Elevated Serum Prostate-specific Antigen Levels Research Articles

Androgen Receptor Signaling Inhibitor Withdrawal Syndrome After Castration-resistant Prostate Cancer.

Androgen-deprivation therapy is an extremely effective treatment for progressive prostate cancer. Previously, the first-line treatment for progressive prostate cancer was combined androgen blockade (CAB). If the disease progressed to castration-resistant prostate cancer, the administration of androgen receptor signaling inhibitors (ARSIs) was recommended. When elevated serum prostate-specific antigen (PSA) levels are seen during CAB treatment, it is important to suspect antiandrogen withdrawal syndrome (AWS), discontinue CAB, and monitor the changes in the serum PSA levels. If a reduction in the patient's PSA levels is subsequently observed, antiandrogens should be discontinued and the patient should be followed, but if their PSA level rises they should be transitioned to ARSI treatment. Recently, there have been reports of withdrawal syndrome (WS) after ARSI treatment. With the increased use of ARSIs, such as abiraterone acetate, enzalutamide, apalutamide, and dalorutamide, it is necessary to consider ARSI WS when a patient's serum PSA level increases during ARSI treatment. Unnecessary treatment can be avoided if the confirmation of ARSI WS is prioritized. Conversely, if it is not confirmed there is a risk that second-line treatment will be delayed. This is a review of recent studies of ARSI WS. It also discusses future prospects in this field.

Clinical Factors That Influence Repeat 68Ga-PSMA-11 PET/CT Scan Positivity in Patients with Recurrent Prostate Cancer Under Observation After a Negative 68Ga-PSMA-11 PET/CT Scan: A Single-Center Retrospective Study.

This analysis aimed to identify clinical factors associated with positivity on repeat 68Ga-PSMA-11 PET/CT after a negative scan in patients with recurrent prostate cancer (PCa) under observation. Methods: This single-center, retrospective analysis included patients who underwent at least 2 68Ga-PSMA-11 PET/CT scans (PET1 and PET2) at UCLA between October 2016 and June 2021 for recurrent PCa with negative PET1 and no PCa-related treatments between the 2 scans. Using Prostate Cancer Molecular Imaging Standardized Evaluation criteria to define negative and positive scans, the final cohort was divided into PET2-negative (PET2-Neg) and PET2-positive (PET2-Pos). The same PET1 was used twice in the more than 2 PET cases with inclusion criteria fulfilled. Patient characteristics and clinical parameters were compared between the 2 cohorts using Mann-Whitney U test and Fisher exact test. Areas under the curve (AUCs) of the receiver operating characteristic and the Youden index were computed to determine the discrimination ability of statistically significant factors and specific cut points that maximized sensitivity and specificity, respectively. Results: The final analysis included 83 sets of 2 PET/CT scans from 70 patients. Thirty-nine of 83 (47%) sets were PET2-Neg, and 44 of 83 (53%) sets were PET2-Pos. Prostate-specific antigen (PSA) increased from PET1 to PET2 for all 83 (100%) sets of scans. Median PSA at PET1 was 0.4 ng/mL (interquartile range, 0.2-1.0) and at PET2 was 1.6 ng/mL (interquartile range, 0.9-3.8). We found higher serum PSA at PET2 (median, 1.8 vs. 1.1 ng/mL; P = 0.015), absolute PSA difference (median, 1.4 vs. 0.7 ng/mL; P = 0.006), percentage of PSA change (median, +270.4% vs. +150.0%: P = 0.031), and median PSA velocity (0.044 vs. 0.017 ng/mL/wk, P = 0.002) and shorter PSA doubling time (DT; median, 5.1 vs. 8.3 mo; P = 0.006) in the PET2-Pos cohort than in the PET2-Neg cohort. Receiver operating characteristic curves showed cutoffs for PSA at PET2 of 4.80 ng/mL (sensitivity, 34%; specificity, 92%; AUC, 0.66), absolute PSA difference of 0.95 ng/mL (sensitivity, 62%; specificity, 71%; AUC, 0.68), percentage of PSA change of a positive 289.50% (sensitivity, 48%; specificity, 82%; AUC, 0.64), PSA velocity of 0.033 ng/mL/wk (sensitivity, 57%; specificity, 80%; AUC, 0.70), and PSA DT of 7.91 mo (sensitivity, 71%; specificity, 62%; AUC, 0.67). Conclusion: Patients with recurrent PCa under observation after a negative 68Ga-PSMA-11 PET/CT scan with markedly elevated serum PSA levels and shorter PSA DT are more likely to have positive findings on repeat 68Ga-PSMA-11 PET/CT.

