Primary Diagnosis Of Prostate Cancer Research Articles

Rurality and outcomes in prostate cancer: role of socioeconomic status and educational attainment

Abstract Background/Introduction Patients diagnosed with prostate cancer (PC) have a higher cardiovascular disease (CVD) prevalence and mortality risk. Rurality have been associated with up to 33% higher CVD risk and 44% higher all-cause mortality risk in patients with PC. Purpose Analyze the impact of rurality (from both patient and provider perspectives) on the development of adverse outcomes after a PC diagnosis according to socioeconomic and educational status. Methods We included men aged ≥66 with a new primary PC diagnosis (defined as ICD-10 = C61) from 2009-2017 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. The primary outcomes were CVD (comprising heart failure, atrial fibrillation, acute myocardial infarction, peripheral artery disease, and ischemic stroke), PC-specific mortality (PCsm), cardiovascular disease mortality (CVDm), and all-cause mortality. Patients living in areas with a population of <2,500 or <20,000, not adjacent to a metropolitan area, were considered to have a positive rural status. The provider status (metropolitan vs. non-metropolitan) was defined according to the 2013 National Center for Health Statistics' Urban-Rural Classification Scheme for Counties. Low socioeconomic status (SES) was defined according to Yost Index quintiles. Low educational status was defined according to percentiles of people >25 years old with less than a high school diploma. Multivariable Fine-Gray models, accounting for competing mortality/type of mortality, and Cox regression models were applied. Results We included 75,221 patients with PC (Picture 1), of which 1,828 were from rural areas and 362 were from rural areas with providers from non-metropolitan areas. Among patients from rural areas under the care of non-metropolitan providers, 82.6% had low SES (Yost Index ≤ 2). In this subgroup, patients from rural areas with non-metropolitan providers had 30% higher CVD risk (sHR 1.30; 95% CI 1.04-1.62) and 44% higher all-cause mortality risk (sHR 1.44; 95% CI 1.14-1.83; Picture 2) when compared to patients with low SES from urban or rural areas with providers from metropolitan areas. Additionally, within patients from rural areas with non-metropolitan providers, the median % of people with only high school diploma was 38.3 (IQR 36.2-40.9). Among those with low educational status (≤41% of high school county-rate), patients from rural areas with non-metropolitan providers had a 35% higher associated CVD risk (sHR 1.35; 95% CI 1.06-1.71), 54% higher associated CVDm risk (sHR 1.54; 95% CI 1.01-2.36), and a 32% higher associated all-cause mortality risk (sHR 1.32; 95% CI 1.04-1.66). Conclusion Patients with PC from rural areas with non-metropolitan providers have higher rates of low SES and low educational status and suffer from up to 54% higher associated risks of adverse outcomes, emphasizing the role of multiple domains of the Social Determinants of Health in health outcomes.

RNA m6a Methylation Regulator Expression in Castration-Resistant Prostate Cancer Progression and Its Genetic Associations.

N6-methyladenosine (m6A) methylation, a prevalent epitranscriptomic modification, plays a crucial role in regulating mRNA expression, stability, and translation in mammals. M6A regulators have gained attention for their potential implications in tumorigenesis and clinical applications, such as cancer diagnosis and therapeutics. The existing literature predominantly addresses m6A regulators in the context of primary prostate cancer (PCa). However, a notable gap in the knowledge emerges regarding the dynamic expression patterns of these regulators as PCa progresses towards the castration-resistant stage (CRPC). Employing sequential window acquisition of all theoretical mass spectra (SWATH-MS) and RNAseq analysis, we comprehensively profiled the expression of 27 m6A regulators in hormone/androgen-dependent and -independent PCa cell lines, revealing distinct clustering between tumor and adjacent normal prostate tissues. High-grade PCa tumors demonstrated the upregulation of METTL3, RBM15B, and HNRNAPA2B1 and the downregulation of ZC3H13, NUDT21, and FTO. Notably, we identified six m6A regulators associated with PCa survival. Additionally, association analysis of the PCa-associated risk loci in the cancer genome atlas program (TCGA) data unveiled genetic variations near the WTAP, HNRNPA2B1, and FTO genes as significant expression quantitative trait loci. In summary, our study unraveled abnormalities in m6A regulator expression in PCa progression, elucidating their association with PCa risk loci. Considering the heterogeneity within the PCa phenotypes and treatment responses, our findings suggest that prognostic stratification based on m6A regulator expression could enhance PCa diagnosis and prognosis.

Prostate-specific membrane antigen SPECT-CT in patients with intermediate and high-risk prostate cancer in primary diagnosis: A comparative analysis with 18F-PSMA PET/CT.

