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Enhancing PSMA PET/CT imaging of prostate cancer: investigating the impact of multiple time point evaluation, diuretic administration, cribriform pattern, and intraductal carcinoma

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Abstract

Objective

Our objective was to correlate staging PSMA PET imaging parameters to final histopathology. Second objective was to assess the performance of standard versus delayed PSMA PET to detect primary prostate tumor.

Methods

Thirty-one patients (mean age, 61.4 ± 8.2) who underwent radical prostatectomy and preoperative staging PSMA PET scans were included in the study. After defining dominant lesion in pathology, correlations with PET images were performed. Additionally, two physicians blind to clinical and pathological information retrospectively reviewed staging Ga-68 PSMA PET scans with standard and delayed imaging.

Results

Dominant lesion SUV’s increased with time 8.2(± 4.5), 10(± 7.1), and 10.2(± 7.8) at 1, 2, and 3 h (P = .03 T1-T3). WHO Grade group 3 had highest SUV (group 3 11.9 ± 5.6 vs. group 2 7.9 ± 1.5, p = .02). Addition of cribriform pattern on intraductal component was associated with higher SUV’s (11 ± 2.9 vs. 6.5 ± 2.1, p = .01) and higher Gleason four ratios (64 ± 9% vs. 37 ± 17%, p = .01). Intraductal carcinoma was associated with larger tumors (6.3 ± 2.3 cm3 vs. 2.6 ± 1.7 cm3, p < .001). Physician sensitivities ranged from 61 to 81%. Excluding Gleason 3 + 3 lesions and small lesions (< 1 cm3), sensitivities increased to 80–100%. Differences of sensitivity between different time points were not significant. Combined evaluation of all time points did not increase sensitivity.

Conclusions

Cribriform pattern correlates with higher Gleason 4 ratios and SUVs in PSMA PET. Intraductal carcinoma is associated with larger tumors but not higher Gleason 4 ratios and SUVs. Multiple late imaging times did not enhance tumor detection and may pose tolerability issues for some patients.

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Funding

This study did not have an external funding.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Acibadem University, Acibadem Maslak Hospital, Sariyer, Istanbul, Turkey

    Levent A. Guner, Kemal Unal & Erkan Vardareli

  2. Department of Radiology, Division of Abdominal Imaging, Columbia University Irving Medical Center, New York, USA

    Volkan Beylergil

  3. Department of Urology, Acibadem Maslak Hospital, Istanbul, Turkey

    Mustafa Bilal Tuna

  4. Department of Pathology, Acibadem University, Istanbul, Turkey

    Yesim Saglican

  5. Department of Urology, Acibadem University, Istanbul, Turkey

    Ali Riza Kural

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  1. Levent A. Guner
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Guner, L.A., Unal, K., Beylergil, V. et al. Enhancing PSMA PET/CT imaging of prostate cancer: investigating the impact of multiple time point evaluation, diuretic administration, cribriform pattern, and intraductal carcinoma. Ann Nucl Med 37, 618–628 (2023). https://doi.org/10.1007/s12149-023-01864-7

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