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Radiotherapy and radical prostatectomy are the definitive treatment options for patients with localized prostate cancer. A rising PSA after radical prostatectomy indicates prostate cancer recurrence, and these patients may still be cured with salvage radiotherapy. To maximize chance for cure, irradiated volumes should completely encompass the exten...

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Background The prostate-specific membrane antigen (PSMA) is a relevant target in prostate cancer and immunohistochemistry studies showed associations with outcome. PSMA-ligand positron emission tomography (PET) is increasingly used for primary prostate cancer staging and the molecular imaging TNM classification (miTNM) standardizes its reporting. W...
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Background ⁶⁸Ga-PSMA Positron Emission Tomography/Computerized Tomography (PET/CT) has shown promising results for the detection of recurrent prostate cancer (RPCa). However, the diagnostic value of this method is yet to be validated. The aim of this study was to determine the influence of clinical and biochemical variables on the detection rate of...
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Purpose The fast-increasing use of positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) ligand for the imaging of prostate cancer (PCA) biochemical recurrence has led to a rapid change in treatment concepts. Since the superiority of ⁶⁸Ga-PSMA-11 PET in detecting recurrent PCA is well established, the aim of our study wa...
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Background Diagnosing the biochemical recurrence (BCR) of prostate cancer (PCa) is a clinical challenge, and early detection of BCR can help patients receive optimal treatment. We conducted a meta-analysis to define the diagnostic accuracy of PET/CT using ¹⁸ F-labeled choline, fluciclovine, and prostate-specific membrane antigen (PSMA) in patients...
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Purpose Up to 30% of patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) never respond or develop resistance to ¹⁷⁷Lu-labeled PSMA-targeted radioligand monotherapy. Single-agent PSMA-targeted radioligand therapy (PRLT) with the alpha-emitter ²²⁵Ac showed promise against mCRPC but...

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... 5,6 Recently, the advent of advanced molecular imaging studies (eg, prostate-specific membrane antigen [PSMA] positron emission tomography [PET]) has enabled detection of occult nodal disease at presentation which may be amenable to a gross nodal boost. [7][8][9] As numerous studies have demonstrated, the prostate is a highly mobile organ and can result in interfraction variations of 1.52 and 1.45 cm in the SI and AP axes, respectively. 10,11−13, On the other hand, previous analysis showed that aligning to IPMs still maintained adequate coverage of elective nodal volumes in most patients. ...
Article
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Purpose: To determine the impact of daily shifts based on rigid registration to intraprostatic markers (IPMs) on coverage of boost doses delivered to gross nodal disease for prostate cancer. Methods: Seventy-five cone-beam CTs (CBCTs) from 15 patients treated with definitive radiation for clinically node-positive prostate cancer underwent fiducial-based and pelvic bony-based registration to the initial planning scans. Gross tumor volumes of nodal boost targets were contoured directly on each CBCT registration. The nodal displacement (3-dimensional translation from the node centroid on planning CT to node centroid on registered CBCT) and dose coverage (minimum dose [Dmin], mean dose [Dmean], dose delivered to 95% of the GTV [D95]) were calculated for each registration on all nodal targets. All doses for each node were normalized to its intended prescription dose (dose covering 95% of a 3 mm PTV expansion). Results: Forty-one gross nodal targets were analyzed. Most boosted nodes (80.5%, 33/41) were treated with conventional fractionation using volumetric-arc radiation therapy (VMAT), while 19.5% (8/41) underwent stereotactic body radiation therapy (SBRT). Dmin, Dmean, and D95 were all significantly lower with fiducial-based registration compared to bony-based registration (P < .0001). Nodal displacement was significantly higher for fiducial-based registrations (P < .0001). The 3-dimensional translation between the fiducial-based and bony-based registrations (bony-to-fiducial vector) was the most significant predictor of nodal displacement (P < .0001). On fiducial-based registrations, a 3-5 mm gross nodal PTV margin is sufficient in most directions; however, superior and posterior margins of 8-9 mm are required as a result of asymmetric prostatic motion. Conclusions: Large and anisotropic PTV margins are likely needed to adequately dose gross nodal targets when patient setup is based on rigid registration to IPMs. Alternative approaches such as adaptive replanning may be required to overcome these limitations.