Is the Serum Prostate-Specific Antigen Level Affected by Urethral Catheterization in Patients with Acute Urinary Retention?

Background: The reason for elevated serum prostate-specific antigen (PSA) levels in patients undergoing urethral catheterization due to acute urinary retention (AUR) remains a significant and controversial issue. Objectives: To assess the serum PSA level in men with AUR and its changes after catheterization. Methods: This prospective quasi-experimental study (reviewer 1 - comment 7) was conducted on 43 patients who underwent transurethral catheterization following AUR caused by benign prostatic hyperplasia (BPH). Total PSA levels and free/total PSA ratios were measured before catheterization and one and three days after catheter insertion. Additionally, prostate volume and urine output after catheterization (UOAC) were recorded. Results: The mean age, prostate volume, and UOAC of the patients were 69.05 ± 9.45 years, 60.51 ± 26.35 g, and 844.04 ± 341.66 mL, respectively. The mean and median baseline total PSA levels were 12.59 ± 17.71 ng/mL and 6.30 ng/mL, respectively. These values changed to 13.73 ± 19.83 ng/mL (median = 4.80 ng/mL) and 11.57 ± 17.70 ng/mL (median = 4.40 ng/mL) after 1 and 3 days of catheterization, respectively. The changes in total PSA and free/total PSA levels during the study period were not statistically significant (P > 0.05). Moreover, the PSA levels showed no statistically significant difference before, 1 day, and 3 days after catheterization in groups with total PSA ≤ 4 and total PSA > 4 (P = 0.37; 0.22, respectively). Conclusions: Our results suggest an initial elevation in PSA levels in patients with AUR before urethral catheterization. Both PSA and free/total PSA ratios showed no statistically significant differences before and after urethral catheter insertion, and initial PSA levels did not affect their changes post-catheterization (reviewer 1 - comment 1).

The role of multiparametric magnetic resonance ımaging in the diagnosis of granulomatous prostatitis mimicking prostate cancer.

Aimed to investigate the role of multiparametric magnetic resonance imaging (mp-MRI) in the diagnosis of granulomatous prostatitis caused by intravesical Bacillus Calmette-Guérin (BCG). In this prospective, single-center study, 10 male patients who were given intravesical BCG due to intermediate- and high-risk bladder cancer were included. Before transurethral resection of bladder tumors (TURB), all patients were evaluated by mp-MRI, serum prostate-specific antigen (PSA), and digital rectal examination (DRE). Serum PSA levels and DRE findings were evaluated before and after intravesical BCG treatment. Prostate mp-MRI was performed for patients with elevated levels of serum PSA and/or with abnormal DRE findings. Then, MRI fusion + systematic prostate biopsy was performed. Demographic data of the patients before and after intravesical BCG were compared. The average age of the patients was 66.9years (55-87years). While PSA was 1.7ng/ml before intravesical BCG treatment, it was 4.3ng/ml after intravesical BCG treatment (p = 0.005). PSA density (PSAD) was 0.04 and 0.10 before and after the treatment, respectively (p = 0.012). DRE findings of all patients were normal before the treatment. However, abnormal findings were detected in 80% of them after the treatment (p = 0.008). PI-RADS ≥ 3 lesions were found to be significantly higher in all patients after intravesical BCG (p = 0.004). Granulomatous prostatitis is a rare complication of intravesical BCG. High PSA, abnormal DRE, and PI-RADS ≥ 3 lesions detected after intravesical BCG should suggest granulomatous prostatitis and unnecessary biopsies may be avoided.

