Correlation between genomic index lesions and mpMRI and ⁶⁸Ga-PSMA-PET/CT imaging features in primary prostate cancer

Area of Science:

• Urology
• Oncology
• Radiology
• Genomics

Background:

• Prostate cancer (PCa) management relies on assessing disease significance and progression.
• Emerging imaging techniques like multiparametric MRI (mpMRI) and 68Ga-PSMA-PET/CT offer new ways to visualize PCa.
• The correlation between imaging findings and the underlying genomic landscape of PCa remains largely unexplored.

Purpose of the Study:

• To establish a genomic index lesion based on chromosomal copy number alterations (CNAs) as a marker of PCa aggressiveness.
• To correlate CNA profiles from prostate biopsies with imaging features from mpMRI and 68Ga-PSMA-PET/CT.
• To explore the potential of radiogenomics in distinguishing between indolent and aggressive PCa lesions.

Main Methods:

• Analysis of CNA profiles from 46 biopsies (suspicious and unsuspicious areas) from five high-risk PCa patients.
• Correlation of CNA data with imaging features obtained from mpMRI and 68Ga-PSMA-PET/CT.
• Performance of radiogenomic analyses to link imaging and genomic data.

Main Results:

• Significant CNAs (≥10 Mbp) were identified in 22 of 46 biopsies, with chromosome 8p, 13q, and 5q losses being most frequent.
• A strong correspondence was observed between radiologic findings and genomic index lesions.
• Radiogenomic analyses indicated the potential to develop imaging signatures for differentiating lesion aggressiveness.

Conclusions:

• Imaging features from mpMRI and 68Ga-PSMA-PET/CT can effectively guide clinicians to the most genomically aggressive lesions in prostate cancer.
• Radiogenomics holds promise for improving the differentiation between indolent and aggressive forms of PCa in future clinical practice.