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Quantitative characterisation of clinically significant intra-prostatic cancer by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11

  • Oncology
  • Published:
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Abstract

Objectives

To quantitatively characterize clinically significant intra-prostatic cancer (IPC) by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11 positron emission tomography/magnetic resonance (PET/MR).

Methods

Retrospective study approved by the institutional review board with informed written consent obtained. Patients with a solitary, biopsy-proven prostate cancer, Gleason score (GS) ≥7, presenting for initial evaluation by PET/computerised tomography (PET/CT), underwent early prostate PET/MR immediately after PSMA-11 tracer injection. PET/MR [MRI-based attenuation correction (MRAC)] and PET/CT [CT-based AC (CTAC)] maximal standardised uptake value (SUVmax) and minimal and mean apparent diffusion coefficient (ADCmin, ADCmean; respectively) in normal prostatic tissue (NPT) were compared to IPC area. The relationship between SUVmax, ADCmin and ADCmean measurements was obtained.

Results

Twenty-two patients (mean age 69.5±5.0 years) were included in the analysis. Forty-four prostate areas were evaluated (22 IPC and 22 NPT). Median MRAC SUVmax of NPT was significantly lower than median MRAC SUVmax of IPC (p < 0.0001). Median ADCmin and ADCmean of NPT was significantly higher than median ADCmin and ADCmean of IPC (p < 0.0001). A very good correlation was found between MRAC SUVmax with CTAC SUVmax (rho = –0.843, p < 0.0001). A good inverse relationship was found between MRAC SUVmax and CTAC SUVmax with ADCmin (rho = –0.717, p < 0.0001 and –0.740, p < 0.0001; respectively; Z = 0.22, p = 0.82, NS) and with MRAC SUVmax and ADCmean (rho = –0.737, p < 0.0001).

Conclusions

PET/MR SUVmax, ADCmin and ADCmean are distinct biomarkers able to differentiate between IPC and NPT in naïve prostate cancer patients with GS ≥ 7.

Key Points

• PSMA PET/MR metrics differentiate between normal and tumoural prostatic tissue.

• A multi-parametric approach combining molecular and anatomical information might direct prostate biopsy.

• PSMA PET/MR metrics are warranted for radiomics analysis.

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Abbreviations

ADC:

Apparent diffusion coefficient

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion-weighted imaging

FWHM:

Full width at half maximum

GS:

Gleason score

IPC:

Intra-prostatic cancer

MR:

Magnetic resonance

MRI:

Magnetic resonance imaging

NPT:

Normal prostatic tissue

OSEM:

Ordered subset expectation maximisation

PET/MR:

Positron emission tomography/magnetic resonance

PiRADS:

Prostate Imaging Reporting and Data System

PSMA:

Prostate-specific membrane antigen

ROI:

Region of interest

SUV:

standardised uptake value

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Acknowledgements

The authors wish to acknowledge Zohar Nitsan, Inbal Machcat and Hagai Baruch for their excellent work in patient scanning, and to Limor Shaharabani-Gargir for patient management.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel St, 6971028, Tel-Aviv, Israel

    Liran Domachevsky, Natalia Goldberg, Hanna Bernstine, Meital Nidam & David Groshar

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Hanna Bernstine & David Groshar

Authors
  1. Liran Domachevsky
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  2. Natalia Goldberg
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  3. Hanna Bernstine
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  4. Meital Nidam
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  5. David Groshar
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Corresponding author

Correspondence to Liran Domachevsky.

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Guarantor

The scientific guarantor of this publication is Dr. Domachevsky Liran.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Domachevsky, L., Goldberg, N., Bernstine, H. et al. Quantitative characterisation of clinically significant intra-prostatic cancer by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11. Eur Radiol 28, 5275–5283 (2018). https://doi.org/10.1007/s00330-018-5484-1

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  • DOI: https://doi.org/10.1007/s00330-018-5484-1

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