BACKGROUND AND OBJECTIVE: Biparametric magnetic resonance imaging (bpMRI), excluding dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), is a potential replacement for multiparametric MRI (mpMRI) in diagnosing clinically significant prostate cancer (csPCa). An extensive international multireader multicase observer study was conducted to assess the noninferiority of bpMRI to mpMRI in csPCa diagnosis. METHODS: An observer study was conducted with 400 mpMRI examinations from four European centers, excluding examinations with prior prostate treatment or csPCa (Gleason grade [GG] ≥2) findings. Readers assessed bpMRI and mpMRI sequentially, assigning lesion-specific Prostate Imaging Reporting and Data System (PI-RADS) scores (3-5) and a patient-level suspicion score (0-100). The noninferiority of patient-level bpMRI versus mpMRI csPCa diagnosis was evaluated using the area under the receiver operating curve (AUROC) alongside the sensitivity and specificity at PI-RADS ≥3 with a 5% margin. The secondary outcomes included insignificant prostate cancer (GG1) diagnosis, diagnostic evaluations at alternative risk thresholds, decision curve analyses (DCAs), and subgroup analyses considering reader expertise. Histopathology and ≥3 yr of follow-up were used for the reference standard. KEY FINDINGS AND LIMITATIONS: Sixty-two readers (45 centers and 20 countries) participated. The prevalence of csPCa was 33% (133/400); bpMRI and mpMRI showed similar AUROC values of 0.853 (95% confidence interval [CI], 0.819-0.887) and 0.859 (95% CI, 0.826-0.893), respectively, with a noninferior difference of -0.6% (95% CI, -1.2% to 0.1%, p < 0.001). At PI-RADS ≥3, bpMRI and mpMRI had sensitivities of 88.6% (95% CI, 84.8-92.3%) and 89.4% (95% CI, 85.8-93.1%), respectively, with a noninferior difference of -0.9% (95% CI, -1.7% to 0.0%, p < 0.001), and specificities of 58.6% (95% CI, 52.3-63.1%) and 57.7% (95% CI, 52.3-63.1%), respectively, with a noninferior difference of 0.9% (95% CI, 0.0-1.8%, p < 0.001). At alternative risk thresholds, mpMRI increased sensitivity at the expense of reduced specificity. DCA demonstrated the highest net benefit for an mpMRI pathway in cancer-averse scenarios, whereas a bpMRI pathway showed greater benefit for biopsy-averse scenarios. A subgroup analysis indicated limited additional benefit of DCE MRI for nonexperts. Limitations included that biopsies were conducted based on mpMRI imaging, and reading was performed in a sequential order. CONCLUSIONS AND CLINICAL IMPLICATIONS: It has been found that bpMRI is noninferior to mpMRI in csPCa diagnosis at AUROC, along with the sensitivity and specificity at PI-RADS ≥3, showing its value in individuals without prior csPCa findings and prostate treatment. Additional randomized prospective studies are required to investigate the generalizability of outcomes.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• multiparametrická magnetická rezonance * MeSH
• nádory prostaty * diagnostické zobrazování   patologie   MeSH
• odchylka pozorovatele MeSH
• senioři MeSH
• stupeň nádoru MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, identified through multiparametric magnetic resonance imaging (mpMRI), present a clinical challenge due to their equivocal nature in predicting clinically significant prostate cancer (csPCa). Aim of the study is to improve risk stratification of patients with PI-RADS 3 lesions and candidates for prostate biopsy. METHODS: A cohort of 4841 consecutive patients who underwent MRI and subsequent MRI-targeted and systematic biopsies between January 2016 and April 2023 were retrospectively identified from independent prospectively maintained database. Only patients who have PI-RADS 3 lesions were included in the final analysis. A multivariable logistic regression analysis was performed to identify covariables associated with csPCa defined as International Society of Urological Pathology (ISUP) grade group ≥2. Performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration, and net benefit. Significant predictors were then selected for further exploration using a Chi-squared Automatic Interaction Detection (CHAID) analysis. RESULTS: Overall, 790 patients had PI-RADS 3 lesions and 151 (19%) had csPCa. Significant associations were observed for age (OR: 1.1 [1.0-1.1]; p = 0.01) and PSA density (OR: 1643 [2717-41,997]; p < 0.01). The CHAID analysis identified PSAd as the sole significant factor influencing the decision tree. Cut-offs for PSAd were 0.13 ng/ml/cc (csPCa detection rate of 1% vs. 18%) for the two-nodes model and 0.09 ng/ml/cc and 0.16 ng/ml/cc for the three-nodes model (csPCa detection rate of 0.5% vs. 2% vs. 17%). CONCLUSIONS: For individuals with PI-RADS 3 lesions on prostate mpMRI and a PSAd below 0.13, especially below 0.09, prostate biopsy can be omitted, in order to avoid unnecessary biopsy and overdiagnosis of non-csPCa.

