February 5, 2018
RESTON, Va. – Using nuclear medicine, German researchers have found a way to accurately differentiate cancerous tissue from healthy tissue in prostate cancer patients. The research is highlighted in the February issue of The Journal of Nuclear Medicine.
According to the American Cancer Society, one in nine men will be diagnosed with prostate cancer in his lifetime. Early diagnosis is key to successful treatment.
The new study demonstrates that the maximum standardized uptake value (SUVmax) on Gallium-68 prostate specific membrane antigen (68Ga-PSMA) PET/CT scans correlates with PSMA-expression in primary prostate cancer. By this means, researchers were able to generate an SUVmax cutoff for the differentiation of cancerous and benign prostate tissue.
“To the best of our knowledge, this was the first study to generate a cutoff SUVmax, validated by immunohistochemistry, for separating prostate cancer from normal prostate tissue by 68Ga-PSMA PET/CT images,” explains Vikas Prasad, MD, PhD, of Charité Universitätsmedizin Berlin in Germany. “Our SUVmax cutoff can be used to confirm or rule out prostate cancer with a very high degree of sensitivity and specificity.”
He points out, “Recent years have brought tremendous advances in image-based biopsy of the prostate. However, in many patients, histopathology may not yield correct diagnosis (e.g., if the tumor is missed during true-cut biopsy). This is especially true for multifocal prostate cancer, less aggressive tumors, and cases of prostatitis or prior prostate irradiation, where MRI alone may not give the correct localization and malignancy grade.”
For the study, the data of 31 men (mean age of 67.2 years) who had undergone prostatectomies and preoperative PET scans were analyzed, with the SUVmax generated for suspicious areas and visually normal tissue. Both cancerous and benign prostate tissue samples (62 total) were stained with monoclonal anti-PSMA antibody. All the cancerous lesions could be confirmed histopathologically. The best cut-off value was determined to be 3.15 (sensitivity 97 percent, specificity 90 percent).
Prasad notes, “This validated cutoff of 3.15 for SUVmax enables the diagnosis of prostate cancer with a high sensitivity and specificity in both unifocal and multifocal disease.” Looking ahead, he posits, “With advancement of image-registration/segmentation software and PET/MRI scanners, it is quite logical to predict that in the future PET images and SUVmax on a suspicious lesion in the prostate will be used for multimodal image-guided fusion biopsy.”
FIGURE: 68Ga-PSMA PET/CT images showing multifocal PCA in peripheral zone with GS of 5 1 5 5 10. (A and C) Axial PET images. (B and D) Fused PET/CT images. SUVmax of lesion in B was 84.3 and that of lesion in D was 5.7. IRS was 3, and 80% of cells were stained. Credit: Senior author V Prasad, Charité Universitätsmedizin Berlin, Berlin, Germany.
Authors of “Immunohistochemical validation of PSMA-expression measured by 68Ga-PSMA PET/CT in primary prostate cancer” include Nadine Woythal, Ruza Arsenic, Kurt Miller, Jan-Carlo Janssen, Kai Huang, Marcus R Makowski, Winfried Brenner and Vikas Prasad, Charité Universitätsmedizin Berlin, Berlin, Germany, and Carsten Kempkensteffen, Franziskus-Krankenhaus Berlin, Berlin, Germany.
Please visit the SNMMI Media Center to view the PDF of the study, including images, and more information about molecular imaging and personalized medicine. To schedule an interview with the researchers, please contact Laurie Callahan at (703) 652-6773 or firstname.lastname@example.org. Current and past issues of The Journal of Nuclear Medicine can be found online at http://jnm.snmjournals.org.
About the Society of Nuclear Medicine and Molecular Imaging
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and medical organization dedicated to raising awareness about nuclear medicine and molecular imaging, vital elements of precision medicine that allow diagnosis and treatment to be tailored to individual patients in order to achieve the best possible outcomes.
SNMMI’s more than 15,000 members set the standard for molecular imaging and nuclear medicine practice by creating guidelines, sharing information through journals and meetings and leading advocacy on key issues that affect molecular imaging and therapy research and practice. For more information, visit www.snmmi.org.