The role of PSMA PET/CT in predicting downgrading in patients with Gleason score 4+4 prostate cancer in prostate biopsy.
Downgrading
Gleason score 8
High risk
PSMA PET CT
Prostate cancer
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
21 May 2024
21 May 2024
Historique:
received:
21
11
2023
accepted:
18
04
2024
medline:
21
5
2024
pubmed:
21
5
2024
entrez:
21
5
2024
Statut:
epublish
Résumé
To investigate the predictable parameters associated with downgrading in patients with a Gleason score (GS) 8 (4+4) in prostate biopsy after radical prostatectomy. We retrospectively analyzed 62 patients with a GS of 4+4 on prostate biopsy who underwent robotic radical prostatectomy between 2017 and 2022. 38 of 62 (61.2%) were downgraded. In multivariable logistic regression model, Ga-68 prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) SUV max was independent predictor of downgrading (OR 0.904; p = 0.011) and a Logistic Regression model was constructed using the following formula: Y = 1.465-0.95 (PSMA PET/CT SUV max). The model using this variable correctly predicted the downgrading in 72.6% of patients. The AUC for PSMA PET/CT SUV max was 0.709 the cut off being 8.8. A subgroup analysis was performed in 37 patients who had no other European Association of Urology (EAU) high risk features. 25 out of 37 (67.5%) were downgraded, and 21 of these 25 had organ confined disease. Low PSMA SUV max (<8.1) and percentage of GS 4+4 biopsy cores to cancer bearing cores (45.0%) were independently associated with downgrading to GS 7. PSMA PET/CT can be used to predict downgrading in patients with GS 4+4 PCa. Patients with GS 4+4 disease, but no other EAU high risk features, low percentage of GS 4+4 biopsy cores to cancer bearing cores, and a low PSMA PET/CT SUV max are associated with a high likelihood of the cancer reclassification to intermediate risk group.
Sections du résumé
BACKGROUND
BACKGROUND
To investigate the predictable parameters associated with downgrading in patients with a Gleason score (GS) 8 (4+4) in prostate biopsy after radical prostatectomy.
METHODS
METHODS
We retrospectively analyzed 62 patients with a GS of 4+4 on prostate biopsy who underwent robotic radical prostatectomy between 2017 and 2022.
RESULTS
RESULTS
38 of 62 (61.2%) were downgraded. In multivariable logistic regression model, Ga-68 prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) SUV max was independent predictor of downgrading (OR 0.904; p = 0.011) and a Logistic Regression model was constructed using the following formula: Y = 1.465-0.95 (PSMA PET/CT SUV max). The model using this variable correctly predicted the downgrading in 72.6% of patients. The AUC for PSMA PET/CT SUV max was 0.709 the cut off being 8.8. A subgroup analysis was performed in 37 patients who had no other European Association of Urology (EAU) high risk features. 25 out of 37 (67.5%) were downgraded, and 21 of these 25 had organ confined disease. Low PSMA SUV max (<8.1) and percentage of GS 4+4 biopsy cores to cancer bearing cores (45.0%) were independently associated with downgrading to GS 7.
CONCLUSION
CONCLUSIONS
PSMA PET/CT can be used to predict downgrading in patients with GS 4+4 PCa. Patients with GS 4+4 disease, but no other EAU high risk features, low percentage of GS 4+4 biopsy cores to cancer bearing cores, and a low PSMA PET/CT SUV max are associated with a high likelihood of the cancer reclassification to intermediate risk group.
Identifiants
pubmed: 38771329
doi: 10.1007/s00345-024-05012-2
pii: 10.1007/s00345-024-05012-2
doi:
Substances chimiques
FOLH1 protein, human
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
341Informations de copyright
© 2024. The Author(s).
Références
Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249
doi: 10.3322/caac.21660
pubmed: 33538338
Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, et al (2024) EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 12:S0302-2838(24)02254-1
Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, et al (2023) Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 21(10):1067–1096
doi: 10.6004/jnccn.2023.0050
pubmed: 37856213
Schreiber D, Wong AT, Rineer J et al (2015) Prostate biopsy concordance in a large population-based sample: a surveillance, epidemiology and end results study. J Clin Pathol 68:453–457
doi: 10.1136/jclinpath-2014-202767
pubmed: 25762729
Qi R, Foo WC, Ferrandino MN et al (2017) Over half of contemporary clinical Gleason 8 on prostate biopsy are downgraded at radical prostatectomy. Can J Urol 24:8982–8989
pubmed: 28971784
Ginsburg K, Cole AI, Silverman ME et al (2020) Should all prostate needle biopsy Gleason score 4 + 4 = 8 prostate cancers be high risk? Implications for shared decision-making and patient counselling. Urol Oncol 38:78.e71-78.e76
doi: 10.1016/j.urolonc.2019.11.002
Ranasinghe W, Reichard CA, Nyame YA et al (2020) Downgrading from biopsy Grade Group 4 prostate cancer in patients undergoing radical prostatectomy for high or very high risk prostate cancer. J Urol 204:748–753
doi: 10.1097/JU.0000000000001074
pubmed: 32259468
Altok M, Troncoso P, Achim MF et al (2019) Prostate cancer upgrading or downgrading of biopsy Gleason scores at radical prostatectomy: prediction of “regression to the mean” using routine clinical features with correlating biochemical relapse rates. Asian J Androl 21:598–604
doi: 10.4103/aja.aja_29_19
pubmed: 31115364
pmcid: 6859655
Wenzel M, Würnschimmel C, Chierigo F et al (2022) Nomogram predicting downgrading in national comprehensive cancer network high-risk prostate cancer patients treated with radical prostatectomy. Eur Urol Focus 8:1133–1140
doi: 10.1016/j.euf.2021.07.008
pubmed: 34334344
Gansler T, Fedewa S, Qi R et al (2018) Most Gleason 8 biopsies are downgraded at prostatectomy-does 4 + 4 = 7? J Urol 199:706–712
doi: 10.1016/j.juro.2017.10.014
pubmed: 29032296
Cano Garcia C, Wenzel M, Piccinelli ML et al (2023) External tertiary-care-hospital validation of the epidemiological SEER-based nomogram predicting downgrading in high-risk prostate cancer patients treated with radical prostatectomy. Diagnostics (Basel) 13(9):1614
doi: 10.3390/diagnostics13091614
pubmed: 37175005
Hosmer DWLS (2000) Applied logistic regression. John Wiley & Sons Inc, Toronto
doi: 10.1002/0471722146
Combes AD, Palma CA, Calopedos R et al (2022) PSMA PET-CT in the diagnosis and staging of prostate cancer. Diagnostics (Basel) 12(11):2594
doi: 10.3390/diagnostics12112594
pubmed: 36359439
Emmett L, Buteau J, Papa N et al (2021) The additive diagnostic value of prostate-specific membrane antigen positron emission tomography computed tomography to multiparametric magnetic resonance imaging triage in the diagnosis of prostate cancer (PRIMARY): a prospective multicentre study. Eur Urol 80:682–689
doi: 10.1016/j.eururo.2021.08.002
pubmed: 34465492
Koseoglu E, Kordan Y, Kilic M et al (2021) Diagnostic ability of Ga-68 PSMA PET to detect dominant and non-dominant tumors, upgrading and adverse pathology in patients with PIRADS 4–5 index lesions undergoing radical prostatectomy. Prostate Cancer Prostatic Dis 24:202–209
doi: 10.1038/s41391-020-00270-8
pubmed: 32826958