Unusual PSMA uptake in seronegative paraneoplastic brainstem encephalitis: A case report

Paraneoplastic encephalitis, especially seronegative, is a heterogeneous group of disorders with varied symptoms at presentation. We present the case of a 63-year-old male who presented with motor weakness and altered sensorium. Magnetic resonance imaging of the brain showed altered signal intensity in the midbrain, pons, anterior part of the medulla, and bilateral middle cerebellar peduncle. T2 hyperintensity was also seen in the bilateral basal ganglia and internal capsule region. 18 fluoro-deoxyglucose positron emission tomography/computed tomography (18 FDG PET/CT) showed increased FDG uptake in the brain stem, left thalamus, and periventricular location. 68Ga-prostate-specific membrane antigen (PSMA) PET/CT done in view of elevated serum Prostate-specific antigen levels show a focal PSMA-avid lesion in the prostate gland and increased PSMA uptake in the brain stem, which is an atypical site of PSMA uptake. Our study highlights the importance of paraneoplastic syndromes with varied clinical presentation and low specificity to antibodies. These spectra of diseases are fatal but treatable and therefore should be evaluated diligently to reduce morbidity

Primary Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of the Prostate: MRI and FDG-PET Imaging Findings

Background: Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the prostate is a rare condition, and there is no report on magnetic resonance imaging (MRI) and its relationship with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). Objectives: The purpose of this article is to present the MRI and FDG-PET imaging findings of primary MALT lymphoma of the prostate and discuss the imaging findings’ importance in the diagnosis and management. Case summaries: A 73-year-old male patient underwent a prostate biopsy for lower urinary tract symptoms and an elevated serum prostate-specific antigen level. Histopathologic and immunohistochemical findings were consistent with MALT lymphoma. As the tumor was confined to the prostate and adjacent tissues and no lymph node metastases were detected on PET-CT, the diagnosis was primary MALT lymphoma of the prostate. The tumor of the transitional zone infiltrated along the obturator internus muscle and into the pubic bone, the levator ani muscle was almost intact on MRI. Conclusion: The absence of lymph node metastasis or gross muscle destruction but a high degree of invasiveness into surrounding tissues is an important imaging finding in the diagnosis of primary MALT lymphoma of the prostate. Keywords: Differential Diagnosis; MRI; Prostate Neoplasms

Flotufolastat F 18: Diagnostic First Approval.

Flotufolastat F 18 (POSLUMA®) is an 18F-labelled radiohybrid (rh) prostate-specific membrane antigen (PSMA)-targeted imaging agent being developed by Blue Earth Diagnostics, a subsidiary of Bracco Imaging, for prostate cancer imaging. In May 2023, flotufolastat F 18 received its first approval in the USA as a radioactive diagnostic agent for positron emission tomography (PET) of PSMA positive lesions in men with prostate cancer with suspected metastasis who are candidates for initial definitive therapy or with suspected recurrence based on elevated serum prostate-specific antigen (PSA) level. This article summarizes the milestones in the development of flotufolastat F 18 leading to this first approval.

Successful radiofrequency ablation of liver metastases from prostate cancer

Patients with liver metastases from prostate cancer show poor prognosis. We performed metastases-directed therapy using radiofrequency ablation of liver metastases in an attempt to improve the prognosis in a patient with metastatic prostate cancer. We present the case of a 66-year-old man who was treated for metastatic castration-resistant prostate cancer. Evaluation showed isolated liver metastases together with elevated serum prostate-specific antigen levels. We performed metastases-directed therapy using radiofrequency ablation of the liver tumor. The patient showed no recurrent liver metastases for 42 months and survived for 66 months after diagnosis of metastatic prostate cancer. To our knowledge, this is the first report that describes radiofrequency ablation of liver metastases from prostate cancer. This procedure may be a useful therapeutic option for metastases-directed therapy in patients with liver metastases from prostate cancer.

