MRI-PET fusion biopsy in prostate cancer at Lerdsin Hospital: two cases report
DOI:
https://doi.org/10.52786/isu.a.113Keywords:
Prostate Cancer, MRI-PET fusion, targeted biopsy, mpMRI, PSMA PET, image-guided biopsyAbstract
MRI–PET fusion biopsy is a novel technique that enhances the accuracy of prostate lesion localization and sampling. This method potentially improves diagnostic precision when compared with conventional MRI-guided biopsy. In the two cases described here MRI–PET fusion ultrasound biopsy was utilized for prostate cancer evaluation. A 65-year-old male with a prostate-specific antigen (PSA) level of 8.0 ng/ml underwent prostate MRI, which revealed two suspicious lesions (PI-RADS 5 and PI-RADS 4). MRI–PET imaging alone identified only the PI-RADS 5 lesion (SUVmax 21.51) and an additional area of uptake in the transitional zone (SUV 6.83). Fusion biopsy confirmed adenocarcinoma Gleason score (GS) 4 + 4 and 4 + 3 in the PI-RADS 5 and 4 lesions, respectively, while the transitional zone was benign (BPH). Laparoscopic radical prostatectomy confirmed GS 4 + 4 with 10% tumor involvement. The second case involved a 75-year-old male with a PSA level of 7.53 ng/mL who underwent MRI, which demonstrated PI-RADS 5 and 3 lesions. PET imaging showed positive uptake in both (SUVmax 10.53). Fusion biopsy revealed benign prostatic hyperplasia in both lesions. In these two cases, MRI–PET fusion ultrasound biopsy enabled improved lesion detection and boundary delineation in comparison with standard MRI. Although slightly more expensive, this technique may enhance diagnostic accuracy. Further studies are warranted to evaluate its role in patients with PSA levels of 4–10 ng/ml.
References
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2023. CA Cancer J Clin 2023;73:17-48.
Yamada Y, Ukimura O, Kaneko M, Matsugasumi T, Fujihara A, Vourganti S, et al. Moving away from systematic biopsies: image-guided prostate biopsy (in-bore biopsy, cognitive fusion biopsy, MRUS fusion biopsy)-literature review. World J Urol 2021;39:677-86.
Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging – Reporting and Data System: 2015, Version 2. Eur Urol 2016;69:16-40.
Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, et al. The diagnostic value of PET/CT imaging with the 68Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2015;42:197-20.
Calais J, Czernin J, Cao M, Kishan AU, Hegde JV, Shaverdian N, et al. 68Ga-PSMA-11 PET/CT mapping of prostate cancer biochemical recurrence after radical prostatectomy in 270 patients with PSA <1.0 ng/mL: impact on salvage radiotherapy planning. J Nucl Med 2019;60:933-9.
Sonne I, Flker ER, Lenis AT, Sisk AE, Bahri S, Auerbach MA, et al. Head-to-Head Comparison of 68Ga-PSMA-11 PET/CT and mpMRI with a Histopathology Gold Standard in the Detection, Intraprostatic Localization, and Determination of Local Extension of Primary Prostate Cancer: Results from a Prospective Single-Center Imaging Trial. J Nucl Med 2022;63:847-54.
Wang R, Shen G, Yang R, Ma X, Tien R.68Ga-PSMA PET/MRI for the diagnosis of primary and biochemically recurrent prostate cancer: A meta-analysis. Eur J Radiol 2020:130:109131.
Pepe P, Pennisi M. Targeted Biopsy in Men High Risk for Prostate Cancer: 68Ga-PSMA PET/CT Versus mpMRI. Clin Genitourin Cancer 2023;21:639-42.
Li Y, Li J, Yang J, Xiao L, Zhou M, Cai Y, et al. Usinga novel PSMA-PET and PSA-based model to enhance the diagnostic accuracy for clinically significant prostate cancer and avoid unnecessary biopsy in men with PI-RADS ≤ 3 MRI. Eur J Nucl Med Mol Imaging 2025;52:913-24.
Rowe SP, Salavati A, Werner RA, Pienta KJ, Gorin MA, Pomper MG, et al. 18F-Labeled Radiotracers for Prostate-specific Membrane Antigen: Historical Perspective and Future Directions. PET Clin 2022;17:585-93.
Maurer T, Schnabel K, Schmidt F. Diagnostic performance of 68 Gallium-PSMA-11 PET/CT to detect primary prostate cancer. Oncotarget. 2017;8:104538-44.
Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. Prostate Imaging Reporting and Data System version 2.1: 2019 update of Prostate Imaging Reporting and Data System version 2. Eur Urol 2019;76:340–51.
Girometti R, Giannarini G, De Martino M, Caregnato E, Cereser L, Soligo M, et al. Multivariable stratification of PI-RADS version 2.1 categories for the risk of false-positive target biopsy: Impact on prostate biopsy decisions. Eur J Radiol 2023;165:110897.
Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017;389:815-22.
Woo S, Suh CH, Kim SY, Cho JY, Kim SH, Moon MH. Head-to-Head Comparison Between Biparametric and Multiparametric MRI for the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018;211:W226-37.
Ling SW, de Jong AC, Schoots IG, Nasserinejad K, Busstra MB, et al. Comparison of 68Ga-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography/Magnetic Resonance Imaging and Positron Emission Tomography /Computed Tomography for Primary Staging of Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Open Sci 2021;33:61-71.
Hope TA, Goodman JZ, Calais J, Behr SC, Hattangadi-Gluth JA, Barbuto DA, et al. Diagnostic accuracy of 68Ga-PSMA-11 PET for regional lymph node staging in high-risk prostate cancer: A prospective multicenter imaging trial. JAMA Oncol 2021;7:1635-42.
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