Assessment of Prostate Carcinoma Aggressiveness: Relation to 68Ga-PSMA-11-PET/MRI and Gleason Score

Jiří Ferda; Ondřej Hes; Milan Hora; Eva Ferdová; Jan Pernický; Vladimir Rudnev; Ladislav Pecen; Ondřej Topolčan; Hynek Mírka

doi:10.21873/anticanres.16181

Assessment of Prostate Carcinoma Aggressiveness: Relation to ⁶⁸Ga-PSMA-11-PET/MRI and Gleason Score

Anticancer Res. 2023 Jan;43(1):449-453. doi: 10.21873/anticanres.16181.

Authors

Jiří Ferda^{1

2}, Ondřej Hes³, Milan Hora⁴, Eva Ferdová⁵, Jan Pernický^{5

2}, Vladimir Rudnev^{5

2}, Ladislav Pecen⁶, Ondřej Topolčan⁶, Hynek Mírka⁵

Affiliations

¹ Department of Imaging Methods, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic; ferda@fnplzen.cz.
² Institute of Anatomy, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic.
³ Šikl's Institute of Pathological Anatomy, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic.
⁴ Department of Urology, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic.
⁵ Department of Imaging Methods, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic.
⁶ Division of Immunochemical Diagnostics, University Hospital Pilsen, Charles University, Medical Faculty in Pilsen, Pilsen, Czech Republic.

PMID: 36585198
DOI: 10.21873/anticanres.16181

Abstract

Background/aim: To test the correlation of ⁶⁸Ga-PSMA-11 uptake and the expression of PSMA (prostatic specific membrane antigen) with the Gleason score, apparent diffusion coefficient (ADC) and pharmacokinetic parameters obtained from dynamic contrast agent-enhanced MRI/PET.

Patients and methods: Forty newly diagnosed, therapy naïve patients with prostatic carcinoma (PC) (mean age of 56.7, range=34-79), who were referred for ⁶⁸Ga-PSMA-11-PET/MRI for primary staging and had undergone radical prostatectomy (RAPE) were included in this prospective study. Their blood samples were tested for serum levels of prostate-specific antigen (PSA) and proPSA. The patients' prostates were evaluated using whole-mount sections, which helped determine the extent and grade of the tumor; tests were performed to determine immunohistochemical PSMA expression.

Results: A correlation between PSMA expression and the accumulation of ⁶⁸Ga-PSMA-11 was found using the Spearman correlation coefficient (p=0.0011). A stronger correlation was found between Gleason patterns 3 or 4 and PSMA expression (p=0.06). Furthermore, the correlation of Gleason score with the overall ⁶⁸Ga-PSMA-11 accumulation within the tumor or non-tumor tissue was found to be significant (p=0.0157). A significant relation was found only with the K_ep elimination rate constant, which was stronger in Gleason pattern 4 than in Gleason pattern 3. A weaker correlation was found between the accumulation of ⁶⁸Ga-PSMA-11 and K^trans in Gleason pattern 4: the most significant relation being between ADC_min and Gleason pattern 3 and 4 (p=0.0074). The total size of the tumor correlated with levels of proPSA (p<0.0001), and its extra prostatic extension correlated with levels of proPSA (p<0.0001).

Conclusion: ⁶⁸Ga-PSMA-11 correlates well with the expression of PSMA. Gleason pattern 3 and 4 had a higher correlation with ⁶⁸Ga-PSMA-11 levels than did Gleason pattern 5. Either no correlation, or a weak correlation, was established with pharmacokinetics.

Keywords: 68Ga-PSMA-11; PET/MRI; Prostatic carcinoma; tumor aggressiveness.

MeSH terms

Carcinoma*
Edetic Acid
Gallium Radioisotopes
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Grading
Oligopeptides
Positron Emission Tomography Computed Tomography
Positron-Emission Tomography
Prospective Studies
Prostate / pathology
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / metabolism
Prostatic Neoplasms* / surgery

Substances

gallium 68 PSMA-11
Oligopeptides
Edetic Acid
Gallium Radioisotopes

Supplementary concepts

Prostate Cancer, Hereditary, 7