Clinical use of the mRNA urinary biomarker SelectMDx test for prostate cancer

BackgroundMolecular biomarker tests are developed as diagnostic tools for prostate cancer (PCa) diagnosis. The SelectMDx (MDxHealth, Nijmegen, The Netherlands) test is a urinary-based biomarker test intended to be used to predict presence of high-grade PCa upon biopsy in men with elevated serum prostate-specific antigen (PSA) levels. Previous validation of the SelectMDx test revealed that 53% of the unnecessary biopsies (biopsies indicating no- or GG1 PCa) could be avoided using the SelectMDx test as a decision-tool to select men for prostate biopsy. The objective of this study is to examine the use of the commercially available SelectMDx test under routine, real-life practice.MethodsMen that underwent a SelectMDx test between May 2019 and December 2020 and that were originating from countries that perform the SelectMDx test on a regular basis were included in this study, resulting in 5157 cases from 10 European countries. Clinical parameters, urinary RNA scores, and test outcomes were compared between PSA groups, age groups, countries, and the validation cohort (described previously [4]) using the Mann–Whitney U test, Chi-Square test, Benjamini–Hochberg and Kruskal–Wallis tests.Results40.72% of the cases received a negative SelectMDx result. The test is also used in patients outside the intended-use population (PSA < 3 and >10 ng/mL). Clinical parameters (age, PSA density, DRE outcome) varied between patient population from individual countries and the validation cohort, resulting in differences in the potential number of saved biopsies using the test.ConclusionsThe potential number of reduced biopsies in clinical use was 40,72% using the SelectMDx test, assuming a negative SelectMDx test resulted in the decision not to biopsy the patient. This is higher compared to the validation cohort, which is explained by differences in patient population.

Does serum prostate specific antigen levels correlate with the prostatic inflammation in elderly patients without clinically proven prostate cancer?

Objectives: To determine the whether histological prostatic inflammation correlates with serum prostate specific antigen (PSA), free PSA (fPSA) and percent of fPSA (%fPSA) levels in elderly patients without clinically proven prostate cancer. Methods: A total of 115 patients without clinically proven prostate cancer with transrectal prostate biopsy were included in this retrospective study. Patients were divided two main groups as patients with and without histologic prostatic inflammation. A grading of the histological prostatic inflammation was performed and patients with prostatic inflammation were divided into three subgroups. The age, prostate volume, serum PSA, fPSA and %fPSA levels were compared between patients with and without prostatic inflammation. Correlation between the parameters and grade of prostatic inflammation was also investigated. Results: Serum PSA and %fPSA levels were significantly higher in men with histologically proven prostatic inflammation (15.47 ± 15.28 ng/mL vs. 11.67 ± 8.12 ng/mL; p = 0.002 and 19.8 ± 0.7 vs. 15.79 ± 0.9; p = 0.01, respectively). The mean serum PSA levels were significantly different among the subgroups (p = 0.02) and prostatic inflammation correlated positively with the PSA levels (r = 0.320, p &amp;lt; 0.001). Conclusions: Our findings suggested that reporting the grade of prostatic inflammation in elderly patients may help avoiding unnecessary repeat biopsies if elevated serum PSA level is the only indication for initial prostate biopsy.

The VISION Forward: Recognition and Implication of PSMA-/18F-FDG+ mCRPC.