43 Background: Prostate cancer (PC) is a leading cause of cancer death in men worldwide. Imaging plays a key role in disease detection and initial staging. Emerging data has shown the superiority of 68Gallium and 18Fluorine labeled-PSMA imaging with PET/CT over conventional imaging for primary diagnosis. Despite the success, there are challenges in meeting the high demand and expensive costs especially in low-income countries. These challenges stimulated interest in 99mTechnetium-labeled-PSMA agents. Single photon emission computer tomography (SPECT/CT) is more worldwide available, and the imaging agent is low cost, which is more promising. The aim of this study is to compare the diagnostic accuracy of 99mTc‐PSMA-SPECT/CT to 18F-PSMA-PET/CT in the primary diagnosis of PC and impact on clinical staging. Methods: Prospective controlled study, total of 16 patients with histologically confirmed PC (intermediate unfavorable and high risk) were recruited to undergo 18F-PSMA-PET/CT and 99mTc-HYNIC-PSMA-SPECT/CT. Mean age of patients was 71 (54-75) years and the median PSA level was 31.5 (4.3-920) ng/ml. Lesions were divided into prostate, seminal vesicles, lymph nodes (LN) (locoregional [LR] and non-locoregional [NLR]), bone, and visceral metastases. The size of LN with PSMA avidity on 99mTc‐PSMA-SPECT/CT were determined. Lesions detected were read independently of PET/CT findings with two experienced nuclear medicine physicians. Volumetric analysis was also performed between the two imaging modalities (Tumoral Total Volume [TTV]) and correlated with PSA levels. Results: A total of 233 lesions were detected on 18F-PSMA-PET/CT; prostate (n=16), seminal vesicles (n=11), LN LR (n=54), NLR (n=66), bone (n=82) and visceral (n=4); of these 99mTc‐PSMA-SPECT/CT both reviewers detected 100% of the lesions in prostate (16/16), seminal vesicles (11/11) and visceral (4/4); LN LR (51/54; 94%), NLR (51/66; 77%) and bone (70/82; 85%). Between reviewers there was discordance in just 3 LN (<4 mm) and 1 bone metastases. The lowest diameter of positive LN detected by SPECT/CT was 4 mm (range 4-18). Pearson-correlation coefficient between PSA and TTV SPECT was r=0.68 (p=0.003) and for TTV PET r=0.71 (p=0.002). There were not statistically significant differences between TTV SPECT and TTV PET (T-student p=0.48). Five cases with high volume disease were detected by both methods. All patients were classified according to miTNM showing no difference. Conclusions: 99mTc‐PSMA-SPECT/CT may be a useful in primary diagnosis of PC. Despite it showed a slightly lower lesion detection rate compared to 18F-PSMA-PET/CT, it exhibited no impact on clinical staging and consequently the initial treatment intension. Our results show that 99mTc‐PSMA-SPECT/CT could be used as a cost-efficient alternative with wider availability and no significant difference.

Evaluation of the tolerability and safety of [225Ac]Ac-PSMA-I&T in patients with metastatic prostate cancer: a phase I dose escalation study

BackgroundLife expectancy of patients with metastatic castration-resistant prostate cancer (mCRPC) is still limited despite several systemic treatments. Within five years after diagnosis of primary prostate cancer, 10–20% of the patients have mCRPC and curation is not an option. Radionuclide therapy (RNT) targeted against prostate-specific membrane antigen (PSMA) emerged as a new treatment option and showed effective results in patients with mCRPC. Survival benefit after [177Lu]Lu-PSMA RNT has already been demonstrated in several clinical trials. However, [225Ac]Ac-PSMA (225Ac-PSMA) appears to be an even more promising radiopharmaceutical for the treatment of mCRPC. The use of alpha emitting radionuclides offers advantages over beta emitting radionuclides due to the high linear energy transfer effective for killing tumor cells and the limited range to reduce the radiation effects on the healthy tissue. However, these results are based on retrospective data and safety data of 225Ac-PSMA are still limited. Therefore, a prospective trial is needed to determine the optimal amount of activity that can be administered.MethodsThe 225Ac-PSMA-Imaging & Therapy (I&T) trial is an investigator-initiated phase I, single-center, open label, repeated dose-escalation and expansion trial. Patient with PSMA-positive mCRPC after at least one line of chemotherapy and/or one line of nonsteroidal antiandrogen will be treated with 225Ac-PSMA-I&T in increasing amount of activity per cycle. Dose-escalation following an accelerated 3 + 3 design which allows to open the next dose-level cohort in the absence of dose limiting toxicity while the previous one is still ongoing. Up to 4 treatment cohorts will be explored including up to 3 dose-escalation cohorts and one expansion cohort where patients will be administered with the recommended dose. A total of up to 30 patients will be enrolled in this trial. All patients will be evaluated for safety. Additionally, dosimetry was performed for the patients in the dose-escalation cohorts after the first 225Ac-PSMA-I&T administration.DiscussionThis trial will assess the safety and tolerability of 225Ac-PSMA-I&T in patients with mCRPC to recommend the optimal dose for the phase II trial.Trial registrationClinicalTrials.gov, (NCT05902247). Retrospectively registered 13 June 2023.

