PD38-02 BPH-RELATED FALSE POSITIVE OF 68 GA-PSMA PET/CT IN THE DIAGNOSIS OF PROSTATE CANCER: THE ACHILLES' HEEL OF BIOPSY-FREE RADICAL PROSTATECTOMY?

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD38-02 BPH-RELATED FALSE POSITIVE OF 68GA-PSMA PET/CT IN THE DIAGNOSIS OF PROSTATE CANCER: THE ACHILLES' HEEL OF BIOPSY-FREE RADICAL PROSTATECTOMY? Wei Tang, Yongxiang Tang, Lin Qi, Ye Zhang, Guyu Tang, Xiaomei Gao, Shuo Hu, and Yi Cai Wei TangWei Tang More articles by this author , Yongxiang TangYongxiang Tang More articles by this author , Lin QiLin Qi More articles by this author , Ye ZhangYe Zhang More articles by this author , Guyu TangGuyu Tang More articles by this author , Xiaomei GaoXiaomei Gao More articles by this author , Shuo HuShuo Hu More articles by this author , and Yi CaiYi Cai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical prostatectomy (RP) is the primary treatment for localized clinically significant prostate cancer (csPCa). However, its application is generally based on prior pathological diagnosis. 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) is considered promising in biopsy-free RP. Notably, inadequate specific or positive predictive value of imaging diagnosis strategy could become the Achilles’ Heel of biopsy-free RP. For 68Ga-PSMA PET/CT, the expression of PSMA in benign prostatic hyperplasia (BPH) tissue and its related positive reaction, which can reduce the specificity of diagnosis, are important concerns affecting the imaging diagnosis of PCa as well as the feasibility of biopsy-free RP. No study has explored the BPH-related false positive of 68Ga-PSMA PET/CT in the detection of PCa. Furthermore, the influence of maximum standardized uptake value (SUVmax) on biopsy-free RP is also poorly characterized. METHODS: A retrospective descriptive observational study was conducted. Patients who received 68Ga-PSMA PET/CT because of clinical suspicion of PCa based on elevated prostate-specific antigen ( >4 ng/ml) or abnormal digital rectal examination and subsequently were confirmed to be BPH or PCa by systematic biopsy or targeted biopsy (TB) were included. The receiver operating characteristic curve was generated for SUVmax values, from which the area under the curve (AUC) and the Youden index was calculated. Sensitivity and specificity were calculated based on the cutoffs. RESULTS: 89 BPH and 94 PCa patients were included. 27 of the 89 BPH cases were considered 68Ga-PSMA PET/CT positive, all dominant lesions were confirmed to be BPH tissue through TB, and thus, were regarded as BPH-related false positive. The rate was 30.3%. SUVmax could effectively distinguish BPH and grade group (GG) one patients with an AUC of 0.8562 and could potentially benefit biopsy-free RP by avoid BPH-related misdiagnosis and GG one-related overtreatment. The optimal SUVmax cutoff value was 9.750 with a sensitivity of 64.71% and a specificity of 97.22%. Given the pivotal role of specificity in biopsy-free RP, we investigated the optimal SUVmax cutoff under when the specificity was 100%. The result was 14.60, with a sensitivity of 41.18% and a specificity of 100%. CONCLUSIONS: Our results revealed, for the first time, the BPH-related false positive rate of 68Ga-PSMA PET/CT in the primary diagnosis of PCa. Using SUVmax values in biopsy-free RP can effectively exclude both BPH and GG one patients. Source of Funding: This research was supported by the key Research and Development program of Hunan Province (2021SK2014), 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) and the clinical research foundation of the National Clinical Research Center for Geriatric Diseases (XIANGYA) (2020LNJJ01) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e993 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wei Tang More articles by this author Yongxiang Tang More articles by this author Lin Qi More articles by this author Ye Zhang More articles by this author Guyu Tang More articles by this author Xiaomei Gao More articles by this author Shuo Hu More articles by this author Yi Cai More articles by this author Expand All Advertisement PDF downloadLoading ...