• MeSH
• hodnocení rizik metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• multiparametrická magnetická rezonance * metody   MeSH
• nádory prostaty * patologie   diagnostické zobrazování   diagnóza   krev   MeSH
• prostata patologie   diagnostické zobrazování   MeSH
• prostatický specifický antigen * krev   MeSH
• retrospektivní studie MeSH
• ROC křivka MeSH
• senioři MeSH
• stupeň nádoru MeSH
• ultrazvukem navigovaná biopsie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Positron Emission Tomography-Computed Tomography using Prostate-Specific Membrane Antigen (PSMA PET/CT) is notable for its superior sensitivity and specificity in detecting recurrent PCa and is under investigation for its potential in pre-treatment staging. Despite its established efficacy in nodal and metastasis staging in trial setting, its role in primary staging awaits fuller validation due to limited evidence on oncologic outcomes. This systematic review and meta-analysis aims to appraise the diagnostic accuracy of PSMA PET/CT compared to CI for comprehensive PCa staging. METHODS: Medline, Scopus and Web of science databases were searched till March 2023. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Primary outcomes were specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of PSMA PET/CT for local, nodal and metastatic staging in PCa patients. Due to the unavailability of data, a meta-analysis was feasible only for detection of seminal vesicles invasion (SVI) and LNI. RESULTS: A total of 49 studies, comprising 3876 patients, were included. Of these, 6 investigated accuracy of PSMA PET/CT in detection of SVI. Pooled sensitivity, specificity, PPV and NPV were 42.29% (95%CI: 29.85-55.78%), 87.59% (95%CI: 77.10%-93.67%), 93.39% (95%CI: 74.95%-98.52%) and 86.60% (95%CI: 58.83%-96.69%), respectively. Heterogeneity analysis revealed significant variability for PPV and NPV. 18 studies investigated PSMA PET/CT accuracy in detection of LNI. Aggregate sensitivity, specificity, PPV and NPV were 43.63% (95%CI: 34.19-53.56%), 85.55% (95%CI: 75.95%-91.74%), 67.47% (95%CI: 52.42%-79.6%) and 83.61% (95%CI: 79.19%-87.24%). No significant heterogeneity was found between studies. CONCLUSIONS: The present systematic review and meta-analysis highlights PSMA PET-CT effectiveness in detecting SVI and its good accuracy in LNI compared to CI. Nonetheless, it also reveals a lack of high-quality research on its performance in clinical T staging, extraprostatic extension and distant metastasis evaluation, emphasizing the need for further rigorous studies.

• MeSH
• antigeny povrchové MeSH
• glutamátkarboxypeptidasa II * metabolismus   MeSH
• lidé MeSH
• nádory prostaty * patologie   diagnostické zobrazování   MeSH
• PET/CT * metody   MeSH
• senzitivita a specificita MeSH
• staging nádorů * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

• MeSH
• lidé MeSH
• nádory prostaty * diagnostické zobrazování   terapie   MeSH
• plánování radioterapie pomocí počítače metody   MeSH
• počítačová rentgenová tomografie * metody   MeSH
• senioři nad 80 let MeSH
• tumor burden MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• Publikační typ
• kazuistiky MeSH

Karcinom prostaty je nejčastěji diagnostikovaným maligním nádorem v české mužské populaci. Důležitá je jeho včasná a správná detekce. Pozitronovou emisní tomografii s prostatickým specifickým membránovým antigenem (prostate specific membrane antigen positron emission tomography, PSMA PET) využíváme jako diagnostický indikátor. PSMA terapeutické radiofarmakum podporované nejspolehlivějšími daty je 177Lu-PSMA-617.

Prostate cancer is the most frequently diagnosed malignant tumor in the Czech male population. Its early and correct detection is important. We use prostate specific membrane antigen positron emission tomography (PSMA PET) as a diagnostic indicator. The PSMA therapeutic radiopharmaceutical supported by the most reliable data is 177Lu-PSMA-617.

