Our Summary

This study looked at how useful a particular type of scan (18F-DCPyL PSMA-PET/CT) is in helping to manage men thought to have prostate cancer. The men in the study had previously had an MRI scan that suggested they might have prostate cancer, but a subsequent biopsy (a small sample of tissue taken for testing) came back negative.

The researchers recruited 29 men who had these conflicting results and gave them all a PSMA-PET/CT scan. Then, they decided what to do next based on whether the new scan agreed with the MRI. If the scans agreed, they did another biopsy using MRI for guidance. If the PSMA-PET/CT scan suggested cancer but the MRI didn’t, they did a biopsy using ultrasound for guidance. If the PET/CT scan didn’t suggest cancer, they just monitored the patients as normal.

They found that in cases where the PET/CT scan agreed with the MRI, 6 out of 14 men were found to have cancer when they did a biopsy. They also found that in cases where the PET/CT scan suggested cancer but the MRI didn’t, or where the PET/CT scan didn’t suggest cancer, only one man was found to have cancer.

The researchers conclude that the PSMA-PET/CT scan could be useful in these situations, but they need to do more research to be sure. They also suggest that when the PET/CT scan does suggest cancer, and agrees with the MRI, doctors should consider doing another biopsy. However, they note that the study is limited by its small size and the short follow-up period.

FAQs

  1. What is the purpose of using 18F-DCPyL PSMA-PET/CT in the management of men with highly suspicious multiparametric MRI prostate?
  2. What is the procedure for biopsy when lesions are concordant on MRI and PSMA-PET/CT?
  3. In this study, what did a higher SUVmax value in PSMA-PET/CT results indicate?

Doctor’s Tip

A doctor might tell a patient about prostate biopsy that it can be a useful tool in determining the presence of prostate cancer, especially in cases where there are suspicious lesions on imaging such as MRI. In some cases, additional imaging tests like PSMA-PET/CT may be recommended to further evaluate the lesions and guide the biopsy process. It is important to follow the recommendations of your healthcare provider and discuss any concerns or questions you may have about the procedure.

Suitable For

Patients who are typically recommended for a prostate biopsy include those with highly suspicious multiparametric MRI prostate lesions (PIRAD 4-5) and discrepant negative prostate biopsy results. In this study, men with prior mpMRI prostate PIRADS 4-5 lesions and negative prostate biopsy were recruited for 18F-DCPyL PSMA-PET/CT imaging. Management decisions were then made based on the concordance between MRI and PET findings, with targeted biopsies performed on concordant lesions and PSMA-PET avidity without MRI correlate.

Overall, the study found that PSMA-PET/CT was useful in identifying prostate cancer in this patient population. Higher SUVmax values on PSMA-PET imaging correlated with a higher likelihood of prostate cancer. However, further investigation is needed to fully understand the utility of PSMA-PET/CT in guiding management decisions for these patients.

Timeline

Before prostate biopsy:

  • Patient undergoes a multiparametric MRI prostate scan with PIRADS 4-5 lesions identified.
  • Patient has a negative prostate biopsy.
  • Patient is referred for a 18F-DCPyL PSMA-PET/CT scan.

After prostate biopsy:

  • If MRI and PET findings are concordant, patient undergoes MRI-targeted biopsy.
  • If PSMA-PET/CT shows avidity without MRI correlate, patient undergoes biopsy using ultrasound guidance.
  • Patients with negative PET/CT findings are returned to standard follow-up care.
  • Analysis showed higher SUVmax on PSMA-PET/CT predicted prostate cancer.
  • Limited study size and short follow-up period of 17 months.

What to Ask Your Doctor

  1. What is the purpose of a prostate biopsy?
  2. How is a prostate biopsy performed?
  3. What are the potential risks and side effects of a prostate biopsy?
  4. How accurate is a prostate biopsy in detecting prostate cancer?
  5. What should I expect during and after the procedure?
  6. How will the results of the biopsy be communicated to me?
  7. What are the next steps if the biopsy results show prostate cancer?
  8. Are there any alternative tests or procedures that could be considered instead of a biopsy?
  9. How should I prepare for a prostate biopsy?
  10. Are there any specific instructions or precautions I should follow before and after the biopsy?

Reference

Authors: Wong LM, Koschel S, Whish-Wilson T, Farag M, Bolton D, Zargar H, Corcoran N, Lawrentschuk N, Christov A, Thomas L, Perry E, Heinze S, Taubman K, Sutherland T. Journal: World J Urol. 2023 Feb;41(2):463-469. doi: 10.1007/s00345-022-04243-5. Epub 2023 Jan 5. PMID: 36602577