Diagnostic Performance of 99mTc-iPSMA SPECT/CT in the Initial Staging of Patients with Unfavorable Intermediate-, High-, and Very High-Risk Prostate Cancer: A Comparative Analysis with 18F-PSMA-1007 PET/CT.

In this prospective controlled study, 18 patients with histologically confirmed prostate cancer with unfavorable intermediate-, high-, and very high-risk characteristics were recruited to undergo 18F-PSMA-PET/CT and 99mTc-iPSMA SPECT/CT. The median age of the patients was 71 years old, and the median PSA level was 23.3 ng/mL. Lesions were divided into the prostate, seminal vesicles, lymph nodes, bone, and visceral metastases. Volumetric analysis was also performed between the two imaging modalities and correlated with PSA levels. A total of 257 lesions were detected on 18F-PSMA-PET/CT: prostate (n = 18), seminal vesicles (n = 12), locoregional lymph nodes (n = 62), non-locoregional (n = 67), bone (n = 90), and visceral (n = 8). Of these, 99mTc-iPSMA-SPECT/CT detected 229 lesions, while both reviewers detected 100% of the lesions in the prostate (18/18), seminal vesicles (12/12), and visceral (8/8); LN LR (56/62; 90%), NLR (57/67; 85%), and bone (78/90; 86%). There were no statistically significant differences between volumetric parameters (t = -0.02122; p = 0.491596). 99mTc-iPSMA SPECT/CT is useful in the primary diagnosis of prostate cancer. Despite it showing a slightly lower lesion detection rate compared to 18F-PSMA PET/CT, it exhibited no impact on clinical staging and, consequently, the initial treatment intention.

Role of psa levels and pathological stadiation before radiation therapy in predicting mp-MRI results in patients with prostate cancer recurrence after radical prostatectomy

ObjectiveTo evaluate PSA value in mp-MRI results prediction, analyzing patients with high (GS≥8, pT≥3, pN1) and low grade (GS<8, pT<3, pN0) Prostate Cancer (PCa). Materials and methodsOne hundred eighty-eight patients underwent 1.5-Tmp-MRI after Radical Prostatectomy (RP) and before Radiotherapy (RT). They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score (GS), pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before RT were performed in order to identify the optimal cut-off to predict mp-MRI result. ResultsGroup A and B showed higher AUC for PSA before RT than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best AUC was 0.646 and 0.685 in group A and B; for high grade the best AUC was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565−0.58ng/mL in group A (sensitivity, specificity: 70.5%, 66%), and 0.11−0.13ng/mL in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265−0.305ng/mL in group A (sensitivity, specificity: 95%, 42.1%), and 0.13−0.15ng/mL in B (sensitivity, specificity: 100%). ConclusionMp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA>0.1−0.15ng/mL.

Abstract 14846: Rurality and Associated Cardiovascular Events and Mortality in Older Men With Prostate Cancer: Longitudinal SEER Medicare Analysis

Introduction: The effect of rurality as a social determinant of health in cardiovascular events (CVE) in patients with prostate cancer (PC) is unknown. Methods: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified males ≥ 66 years old with a new primary diagnosis of PC between 2009 and 2017. We also identified those who were undergoing leuprolide androgen deprivation therapy (ADT). These patients were followed to identify a primary outcome of CVE that included heart failure (HF), atrial fibrillation (AF), acute myocardial infarction (AMI), peripheral artery disease (PAD), coronary artery disease (CAD), ischemic stroke (IS) and cardiovascular death. Adjusted Cox proportional hazards modeling was performed to estimate all-cause mortality in PC patients stratified by rurality as defined by Medicare. Adjusted Fine-Gray modeling with appropriate competing risk (mortality or type of mortality) was utilized for other outcomes as presented. We adjusted for demographic factors, social determinants of health, cancer-specific factors, and other cardiovascular risk factors apart from the primary exposure of rurality. Results: This study included 102,225 PC patients. Among these, 4,945 (4.8%) belonged to areas with a population of less than 2,500 or less than 20,000 not next to a metro (rural). The use of ADT was noted in 9,071 (8.9%) of patients. The incidence of new CVE and mortality risk due to rurality is presented in Table 1. Rural area was noted to be a risk factor for all-cause mortality [adjusted hazards ratio (aHR) = 1.114 (95% CI= 1.070-1.161)]. No statistically significant association between CVE and rurality, however, was observed in the data. Conclusions: PC patients have a high burden of pre-existing cardiovascular disease prior to PC diagnosis, and rurality increases all-cause mortality. This is consistent with those who are treated with ADT as well.