Metastatic castration resistant prostate cancer (mCRPC) is incurable. The expression of the transmembrane protein prostate-specific membrane antigen (PSMA) is markedly increased in most mCRPC lesions. PSMA has been recognized as a viable biologic target for imaging and radionuclide therapy (theranostics) in mCRPC. The PET agents 68Ga-PSMA-11 and 18F-DCFPyL have recently been approved for imaging evaluation of patients with suspected metastasis who are candidates for initial definitive therapy and patients with suspected recurrence based on elevated serum prostate-specific antigen level. Radioligand therapy (RLT) with 177Lu-PSMA-617 (177Lu-vipivotide tetraxetan, Pluvicto, Novartis/AAA) was approved on March 23, 2022, based on the favorable results of the VISION trial. It has been recognized that PET imaging of PSMA expression and glucose metabolism (with 18F-FDG) provides a more comprehensive assessment of the tumor burden and heterogeneity. However, there are many unresolved issues that surround whether or not imaging with 18F-FDG PET is advantageous in the clinical setting of PSMA RLT in mCRPR.

Presence of Specific Periodontal Pathogens in Prostate Gland Diagnosed With Chronic Inflammation and Adenocarcinoma.

BackgroundIntraprostatic inflammation is frequently observed in the prostate and linked to prostatic diseases, including prostatitis, benign prostatic hyperplasia (BPH), and cancer. The etiology of prostate diseases is unclear. Periodontal diseases are associated with an increased risk of prostate diseases. In men, chronic prostatitis and moderate/severe periodontitis have significantly elevated serum prostate-specific antigen (PSA) levels. Treatment of periodontal disease reduced PSA levels in men. The presence of periodontal pathogens deoxyribonucleic acid (DNA) was identified in the prostate fluid of prostatitis patients. These pathogenic bacteria might have the potential to trigger prostatitis progressing to prostatic adenocarcinoma. The mechanism(s) explaining the etiology of association between periodontal disease and prostate cancer remains unclear. However, the presence of periodontal pathogens has not been analyzed in the prostate gland.ObjectiveTo identify and compare the presence of specific periodontal pathogens in the areas of BPH, inflammation, and cancer of the prostate glands diagnosed with malignancy.Materials and methodsWhole-mount radical prostatectomy sections from men (n=30) were identified for BPH, inflammation, and cancer areas and marked for tissue procurement. The tissues were subjected to DNA isolation and analysis of microbial DNA and total bacterial load for the following pathogens, including Porphyromonas gingivalis strain ATCC 33277, Prevotella intermedia strain B422, Treponema denticola strain 35405, Fusobacterium nucleatum subsp. fusiform strain, Tannerella forsythia strain ATCC 43037, and Campylobacter​​​​​​​ rectus strain ATCC 33238performed real-time PCR. The universal bacterial primer pairs were used to detect genomic DNA (gDNA) from the total bacteria present in the samples. All species-specific primers were designed to target the variable regions of the 16S ribosomal RNA (rRNA). Data were analyzed using the 2-ΔΔCT method, statistically validated using unpaired t-test and ANOVA test.ResultsA total of 90 samples of prostate tissue specimens were analyzed for periodontal pathogens; only one pathogen (F. nucleatum subsp. fusiform strain ATCC 51190) showed a significant difference compared to the expression of S. epidermidis (internal control). In particular, F. nucleatum expression was 9, 11.9, and 10.3-fold higher in BPH, inflammation, and cancer, respectively, at p-value <0.05. Moreover, the bacterial load abundance/expression was almost similar in BPH (46.8-fold), inflammation (40.9 fold), and cancer (41.5 fold) higher. There was no significant difference in bacterial load (folder change) among the three areas of BPH, inflammation, and cancer (p-valve>0.05). Similarly, there was no significant difference between F. nucleatum (folder change) among the three areas (p-valve>0.05).Conclusion Fusobacterium nucleatum is identified in the prostates that harbor cancer, chronic inflammation, and BPH.

Case 297.

