164P - F-18 PSMA-PET/CT-guided percutaneous prostate biopsy

Background

Prostatic cancer is the most common non-cutaneous malignancy in men and the second leading cause of cancer-related mortality. Present study was planned to evaluate the F-18 PSMA-PET/CT-guided biopsy from a PSMA-expressing prostatic lesion through the trans-gluteal approach to avoid rectal penetration.

Methods

In the present study, we prospectively recruited patients with clinical suspicion of prostate cancer (serum PSA >4ng/dl). All the patients underwent whole-body F-18 PSMA-PET/CT-imaging. A focal PSMA avid lesion in the prostate was considered PET-positive. The PET-positive patients underwent PET-guided prostatic biopsies through the trans-gluteal approach using an automated-robotic arm to place the needle to target prostatic lesions. Society of interventional radiology consensus guidelines was followed for the procedures. The visual analysis score (VAS) for pain, procedure-related complication, and histopathology were documented. Urine culture reports at 48 hours after the procedure was also evaluated.

Results

A total of 40 patients were enrolled. Of these, 32 patients were PET-positive with mean SUV max 19.1 ±13.9. Biopsy was technically feasible in 32 procedures, and retrieved specimens were adequate for pathological analysis. Histopathology demonstrated prostate cancer in 30 patients and chronic prostatitis in remaining two participants. The procedure demonstrated a diagnostic yield of 100%. Minor complications (hematuria, hematospermia and gluteal pains) were noted in five patients. Non of the patient required hospitalization. The mean VAS was 2.5 ±1.8. None of the patients developed fever or post-procedural infection.

Conclusions

The present study demonstrated that transgluteal PSMA PET/CT-guided prostatic biopsy is feasible, safe, and has excellent diagnostic yield. It also negates the chance of inoculation of the prostate with rectal flora, thus reducing the morbidity due to bacterial infection. The findings pave the way for use of PSMA-PET/CT and guided prostate biopsy for early diagnosis of prostate cancer.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.