El papel del antígeno prostático específico (PSA) y el estadio patológico antes de la radioterapia en la predicción de los resultados de la resonancia magnética multiparamétrica (RMmp) en pacientes con recidiva del cancer de próstata tras prostatectomía radical

ObjectiveTo evaluate prostate-specific antigen (PSA) value in multiparametric magnetic resonance imagin (mp-MRI) results prediction, analyzing patients with high (Gleason Score ≥8, pT≥3, pN1) and low grade (Gleason Score <8, pT<3, pN0) prostate cancer (PCa). Materials and methodsOne hundred eighty-eight patients underwent 1.5-T mp-MRI after radical prostatectomy and before radiotherapy. They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score, pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before radiotherapy were performed in order to identify the optimal cut-off to predict mp-MRI result. ResultsGroup A and B showed higher area under the curve for PSA before radiotherapy than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best area under the curve was 0.646 and 0.685 in group A and B; for high grade the best area under the curve was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565-0.58ng/ml in group A (sensitivity, specificity: 70.5%, 66%), and 0.11-0.13ng/ml in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265-0.305ng/ml in group A (sensitivity, specificity: 95%, 42.1%), and 0.13-0.15ng/ml in B (sensitivity, specificity: 100%). ConclusionMp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA>0.1-0.15ng/ml.

Prostate MRI and PSMA-PET in the Primary Diagnosis of Prostate Cancer.

Over the last years, prostate magnetic resonance imaging (MRI) has gained a key role in the primary diagnosis of clinically significant prostate cancer (csPCa). While a negative MRI can avoid unnecessary prostate biopsies and the overdiagnosis of indolent cancers, a positive examination triggers biopsy samples targeted to suspicious imaging findings, thus increasing the diagnosis of csPCa with a sensitivity and negative predictive value of around 90%. The limitations of MRI, including suboptimal positive predictive values, are fueling debate on how to stratify biopsy decisions and management based on patient risk and how to correctly estimate it with clinical and/or imaging findings. In this setting, "next-generation imaging" imaging based on radiolabeled Prostate-Specific Membrane Antigen (PSMA)-Positron Emission Tomography (PET) is expanding its indications both in the setting of primary staging (intermediate-to-high risk patients) and primary diagnosis (e.g., increasing the sensitivity of MRI or acting as a problem-solving tool for indeterminate MRI cases). This review summarizes the current main evidence on the role of prostate MRI and PSMA-PET as tools for the primary diagnosis of csPCa, and the different possible interaction pathways in this setting.

Novel non-MRI imaging techniques for primary diagnosis of prostate cancer: micro-ultrasound, contrast-enhanced ultrasound, elastography, multiparametric ultrasound, and PSMA PET/CT.

Multiparametric magnetic resonance imaging (mpMRI) provides enhanced diagnostic accuracy in the detection of prostate cancer, but is not devoid of limitations. Given the recent evolution of non-MRI imaging techniques, this critical review of the literature aimed at summarizing the available evidence on ultrasound-based and nuclear medicine imaging technologies in the initial diagnosis of PCa. Three databases (PubMed®, Web of Science™, and Scopus®) were queried for studies examining their diagnostic performance in the primary diagnosis of PCa, weighted against a histological confirmation of PCa diagnosis, using a free-text protocol. Retrospective and prospective studies, both comparative and non-comparative, systematic reviews (SR) and meta-analysis (MA) were included. Based on authors' expert opinion, studies were selected, data extracted, and results qualitatively described. Micro-ultrasound (micro-US) appears as an appealing diagnostic strategy given its high accuracy in detection of PCa, apparently non-inferior to mpMRI. The use of multiparametric US (mpUS) likely gives an advantage in terms of effectiveness coming from the combination of different modalities, especially when certain modalities are combined. Prostate-specific membrane antigen (PSMA) PET/CT may represent a whole-body, one-step approach for appropriate diagnosis and staging of PCa. The direct relationship between lesions avidity of radiotracers and histopathologic and prognostic features, and its valid diagnostic performance represents appealing characteristics. However, intrinsic limits of each of these techniques exist and further research is needed before definitively considering them reliable tools for accurate PCa diagnosis. Other novel technologies, such as elastography and multiparametric US, currently relies on a limited number of studies, and therefore evidence about them remains preliminary. Evidence on the role of non-MRI imaging options in the primary diagnosis of PCa is steadily building up. This testifies a growing interest towards novel technologies that might allow overcoming some of the limitations of current gold standard MRI imaging.