... Figure 2 summarizes and compares the different radiation dosage profiles achievable using these methods. [85][86][87] As an example, a cross section CT scan of the pelvis is shown with the radiation dosage histogram for the treatment of prostate cancer. The target region and organs at risk are outlined in Fig. 2(a). ...
Article
In the past 100 years, external beam energy for the treatment of cancer has continually evolved. Two main modes have been developed. The first is radiotherapy which involves using x-ray, gamma, and proton beams to cause ionizing damage. The second is photodynamic therapy, which uses photons to activate photosensitizers to generate reactive oxidating species causing cytotoxicity. For decades, these two fields have developed separately, with photodynamic therapy being used for treating surface tumors and radiotherapy, for deeper tumors. In the first half of this article, a detailed review of radiotherapy and photodynamic therapy will be presented. For each field, the underlying physical mechanisms will be discussed, followed by the existing technological and engineering designs, and ending off with the relevant vivo studies and clinical applications. In the second half, the recent efforts to combine radiotherapy and photodynamic therapy, leading to the generation of new techniques such as x-ray photodynamic therapy, proton-induced photodynamic therapy and even the possibility of hybrid approaches such as intensity and fluence modulated photodynamic therapy will be discussed. This new field is known as radiodynamic therapy. It has the potential to achieve increased conformality in the treatment of cancer, dealing maximal dosage to the lesion while sparing healthy tissues, paving the way for new advances in precision medicine. The connection between these fields is a neglected area, and this review addresses this gap. It also serves as a repository for researchers who are keen to venture into radiodynamic therapy.
... Data on the performance of conventional imaging (including MRI, CT and bone scan) in the setting of biochemical recurrence of prostate cancer following radical prostatectomy are heterogenous and suggest low sensitivity for the detection and localization of the biochemical recurrence, especially at PSA values <2.0 ng/ml 1,6,7,[39][40][41][42] . The mean PSA value at the time of imaging in these studies often varies between 0.2 and ≥10 ng/ml, which is far above the level at which clinicians would normally apply local salvage treatment such as radiation therapy 43 . ...
... Salvage radiotherapy planning is based on information gained from CT imaging and on typical recurrence patterns, and can generate target volumes in the absence of visible recurrent disease 29,42,131 . Thus, any imaging modality that is more sensitive for detecting disease than conventional CT could affect salvage radiotherapy planning. ...
... Discovery of occult distant metastatic disease on PET-CT might shift the focus of management towards a systemic treatment plan rather than local salvage, or change the location of the radiation entirely. Multiple studies assessing the effect of PET-CT on salvage radiotherapy planning demonstrate rates of change in planning ranging from 14 to 87% 29,42 . Of all the PET-CT imaging techniques, PSMA PET has the highest effect on salvage radiotherapy planning owing to its high sensitivity of detecting metastases at low PSA values [102][103][104][105][106][107]112,116 . ...
Article
More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.
... The detection rate of PSMA PET/CT for recurrent PCa exceeds that of choline PET [35,36], and of 18 F-Fluciclovine PET [29,37,38]. PSMA PET/CT can improve RT planning and patient selection for salvage radiation therapy (SRT) thus may potentially improve its outcome [39][40][41]. Randomized trials investigating the outcome of SRT based on PSMA PET/CT and conventional imaging are now ongoing (NCT03525288, NCT03762759, NCT03582774) [42]. ...
