Abstract

Aim: PSMA expression has been observed in increased levels in patients with high Gleason scores. Current information on Ga-68 PSMA PET/CT shows that primary staging with PET/CT is important in patients with high-risk PC. Ga-68 PSMA PET/CT may also have a place in patients with intermediate risk PC, but only a few data are available at present. In this study, we aimed to elucidate the relationship between PSMA expression value in the prostate gland, total PSA levels and GS in patients diagnosed with prostate cancer.
 Material and Method: A total of 98 patients who were pathologically diagnosed with prostate cancer that did not receive any treatment and underwent Ga‐68 PSMA PET/CT imaging for staging were included in the study. Findings detected in Ga‐68 PSMA PET/CT imaging were categorized as prostate, lymph node, bone, and visceral organ. The focal increased PSMA expression values ​​observed in the prostate gland were recorded as SUVmax. The patients were divided into two separate groups according to their GS score (GS>7 and GS≤7). Correlations between prostate PSMA SUVmax, GS score and total PSA scores were investigated.
 Results: PSMA SUVmax levels of the group with a Gleason score of >7 were found to be significantly higher than the group with a Gleason score of ≤7 (p=0.03). The rates of lymph node metastasis, bone metastasis and visceral organ metastases were found to be significantly higher in the group with a Gleason score >7 compared to the group with a Gleason score ≤7. A positive correlation was observed between PSMA SUVmax and Total PSA (r=0.260, p=0.01). A positive correlation was observed between PSMA SUVmax and Gleason score (r=0.260, p=0.01). A positive correlation was observed between total PSA and Gleason score (r=0.320, p=0.001).
 Conclusion: In conclusion, PSMA SUVmax and Total PSA levels were higher in the group with high Gleason score. There is a positive correlation between PSMA SUVmax and total PSA. Clinicians should be careful in this regard, as the possibility of metastasis will be high in groups with high Gleason scores.

Highlights

  • Prostate cancer (PC) is the second most common type of cancer seen in men all over the world and ranks fourth among all cancers [1]

  • The rates of lymph node metastasis, bone metastasis and visceral organ metastases were found to be significantly higher in the group with a Gleason score >7 compared to the group with a Gleason score ≤7

  • In conclusion, PSMA SUVmax and Total prostate-specific antigen (PSA) levels were higher in the group with high Gleason score

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Summary

Introduction

Prostate cancer (PC) is the second most common type of cancer seen in men all over the world and ranks fourth among all cancers [1]. Despite all the advances in early diagnosis and treatment, including prostate-specific antigen (PSA) screening as well as imaging methods and genetic analysis, prostate cancer is the second leading cause of cancer-related death in men after lung cancer. PSMA has been an ideal molecular target for both the diagnosis and treatment (theranostic) of prostate cancer in nuclear medicine. The intense expression of PSMA in prostate cancer cells is up to 1000 times compared to normal prostate cells, which is not released freely into the circulation. This constitutes an important molecular target in the diagnosis and treatment of metastatic castration resistant prostate cancers (mCRPC) [3]

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