The role of PSMA PET/CT in predicting downgrading in patients with Gleason score 4+4 prostate cancer in prostate biopsy - W Jour Uro 5/21/24

[cujoe]

An interesting investigation aimed at validating the use of PSMA PET/CT in patients to adjust the Gleason score (downward) of their cancer based on conventional pre-surgery biopsy, scans (ultrasound & MRI). In this instance the focus was on downgrading from a high-risk of 8 to an intermediate-risk score of 7. As a retrospective study, it develops a predictive model based on the comparison of PSMA PET/CT results with those of post-prostatectomy and needle biopsies.

The study Abstract is reproduced below. The full Article is linked at the bottom.

The role of PSMA PET/CT in predicting downgrading in patients with Gleason score 4+4 prostate cancer in prostate biopsy, World Journal of Urology, Original Article, Open access, Published: 21 May 2024

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Abstract

Background

To investigate the predictable parameters associated with downgrading in patients with a Gleason score (GS) 8 (4+4) in prostate biopsy after radical prostatectomy.

Methods

We retrospectively analyzed 62 patients with a GS of 4+4 on prostate biopsy who underwent robotic radical prostatectomy between 2017 and 2022.

Results

38 of 62 (61.2%) were downgraded. In multivariable logistic regression model, Ga-68 prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) SUV max was independent predictor of downgrading (OR 0.904; p = 0.011) and a Logistic Regression model was constructed using the following formula: Y = 1.465–0.95 (PSMA PET/CT SUV max). The model using this variable correctly predicted the downgrading in 72.6% of patients. The AUC for PSMA PET/CT SUV max was 0.709 the cut off being 8.8.

A subgroup analysis was performed in 37 patients who had no other European Association of Urology (EAU) high risk features. 25 out of 37 (67.5%) were downgraded, and 21 of these 25 had organ confined disease. Low PSMA SUV max (<8.1) and percentage of GS 4+4 biopsy cores to cancer bearing cores (45.0%) were independently associated with downgrading to GS 7.

Conclusion

PSMA PET/CT can be used to predict downgrading in patients with GS 4+4 PCa. Patients with GS 4+4 disease, but no other EAU high risk features, low percentage of GS 4+4 biopsy cores to cancer bearing cores, and a low PSMA PET/CT SUV max are associated with a high likelihood of the cancer reclassification to intermediate risk group.

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The full Article can be found here:

The role of PSMA PET/CT in predicting downgrading in patients with Gleason score 4+4 prostate cancer in prostate biopsy, World Journal of Urology, Original Article, Open access, Published: 21 May 2024, Volume 42, article number 341, (2024)

link.springer.com/article/1...

Interestingly, my Gleason was upgraded from 3+4 to 4+3 after the final biopsy. My understanding was that it was not uncommon for Gleason to be upgraded post-prostatectomy at that time. (circa 2013.) A pre-biopsy/surgery PSMA scan would surely provide more granular information for making decisions about best treatment approaches. Cost will, no doubt, factor into whether or not patients get one.

Stay S&W, Ciao - cujoe

[6357axbz]

What difference does it make if my cancer was G8 or G7? I was stage 4 metastatic PCa at diagnosis.

[cujoe in reply to 6357axbz]

6357axbz - In all due respects to you and others with Stage 4 mPCa (like me), much of the information I choose to provide is not just about us individually. By name, this forum is not the one for "Advanced" patients.

A major goal for all of us should be to help others obtain a curative treatment in the first place - or a more effective treatment, if that is not possible. This sentence from the full report Conclusion sums up the goal of research such as this quite well:

"To be ble to predict pathological downgrading in patients with biopsy GS 4+4 PCa may help the clinician to have a more detailed and structured presentation of the treatment options to the patient." (emphasis added)

Stay S&W - Ciao - cujoe

[NPfisherman]

Dog of Information and Terror (DO IT),

The newer scans are changing the approach to evaluating and treating prostate cancer... PERIOD !!! As the scans get better, will we see the possibility of cure in oligometastatic patients... I do believe !!!

The Golden Age of Oncological Research is Here !!!

DD

[cujoe in reply to NPfisherman]

No doubt, NP! However, getting the effective wide-use of expensive scans like PSMA PET/CT and even MRIs will take some effort on the part of patients, uros, MOs, independent scan services, and, most importantly, health insurance providers (both public and private). In many instances, the best diagnostic technology is not used due to cost or available equipment - with the result being treatment taken after the cancer is no longer either organ-confined or locally metastatic. I expect had my Uro done an MRI (or had PSMA diagnostics available), I would have been treated years earlier and now not be Stage 4.

That said, I now am "driving like and Italian" with my 2 x cancers (sans a rearview mirror) and focusing on keeping a positive balance between longevity and QOL. I sense you are doing likewise, and while it is n=1 uncharted territory for each of us, trusting in our own instincts, the current treatment science (as it is), and the knowledge of our MO + research team, we take things best by embracing it a day at a time.

Stay Safe and Well, Young Grasshopper,

Ciao - Capt'n K9

[NPfisherman in reply to cujoe]

K9 Driving Terror,

The first rule of Italian racing... good philosophy... I do try and focus on the current and the positive...

My MO has said that this n=1 is likely my play until one is not needed, so why worry...Working on projects, and tonight, if no rain... a bonfire... Hope all is well on the good ship..

Sad to hear about Patrick... guilt by association... and you call me ,..."dangerous"??

When being "dangerous ", one should...

Live- Laugh- Love

DD

[cujoe in reply to NPfisherman]

Bonfire sounds good. In contrast I'm away from the coast getting two of my mid-year doc appts done. One beautiful travel day yesterday and another today for CLL annual. One more tomorrow with dermatologists and then back to my water-based home. (No bonfires allowed there, of course.)

Your plan fits your "needs" and I expect that, like the others we know who are to some degree or the other doing their own n=1 treatments, you will tweak yours or move on to something different when conditions warrant doing so. NPs are frequently better advisors than MDs . . . do you happen to know any?

BTW, Hands down, those are definitely three essential "Ls" to live by.

Stay Safe and Well, My Dangerous Friend,

Ciao - K9 terror