Benign Prostatic Hyperplasia–Related False-Positive of Prostate-Specific Membrane Antigen–Positron Emission Tomography in the Diagnosis of Prostate Cancer: The Achilles’ Heel of Biopsy-Free Radical Prostatectomy?

No AccessJournal of UrologyAdult Urology1 Dec 2023Benign Prostatic Hyperplasia–Related False-Positive of Prostate-Specific Membrane Antigen–Positron Emission Tomography in the Diagnosis of Prostate Cancer: The Achilles' Heel of Biopsy-Free Radical Prostatectomy?This article is commented on by the following:Editorial CommentEditorial Comment Wei Tang, Yongxiang Tang, Lin Qi, Ye Zhang, Guyu Tang, Xiaomei Gao, Shuo Hu, and Yi Cai Wei TangWei Tang https://orcid.org/0000-0001-7411-3268 Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China , Yongxiang TangYongxiang Tang Department of PET Center, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China , Lin QiLin Qi Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China , Ye ZhangYe Zhang https://orcid.org/0000-0001-6692-2452 Department of Oncology, NHC Key Laboratory of Cancer Proteomics, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China , Guyu TangGuyu Tang https://orcid.org/0000-0003-0976-3939 Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China , Xiaomei GaoXiaomei Gao https://orcid.org/0000-0002-9247-5825 Department of Pathology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China , Shuo HuShuo Hu Department of PET Center, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China , and Yi CaiYi Cai †Correspondence: Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, No. 87 Xiangya Rd, Changsha City, 410008, Hunan Province , PR China telephone: +86-13637310713; E-mail Address: [email protected] https://orcid.org/0000-0001-7773-2064 Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China View All Author Informationhttps://doi.org/10.1097/JU.0000000000003680AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Radical prostatectomy is one of the primary treatments for localized clinically significant prostate cancer. Generally, its application is based on prior biopsy. PSMA (prostate-specific membrane antigen)-PET (positron emission tomography) is considered promising in biopsy-free radical prostatectomy. The expression of PSMA in benign prostatic hyperplasia tissue and corresponding positive reaction are crucial concerns for a no-biopsy strategy. Currently, no study has explored the benign prostatic hyperplasia–related false-positive of PSMA-PET in the detection of prostate cancer. Furthermore, the influence of maximum standardized uptake value and Prostate Imaging Reporting & Data System on biopsy-free radical prostatectomy is also poorly characterized. Materials and Methods: A retrospective study was conducted on patients who received PSMA-PET because of clinical suspicion of prostate cancer and were confirmed to have benign prostatic hyperplasia or prostate cancer. The receiver operating characteristic curve was generated for maximum standardized uptake value. Results of interest were the false-positive rate of PSMA-PET and the efficacy of maximum standardized uptake value or multiparametric MRI in excluding false-positives. Results: The benign prostatic hyperplasia–related false-positive rate of PSMA-PET in detecting prostate cancer was 30%. Maximum standardized uptake value could effectively exclude benign prostatic hyperplasia and Grade Group 1 patients with an area under the curve of 0.86; the optimal maximum standardized uptake value cutoff value with 100% specificity was 15, with a sensitivity of 41%. Notably, the sensitivity and specificity of stringent PET score and Prostate Imaging Reporting & Data System criteria (both ≥4) in diagnosing clinically significant prostate cancer were 49% and 100%, respectively. Conclusions: Our findings revealed benign prostatic hyperplasia–related false-positive rate of PSMA-PET and provided a preliminary reference in biopsy-free radical prostatectomy. REFERENCES 1. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3):209-249. Crossref, Medline, Google Scholar 2. . Considering the role of radical prostatectomy in 21st century prostate cancer care. Nat Rev Urol. 2020; 17(3):177-188. Crossref, Medline, Google Scholar 3. . Clinically localized prostate cancer: AUA/ASTRO guideline, part II: principles of active surveillance, principles of surgery, and follow-up. J Urol. 2022; 208(1):19-25. Link, Google Scholar 4. . Metaanalysis of 68Ga-PSMA-11 PET accuracy for the detection of prostate cancer validated by histopathology. J Nucl Med. 2019; 60(6):786-793. Crossref, Medline, Google Scholar 5. . The additive diagnostic value of prostate-specific membrane antigen positron emission tomography computed tomography to multiparametric magnetic resonance imaging triage in the diagnosis of prostate cancer (PRIMARY): a prospective multicentre study. Eur Urol. 2021; 80(6):682-689. Crossref, Medline, Google Scholar 6. . Radical prostatectomy without prior biopsy following multiparametric magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography. Eur Urol. 2022; 82(2):156-160. Crossref, Medline, Google Scholar 7. . Establishment and prospective validation of an SUVmax cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by 68Ga-PSMA PET/CT: a real-world study. Theranostics. 2021; 11(17):8396-8411. Crossref, Medline, Google Scholar 8. . Insulin signaling, androgen receptor and PSMA immunohistochemical analysis by semi-automated tissue microarray in prostate cancer with diabetes (DIAMOND study). Transl Res. 2021; 238:25-35. Crossref, Medline, Google Scholar 9. . Ultrasonically guided precise needle placement in the prostate and the seminal vesicles. J Urol. 1981; 125(3):385-387. Link, Google Scholar 10. . Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017; 389(10071):815-822. Crossref, Medline, Google Scholar 11. . Feasibility of prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques. World J Clin Cases. 