Conference Paper
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p>Background: Definitive radiation therapy (dRT) is an effective initial treatment of intermediate-risk (IR) and high-risk (HR) prostate cancer (PCa). PSMA PET/CT is superior to standard of care imaging (CT, MRI, bone scan) for detecting regional and distant metastatic PCa. PSMA PET/CT thus has the potential to guide patient selection and the planning for dRT and improve patient outcomes. Methods: This is a multicenter randomized phase 3 trial (NCT04457245). We will randomize 312 patients to proceed with standard dRT (control Arm, n=150), or undergo a PSMA PET/CT scan at the study site (both 18F-DCFPyL and 68Ga-PSMA-11 can be used) prior to dRT planning (intervention arm, n = 162). dRT will be performed at the treating radiation oncologist facility. In the control arm, dRT will be performed as routinely planned. In the intervention arm, the treating radiation oncologist can incorporate PSMA PET/CT findings into the RT planning. Androgen deprivation therapy (ADT) is administered per discretion of the treating radiation oncologist and may be modified as a result of the PSMA PET/CT results. We assume that approximately 8% of subjects randomized to the PSMA PET arm will be found to have M1 disease and thus will be more appropriate candidates for long-term systemic or multimodal therapy, rather than curative intent dRT. PET M1 patients will thus not be included in the primary endpoint analysis. The primary endpoint is the success rate of patients with unfavorable IR and HR PCa after standard dRT versus PSMA PET-based dRT. Secondary Endpoints (whole cohort) include progression free survival (PFS), metastasis-free survival after initiation of RT, overall survival (OS), % of change in initial treatment intent and Safety. Discussion: This is the first randomized phase 3 prospective trial designed to determine whether PSMA PET/CT molecular imaging can improve outcomes in patients with PCa who receive dRT. In this trial the incorporation of PSMA PET/CT may improve the success rate of curative intent radiotherapy in two ways: to optimize patient selection as a biomarker and to personalizes the radiotherapy plan. Citation Format: Jeremie Calais, Shaojun Zhu, Nader Hrimas, Matthias Eiber, Boris Hadaschik, Martin Stuschke, Ken Herrmann, Johannes Czernin, Amar U. Kishan, Nicholas G. Nickols, David Elashoff, Wolfgang Fendler. Phase 3 multicenter randomized trial of PSMA PET/CT prior to definitive radiation therapy for unfavorable intermediate-risk or high-risk prostate cancer [PSMA dRT]: Study Protocol [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT257.</p
... The detection rate of PSMA PET/CT for recurrent PCa exceeds that of choline PET [35,36], and of 18 F-Fluciclovine PET [29,37,38]. PSMA PET/CT can improve RT planning and patient selection for salvage radiation therapy (SRT) thus may potentially improve its outcome [39][40][41]. Randomized trials investigating the outcome of SRT based on PSMA PET/CT and conventional imaging are now ongoing (NCT03525288, NCT03762759, NCT03582774) [42]. ...
Article
Full-text available
Background Definitive radiation therapy (dRT) is an effective initial treatment of intermediate-risk (IR) and high-risk (HR) prostate cancer (PCa). PSMA PET/CT is superior to standard of care imaging (CT, MRI, bone scan) for detecting regional and distant metastatic PCa. PSMA PET/CT thus has the potential to guide patient selection and the planning for dRT and improve patient outcomes. Methods This is a multicenter randomized phase 3 trial (NCT04457245). We will randomize 312 patients to proceed with standard dRT (control Arm, n = 150), or undergo a PSMA PET/CT scan at the study site (both 18F-DCFPyL and 68Ga-PSMA-11 can be used) prior to dRT planning (intervention arm, n = 162). dRT will be performed at the treating radiation oncologist facility. In the control arm, dRT will be performed as routinely planned. In the intervention arm, the treating radiation oncologist can incorporate PSMA PET/CT findings into the RT planning. Androgen deprivation therapy (ADT) is administered per discretion of the treating radiation oncologist and may be modified as a result of the PSMA PET/CT results. We assume that approximately 8% of subjects randomized to the PSMA PET arm will be found to have M1 disease and thus will be more appropriate candidates for long-term systemic or multimodal therapy, rather than curative intent dRT. PET M1 patients will thus not be included in the primary endpoint analysis. The primary endpoint is the success rate of patients with unfavorable IR and HR PCa after standard dRT versus PSMA PET-based dRT. Secondary Endpoints (whole cohort) include progression free survival (PFS), metastasis-free survival after initiation of RT, overall survival (OS), % of change in initial treatment intent and Safety. Discussion This is the first randomized phase 3 prospective trial designed to determine whether PSMA PET/CT molecular imaging can improve outcomes in patients with PCa who receive dRT. In this trial the incorporation of PSMA PET/CT may improve the success rate of curative intent radiotherapy in two ways: to optimize patient selection as a biomarker and to personalizes the radiotherapy plan. Clinical trial registration UCLA IND#147591 ○ Submission: 02.27.2020 ○ Safe-to-proceed letter issued by FDA: 04.01.2020 UCLA IRB #20–000378 ClinicalTrials.gov Identifier NCT04457245 . Date of Registry: 07.07.2020. Essen EudraCT 2020–003526-23
... Patients were evaluated by Axumin PET/CT scans [31][32][33] and were found to have two or more PET positive LNs. For all LNs patients, the evidence of two or more enlarged PET positive LNs metastases were found on Axumin PET/CT scans with no other sites of diseases. ...
