⁶⁸Ga-PSMA-PET/CT and Diffusion MRI Targeting for Cone-Beam CT-Guided Bone Biopsies of Castration-Resistant Prostate...

Area of Science:

• Oncology
• Radiology
• Molecular Diagnostics

Background:

• Metastatic castration-resistant prostate cancer (mCRPC) treatment relies on precision medicine targeting genetic aberrations.
• Bone metastases in mCRPC often yield insufficient tumor cells for molecular analysis via standard biopsies.
• Current CT-guided bone biopsies have limited success rates for molecular profiling.

Purpose of the Study:

• To assess the feasibility of advanced target planning and needle guidance for bone biopsies in mCRPC.
• To determine if this enhanced biopsy method increases tumor cell yield and molecular analysis success.
• To compare the outcomes with standard CT-guided biopsy techniques.

Main Methods:

• A pilot study involved ten mCRPC patients undergoing ⁶⁸Ga-PSMA-PET/CT and diffusion-weighted MRI for biopsy planning.
• Image fusion was used to target metastatic lesions with high tumor density.
• Biopsies were performed using cone-beam CT (CBCT) guidance for precise needle placement.

Main Results:

• The advanced target planning and CBCT needle guidance were feasible.
• Nine out of ten biopsies (90%) contained prostate cancer cells, with median tumor cell percentages of 39% and 40%.
• Molecular analysis success rate was 80% (8/10 patients), significantly higher than reported rates for CT-guided biopsies (33-44%).
• Druggable genetic aberrations were identified in two patients.

Conclusions:

• Advanced biopsy techniques integrating imaging fusion and CBCT guidance are feasible for mCRPC bone metastases.
• This method significantly increases the success rate of molecular analysis compared to conventional approaches.
• The improved molecular profiling has the potential to enhance treatment selection and outcomes for mCRPC patients.