2019; 7(12):1403-1409. Crossref, Medline, Google Scholar 12. . The preliminary clinical study on radical prostatectomy without preoperative prostate biopsy. Zhonghua Yi Xue Za Zhi. 2020; 100(34):2658-2662. Medline, Google Scholar 13. . Dual-tracer PET/CT-targeted, mpMRI-targeted, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer: a pilot study. Eur J Nucl Med Mol Imaging. 2022; 49(8):2821-2832. Crossref, Medline, Google Scholar Support: This research was supported by the key Research and Development program of Hunan Province (2021SK2014, 2023SK2017), the Science and Technology Innovation Team Talent Project of Hunan Province (2021 RC4056), the National Natural Science Foundation of China (82272907, 81974397, 81572524, 91859207, 81771873), the National Natural Science Foundation of Hunan Province (2020JJ5882, 2020JJ5949), the clinical research foundation of the National Clinical Research Center for Geriatric Diseases (XIANGYA; 2020LNJJ01), and the Fundamental Research Funds for the Central Universities of Central South University (1053320220574). Conflict of Interest Disclosures: The Authors declare that they have no conflict of interest. Ethics Statement: The study protocol was approved by the Ethics Committee of Xiangya Hospital (IRB No. 202110113). All patients provided written informed consent to participate in the study. Author Contributions: Wei Tang analyzed the data, interpreted the results, prepared the figures and tables, and wrote the manuscript. Xiaomei Gao analyzed the histopathologic and immunohistochemical data. Yongxiang Tang and Shuo Hu analyzed the data of PSMA-PET. Ye Zhang performed the IHC staining assay and analyzed the results. Guyu Tang prepared the figures and tables. Yi Cai and Lin Qi designed the study and revised the manuscript for important intellectual content. All authors approved the final version of the manuscript. Data Availability: The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Editor's Note: This article is the first of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 932 and 933. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySiemens D (2023) This Month in Adult UrologyJournal of Urology, VOL. 210, NO. 6, (827-828), Online publication date: 1-Dec-2023.Tang W, Tang Y, Qi L, Zhang Y, Tang G, Gao X, Hu S and Cai Y (2023) Reply By AuthorsJournal of Urology, VOL. 210, NO. 6, (854-855), Online publication date: 1-Dec-2023.Cotta B (2023) Editorial CommentJournal of Urology, VOL. 210, NO. 6, (854-854), Online publication date: 1-Dec-2023.Baker B and Berger J (2023) Editorial CommentJournal of Urology, VOL. 210, NO. 6, (853-854), Online publication date: 1-Dec-2023.Related articlesJournal of Urology5 Oct 2023Editorial CommentJournal of Urology5 Oct 2023Editorial Comment Volume 210Issue 6December 2023Page: 845-855Supplementary Materials Peer Review Report Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmspositron emission tomography computed tomographyfalse positive reactionsprostatectomybiopsyAcknowledgmentsWe thank Professor Jingcheng Shi from the School of Public Health, Xiangya School of Medicine, Central South University, for her guidance on the statistical methods used in this article.Metrics Author Information Wei Tang Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China Co-first authors. More articles by this author Yongxiang Tang Department of PET Center, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China Co-first authors. More articles by this author Lin Qi Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China More articles by this author Ye Zhang Department of Oncology, NHC Key Laboratory of Cancer Proteomics, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China More articles by this author Guyu Tang Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China More articles by this author Xiaomei Gao Department of Pathology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China More articles by this author Shuo Hu Department of PET Center, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China More articles by this author Yi Cai Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China †Correspondence: Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, No. 87 Xiangya Rd, Changsha City, 410008, Hunan Province , PR China telephone: +86-13637310713; E-mail Address: [email protected] More articles by this author Expand All Support: This research was supported by the key Research and Development program of Hunan Province (2021SK2014, 2023SK2017), the Science and Technology Innovation Team Talent Project of Hunan Province (2021 RC4056), the National Natural Science Foundation of China (82272907, 81974397, 81572524, 91859207, 81771873), the National Natural Science Foundation of Hunan Province (2020JJ5882, 2020JJ5949), the clinical research foundation of the National Clinical Research Center for Geriatric Diseases (XIANGYA; 2020LNJJ01), and the Fundamental Research Funds for the Central Universities of Central South University (1053320220574). Conflict of Interest Disclosures: The Authors declare that they have no conflict of interest. Ethics Statement: The study protocol was approved by the Ethics Committee of Xiangya Hospital (IRB No. 202110113). All patients provided written informed consent to participate in the study. Author Contributions: Wei Tang analyzed the data, interpreted the results, prepared the figures and tables, and wrote the manuscript. Xiaomei Gao analyzed the histopathologic and immunohistochemical data. Yongxiang Tang and Shuo Hu analyzed the data of PSMA-PET. Ye Zhang performed the IHC staining assay and analyzed the results. Guyu Tang prepared the figures and tables. Yi Cai and Lin Qi designed the study and revised the manuscript for important intellectual content. All authors approved the final version of the manuscript. Data Availability: The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Editor's Note: This article is the first of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 932 and 933. Advertisement PDF downloadLoading ...