Performance of 18F-DCFPyL PET/CT in Primary Prostate Cancer Diagnosis, Gleason Grading and D'Amico Classification: A Radiomics-Based Study.

The online version contains supplementary material available at 10.1007/s43657-023-00108-y.

Association between social determinants of health and outcomes among young patients with prostate cancer.

e18500 Background: Influence of Social Determinants of Health (SDHs) on Outcomes among Young Patients with Prostate Cancer. SDHs significantly influence prostate cancer patients' incidence, presentation, and outcomes. However, how these factors affect outcomes in younger patients with prostate cancer has been understudied in the literature. Prostate cancer is the commonest cancer among men in the US, and studying these factors will further enhance efforts to develop appropriate public health strategies to combat the disease. Aim: To determine the influence of patients' race and SDHs on outcomes among young patients with prostate cancer. Methods: Utilizing data from the National Cancer Database (NCDB), we conducted a retrospective analysis of all patients with a primary diagnosis of prostate cancer from January 2004 to December 2018. The outcome measures were diagnosis to definitive treatment time (days), length of hospitalization (days), and overall survival. We determined the influence of patients’ race/ethnicity, insurance type, residence annual median income (median household income for each patient's area of residence), and residence education level (defined as the proportion of adults ≥25 years who did not complete high school in the patients' zip code) on the overall survival among young patients with prostate cancer. Results: There were 843,511 cases of prostate malignancy reported in the National Cancer Database between 2004 and 2018. About 6.3% of these patients were younger than 50 years (N=52,890). Among the younger patients, 74.0% were whites, and 21.3% were Blacks. These compare to the control of adults older than 50 years, with 84.3% whites and only 11.3% Blacks. On multivariate analysis, Black patients have a longer diagnosis to definitive treatment time and overall longer hospital stay but no racial disparity in overall survival. Significant predictors of overall survival among the young prostate cancer survivors were patients with private insurance and higher income quintiles (see table). Conclusions: Insurance and income rather than race/ethnicity or education level appear to constitute a significant predictor of survival among young prostate cancer patients in the United States.[Table: see text]

An Australian experience using Tc-PSMA SPECT/CT in the primary diagnosis of prostate cancer and for staging at biochemical recurrence after local therapy.

Technetium 99 prostate-specific membrane antigen(Tc-PSMA) single-photon emission computed tomography/computed tomography (SPECT/CT) has the potential to provide greater accessibility globally thangallium 68(Ga)-PSMA positron emission tomography (PET)/CT but has not been studied as extensively in primary diagnosis, staging, or relapse of prostate cancer (PC). We instituted a novel SPECT/CT reconstruction algorithm using Tc-PSMA and established a database to prospectively accumulate data on all patients referred with PC. This study extracts data on all patients referred over a 3.5-year period with the primary aim of comparing the diagnostic accuracy of Tc-PSMA and multiparametric magnetic resonance imaging (mpMRI) in the primary diagnosis of PC. The secondary aim was to assess the sensitivity of Tc-PSMA in detecting disease with relapse after either radical prostatectomy or primary radiotherapy. A total of 425 men referred for primary staging (PS) of PC and 172 men referred with biochemical relapse (BCR) were evaluated. We evaluated diagnostic accuracy and correlations between Tc-PSMA SPECT/CT, magnetic resonance imaging(MRI), prostate biopsy, prostate-specific antigen (PSA), and age in the PS group and positivity rates at different PSA levels in the BCR group. Taking the biopsy's grade according to the International Society of Urological Pathologyprotocol as a reference, the sensitivity (true positive rate), specificity (true negative rate), accuracy (positive and negative predictive value), and precision (positive predictive value) for Tc-PSMA in the PS group were 99.7%, 83.3%, 99.4%, and 99.7%, respectively. Comparison rates for MRI in this group were 96.4%, 71.4%, 95.7%, and 99.1%. We found moderate correlations between Tc-PSMA uptake in the prostate and biopsy grade, the presence of metastases, and PSA. In BCR, the Tc-PSMA positive rates were 38.9%, 53.2%, 62.5%, and 84.6% at PSA levels of <0.2, 0.2 to <0.5, 0.5 to <1.0, and > 1.0 ng/mL respectively. We have shown that Tc-PSMA SPECT/CT using an enhanced reconstruction algorithm has a diagnostic performance similar to Ga-PSMA PET/CT and mpMRI in an everyday clinical setting. It may have some advantages in cost, sensitivity for primary lesion detection, and the ability for intraoperative localization of lymph nodes.