Article
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Purpose/objectives: This work seeks to evaluate the plan quality, treatment delivery efficiency, and accuracy of single-isocenter volumetric modulated arc therapy (VMAT) of abdominal/pelvic oligometastatic lymph nodes (LNs) stereotactic body radiation therapy (SBRT) on Halcyon Linac. Materials and methods: After completing the in-house multitarget end-to-end phantom testing and independent dose verification using MD Anderson's single-isocenter/multi-target (lung and spine target inserts) thorax phantom, eight patients with two to three abdominal/pelvic oligometastatic LNs underwent highly conformal single-isocenter VMAT-SBRT treatment using the Halcyon Linac 6MV flattening filter free (FFF) beam. Targets were identified using an Axumin PET/CT scan co-registered with planning CT images and a single-isocenter was placed between/among the targets. Doses between 25 and 36.25 Gy in 5 fractions were delivered. Patients were treated every other day. Plans were calculated in Eclipse with advanced AcurosXB algorithm for heterogeneity corrections. For comparison, Halcyon VMAT-SBRT plans were retrospectively generated for SBRT-dedicated TrueBeam with a 6MV-FFF beam using identical planning geometry and objectives. Target coverage, conformity index (CI), dose to 2 cm away from each target (D2cm) and dose to adjacent organs-at-risk (OAR) were evaluated. Additionally, various treatment delivery parameters including beam-on time were recorded. Results: Phantom measurements showed acceptable spatial accuracy of conebeam CT-guided Halcyon SBRT treatments including compliance with MD Anderson's single-isocenter/multi-targets phantom credentialing results. For patients, the mean isocenter to tumor center distance was 3.4 ± 1.2 cm (range, 1.5-4.8 cm). The mean combined PTV was 18.9 ± 10.9 cc (range, 5.6-39.5 cc). There was no clinically significant difference in dose to LNs, CI, D2cm and maximal doses to OAR between single-isocenter Halcyon and Truebeam VMAT-SBRT plans, although, Halcyon plans provided preferably lower maximal dose to adjacent OAR. Additionally, total monitor units, beam-on time and overall treatment time was lower with Halcyon plans. Halcyon's portal dosimetry demonstrated a high pass rate of 98.1 ± 1.6% for clinical gamma passing criteria of 2%/2 mm. Conclusion: SBRT treatment of abdominal/pelvic oligometastatic LNs with single-isocenter VMAT on Halcyon was dosimetrically equivalent to TrueBeam. Faster treatment delivery to oligometastatic LNs via single-isocenter Halcyon VMAT can improve clinic workflow and patient compliance, potentially reducing intrafraction motion errors for well-suited patients. Clinical follow-up of these patients is ongoing.
... However, standard-of-care imaging is insufficiently sensitive for anatomic localization of recurrence. Therefore, SRT target volumes are usually drawn in the absence of radiographically visible disease [3,4]. ...
... Prostate-specific membrane antigen (PSMA) is highly overexpressed by PCa cells and represents a relevant target for PCa imaging and therapy. PSMA positron emission tomography (PET) using small radiolabeled ligands is highly sensitive, even at low PSA levels, and may offer early localization of PCa biochemical recurrence (BCR) [3,5]. ...