History A 70-year-old man was referred to our institution with chronic obstructive urinary symptoms and constipation for 2 years before admission. His medical history was unremarkable. Outside laboratory tests revealed an elevated serum prostate-specific antigen level (21.7 ng/mL [normal range, 0.00-4.00 ng/mL]), and urinalysis results were negative. He was admitted for evaluation of possible prostate cancer. The patient reported no specific symptoms of infection and denied fever, dysuria, hematuria, and abdominal pain. He had no family history of prostate cancer. On physical examination, he was afebrile, and the digital rectal examination was not painful. These findings were evidence of an enlarged prostate and a hard multilobulated mass, which was palpable bilaterally. The urologic team performed MRI of the prostate (Figs 1-4).

Elevated serum prostate-specific antigen levels due to prostate infarction following aortic rupture

Introduction: There are several causes of elevated serum prostate-specific antigen (PSA) levels, including benign prostatic hyperplasia, prostate cancer, urinary retention, and prostate infarction. Case Series: We present two cases of elevated PSA levels that were caused by prostate infarction following acute rupture of an aortic aneurysm. Conclusion: Aortic rupture can cause an elevation in serum PSA levels due to prostate infarction. This causes unreliable PSA levels in the weeks following first presentation.

Serum core-type fucosylated prostate-specific antigen index for the detection of high-risk prostate cancer.

It is known that core-type fucosylation is higher in prostate cancer cells than in other cancer cell types and is associated with high-risk prostate cancer. Here, we developed an automated microcapillary electrophoresis-based immunoassay system for measuring serum core-type fucosylated prostate-specific antigen (PSA) and evaluated whether the serum fucosylated PSA index (FPI) can detect high-risk prostate cancer. Core-type fucosylated-free PSA was measured by our automated microcapillary electrophoresis-based immunoassay system with Pholiota squarrosa lectin. The FPI was calculated from total PSA and the percentage of fucosylated-free PSA. The optimum model to predict Gleason grade (GG) ≥2 was constructed by multivariate logistic regression analysis. Discrimination was assessed by determining the area under the receiver operator characteristic curve (AUC). The study included 252 men who underwent prostate needle biopsy due to elevated serum PSA levels (4-20 ng/mL), including 138 with GG ≥2. A higher FPI was significantly associated with GG (P < .0001). Multivariate logistic regression analysis showed that age, prostate volume and FPI were significant predictors of GG ≥2. The AUC of FPI and the model were 0.729 (95% confidence interval [CI]: 0.668-0.790) and 0.837 (95% CI: 0.788-0.886), respectively, compared to 0.629 (95% CI: 0.561-0.698) for PSA. Decision curve analysis showed the superior benefit of FPI and the model when compared to PSA. In a cohort with serum PSA levels <20 ng/mL, FPI could differentiate high-risk prostate cancer from biopsy-negative or low-risk prostate cancer. Therefore, FPI could be a useful adjunct in prostate biopsy counseling for men with abnormal PSA levels.