• MeSH
• lidé MeSH
• nádory prostaty * diagnostické zobrazování   radioterapie   MeSH
• PET/CT metody   MeSH
• prostatický specifický antigen MeSH
• radiofarmaka terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH

BACKGROUND: To validate the clinical utility of a previously identified circulating tumor DNA methylation marker (meth-ctDNA) panel for disease detection and survival outcomes, meth-ctDNA markers were compared to PSA levels and PSMA PET/CT findings in men with different stages of prostate cancer (PCa). METHODS: 122 PCa patients who underwent [68Ga]Ga-PSMA-11 PET/CT and plasma sampling (03/2019-08/2021) were analyzed. cfDNA was extracted, and a panel of 8 individual meth-ctDNA markers was queried. PET scans were qualitatively and quantitatively assessed. PSA and meth-ctDNA markers were compared to PET findings, and their relative prognostic value was evaluated. RESULTS: PSA discriminated best between negative and tumor-indicative PET scans in all (AUC 0.77) and hormone-sensitive (hsPC) patients (0.737). In castration-resistant PCa (CRPC), the meth-ctDNA marker KLF8 performed best (AUC 0.824). CHST11 differentiated best between non- and metastatic scans (AUC 0.705) overall, KLF8 best in hsPC and CRPC (AUC 0.662, 0.85). Several meth-ctDNA markers correlated low to moderate with the tumor volume in all (5/8) and CRPC patients (6/8), while PSA levels correlated moderately to strongly with the tumor volume in all groups (all p < 0.001). CRPC overall survival was independently associated with LDAH and PSA (p = 0.0168, p < 0.001). CONCLUSION: The studied meth-ctDNA markers are promising for the minimally-invasive detection and prognostication of CRPC but do not allow for clinical characterization of hsPC. Prospective studies are warranted for their use in therapy response and outcome prediction in CRPC and potential incremental value for PCa monitoring in PSA-low settings.

• MeSH
• cirkulující nádorová DNA genetika   krev   MeSH
• EDTA analogy a deriváty   MeSH
• izotopy gallia * MeSH
• lidé středního věku MeSH
• lidé MeSH
• metylace DNA * genetika   MeSH
• nádorové biomarkery * genetika   krev   MeSH
• nádory prostaty rezistentní na kastraci genetika   krev   diagnostické zobrazování   MeSH
• nádory prostaty * genetika   krev   diagnostické zobrazování   MeSH
• PET/CT * metody   MeSH
• prognóza MeSH
• prostatický specifický antigen * krev   genetika   MeSH
• průřezové studie MeSH
• radioizotopy galia * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Zobrazení vlastní tkáně nádoru prostaty je při použití postupů zobrazení obvyklých u jiných nádorů obtížné, nedostatečné je používat metody zobrazení pomocí kontrastního CT vyšetření, z hybridních metod také PET/CT s aplikací 18F-fluorodeoxyglukózy. Magnetickou rezonanci je možné využít v detekci karcinomu prostaty u mužů s elevací prostatického specifického antigenu (PSA) a/nebo zvýšeným indexem zdravé prostaty (PHI). V současnosti je možné využití spojení radiologických metod a nukleární medicíny - výpočetní tomografie a pozitronové emisní tomografie (PET/CT) nebo magnetické rezonance a pozitronové emisní tomografie (PET/MR). Pro pozitronovou emisní tomografii je možné využití 18F-fluorocholinu (18F-FCH), 18F-fluciclovinu, a 18F-natriumfluoridu (18F-NaF) nebo 68Ga-PSMA-11 (ligand prostatického specifického membránového antigenu), a to ve vyhledávání, stagingu a restagingu karcinomu prostaty. PET/MR nebo PET/CT s podáním 68Ga-PSMA-11 představuje současnou optimální metodu při stagingu, restagingu a kontrole účinku terapie karcinomu prostaty.

Imaging of the prostate tumour ́s own tissue is using standard tumour imaging approaches remains difficult, the imaging using contrast enhanced computed tomography and also the hybrid imaging using PET/CT with the application of the 18F-fluorodeoxyglucose is insufficient. Magnetic resonance imaging is useful in detection of prostate cancer in patients with elevated prostatic specific antigen (PSA) and/or with increased prostate health index (PHI). Currently, it is possible to use combination of radiological and nuclear medicine methods - hybrid positron emission tomography combined with computed tomography (PET/CT) or with magnetic resonance imaging (PET/MRI) with the application of 18F-fluorocholine (FCH), 18F-fluciclovine, 18F-natriumfluoride (18F-NaF) or 68Ga-PSMA-11 (ligand of prostatic specific membrane antigen) in detection, staging or restaging of prostate carcinoma. PET/CT or PET/MRI with the application of 68Ga-PSMA-11 represents current optimal method for staging, restaging and evaluation of prostate cancer therapy response.

