Identifying Candidates for Biopsy Omission in Prostate Cancer Using mpMRI and PSMA PET/CT

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Novel imaging like multiparametric MRI (mpMRI) and PSMA PET/CT offer advanced diagnostic capabilities for prostate cancer.
• These modalities may support a prostate biopsy-omitting approach in select patient groups.

Purpose of the Study:

• To evaluate the predictive value of mpMRI and PSMA PET/CT for adverse pathology in prostate cancer patients.
• To identify independent predictors of adverse pathology in patients undergoing radical prostatectomy.

Main Methods:

• Retrospective evaluation of 413 patients who underwent radical prostatectomy and both mpMRI and PSMA PET/CT.
• Analysis of patient characteristics, mpMRI (PI-RADS), and PSMA PET (SUVmax) findings.
• Multivariable logistic regression to determine independent predictors of adverse pathology (≥pT3a, pN1, or GG≥3).

Main Results:

• 60% of patients (248/413) exhibited adverse pathology post-radical prostatectomy.
• Independent predictors of adverse pathology included age, PSA density (PSAD), PI-RADS-5 score on mpMRI, and prostatic SUVmax ≥12 (PRIMARY-5) on PSMA PET.
• A combination of PSAD >0.15 ng/ml/cc, PI-RADS-5, and PRIMARY-5 consistently predicted adverse pathology.

Conclusions:

• The combination of PSAD, mpMRI (PI-RADS), and PSMA PET/CT (PRIMARY score) effectively predicts adverse pathology in prostate cancer.
• These findings suggest a potential role for a biopsy-omitting approach in selected patients, pending further validation.