CLINICAL SIGNIFICANSE OF PROSTATE-SPECIFIC ANTIGEN IN BREAST CANCER PATIENTS

Background. Prostate-specific antigen (PSA ) is predominantly produced by prostate epithelium, however, other tissues can serve as its minor sources in both men and women, including breast tissue. In women, elevated serum PSA levels have been described in different physiological and pathological conditions, including benign breast diseases and breast cancer (BC). PSA is considered as a potential serum tumor marker for BC, but evidences of its possible clinical significance are insufficiently convincing.Aim of the study: investigation of PSA levels in female BC patients and assessment of perspectives of its study as a diagnostic tool for early detection of BC.Material and methods. Serum PSA levels were measured by chemiluminescence immunoassay (ARCHITECT , Abbott) in 99 female patients with histologically confirmed BC (carcinoma in situ – 11, stage I – 56, stage IIA – 32) and 25 conditionally healthy female donors.Results. In the donor group, serum PSA was revealed in 22/25 (88,0 %) cases, and its mean level was 4.0 ± 0.9 ng/l. In the group of BC patients, detectable PSA level was revealed in 68/99 (68.7 %) cases, and its mean level was 2.8 ± 0.9 ng/l. Differences between groups of BC patients and donors in mean marker values were not statistically significant (p&gt;0,05). Serum PSA levels were higher in young women: in the group of BC patients under 40 years old, percentage of PSA -positive cases was 89 %, in the group of patients over 50 years old – 60 %; in groups of donors under 40 and over 50 years old – 100 % and 80 %, respectively. In cases of in situ carcinoma, the mean serum PSA was higher than in cases with stages I and II (3.0 ± 1.2 ng/l vs 1.9 ± 0.3 ng/l and 1.6 ± 0.3 ng/l, respectively; p&gt;0,05). In the group of BC patients, no PSA levels were found to be dependent on the histological type, grade and molecular subtype of the tumor.Conclusion. The PSA level has no clinical significance in early stages of BC, since the proportion of cases with elevated PSA levels and it’s mean value in patients with early stages of BC don’t differ from those in the group of healthy women.

Extended 14-core schematic diagram mapping prostate biopsy increases both the cancer detection rate and the accuracy of Gleason Score

Objective: To evaluate the effectiveness of extended 14-core schematic diagram mapping prostate biopsy for improving the cancer detection rate (CDR) and accuracy of Gleason score. Material and Method: This study included 184 patients who underwent transrectal ultrasound (TRUS)-guided lateral sextant biopsy (group I) and 196 patients who underwent extended 14-core biopsy (group II). Inclusion criteria for prostate biopsy were elevated serum prostate-specific antigen (PSA) levels (&gt;4.0 ng/ml) and/or suspicious digital rectal examination (DRE). Results: Median patient age was 69.68 years (±7.89) and 70.07 years (±8.83) for group I and II, respectively. Median pre-biopsy PSA was 18.04 (range: 8.42-22.35) and 15.83 ng/ml (range: 6.54-21.72) for group I and II. Out of the first group, 65 (35.3%) patients had prostate cancer, whereas 78 (40.0%) patients of group II had cancers. The overall cancer detection rate was significantly higher in group II (40.0%) than group I (35.3%), p=0.034, and in particular showed a significant increase in the cancer detection rate in the subgroup with PSA level between 4-10 ng/ml. Moreover, rising Gleason sum after radical prostatectomy was 1 in 3 (11.1%) patients and 2 in 1 (3.7%) patient. Conclusion: Extended 14-core schematic diagram mapping prostate biopsy significantly increased the cancer detection rate of prostate cancer and increased the accuracy of biopsy Gleason score. Thus, schematic diagram mapping prostate biopsy should be the standard ultrasound guided prostate biopsy in our institute for increasing the cancer detection rate and also for planning treatments.

68Ga-PSMA PET/CT targeted biopsy for the diagnosis of clinically significant prostate cancer compared with transrectal ultrasound guided biopsy: a prospective randomized single-centre study

