A Pilot Study of 68Ga-PSMA11 and 68Ga-RM2 PET/MRI for Biopsy Guidance in Patients with Suspected Prostate Cancer

Heying Duan, Pejman Ghanouni, Bruce Daniel, Jarrett Rosenberg, Alan Thong, Christian Kunder, Carina Mari Aparici, Guido A Davidzon, Farshad Moradi, Geoffrey A Sonn, Andrei Iagaru, Heying Duan, Pejman Ghanouni, Bruce Daniel, Jarrett Rosenberg, Alan Thong, Christian Kunder, Carina Mari Aparici, Guido A Davidzon, Farshad Moradi, Geoffrey A Sonn, Andrei Iagaru

Abstract

Targeting of lesions seen on multiparametric MRI (mpMRI) improves prostate cancer (PC) detection at biopsy. However, 20%-65% of highly suspicious lesions on mpMRI (PI-RADS [Prostate Imaging-Reporting and Data System] 4 or 5) are false-positives (FPs), while 5%-10% of clinically significant PC (csPC) are missed. Prostate-specific membrane antigen (PSMA) and gastrin-releasing peptide receptors (GRPRs) are both overexpressed in PC. We therefore aimed to evaluate the potential of 68Ga-PSMA11 and 68Ga-RM2 PET/MRI for biopsy guidance in patients with suspected PC. Methods: A highly selective cohort of 13 men, aged 58.0 ± 7.1 y, with suspected PC (persistently high prostate-specific antigen [PSA] and PSA density) but negative or equivocal mpMRI results or negative biopsy were prospectively enrolled to undergo 68Ga-PSMA11 and 68Ga-RM2 PET/MRI. PET/MRI included whole-body and dedicated pelvic imaging after a delay of 20 min. All patients had targeted biopsy of any lesions seen on PET followed by standard 12-core biopsy. The SUVmax of suspected PC lesions was collected and compared with gold standard biopsy. Results: PSA and PSA density at enrollment were 9.8 ± 6.0 (range, 1.5-25.5) ng/mL and 0.20 ± 0.18 (range, 0.06-0.68) ng/mL2, respectively. Standardized systematic biopsy revealed a total of 14 PCs in 8 participants: 7 were csPC and 7 were nonclinically significant PC (ncsPC). 68Ga-PSMA11 identified 25 lesions, of which 11 (44%) were true-positive (TP) (5 csPC). 68Ga-RM2 showed 27 lesions, of which 14 (52%) were TP, identifying all 7 csPC and also 7 ncsPC. There were 17 concordant lesions in 11 patients versus 14 discordant lesions in 7 patients between 68Ga-PSMA11 and 68Ga-RM2 PET. Incongruent lesions had the highest rate of FP (12 FP vs. 2 TP). SUVmax was significantly higher for TP than FP lesions in delayed pelvic imaging for 68Ga-PSMA11 (6.49 ± 4.14 vs. 4.05 ± 1.55, P = 0.023) but not for whole-body images, nor for 68Ga-RM2. Conclusion: Our results show that 68Ga-PSMA11 and 68Ga-RM2 PET/MRI are feasible for biopsy guidance in suspected PC. Both radiopharmaceuticals detected additional clinically significant cancers not seen on mpMRI in this selective cohort. 68Ga-RM2 PET/MRI identified all csPC confirmed at biopsy.

Keywords: 68Ga-PSMA11; 68Ga-RM2; PET/MRI; biopsy guidance; prostate cancer.

© 2023 by the Society of Nuclear Medicine and Molecular Imaging.

Figures

Graphical abstract
Graphical abstract
FIGURE 1.
FIGURE 1.
Venn diagram of 68Ga-PSMA11 and 68Ga-RM2 positivity with their congruent lesional uptake compared with biopsy results.
FIGURE 2.
FIGURE 2.
A 58-y-old man presenting with PSA of 12.8 ng/mL and PSA density of 0.41 ng/mL2. (A and B) 68Ga-RM2 (B, axial PET [left-most image], fused PET/MRI [second image], MRI [third image], and maximum-intensity-projection images [right-most image]) shows intense uptake in anterior prostate (red arrows), which is less pronounced on 68Ga-PSMA11 PET/MRI (A). PET-guided biopsy demonstrated Gleason 3 + 4 prostate cancer. (C) Coregistration of biopsy needle tracks are shown in green; index tumor is outlined in red on mpMRI as well as on 3-dimensional–rendered image. A = anterior; P = posterior.

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Source: PubMed

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