Abstract
ObjectivesThe purpose of this study was to evaluate the feasibility and diagnostic performance of prostate-specific membrane antigen (PSMA) based 18F-DCFPyL PET/CT-ultrasound (PET/CT-US) or PET/MRI-ultrasound (PET/MRI-US) fusion targeted biopsy for intra-prostatic PET-positive lesions.MethodsFrom April 2018 to November 2019, we prospectively enrolled 55 candidates to perform PET/CT-US or PET/MRI-US fusion targeted biopsies for solitary PET-positive prostate lesions (two to four cores/lesion). The positive rates of prostate cancer based on patients and biopsy cores were calculated respectively. With reference to the pathological results of biopsy cores, the MR signal characteristics in the area of the PET-positive lesion were analyzed for the patients who underwent PET/MRI.ResultsA total of 178 biopsy cores were taken on the 55 patients. One hundred forty-six biopsy cores (82.0%, 146/178) from 51 (92.7%, 51/55) patients were positive for prostate cancer; 47 (85.5%, 47/55) were clinically significant prostate cancer. It is noteworthy that nine patients underwent both 18F-DCFPyL PET/CT and PET/MRI examinations; the seven patients with prostate cancer showed abnormal MR signal in the area of the PET-positive lesion while the other two patients with prostatic hyperplasia and prostatitis showed normal MR signal in the area of the PET-positive lesion.ConclusionThis study indicated that 18F-DCFPyL PET/CT-US or PET/MRI-US fusion targeted prostate biopsies may be valuable for prostate cancer diagnosis and have a high detection rate of clinically significant prostate cancer for PET-positive lesions. PET/MR can rule out some false PET-positive lesions, which may potentially reduce unnecessary prostate biopsies.
Highlights
Prostate cancer remains one of the most common male malignancies worldwide
The inclusion criteria were: [1] 18F-DCFPyL PET/CT or PET/MRI showed solitary radioactive concentration (PET-positive lesion) in the prostate; and, [2] the solitary PET-positive lesion involved less than one half of one lobe; and, [3] a targeted biopsy performed by 18FDCFPyL PET/CT-US or PET/Magnetic resonance imaging and ultrasonography (MRI-US) targeted at the solitary intraprostatic PET-positive lesion
A total of 55 patients with solitary PET-positive prostate lesions agreed to undergo 18F-DCFPyL PET/CT-US or PET/MRI-US fusion targeted prostate biopsy were enrolled in this study (Figure 2)
Summary
Prostate cancer remains one of the most common male malignancies worldwide. Systematic 12-core transrectal ultrasound-guided prostate biopsy and histopathology are the most commonly used techniques for the diagnosis of prostate cancer before radical prostatectomy [1]. Benign prostate diseases, and clinically insignificant prostate cancer are often detected by this conventional biopsy scheme. This conventional approach is poor at sampling the anterior, midline, and apex of the prostate, which leads to the underdiagnosis of patients with clinically significant prostate cancer. Clinicians are constantly exploring new methods, such as direct in-bore MRI guidance and image fusion guidance targeted prostate biopsy, to improve the detection of clinically significant prostate cancer and reduce the number of biopsy procedures and associated complications [2]. 24% of men with negative multiparametric MRI have a significant risk of harboring clinically significant prostate cancer [3]
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