Purpose68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is valuable for detecting primary and recurrent prostatic lesions. This study aimed to evaluate the efficacy of 68Ga-PSMA-11 PET/CT as a triage tool for prostate biopsy (PSMA-TB) and compare with transrectal ultrasound-guided biopsy (TRUS-GB) for the diagnosis of clinically significant prostate cancer (csPCa).MethodsThis single-centre study randomly allocated 120 patients with elevated serum prostate-specific antigen (PSA) levels (> 4 ng/ml) to PSMA-PET or TRUS group. Patients with PSMA-avid lesions (SUVmax ≥ 8.0) underwent PSMA-TB via a single-puncture percutaneous transgluteal approach (n = 25), whilst patients with negative PSMA-PET underwent systematic TRUS-GB (n = 35). All patients in the TRUS group underwent TRUS-GB directly (n = 60).ResultsPCa and csPCa were detected in 26/60 (43.3%) and 24/60 (40.0%) patients in the PSMA-PET group and 19/60 (31.6%) and 15/60 (25.0%) in the TRUS group, respectively. In the PSMA-PET group, the detection rate of PCa and csPCa were significantly higher in PSMA-PET-positive than negative patients (PCa, 23/25 (92.0%) vs 3/35 (8.6%), P < 0.01; csPCa, 22/25 (88.0%) vs 2/35 (5.7%), P < 0.01). PSMA-TB detected significantly more PCa and csPCa than TRUS-GB in the TRUS controls (PCa, 21/25 (84.0%) vs 19/60 (31.6%), P < 0.01; csPCa, 20/25 (80.0%) vs 15/60 (25.0%), P < 0.01). PSMA-PET detected significantly more cases of csPCa amongst patients with PSA 4.0–20.0 ng/ml than TRUS (27.02% vs 8.82%, P < 0.05). No haematuria, urinary retention or pelvic infection was observed after PSMA-TB compare with TRUS-GB.Conclusions68Ga-PSMA-11 PET/CT is a feasible imaging technique that may serve as a triage tool for prostate biopsy, and may improve the detection rate of csPCa compared with TRUS-GB, especially in patients with serum PSA 4.0–20.0 ng/ml.

MP13-04 DO ALL CASES OF MAGNETIC RESONANCE IMAGING NEGATIVE HAVE GOOD PROGNOSIS?

INTRODUCTION AND OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) has been increasingly used these days and has a role in detecting clinically significant prostate cancer in men with elevated serum prostate-specific antigen levels. However, it is not clear whether mpMRI could reduce unnecessary prostate biopsies when no prostate cancer was detected on mpMRI. The purpose of this study is to assess the accuracy of preoperative mpMRI. METHODS: We retrospectively reviewed the clinicopathological data of 1240 consecutive patients who underwent radical prostatectomy between 2005 and 2018. Multiple variables were evaluated as predictors for the biochemical recurrence after radical prostatectomy. Patients receiving adjuvant therapy were excluded. The preoperative clinical variables and postoperative pathological variables were assessed with multivariate logistic regression. Kaplan-Meier analysis and competing risks regression were used to test cumulative incidence and risk of biochemical recurrence after prostatectomy. RESULTS: The median follow-up was 54 months and the median age was 66 years. In 276 cases, no prostate cancer was detected on preoperative mpMRI (cT1c). In 522 cases, a prostate cancer was detected in less than one-half of one lobe on mpMRI (cT2a). Univariate analysis revealed that serum PSA level (p=0.016), prostate volume (p=0.002), PSA density (p=0.027), percentage of positive/total cores (p<0.001) and Gleason score (p=0.001) were associated with MRI positivity. Multivariate Cox regression analysis showed that percentage of positive/total cores (hazard ratio: 1.602, p=0.011) and Gleason score (hazard ratio: 1.571, p=0.008) were independent indicators of MRI positivity.Of the cT1c stage cases, we compared Gleason score of prostate biopsy and that of prostatectomy. 45% of postoperative results were worse than those of biopsy. 8 patients (3.9%) of low Gleason score (≦3+4) of biopsy resulted in high Gleason score (≧8) after prostatectomy. However, 6 patients (5.1%) of 117 cT1c patients underwent imaging with 1.5 Tesla-MRI, and 2 patients (1.3%) of 159 cT1c patients underwent imaging with 3 Tesla-MRI. CONCLUSIONS: 3 Tesla-MRI is useful for detecting significant prostate cancer before prostate biopsy, so mpMRI could reduce unnecessary prostate biopsies when no prostate cancer was detected on mpMRI. Source of Funding: none

Appropriate Use Criteria for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer After Definitive Primary Treatment.

Imaging is often used to evaluate men with biochemical recurrence (BCR) of prostate cancer after definitive primary treatment (radical prostatectomy [RP] or radiotherapy [RT]). The goal of imaging is to identify the source of elevated or rising serum prostate-specific antigen (PSA) levels because