Performance of 68Ga-labeled prostate-specific membrane antigen ligand positron emission tomography/computed tomography in the diagnosis of primary prostate cancer: a systematic review and meta-analysis.

To explore the feasibility of 68Ga-PSMA PET/CT in diagnosing primary prostate cancer. Embase, PubMed and Cochrane Library databases were searched for studies published before July 2020. The studies that used 68Ga-PSMA PET/CT for detecting primary prostate cancer, and pathological biopsy as the reference standard were included. The selecting process used preferred reporting items for systematic reviews and meta-analyses (PRISMA). The quality of enrolled studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. According to our search strategy, 9 studies were included for analysis. A total of 547 patients with primary prostate cancer and 443 lesion segments that underwent 68Ga-PSMA PET/CT scans were included and their pathological biopsies were compared. The results of these studies showed some differences. For instance, the lowest sensitivity of 68Ga-PSMA PET/CT in diagnosing primary prostate cancer was 67%, while the highest sensitivity recorded was 97%. Compared with conventional imaging examinations, 68Ga-PSMA PET/CT had higher sensitivity and specificity in detecting primary prostate cancer. At present, most of the studies that used 68Ga-PSMA PET/CT for detecting prostate cancer are retrospective studies. Based on its advantage of high detection rate, the use of 68Ga-PSMA PET/CT in the detection of primary prostate cancer is worthy of promotion.

PD22 Exploratory Analysis of a Brazilian Real-World Open Database Applied to Prostate Cancer

IntroductionProstate cancer was the second most frequent cancer and the fifth leading cause of cancer death among men in 2020. The incidence rates vary substantially in countries with different Human Development Indexes (HDI), while the mortality rates decrease with improved access to the health system, availability of therapies and earlier detection. Worldwide, population-based cancer registries are important tools for planning and managing health systems. The Fundação Oncocentro de São Paulo (FOSP) is responsible to collect, clean and publicize data from cancer treatment institutions. This study aimed to describe retrospectively the demographic and clinical profile of prostate cancer (PC) in Brazil using this database. It is not an incidence study as data is representative only from specific institutions.MethodsThis was a retrospective observational study of the years 2000 to 2020 from analysis of the publicly available FOSP database (http://www.fosp.saude.sp.gov.br).The records were extracted, merged, and cleaned using a fully documented and validated data process. Only patients included on the register with a primary PC diagnosis were considered.ResultsFrom January 2010 to June 2020, there were 943,660 patients diagnosed with C61 in FOSP database for the considered time period. The majority of the FOSP database records are from patients who live and/or were born in SP (91.8 and 58.4%, respectively) or MG (2.8 and 10.5%, respectively). The mean age of PC at baseline was 69 years. Considering the stage of the disease, the mean ages are 55, 70, 67, 66 and 61, for stages 0, 1, 2, 3 and 4, respectively. This cohort was also analyzed in relation to treatments received, and status at the end of treatment (51.3% are disease-free, 18.4% are alive with cancer, and 30.3% are dead).ConclusionsFOSP population-based cancer registries are a powerful tool to obtain information for planning, and improving the management of healthcare services especially for São Paulo.

Comparison of Multiparametric Magnetic Resonance Imaging with Prostate-Specific Membrane Antigen Positron-Emission Tomography Imaging in Primary Prostate Cancer Diagnosis: A Systematic Review and Meta-Analysis.

