You have accessJournal of UrologyProstate Cancer: Detection & Screening V (MP36)1 Apr 2019MP36-17 DEFINING BIOCHEMICAL RECURRENCE IN PROSTATE CANCER WITH HYBRID PSMA PET MRI Paria Saadat, Georges Mehawed*, Michelle Ong, Andre Joshi, Matthew Roberts, Marlon Perera, Handoo Rhee, Yeates Alexander, Ian McKenzie, Janelle Munns, Greg Malone, Eric Chung, Peter Heathcote, John Preston, Lawson Malcolm, Simon Wood, David Pryor, Margot Lehman, Gustafson Sonja, Kenneth Miles, Stanley Ngai, and Ian Vela Paria SaadatParia Saadat More articles by this author , Georges Mehawed*Georges Mehawed* More articles by this author , Michelle OngMichelle Ong More articles by this author , Andre JoshiAndre Joshi More articles by this author , Matthew RobertsMatthew Roberts More articles by this author , Marlon PereraMarlon Perera More articles by this author , Handoo RheeHandoo Rhee More articles by this author , Yeates AlexanderYeates Alexander More articles by this author , Ian McKenzieIan McKenzie More articles by this author , Janelle MunnsJanelle Munns More articles by this author , Greg MaloneGreg Malone More articles by this author , Eric ChungEric Chung More articles by this author , Peter HeathcotePeter Heathcote More articles by this author , John PrestonJohn Preston More articles by this author , Lawson MalcolmLawson Malcolm More articles by this author , Simon WoodSimon Wood More articles by this author , David PryorDavid Pryor More articles by this author , Margot LehmanMargot Lehman More articles by this author , Gustafson SonjaGustafson Sonja More articles by this author , Kenneth MilesKenneth Miles More articles by this author , Stanley NgaiStanley Ngai More articles by this author , and Ian VelaIan Vela More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556027.16655.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Biochemical recurrence (BCR) can occur in in up to 50% or more of men with high risk prostate cancer previously treated with surgery of curative intent. Detection of locally recurrent or metastatic disease in the presence of BCR after treatment of localised disease at low prostate specific antigen (PSA) may be improved by use of hybrid Prostate Specific Membrane Antigen (PSMA), Positron Emission Tomography (PET) with magnetic resonance imaging (MRI). The clinical utility of this approach has been minimally reported. We sought to report on a large series of hybrid PSMA PET MRI in defining BCR. METHODS: Following Institutional Research Board approval, a retrospective review of all PSMA PET MRI studies between April 2015 and April 2017 within a tertiary referral institution was conducted. Clinical variables, including patient demographics, PSA, previous treatment and histology prior to scan, indication for scan, imaging results, and outcome post imaging were collected prior to statistical analysis. RESULTS: A total of 300 PSMA PET MRI scans were performed, of which 135 were to investigate BCR. Sixty-four patients had undergone radical prostatectomy with a median PSA of 0.43 ng/ml (Interquartile Range (IQR) = 0.21 - 1.35), in whom 15 received postoperative external beam radiation therapy (EBRT) while 71 patients had received EBRT alone. From the surgical cohort, 31 patients (48.5%) had a positive scan (median PSA level 1.3 ng/ml, IQR = 0.26 – 4; Gleason score 4 + 4 in 17 patients) involving the prostatic bed (n = 6), lymph nodes (n = 18), bone (n = 6), and soft tissue (n = 11), for median serum PSAs of 1.8, 1.35, 1.6 and 0.4 ng/mL, respectively. Median PSA for those with a negative scan was 0.28 ng/mL (IQR = 0.17 – 0.57), despite 10 patients (30%) with a Gleason score 4 + 4. CONCLUSIONS: PSMA PET MRI imaging may play an important role in detecting recurrent disease in men with BCR post radical prostatectomy. The average PSA for detection of metastatic lesions are substantially less than previously quoted figures using the standard of care imaging in the setting of biochemical recurrence. Source of Funding: None. South Brisbane, Australia; Brisbane, Australia© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e520-e521 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paria Saadat More articles by this author Georges Mehawed* More articles by this author Michelle Ong More articles by this author Andre Joshi More articles by this author Matthew Roberts More articles by this author Marlon Perera More articles by this author Handoo Rhee More articles by this author Yeates Alexander More articles by this author Ian McKenzie More articles by this author Janelle Munns More articles by this author Greg Malone More articles by this author Eric Chung More articles by this author Peter Heathcote More articles by this author John Preston More articles by this author Lawson Malcolm More articles by this author Simon Wood More articles by this author David Pryor More articles by this author Margot Lehman More articles by this author Gustafson Sonja More articles by this author Kenneth Miles More articles by this author Stanley Ngai More articles by this author Ian Vela More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: Positron emission tomography using ligands targeting prostate specific membrane antigen has recently been introduced. Positron emission tomography imaging with 68 Ga-PSMA-HBED-CC has been shown to detect metastatic prostate cancer lesions at a high rate. In this study we compare multiparametric magnetic resonance imaging and prostate specific membrane antigen positron emission tomography of the prostate with whole mount ex vivo prostate histopathology to determine the true sensitivity and specificity of these imaging modalities for detecting and locating tumor foci within the prostate.Materials and Methods: In a prospective clinical trial setting 20 patients with localized prostate cancer and a planned radical prostatectomy were recruited. All patients underwent multiparametric magnetic resonance imaging and positron emission tomography before surgery, and whole mount histopathology slides were directly compared to the images. European Society of Urogenital Radiology guidelines for reporting magnetic resonance imaging were used as a template for regional units of analysis. The uropathologist and radiologists were blinded to individual components of the study, and the final correlation was performed by visual and deformable registration analysis.Results: A total of 50 clinically significant lesions were identified from the whole mount histopathological analysis. Based on regional analysis the sensitivity, specificity, positive predictive value and negative predictive value for multiparametric magnetic resonance imaging were 44%, 94%, 81% and 76%, respectively. With prostate specific membrane antigen positron emission tomography the sensitivity, specificity, positive predictive value and negative predictive value were 49%, 95%, 85% and 88%, respectively. Prostate specific membrane antigen positron emission tomography yielded a higher specificity and positive predictive value.Conclusions: A significant proportion of cancers are potentially missed and underestimated by both imaging modalities. Prostate specific membrane antigen positron emission tomography may be used in addition to multiparametric magnetic resonance imaging to help improve local staging in those patients undergoing retropubic radical prostatectomy.

Tropical spastic paraparesis (TSP), a neuromyelopathy predominantly involving the pyramidal tract and commonly observed in tropical and equatorial areas, was recently found to be associated with human T lymphotropic virus type I (HTLV-I). We investigated sera and cerebrospinal fluid (CSF) from 19 patients with TSP who were from the Caribbean area, French Guiana, and Africa. Our results showed an elevated intra-blood-brain barrier IgG synthesis rate and an elevated IgG index, with an increased HTLV-I antibody-to-albumin ratio and the presence of CSF oligoclonal bands in the majority of the patients. These data, in association with similar HTLV-I antibody patterns between patients with TSP who were from these three regions, strengthen the probable etiologic role of HTLV-I in the pathogenesis of such chronic neuromyelopathies.