Article
30 Background: The purpose of this trial is to evaluate the success rate of salvage radiation therapy (SRT) for recurrence of prostate cancer (PCa) after radical prostatectomy with and without planning based on prostate specific membrane antigen (PSMA) positron emission tomography (PET). Methods: This is a multicenter, prospective, randomized, controlled, open-label, Phase 3 clinical imaging trial powered for clinical outcome at 5 years. UCLA is the leading central site in which PSMA PET, clinical follow-up and data management are being done. UCSF was a participating site in which PSMA PET imaging can be done. SRT can be performed anywhere, patients are followed remotely by the UCLA investigators. Patients scheduled for SRT for recurrence after primary prostatectomy and with PSA ≥ 0.1ng/ml at time of enrollment were eligible. Patients were randomized to proceed with standard SRT allowing for any conventional imaging aside from PSMA PET/CT (control arm) or undergo a 68Ga-PSMA-11 PET/CT scan prior to SRT planning (investigational arm). The primary endpoint is the success rate of SRT at 5 years in patients who undergo SRT. We report here the preliminary results of a secondary endpoint: the impact of PSMA PET on SRT planning by comparing the pre-randomization RT plans prospectively obtained on surveys before randomization to the actually delivered RT plans obtained after follow-up. Results: Enrollment of the trial was complete. 193 patients were enrolled from 09.06.2018 to 08.17.2020. 7/90 patients (9%) in the control arm dropped-out the study because they underwent a PSMA PET at another institution, while 1/103 (1%) patients of the intervention arm dropped-out due to COVID-19 related complications. After a median follow-up of 13.3 months (last follow-up date 09/01/2020), delivered RT plans were obtained in 60/83 (72%) and 70/102 (69%) of patients of the control and the PSMA arms, respectively. Median PSA at enrollment was 0.32 ng/ml (IQR 0.17-1.35) and 0.22 ng/ml (IQR 0.14-0.50) in the control and PSMA arms, respectively. There was a change between the intended pre-randomization RT plan and the actually delivered RT plan in 17/60 (28%) and 40/70 (57%) of the patients in the control and PSMA arms, respectively (p = 0.002). SRT was aborted in favor of systemic therapy and/or metastasis directed RT for extra-pelvic M1 disease in 2/60 (3%) and 12/70 (17%) of the control and PSMA arms, respectively (p = 0.17). Dose prescription and/or target volume delineation was changed in 2/60 (3%) and 1/70 (26%) in the control and PSMA arms, respectively (p = 0.001). Conclusions: In this prospective randomized phase 3 study, PSMA PET had an impact on the SRT plan in more than half of the patients. Long-term follow-up will show if the impact of PSMA PET on SRT planning translates into improved outcome or not. Clinical trial information: NCT03582774.
... The detection rate of PSMA PET/CT for recurrent PCa exceeds that of choline PET [35,36], and of 18 F-Fluciclovine PET [29,37,38]. PSMA PET/CT can improve RT planning and patient selection for salvage radiation therapy (SRT) thus may potentially improve its outcome [39][40][41]. Randomized trials investigating the outcome of SRT based on PSMA PET/CT and conventional imaging are now ongoing (NCT03525288, NCT03762759, NCT03582774) [42]. ...
Article
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TPS172 Background: Definitive radiation therapy (dRT) is an effective initial treatment of intermediate-risk (IR) and high-risk (HR) prostate cancer (PCa). Positron emission tomography (PET) using small molecule probes targeting prostate-specific membrane antigen (PSMA PET) is superior to standard of care imaging (CT, MRI, bone scan) for detecting regional and distant metastatic PCa. PSMA PET thus has the potential to guide primary radiotherapy planning in patients and improve outcomes. The purpose of the present randomized trial is to evaluate the success rate of dRT for IR or HR PCa with and without planning based on PSMA PET. Methods: We will randomize 312 patients to proceed with standard dRT (control Arm 1, n=150), or undergo a PSMA PET scan prior to dRT planning (intervention arm 2, n = 162). In the control arm, dRT will be performed as routinely planned in accordance with initial stratification. In the intervention arm, the treating radiation oncologist can incorporate PSMA PET findings into the RT planning. We assume that approximately 8% of subjects randomized to arm 2 will be found to have M1 disease and thus will be more appropriate candidates for long-term systemic or multimodal therapy, rather than curative intent dRT. PET M1 patients will thus not be included in the analysis of the primary endpoint. The primary endpoint is the success rate of dRT measured as PFS after initiation of dRT. Progression is defined as (whichever occurs first): biochemical recurrence defined as a rise by 2 ng/mL or more above the nadir PSA (defined as the lowest PSA achieved) after radiotherapy with or without short-term hormonal therapy; appearance of metastasis or loco-regional recurrence (diagnosed by any imaging or biopsy); initiation of any new salvage therapy, or death from any cause. Discussion: This is the first randomized phase 3 prospective trial designed to determine whether PSMA PET molecular imaging can improve outcomes in patients with PCa who receive dRT. In this trial the incorporation of PSMA PET may improve the success rate of curative intent radiotherapy in two ways: to optimize patient selection and to personalizes the radiotherapy plan. Clinical trial registration: IND#147591, UCLA IRB #20-000378, ClinicalTrials.gov Identifier NCT04457245. Clinical trial information: NCT04457245.