Simple SummaryMultiparametric magnetic-resonance imaging (mpMRI) is a routinely used imaging modality for diagnosing prostate cancer but misses 10–20% of prostate tumours. Recently, prostate-specific membrane antigen positron-emission tomography (PSMA PET) has been proposed as an alternative to mpMRI for diagnosis. Our systematic review and meta-analysis aimed to compare the diagnostic performance between mpMRI and PSMA PET modalities prior to biopsy. Ten articles directly comparing the performance of both modalities in the same patient cohort were investigated. PSMA PET/CT was superior in diagnosing patients with prostate cancer over mpMRI, but not in defining the location of the cancer. Early evidence suggests that the addition of PSMA PET within the diagnostic pathway may enhance the detection of clinically significant prostate cancer.Multiparametric magnetic-resonance imaging (mpMRI) has proven utility in diagnosing primary prostate cancer. However, the diagnostic potential of prostate-specific membrane antigen positron-emission tomography (PSMA PET) has yet to be established. This study aims to systematically review the current literature comparing the diagnostic performance of mpMRI and PSMA PET imaging to diagnose primary prostate cancer. A systematic literature search was performed up to December 2021. Quality analyses were conducted using the QUADAS-2 tool. The reference standard was whole-mount prostatectomy or prostate biopsy. Statistical analysis involved the pooling of the reported diagnostic performances of each modality, and differences in per-patient and per-lesion analysis were compared using a Fisher’s exact test. Ten articles were included in the meta-analysis. At a per-patient level, the pooled values of sensitivity, specificity, and area under the curve (AUC) for mpMRI and PSMA PET/CT were 0.87 (95% CI: 0.83–0.91) vs. 0.93 (95% CI: 0.90–0.96, p < 0.01); 0.47 (95% CI: 0.23–0.71) vs. 0.54 (95% CI: 0.23–0.84, p > 0.05); and 0.84 vs. 0.91, respectively. At a per-lesion level, the pooled sensitivity, specificity, and AUC value for mpMRI and PSMA PET/CT were lower, at 0.63 (95% CI: 0.52–0.74) vs. 0.79 (95% CI: 0.62–0.92, p < 0.001); 0.88 (95% CI: 0.81–0.95) vs. 0.71 (95% CI: 0.47–0.90, p < 0.05); and 0.83 vs. 0.84, respectively. High heterogeneity was observed between studies. PSMA PET/CT may better confirm the presence of prostate cancer than mpMRI. However, both modalities appear comparable in determining the localisation of the lesions.

Treatment patterns and outcomes in prostate cancer patients tested with Decipher in SEER.

e17006 Background: In 2021, national data between the Decipher 22-gene prognostic gene expression classifier (GC) for men with prostate cancer and the Surveillance, Epidemiology, and End Results (SEER) cancer registries were linked. The purpose of the work is to report on the linkage by characterizing national GC usage and its association with treatment decisions for men with prostate cancer. Methods: Patients in the SEER registries with primary prostate cancer diagnosis from 2010 to 2018 were included and linked to data from GC testing conducted between 2014 to 2020 (Veracyte, San Diego, CA). GC scores (range 0-1) and GC risk groups (low, intermediate, and high) were used for continuous and categorical analyses. Multivariable logistic regression was used to quantify the association between GC and active surveillance and watchful waiting (AS/WW) use and adverse pathology at radical prostatectomy (RP). Adverse pathology was defined as pathological grade group ≥3, pathological stage ≥pT3b, or lymph node invasion. Results: A total of 575,363 patients were eligible for analysis, of which 10,528 patients underwent GC testing (5,015 GC biopsy test, and 5,513 GC RP test). The median age was 67 for both tested and untested, but more white patients underwent testing (82% vs 76%, p &lt; 0.001). For GC biopsy tested patients, AS/WW was highest for those with GC low risk results (41%) as compared to those with intermediate (32%) or high (17%) GC risk (p &lt; 0.001). RP rates were lower in the tested compared to untested (25% vs. 36%, p &lt; 0.001), and among the tested patients, RP use increased by GC risk group (19% of low, 25% of intermediate, and 34% of high GC risk, p &lt; 0.001). A similar trend by GC risk group in management for radiation therapy was observed (13% of low, 19% of intermediate, and 29% of high GC risk, p &lt; 0.001). In a multivariable logistic regression adjusted for age, race, NCCN risk group, and year of diagnosis, GC tested patients were more likely to undergo AS/WW compared to untested (OR 2.9 [95% CI, 2.8-3.1], p &lt; 0.001). Within the subset of patients classified as NCCN low/favorable intermediate risk at biopsy and who were subsequently treated with RP (n = 594), GC high risk (&gt; 0.6) was associated with more than 3 times the odds of harboring adverse pathology (OR 3.2 [95% CI 1.6-6.4], p &lt; 0.001). Conclusions: Using the first ever linked SEER-Decipher data, we demonstrate that population-based treatment patterns are independently associated with GC test results. Patients with lower GC scores are independently more likely to undergo AS/WW; those with higher scores are more likely to have adverse pathology at time of RP.

