Prostate-Specific Membrane Antigen Expression in Patients with Primary Prostate Cancer: Diagnostic and Prognostic Value in Positron Emission Tomography-Prostate-Specific Membrane Antigen.

Prostate cancer represents a significant public health challenge, with its management requiring precise diagnostic and prognostic tools. Prostate-specific membrane antigen (PSMA), a cell surface enzyme overexpressed in prostate cancer cells, has emerged as a pivotal biomarker. PSMA's ability to increase the sensitivity of PET imaging has revolutionized its application in the clinical management of prostate cancer. The advancements in PET-PSMA imaging technologies and methodologies, including the development of PSMA-targeted radiotracers and optimized imaging protocols, led to diagnostic accuracy and clinical utility across different stages of prostate cancer. This highlights its superiority in staging and its comparative effectiveness against conventional imaging modalities. This paper analyzes the impact of PET-PSMA on prostate cancer management, discussing the existing challenges and suggesting future research directions. The integration of recent studies and reviews underscores the evolving understanding of PET-PSMA imaging, marking its significant but still expanding role in clinical practice. This comprehensive review serves as a crucial resource for clinicians and researchers involved in the multifaceted domains of prostate cancer diagnosis, treatment, and management.

Predictive model containing PI-RADS v2 score for postoperative seminal vesicle invasion among prostate cancer patients.

BACKGROUND: Seminal vesicle invasion (SVI) is considered to be one of most adverse prognostic findings in prostate cancer, affecting the biochemical progression-free survival and disease-specific survival. Multiparametric magnetic resonance imaging (mpMRI) has shown excellent specificity in diagnosis of SVI, but with poor sensitivity. The aim of this study is to create a model that includes the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score to predict postoperative SVI in patients without SVI on preoperative mpMRI. METHODS: A total of 262 prostate cancer patients without SVI on preoperative mpMRI who underwent radical prostatectomy (RP) at our institution from January 2012 to July 2019 were enrolled retrospectively. The prostate-specific antigen levels in all patients were <10 ng/mL. Univariate and multivariate logistic regression analyses were used to assess factors associated with SVI, including the PI-RADS v2 score. A regression coefficient-based model was built for predicting SVI. The receiver operating characteristic curve was used to assess the performance of the model. RESULTS: SVI was reported on the RP specimens in 30 patients (11.5%). The univariate and multivariate analyses revealed that biopsy Gleason grade group (GGG) and the PI-RADS v2 score were significant independent predictors of SVI (all P<0.05). The area under the curve of the model was 0.746 (P<0.001). The PI-RADS v2 score <4 and Gleason grade <8 yielded only a 1.8% incidence of SVI with a high negative predictive value of 98.2% (95% CI, 93.0-99.6%). CONCLUSIONS: The PI-RADS v2 score <4 in prostate cancer patients with prostate-specific antigen level <10 ng/mL is associated with a very low risk of SVI. A model based on biopsy Gleason grade and PI-RADS v2 score may help to predict SVI and serve as a tool for the urologists to make surgical plans.

Comparison of 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and multi-parametric magnetic resonance imaging (MRI) in the evaluation of tumor extension of primary prostate cancer.

BACKGROUND: To compare the diagnostic performance of 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) with multi-parametric magnetic resonance imaging (mpMRI) on extracapsular extension (ECE) and seminal vesicle invasion (SVI) in primary prostate cancer and its impact on therapeutic decisions. METHODS: We retrospectively enrolled 54 patients with both PET/CT and mpMRI before radical prostatectomy. Diagnostic performance of mpMRI, PET/CT and their combination (com-MRI/PET) on ECE and SVI on a patient basis were analyzed. The impact of additional PET/CT scanning on therapeutic decisions were presented. RESULTS: Among the 54 patients, 17 had tumor limited in the prostate gland, 25 only had ECE and 12 patients had both SVI and ECE on pathology. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ECE were 54%, 94%, 95%, 48% on mpMRI, 78%, 94%, 97%, 67% on PET/CT and 83%, 88%, 94%, 71% on com-MRI/PET. Both PET/CT and com-MRI/PET had a higher sensitivity than mpMRI on ECE diagnosis (78% vs. 54%, P<0.05 and 83% vs. 54%, P<0.05). No difference was observed between PET/CT and com-MRI/PET (78% vs. 83%, P=0.17). The Sensitivity, specificity, PPV and NPV of SVI were 67%, 93%, 72%, 91% on mpMRI, 75%, 95%, 82%, 93% on PET/CT and 75%, 88%, 64%, 93% on com-MRI/PET. No difference was found between the three scannings. After the additional evaluation of PET/CT, 18.5% (10/54) turned from nerve-sparing surgery to non-nerve sparing surgery. CONCLUSIONS: 68Ga-PSMA PET/CT has a higher sensitivity on ECE detection than mpMRI but shows no superiority on SVI.