V07-10 PROSTATE SPECIFIC MEMBRANE ANTIGEN (PSMA)-TARGETED PROSTATE BIOPSY

Abstract

You have accessJournal of UrologyCME1 Apr 2023V07-10 PROSTATE SPECIFIC MEMBRANE ANTIGEN (PSMA)-TARGETED PROSTATE BIOPSY David Kuppermann, Jeremie Calais, and Leonard Marks David KuppermannDavid Kuppermann More articles by this author , Jeremie CalaisJeremie Calais More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI-guided biopsy (MRGB) has emerged as the de facto standard for the best accuracy in diagnosis of prostate cancer (PCa). However, MRI is imperfect, and both falsely positive and falsely negative results have been observed. A new method has been developed for diagnosis of PCa by using a new way to image PCa anywhere in the body. In the present video we illustrate how PSMA-targeted prostate biopsy can complement conventional MRGB. METHODS: PSMA PET scanning employs a radiotracer labeled with gallium 68 (Ga68) or fluor 18 (F18). When injected the radiotracer binds to the extracellular part of the PSMA molecule which sits on the surface of PCa cells. The bound molecule then becomes internalized into the cytoplasm of PCa cells, where it accumulates allowing visualization by PET scanning. A CT scan is then performed and overlayed for anatomic localization. The result is a visual representation of PCa, wherever it may be in the body including within the prostate. RESULTS: PSMA PET/CT detects lesions suspicious for clinically significant PCa (csPCa). The degree of suspicion is based on the pattern of the PSMA PET signal. When focal, the level of suspicion increases. When diffuse and faint, the level of suspicion decreases. The PSMA PET signal intensity is also quantified using a metric called Standardized Uptake Value (SUV). The suspicious lesions identified on PSMA PET/CT can be contoured, transferred onto an ultrasound (US) image fusion device, and used as targets for biopsy. At our institution the Artemis device is used, but the procedure is also applicable to other fusion devices. The prostate is imaged using US, anesthetized, scanned, and a 3D representation of the prostate is created for targeting and tracking of biopsy data. Next the PET/CT image, with a contoured region of interest, is fused with real-time US images of the prostate. Biopsy samples targeted to the PSMA avid spot are obtained in and around the lesion. If not obtained previously, systematic samples may also be obtained at this time. The tissue cores are submitted individually for pathologic review. The workflow is identical to that used in MRI-US fusion procedures. At this time PSMA guided biopsies are limited to cases where MRI is suspected of being falsely negative or where MRI is contraindicated. At our institution we have performed 21 PSMA-targeted biopsies in men whose MRGBs were negative, but PSA density remained elevated, of which 14 (66.67%) showed csPCa (≥ GG2). CONCLUSIONS: PSMA scanning and PSMA-targeted biopsy have brought on a disruptive innovation in the world of prostate cancer. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e599 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Kuppermann More articles by this author Jeremie Calais More articles by this author Leonard Marks More articles by this author Expand All Advertisement PDF downloadLoading ...