The Role of PET/CT with 68Ga‑PSMA in the Primary Diagnosis of Prostate Cancer

Relevance: Prostate cancer is one of the most frequently diagnosed malignant neoplasms of the genitourinary system in men in the world. Recently, there has been an active introduction into clinical practice of positron emission tomography technology combined with computed tomography (PET/CT) with 68Ga‑PSMA‑617 based on prostate‑specific membrane antigen (PSMA), the capabilities of which significantly increase the effectiveness of the diagnosis of prostate cancer at various clinical stages compared with routine methods used in the staging of prostate cancer.Purpose: To compare the diagnostic effectiveness of PET/CT with 68Ga‑PSMA‑617 with traditional methods of radiation imaging (computed tomography, magnetic resonance imaging and bone scan) in the staging of prostate cancer and to clarify the impact of this technology on the choice of surgical treatment.Material and methods: PET/CT with 68Ga‑PSMA was performed in our center in order to stage the verified prostate cancer in 109 patients aged 48 to 80 years (median 64.5). The selection criteria were: a PSA level of more than 5 ng/ml, the presence of a newly identified, histologically verified prostate cancer, lack of treatment, suspicion of metastatic lesion of the lymph nodes of the pelvis and skeleton. Patients were divided into groups by prostate‑specific antigen level, Gleason score, and d’Amico.Results: In the analysis of PET/CT results and MRI/CT comparison and Bone scan, 56 (51.4 %) of 109 patients showed a change in the TNM stage. A change in the data on the local spread of the tumor with an increase in the stage according to criterion T due to the detection of pathological accumulation of RFP in seminal vesicles was detected in 21 (37.5 %) of 56 patients. Additionally, according to PET/CT data, 13 (23.2 %) of 56 patients were found to have lesions of regional lymph nodes (N). Metastatic lesions of distant lymph nodes (M1a) and bones (M1b), not visualized during routine radiation examination, were observed in 32 (57.1 %) and 36 (64.3 %) of 56 patients, respectively.Conclusions: The use of PET/CT 68Ga‑PSMA‑617 in patients with newly diagnosed prostate cancer at the staging stage allows us to obtain valuable additional information about the local, regional and long‑term prevalence of the pathological process, and in some cases — to change the stage of the disease by TNM (usually by increasing it), which has a significant impact on the tactics of therapeutic measures and the choice of the optimal method of therapy for prostate cancer.

MODERN OPPORTUNITIES OF PET/CT IN THE DIAGNOSIS OF PROSTATE CANCER

The purpose is to present a modern data on the possibilities of positron emission computed tomography combined with computed tomography (PET/CT) in the diagnosis, staging and monitoring of prostate cancer (PC).Material and Methods. A search and analysis of the largest domestic and English-language databases (Elibrary, PubMed, Elsevier, etc.) on this problem was carried out. 37 sources were found devoted to studying the results of clinical trials of the diagnostic capabilities of PET/CT with various radiopharmaceuticals.Results. The presented data on the possibilities of PET/CT with various radiopharmaceuticals in the diagnosis of primary prostate cancer, imaging of lymphogenous and distant metastases, as well as in assessing the effectiveness of treatment.Conclusion. This review of the literature showed that the use of PET/CT in prostate cancer largely depends on the chosen radiopharmaceutical. Moreover, it is PET/CT with PSMA-based radiopharmaceuticals that is the most promising method for examining patients with prostate cancer and can be recommended as an additional study in cases where other methods of radiation diagnostics do not give an unambiguous answer. The development of new and improving the already used radiopharmaceuticals, which will increase the sensitivity, specificity and accuracy of the diagnosis, staging, monitoring and prognosis of treatment of prostate cancer, remains relevant.

Positron emission tomography with computed tomography/magnetic resonance imaging for primary staging of prostate cancer

Prostate cancer is the most common malignancy and the second leading cause of cancer-related death in men. Accurate imaging diagnosis and staging are crucial for patient management and treatment. The role of nuclear medicine in the diagnosis of prostate cancer has evolved rapidly in recent years due to the availability of hybrid imaging with radiopharmaceuticals targeting the prostate-specific membrane antigen (PSMA). Hybrid imaging provides higher diagnostic accuracy compared to conventional imaging and has a significant impact on clinical management. Numerous radiotracers have been used in clinical applications, with PSMA ligands being the most commonly used. Hybrid imaging provides higher diagnostic accuracy for lymph node and bone metastases compared to conventional imaging and has asignificant impact on clinical management. The high accuracy for primary staging in high-risk prostate cancer using PSMA ligands has led to the inclusion of PSMA positron emission tomography (PET)/computed tomography (CT) in the new German S3 guideline for primary staging of prostate cancer. The aim of this article is to provide an overview of the use of PET imaging in the primary diagnosis of prostate cancer, to present the most commonly used radiotracers, and to highlight the results of recent studies.