A Pilot Study of 18F-DCFPyL PET/CT or PET/MRI and Ultrasound Fusion Targeted Prostate Biopsy for Intra-Prostatic PET-Positive Lesions

Yachao Liu; Hongkai Yu; Jiajin Liu; Xiaojun Zhang; Mu Lin; Holger Schmidt; Jiangping Gao; Baixuan Xu

doi:10.3389/fonc.2021.612157

A Pilot Study of ¹⁸F-DCFPyL PET/CT or PET/MRI and Ultrasound Fusion Targeted Prostate Biopsy for Intra-Prostatic PET-Positive Lesions

Front Oncol. 2021 Mar 5:11:612157. doi: 10.3389/fonc.2021.612157. eCollection 2021.

Authors

Yachao Liu¹, Hongkai Yu², Jiajin Liu¹, Xiaojun Zhang¹, Mu Lin³, Holger Schmidt⁴, Jiangping Gao², Baixuan Xu¹

Affiliations

¹ Department of Nuclear Medicine, Chinese People's Liberation Army General Hospital, Beijing, China.
² Department of Urology Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.
³ Magnetic Resonance Collaboration, Diagnostic Imaging, Siemens Healthineers Ltd., Shanghai, China.
⁴ Magnetic Resonance Education, Customer Services, Siemens Healthcare GmbH, Erlangen, Germany.

Abstract

Objectives: The purpose of this study was to evaluate the feasibility and diagnostic performance of prostate-specific membrane antigen (PSMA) based ¹⁸F-DCFPyL PET/CT-ultrasound (PET/CT-US) or PET/MRI-ultrasound (PET/MRI-US) fusion targeted biopsy for intra-prostatic PET-positive lesions.

Methods: From April 2018 to November 2019, we prospectively enrolled 55 candidates to perform PET/CT-US or PET/MRI-US fusion targeted biopsies for solitary PET-positive prostate lesions (two to four cores/lesion). The positive rates of prostate cancer based on patients and biopsy cores were calculated respectively. With reference to the pathological results of biopsy cores, the MR signal characteristics in the area of the PET-positive lesion were analyzed for the patients who underwent PET/MRI.

Results: A total of 178 biopsy cores were taken on the 55 patients. One hundred forty-six biopsy cores (82.0%, 146/178) from 51 (92.7%, 51/55) patients were positive for prostate cancer; 47 (85.5%, 47/55) were clinically significant prostate cancer. It is noteworthy that nine patients underwent both ¹⁸F-DCFPyL PET/CT and PET/MRI examinations; the seven patients with prostate cancer showed abnormal MR signal in the area of the PET-positive lesion while the other two patients with prostatic hyperplasia and prostatitis showed normal MR signal in the area of the PET-positive lesion.

Conclusion: This study indicated that ¹⁸F-DCFPyL PET/CT-US or PET/MRI-US fusion targeted prostate biopsies may be valuable for prostate cancer diagnosis and have a high detection rate of clinically significant prostate cancer for PET-positive lesions. PET/MR can rule out some false PET-positive lesions, which may potentially reduce unnecessary prostate biopsies.

Keywords: 18F-DCFPyL; PET/CT; PET/MR; biopsy; prostate cancer.