Enhancing Prostate Cancer Staging: Association of 68Ga-PSMA PET/CT Imaging with Histopathological Grading in Treatment-Naive Patients
by
Oleksii Pisotskyi
1,*, 
Piotr Petrasz
1,*,
Piotr Zorga
2,
Marcin Gałęski
1,
Pawel Szponar
1,
Katarzyna Brzeźniakiewicz-Janus
3,
Tomasz Drewa
4,
Krzysztof Kaczmarek
5,
Michał Cezary Czarnogórski
6 and
Jan Adamowicz
4 1
Department of Urology, Voivodeship Hospital Gorzów Wielkopolski, 66-400 Gorzów Wielkopolski, Poland
2
Clinical Department of Nuclear Medicine, University of Zielona Góra, 65-002 Zielona Góra, Poland
3
Clinic of Hematology, Clinical Oncology, and Radiotherapy with the Chemotherapy Subunit, University of Zielona Góra, 65-002 Zielona Góra, Poland
4
Chair of Urology and Andrology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-790 Bydgoszcz, Poland
5
Department of Gynecology and Obstetrics, Voivodeship Hospital Gorzów Wielkopolski, 66-400 Gorzów Wielkopolski, Poland
6
Ludwik Rydygier Collegium Medicum, Bydgoszcz Nicolaus Copernicus University, 85-790 Bydgoszcz, Poland
*
Authors to whom correspondence should be addressed.
Cancers 2024, 16(20), 3526; https://doi.org/10.3390/cancers16203526
Submission received: 24 September 2024
/
Revised: 13 October 2024
/
Accepted: 16 October 2024
/
Published: 18 October 2024
(This article belongs to the Special Issue Advances in the Management of Pelvic Tumors)
Simple Summary
This study investigates the correlation between 68Ga-PSMA PET/CT imaging and histopathological grading in treatment-naive prostate cancer patients. We retrospectively analyzed 86 patients who underwent 68Ga-PSMA PET/CT scans for prostate cancer staging, with a subset of 40 patients also undergoing radical prostatectomy. The PET/CT results, specifically SUVmax values, were compared with Gleason scores and PSA levels to assess their association with cancer grades. Results indicated a significant positive correlation between SUVmax and ISUP grades, suggesting that higher SUVmax values correspond to more advanced prostate cancer stages. Furthermore, the analysis of biopsy and radical prostatectomy pathology reports revealed a substantial rate of grading changes, underscoring the limitations of biopsy alone for accurate staging. These findings highlight the potential utility of 68Ga-PSMA PET/CT as a diagnostic tool in stratifying prostate cancer risk and guiding treatment decisions. Future studies are recommended to validate these observations and explore further applications of this imaging modality.
Abstract
Objective: This study aimed to evaluate the correlation between 68Ga-PSMA uptake in PSMA PET/CT in primary prostate cancer (PC) and its histopathological grading (Gleason score and ISUP grade). Additionally, we compared preoperative biopsy histopathological findings with definitive pathology results in radical prostatectomy (RP) specimens. Methods: We retrospectively analyzed 86 patients who underwent 68Ga-PSMA PET/CT for primary PC staging, of which 40 patients later underwent radical prostatectomy. PET/CT results, including SUVmax values, were correlated with GS and PSA concentrations. Histopathology reports were analyzed and compared between biopsy and final pathology results following RP. Results: A significant positive correlation was observed between SUVmax and ISUP grades (Pearson’s ρ = 0.34, p < 0.001), with higher SUVmax values associated with more advanced grades. A cut-off SUVmax value of 5.64 was determined to predict upstaging in patients, yielding a sensitivity of 76% and a specificity of 60% (AUC = 0.82, 95% CI: 0.70–0.94). Additionally, 57.5% of patients experienced a grade shift following RP, with a 35% upgrade and 22.5% downgrade in ISUP grades. Conclusion: 68Ga-PSMA PET/CT demonstrated high sensitivity in detecting high-risk prostate cancer, particularly in patients with GS > 7 or PSA levels ≥ 10 ng/mL. The findings suggest that this imaging modality may be less effective for the staging of patients with lower GS or PSA values, that is, low-risk PCa. Further prospective studies are necessary to validate these results.
