Related Experiment Video
Updated: Sep 26, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Infiltrative growth pattern of prostate cancer is associated with lower uptake on PSMA PET and reduced diffusion
Riccardo Laudicella1,2, Jan H Rüschoff3, Daniela A Ferraro1,4
1Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 10, 8091, Zurich, Switzerland.
Purpose:
Recently, a significant association was shown between novel growth patterns on histopathology of prostate cancer (PCa) and prostate-specific membrane antigen (PSMA) uptake on [68Ga]PSMA-PET. It is the aim of this study to evaluate the association between these growth patterns and ADC (mm2/1000 s) values in comparison to [68Ga]PSMA uptake on PET/MRI.
Methods:
We retrospectively evaluated patients who underwent [68Ga]PSMA PET/MRI for staging or biopsy guidance, followed by radical prostatectomy at our institution between 07/2016 and 01/2020. The dominant lesion per patient was selected based on histopathology and correlated to PET/MRI in a multidisciplinary meeting, and quantified using SUVmax for PSMA uptake and ADCmean for diffusion restriction. PCa growth pattern was classified as expansive (EXP) or infiltrative (INF) according to its properties of forming a tumoral mass or infiltrating diffusely between benign glands by two independent pathologists. Furthermore, the corresponding WHO2016 ISUP tumor grade was evaluated. The t test was used to compare means, Pearson's test for categorical correlation, Cohen's kappa test for interrater agreement, and ROC curve to determine the best cutoff.
Results:
Sixty-two patients were included (mean PSA 11.7 ± 12.5). The interrater agreement between both pathologists was almost perfect with κ = 0.81. While 25 lesions had an EXP-growth with an ADCmean of 0.777 ± 0.109, 37 showed an INF-growth with a significantly higher ADCmean of 1.079 ± 0.262 (p < 0.001). We also observed a significant difference regarding PSMA SUVmax for the EXP-growth (19.2 ± 10.9) versus the INF-growth (9.4 ± 6.2, p < 0.001). Within the lesions encompassing the EXP- or the INF-growth, no significant correlation between the ISUP groups and ADCmean could be observed (p = 0.982 and p = 0.861, respectively).
Conclusion:
PCa with INF-growth showed significantly lower SUVmax and higher ADCmean values compared to PCa with EXP-growth. Within the growth groups, ADCmean values were independent from ISUP grading.
Insights
Infiltrative prostate cancer (PCa) shows higher apparent diffusion coefficient (ADC) values and lower prostate-specific membrane antigen (PSMA) uptake compared to expansive PCa. ADC values were independent of ISUP grade within these growth patterns.
Area of Science:
- Oncology
- Radiology
- Pathology
Background:
- Prostate cancer (PCa) growth patterns on histopathology are associated with prostate-specific membrane antigen (PSMA) uptake.
- Evaluating these growth patterns alongside imaging biomarkers like ADC values can enhance diagnostic accuracy.
Purpose of the Study:
- To investigate the relationship between PCa histopathological growth patterns (expansive vs. infiltrative) and apparent diffusion coefficient (ADC) values from MRI.
- To compare these findings with [68Ga]PSMA uptake on PET/MRI.
Main Methods:
- Retrospective analysis of 62 patients who underwent [68Ga]PSMA PET/MRI and radical prostatectomy.
- Classification of PCa growth patterns as expansive (EXP) or infiltrative (INF) by pathologists.
- Quantification of PSMA uptake (SUVmax) and ADC values (ADCmean) and statistical comparison between groups.
Main Results:
- Infiltrative (INF) PCa demonstrated significantly higher ADCmean (1.079 ± 0.262) compared to expansive (EXP) PCa (0.777 ± 0.109) (p < 0.001).
- INF PCa showed significantly lower PSMA SUVmax (9.4 ± 6.2) than EXP PCa (19.2 ± 10.9) (p < 0.001).
- ADCmean values were independent of ISUP grade within both EXP and INF growth groups.
Conclusions:
- Prostate cancer with infiltrative growth exhibits higher ADCmean and lower PSMA SUVmax compared to expansive growth.
- ADC values are not significantly correlated with ISUP grading within distinct PCa growth patterns.
