jr. and Equities First Holdings, and ICTSI (Indiana Clinical and Translational Science Institute) NIH (National Institutes of Health)/NCRR (National Center for Research Resources) Project Development Team Grant No. UL1TR001108. Supplementary reference 31 is available at https://www.jurology.com. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology21 Oct 2019Editorial Comment Volume 203Issue 1January 2020Page: 92-99Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsearly detection of cancersurgicalpathologyprostatic neoplasmspositron-emission tomographyriskMetricsAuthor Information Clinton D. Bahler Departments of Urology, Indiana University, Indianapolis, Indiana *Correspondence: Department of Urology, Indiana University School of Medicine, 535 North Barnhill Dr., Suite 420, Indianapolis, Indiana 46202 telephone: 317-944-3458; FAX: 317-944-0174; E-mail Address: [email protected] More articles by this author Mark Green Departments of Radiology, Indiana University, Indianapolis, Indiana More articles by this author Gary D. Hutchins Departments of Radiology, Indiana University, Indianapolis, Indiana More articles by this author Liang Cheng Departments of Pathology, Indiana University, Indianapolis, Indiana More articles by this author Martin J. Magers Departments of Pathology, Indiana University, Indianapolis, Indiana More articles by this author James Fletcher Departments of Radiology, Indiana University, Indianapolis, Indiana More articles by this author Michael O. Koch Departments of Urology, Indiana University, Indianapolis, Indiana More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. ClinicalTrial.gov NCT03213951. Supported by a donation to the Indiana University Foundation prostate cancer research fund by Al Christy, Jr. and Equities First Holdings, and ICTSI (Indiana Clinical and Translational Science Institute) NIH (National Institutes of Health)/NCRR (National Center for Research Resources) Project Development Team Grant No. UL1TR001108. Supplementary reference 31 is available at https://www.jurology.com. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ...