Value of Targeted Biopsies and Combined PSMA PET/CT and mp-MRI Imaging in Locally Recurrent Prostate Cancer after Primary Radiotherapy
Rasing, Marnix; van Son, Marieke; Moerland, Marinus; de Keizer, Bart; Wessels, Frank; Jonges, Trudy; van de Pol, Sandrine; Eppinga, Wietse; Noteboom, Juus; Lagendijk, Jan; van der Voort van Zijp, Jochem; Peters, Max
(2022) Cancers, volume 14, issue 3, pp. 1 - 13
(Article)
Abstract
Radiorecurrent prostate cancer is conventionally confirmed using systematic and/or targeted biopsies. The availability of multiparametric (mp) MRI and prostate specific membrane antigen (PSMA) PET/CT has increased diagnostic accuracy. The objective was to determine the positive predictive value (PPV) of combined mp-MRI and PSMA PET/CT and whether pathology verification with MR-targeted
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biopsies remains necessary for patients with radiorecurrent prostate cancer. Patients with locally recurrent prostate cancer who were referred for 19 Gy single-dose MRI-guided focal salvage high dose rate (HDR) brachytherapy between 2015 and 2018 were included in the current analysis. Patients were selected if they underwent pre-biopsy mp-MRI and PSMA PET/CT. Based on these images, lesions suspect for isolated tumor recurrence were transperineally biopsied using transrectal ultrasound fused with MRI. A total of 41 patients were identified from the database who underwent cognitive targeted (n = 7) or MRI/PSMA-transrectal ultrasound (TRUS) fused targeted (n = 34) biopsies. A total of 40 (97.6%) patients had positive biopsies for recurrent cancer. Five patients initially had negative biopsies (all MRI/PSMA-TRUS fusion targeted), four of whom recurrence was confirmed after a re-biopsy. One (2.4%) patient refused re-biopsy, leading to a positive predictive value (PPV) for combined imaging of 97.6%. Biopsies can therefore safely be withheld when the results of the combined mp-MRI and PSMA PET/CT are conclusive, avoiding an unnecessary invasive and burdensome procedure.
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Keywords: PSMA PET/CT, local recurrence, multiparametric MRI, positive predictive value, radiorecurrent prostate cancer;, targeted biopsies, Local recurrence, Positive predictive value, Radiorecurrent prostate cancer, Targeted biopsies, Multiparametric MRI, Oncology, Cancer Research, Journal Article
ISSN: 2072-6694
Publisher: Multidisciplinary Digital Publishing Institute (MDPI)
Note: Funding Information: Funding: We received external funding from the KWF Dutch Cancer Society in support of our research on focal HDR brachytherapy for prostate cancer, which covered the current study. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
(Peer reviewed)