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Intense Focal Peripheral Uptake Pattern on 18F-PET/PSMA as a Predictor of Histological Upgrading in Prostate Cancer
Carlos Alexis González-Martínez1, Jorge Augusto Alcacio-Mendoza1, Rodrigo Hernández-Ramírez2
1Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
The Prostate
|July 23, 2026
Summary
The peripheral focal intense uptake pattern (IFPUP) on PSMA PET scans predicts histologic upgrading in prostate cancer patients. This finding aids in preoperative risk stratification for localized prostate cancer.
Area of Science:
- Oncologic imaging
- Prostate cancer diagnostics
- Pathology
Background:
- 18F-PET/PSMA uptake patterns correlate with prostate cancer significance.
- The predictive value of peripheral focal intense uptake pattern (IFPUP) for histologic upgrading post-prostatectomy is not well-established.
Purpose of the Study:
- To investigate the association between IFPUP on PET/PSMA and histologic upgrading in prostatectomy specimens.
- To evaluate IFPUP as a potential preoperative biomarker for predicting adverse pathology in prostate cancer.
Main Methods:
- Retrospective cohort study of localized prostate cancer patients undergoing PET/PSMA before radical prostatectomy.
- IFPUP defined as SUVmax ≥ 11.4; histologic upgrading defined as ISUP grade increase from biopsy to prostatectomy.
- Multivariable logistic regression and diagnostic performance metrics (AUROC, sensitivity, specificity, PPV, NPV) were used for analysis.
Main Results:
- Histologic upgrading occurred in 47.1% of 34 patients.
- IFPUP was present in 33% of patients and significantly associated with upgrading (56% vs. 12%, p=0.008).
- IFPUP independently predicted upgrading (OR 16.63, p=0.025) with AUROC of 0.722.
Conclusions:
- Peripheral focal intense uptake pattern (IFPUP) on PET/PSMA is an independent predictor of histologic upgrading in localized prostate cancer.
- High specificity (88%) and PPV (82%) suggest IFPUP's clinical utility for preoperative risk stratification.
- Further validation in larger cohorts is warranted to confirm its role as a complementary biomarker.
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