PSMA-guided Prostate Biopsies: A Feasible Pathway for High-Risk Men

What is it about?

This study evaluated the feasibility of using prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) as a single imaging modality to guide targeted biopsy and detect clinically significant prostate cancer (csPCa) in biopsy-naive men at high-risk of disease. A total of 60 men with a prostate-specific antigen (PSA) level of 20-50 ng/mL underwent 18 F-PSMA(DCFPyL)-PET/CT prior to prostate biopsies. PSMA-guided targeted biopsy detected PCa in 56/60 (93.3%) patients, with 52 of them (92.9%) having csPCa. PSMA-guided targeted biopsy, if performed as a single biopsy modality, identified PCa in 52/60 men (86.7%) and in 27/27 men (100%) men with metastases. This PSMA-driven diagnostic pathway could be a suitable alternative to the conventional MRI-driven diagnostic pathway for men at high-risk of PCa. The PSMA-driven pathway has advantages such as using a single imaging modality for guidance of prostate biopsies and staging of metastases, and avoiding diagnostic MRI scans in the vast majority of cases.

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Why is it important?

This research is important because it is one of the first prospective studies to evaluate 18 F-PSMA(DCFPyL)-PET/CT targeted prostate biopsy in biopsy-naive men at high-risk of prostate cancer (csPCa). The study found that using a single imaging modality for guidance of prostate biopsies and staging of metastases within a PSMA-driven diagnostic pathway is a suitable alternative to the conventional MRI-driven diagnostic pathway. Key Takeaways: 1. The use of PSMA-guided targeted biopsy resulted in a high detection rate of prostate cancer (csPCa) in biopsy-naive men at high-risk of disease. 2. Using a single imaging modality (PSMA-PET/CT) for guidance of prostate biopsies and staging of metastases could save diagnostic time and avoid the need for additional diagnostic tests such as MRI. 3. In men with metastatic disease on initial imaging, targeted biopsies could reduce the number of prostate biopsies needed for diagnosis. 4. The PSMA-driven diagnostic pathway could be a useful alternative to the conventional MRI-driven diagnostic pathway for men at high-risk of disease.