Value of Targeted Biopsies and Combined PSMA PET/CT and mp-MRI Imaging in Locally Recurrent Prostate Cancer after Primary Radiotherapy

Marnix Rasing, Marieke van Son, Marinus Moerland, Bart de Keizer, Frank Wessels, Trudy Jonges, Sandrine van de Pol, Wietse Eppinga, Juus Noteboom, Jan Lagendijk, Jochem van der Voort van Zijp, Max Peters

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Abstract

Radiorecurrent prostate cancer is conventionally confirmed using systematic and/or targeted biopsies. The availability of multiparametric (mp) MRI and prostate specific membrane antigen (PSMA) PET/CT has increased diagnostic accuracy. The objective was to determine the positive predictive value (PPV) of combined mp-MRI and PSMA PET/CT and whether pathology verification with MR-targeted biopsies remains necessary for patients with radiorecurrent prostate cancer. Patients with locally recurrent prostate cancer who were referred for 19 Gy single-dose MRI-guided focal salvage high dose rate (HDR) brachytherapy between 2015 and 2018 were included in the current analysis. Patients were selected if they underwent pre-biopsy mp-MRI and PSMA PET/CT. Based on these images, lesions suspect for isolated tumor recurrence were transperineally biopsied using transrectal ultrasound fused with MRI. A total of 41 patients were identified from the database who underwent cognitive targeted (n = 7) or MRI/PSMA-transrectal ultrasound (TRUS) fused targeted (n = 34) biopsies. A total of 40 (97.6%) patients had positive biopsies for recurrent cancer. Five patients initially had negative biopsies (all MRI/PSMA-TRUS fusion targeted), four of whom recurrence was confirmed after a re-biopsy. One (2.4%) patient refused re-biopsy, leading to a positive predictive value (PPV) for combined imaging of 97.6%. Biopsies can therefore safely be withheld when the results of the combined mp-MRI and PSMA PET/CT are conclusive, avoiding an unnecessary invasive and burdensome procedure.

Original languageEnglish
Article number781
Pages (from-to)1-13
JournalCancers
Volume14
Issue number3
DOIs
Publication statusPublished - 1 Feb 2022

Keywords

  • PSMA PET/CT
  • local recurrence
  • multiparametric MRI
  • positive predictive value
  • radiorecurrent prostate cancer;
  • targeted biopsies
  • Local recurrence
  • Positive predictive value
  • Radiorecurrent prostate cancer
  • Targeted biopsies
  • Multiparametric MRI

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