• MeSH
• diagnostické zobrazování klasifikace   metody   MeSH
• fluorodeoxyglukosa F18 terapeutické užití   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• multimodální zobrazování * klasifikace   metody   MeSH
• nádory prostaty * diagnostické zobrazování   diagnóza   MeSH
• PET/CT metody   MeSH
• prostatický specifický antigen analýza   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

• Klíčová slova
• PSMA-PET/CT,
• MeSH
• lidé MeSH
• nádory prostaty * diagnostické zobrazování   diagnóza   terapie   MeSH
• PET/CT metody   MeSH
• prostatický specifický antigen terapeutické užití   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Prediction of side-specific extraprostatic extension (EPE) is crucial in selecting patients for nerve-sparing radical prostatectomy (RP). Multiple nomograms, which include magnetic resonance imaging (MRI) information, are available predict side-specific EPE. It is crucial that the accuracy of these nomograms is assessed with external validation to ensure they can be used in clinical practice to support medical decision-making. METHODS: Data of prostate cancer (PCa) patients that underwent robot-assisted RP (RARP) from 2017 to 2021 at four European tertiary referral centers were collected retrospectively. Four previously developed nomograms for the prediction of side-specific EPE were identified and externally validated. Discrimination (area under the curve [AUC]), calibration and net benefit of four nomograms were assessed. To assess the strongest predictor among the MRI features included in all nomograms, we evaluated their association with side-specific EPE using multivariate regression analysis and Akaike Information Criterion (AIC). RESULTS: This study involved 773 patients with a total of 1546 prostate lobes. EPE was found in 338 (22%) lobes. The AUCs of the models predicting EPE ranged from 72.2% (95% CI 69.1-72.3%) (Wibmer) to 75.5% (95% CI 72.5-78.5%) (Nyarangi-Dix). The nomogram with the highest AUC varied across the cohorts. The Soeterik, Nyarangi-Dix, and Martini nomograms demonstrated fair to good calibration for clinically most relevant thresholds between 5 and 30%. In contrast, the Wibmer nomogram showed substantial overestimation of EPE risk for thresholds above 25%. The Nyarangi-Dix nomogram demonstrated a higher net benefit for risk thresholds between 20 and 30% when compared to the other three nomograms. Of all MRI features, the European Society of Urogenital Radiology score and tumor capsule contact length showed the highest AUCs and lowest AIC. CONCLUSION: The Nyarangi-Dix, Martini and Soeterik nomograms resulted in accurate EPE prediction and are therefore suitable to support medical decision-making.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * metody   MeSH
• nádory prostaty * diagnostické zobrazování   patologie   chirurgie   MeSH
• nomogramy * MeSH
• prognóza MeSH
• prostata diagnostické zobrazování   patologie   chirurgie   MeSH
• prostatektomie * metody   MeSH
• retrospektivní studie MeSH
• roboticky asistované výkony metody   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• validační studie MeSH

BACKGROUND: 68 Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) is a recommended imaging modality for patients with recurrent prostate cancer (PCa). Its routine implementation before radical prostatectomy (RP) may allow avoiding undertreatment. We aimed to analyze the diagnostic accuracy of 68 Ga-PSMA-PET/CT for pelvic lymph node metastases in a large cohort of patients treated with RP and extended pelvic lymph node dissection (ePLND) for high-risk PCa. METHODS: This is a retrospective analysis of an institutional database of patients who underwent 68 Ga-PSMA-PET/CT before RP and ePLND for high-risk PCa. The diagnostic estimates of 68 Ga-PSMA-PET/CT with 95% confidence intervals (CIs) for lymph node involvement were calculated. RESULTS: We included 165 high-risk PCa patients. The median PSA value was 24.5 ng/mL (range: 6.7-185) and all the patients had biopsy Grade Group 4-5. In total, 46 (28%) of patients had clinical lymph node involvement at 68 Ga-PSMA-PET/CT. A mean number of resected lymph nodes per patient was 22 (range: 15-45) and 149 (4.2%) of all resected nodes were positive for lymph node metastasis at final pathology. The diagnostic estimates for the detection of pN+ disease at RP were as follows: sensitivity 63% (95% CI: 51-75), specificity 97% (95% CI: 91-99), positive predictive value 94% (95% CI: 82-99), and negative predictive value 79% (95% CI: 70-86). The total accuracy of PSMA-PET was 83% (95% CI: 76-88). CONCLUSION: Our analyses support high specificity and positive predictive value of pretreatment 68 Ga-PSMA PET/CT for the detection of pelvic lymph node metastasis in patients treated with RP for high-risk PCa. While a positive finding should be considered as robust indicator for clinical decision-making, a negative result cannot reliably rule out the presence of lymph node involvement in high-risk PCa; there is a need for advanced risk stratification in those patients.

• MeSH
• lidé MeSH
• lokální recidiva nádoru patologie   MeSH
• lymfatické metastázy diagnostické zobrazování   patologie   MeSH
• nádory prostaty * diagnostické zobrazování   chirurgie   patologie   MeSH
• PET/CT * metody   MeSH
• prostata diagnostické zobrazování   chirurgie   patologie   MeSH
• prostatektomie MeSH
• radioizotopy galia MeSH
• retrospektivní studie MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH