Correlation of Ga-68 PSMA PET/CT Positivity with Gleason Scores and Serum PSA Levels in Initial Staging of Prostate Adenocarcinoma, and the Contribution of PET/CT Imaging to Patient Management
Acta Haematologica Oncologica Turcica, cilt.58, sa.3, ss.169-176, 2025 (Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 58 Sayı: 3
- Basım Tarihi: 2025
- Doi Numarası: 10.4274/ahot.galenos.2025.2025-7-6
- Dergi Adı: Acta Haematologica Oncologica Turcica
- Derginin Tarandığı İndeksler: Scopus, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.169-176
- Anahtar Kelimeler: Clinical oncology, gallium-68, oncology, positron emission tomography computed tomography, prostate cancer, prostatic neoplasms
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Aim: Prostate cancer is the second most frequently diagnosed malignancy and the fifth leading cause of cancer-related mortality worldwide. Accurate staging at diagnosis is crucial for guiding treatment decisions. However, conventional imaging methods have limited sensitivity, especially for detecting early metastatic disease. Gallium-68 (Ga-68) prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT), a molecular imaging modality targeting PSMA, provides high sensitivity and specificity by visualizing PSMA expression in both primary and metastatic lesions. This study aimed to evaluate the correlation of serum prostate-specific antigen (PSA) levels and Gleason grade groups with primary lesion standardized uptake value maximum (SUVmax ), and to assess the predictive value of PSMA expression for extraprostatic involvement in patients undergoing initial staging for prostate adenocarcinoma. Methods: This retrospective study included 37 patients with biopsy-proven prostate adenocarcinoma who underwent Ga-68 PSMA PET/CT for initial staging. Correlations between primary tumor SUVmax, serum PSA levels, and Gleason grade groups were analyzed. The predictive value of SUVmax for extraprostatic metastases was assessed. Additionally, associations between PSA, Gleason grade groups, and the presence of lymph node or bone metastases were evaluated. In 33 patients, Ga-68 PSMA PET/CT findings were compared with concurrent bone scintigraphy. A subgroup underwent dual-phase PET/CT imaging to assess changes in delayed SUVmax in relation to PSA and Gleason grade groups. Results: SUVmax of the primary tumor showed significant positive correlations with PSA levels (p<0.001) and Gleason grade groups (p=0.005). Gleason grade group was significantly associated with lymph node metastasis (p=0.04), but not with bone metastasis. A SUVmax threshold of 8.97 predicted extraprostatic disease with 81.25% sensitivity and 66.67% specificity. No significant association was found between PSA levels and lymphatic or osseous metastases. PSMA PET/CT outperformed bone scintigraphy in 76% of cases with suspected skeletal lesions. Although dual-phase imaging revealed no additional lesions, delayed SUVmax values remained significantly correlated with PSA and Gleason grade groups (p=0.002 and p=0.013, respectively). Conclusion: Ga-68 PSMA PET/CT demonstrates high diagnostic performance in the staging of prostate adenocarcinoma and correlates significantly with key prognostic factors. It offers superior accuracy compared to bone scintigraphy and may guide personalized management strategies. While dual-phase imaging adds limited incremental value, it may be beneficial in selected cases. Further prospective studies are warranted to validate these findings.