... If the SUV max of a patient exceeded 10.9, the specificity of the diagnosis in this study was 95%. Previous studies showed that PET/CT test results could indicate the malignancy of a tumour and had advantages over MRI results in detecting extrapelvic metastases and early recurrence of PCa (13,24,25). Maurer et al. confirmed that PET/CT is more accurate than conventional imaging in detecting PCa lymph node metastases and is conducive to providing targeted guidance for extended lymphadenectomy in patients with intermediate-and high-risk PCa (26). ...
Article
Background: This retrospective study aimed to investigate the efficacy of the combined application of biparametric magnetic resonance imaging (bpMRI) and 68Ga-PSMA-11 positron emission computed tomography/computed tomography (bpMRI/PET) in the qualitative diagnosis of intermediate- to high-risk prostate cancer (PCa). Methods: The 105 patients with suspected PCa included in the study underwent bpMRI and PET/CT. BpMRI examinations included conventional sequences and diffusion-weighted imaging (DWI) sequences. Major lesions were qualitatively diagnosed according to the Prostate Imaging Reporting and Data System (PI-RADS). A PET/CT scan was started 60 min after intravenous 68Ga-PSMA-11 injection. The area with the highest radioactivity on PET/CT images was defined as the major lesion, and the maximum standard uptake value (SUVmax) was measured. All cases were confirmed by biopsy and pathology. Receiver operating characteristic curve (ROC) analysis was performed on the data to calculate sensitivity, specificity, and the Youden index. Results: Of the 105 patients, 68 patients were diagnosed with PCa, and 37 patients had benign prostatic lesions. With a PI-RADS score ≥3 as the diagnostic threshold, the accuracy of bpMRI in identifying benign and malignant prostate lesions was similar to that of PET/CT (SUVmax threshold ≥10.9), and the Youden indices were 0.60 and 0.64, respectively. The sensitivity and specificity of bpMRI in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 63% and 88%, respectively, and the Youden index was 0.51. With an SUVmax ≥12.9 as the diagnostic threshold, the sensitivity and specificity of PET/CT in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 74% and 94%, respectively, and the Youden index was 0.68. The sensitivity and specificity of bpMRI/PET in diagnosing PCa were 94% and 81%, respectively, and the Youden index was 0.75. The sensitivity and specificity of bpMRI/PET in the differential diagnosis of intermediate- to high-risk PCa versus low-risk PCa or benign lesions were 80% and 88%, respectively, and the Youden index was 0.68. Conclusions: The combined application of bpMRI and PET improves the accuracy of the qualitative diagnosis of prostate lesions, and its diagnostic efficacy for risk stratification in patients with intermediate- to high-risk PCa is similar to that of PET/CT and higher than that of bpMRI alone.
... However, according to the National Comprehensive Cancer Network (NCCN) guidelines, asymptomatic patients with PCa are not recommended for routine assessment or skeletal imaging (10). Furthermore, even if patients underwent imaging examinations, such as computed tomography (CT), magnetic resonance imaging (MRI), or bone scans, the recurrence of the disease may not be diagnosed in time because of the low sensitivity of these techniques (11). Thus, the prediction of bone metastasis is essential for choosing therapeutic strategies. ...
Article
Background: Patients with prostate cancer (PCa) commonly suffer from bone metastasis during disease progression. This study aims to construct and validate a nomogram to quantify bone metastasis risk in patients with PCa. Methods: Clinicopathological data of patients diagnosed with PCa between 2010 and 2015 were retrospectively retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Predictors for bone metastasis were identified by logistic regression analyses to establish a nomogram. The concordance index (c-index) and calibration plots were generated to assess the nomogram's discrimination, and the area under the receiver operating characteristic curve (AUC) was used to compare the precision of the nomogram with routine staging systems. The nomogram's clinical performance was evaluated by decision curve analysis (DCA) and clinical impact curves (CIC). Independent prognostic factors were identified by Cox regression analysis. Results: A total of 168,414 eligible cases were randomly assigned to the training cohort or validation cohort at a ratio of 1:1. The nomogram, which was established based on independent factors, showed good accuracy, with c-indexes of 0.911 in the training set and 0.910 in the validation set. Calibration plots also approached 45 degrees. After other distant metastatic sites were included in the predictive model, the new nomogram displayed superior prediction performance. The AUCs and net benefit of the nomograms were both higher than those of other routine staging systems. Furthermore, bone metastasis prediction points were shown to be a new risk factor for overall survival. Conclusions: Novel validated nomograms can effectively predict the risk of bone metastasis in patients with PCa and help clinicians improve cancer management.