Mp55-11 psma-guided prostate biopsy

You have accessJournal of UrologyCME1 Apr 2023MP55-11 PSMA-GUIDED PROSTATE BIOPSY David Kuppermann, Jeremie Calais, Elizabeth Tran, Samantha Gonzalez, Merdie Delfin, and Leonard Marks David KuppermannDavid Kuppermann More articles by this author , Jeremie CalaisJeremie Calais More articles by this author , Elizabeth TranElizabeth Tran More articles by this author , Samantha GonzalezSamantha Gonzalez More articles by this author , Merdie DelfinMerdie Delfin More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSMA scanning is a most accurate method for detection of metastatic PCa. PSMA scanning may also reveal intra-prostatic cancer (PCa). Since MRI-guided biopsy (MRGB) may miss 15-20% of clinically-significant csPCa (≥GG2), we postulated that biopsy targeting PSMA foci in the prostate (PSMA-guided biopsy, PSMA-GB) might provide PCa detection in cases where MRGB failed. METHODS: 48 men with negative MRI-guided biopsy (MRGB), but continued suspicion of PCa (increased PSA density), underwent PSMA scanning within 6 months of MRGB. In the 23 with focal PSMA uptake in the prostate, a PSMA-GB was performed using PET/CT images instead of MR images for fusion with ultrasound. 4-8 biopsy cores were taken from each PSMA ‘hot spot’(Figure 1). Method of PSMA-GB was identical to MRGB, but employed US fusion with PET/CT instead of MRI, as detailed in the original case report (PMID: 28607878). Method of Ga-PSMA image acquisition via PET/CT scanning has been reported (PMID: 30920593). Contouring of PSMA foci within the prostate was via Profuse software by co-author J.C. Image fusion and trans-rectal targeted biopsy was via Artemis device (LSM). Detection rate of csPCa by PSMA-GB was primary endpoint. RESULTS: Among the 23 study patients, mean age=67 yrs (Range: 53-81); prostate volume=58.5cc (22.7-109.3); PSA=13.8 ng/ml (4.5- 34.8); PSA density=0.245 ng/ml/cc (0.073- 0.57). At first biopsy (MRGB), PIRADS score = 0-2 in 19 men and >3 in 4. PSMA-GB was successfully completed in all 23. Overall detection rate of csPCa was 15/23 (65.22%): GG2 in 6, GG3 in 6, GG4 in 2, and GG5 in 1. Median SUVmax (standardized uptake value) was 12.5 (5.8-28.7) in men whose PSMA hotspot revealed csPCa vs 5.8 (3.2-10.4) in men with negative PSMA-GB. Of 12 men whose PSMA focus was highly suspicious, i.e., Emmett’s Primary Score of 4 or 5 (PMID: 34373749 ), 11 had csPCa. CONCLUSIONS: Prostate biopsy, which targets PSMA ‘hot spots’ via PET/CT-US fusion, often leads to detection of csPCa missed by MRI-guided biopsy. Source of Funding: Jean Perkins Foundation; NCI-R01 CA 195505; and Department of Nuclear Medicine, UCLA. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e767 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Kuppermann More articles by this author Jeremie Calais More articles by this author Elizabeth Tran More articles by this author Samantha Gonzalez More articles by this author Merdie Delfin More articles by this author Leonard Marks More articles by this author Expand All Advertisement PDF downloadLoading ...