Introduction
Prostate cancer treatments have been revolutionised by improvements made in several imaging modalities. The Prostate Cancer Research Center performed multiple prospective studies and has led in the establishment of both multiparametric Magnetic Resonance Imaging (MRI) and Prostate-Specific Membrane Antigen (PSMA) PET CT scan imaging.
These imaging modalities are able to locate and diagnose prostate cancer with great accuracy, thus reducing the need for biopsies and detect or rule out the presence of metastatic disease.
One of the highlights was the publication of the collaborative PRIMARY trial, using PSMA PET CT in addition to MRI to improve the diagnosis prostate cancer (Emmett et al., 2021). This publicaton was awarded “best paper” by European Urology.
What we’ve done so far
MRI
Our institute was one of the first to publish a prospective series that showed the superiority of MRI-based diagnosis of prostate cancer over the standard prostate biopsy pathway (J. E. Thompson et al., 2016; James E. Thompson et al., 2014; James E Thompson & Stricker, 2017). However, when combined most significant prostate cancer was detected (Tran et al., 2016). Based on this data we developed a nomogram for the use of MRI outcomes with clinical parameters to predict the presence of prostate cancer (van Leeuwen, Hayen, et al., 2017). We collaborated on computer-based (artificial) analysis of MRI, and found it to be able to differentiate between prostate regions/shapes and cancer versus non-cancer characteristics (Algohary et al., 2020, 2018; Penzias et al., 2018; Rusu et al., 2017)
PSMA PET CT
One of our first series showed that PSMA PET CT had a high specificity and a moderate sensitivity to detect lymph node metastasis. These results were really promising, showing that PSMA PET CT had the potential to replace current imaging for staging of patients that were scheduled to undergo surgery (Nandurkar et al., 2019; van Leeuwen, Emmett, et al., 2017). It also provides important prognostic information for those patients (van Leeuwen et al., 2019)This was also showed in an Australian collaboration (Roach et al., 2018). Moreover, it can also be used to improve the diagnosis of lymph node metastasis after surgery and guide adjuvant radiotherapy (Emmett et al., 2019, 2017; Huits et al., 2020; van Leeuwen et al., 2016). It was also shown that PSMA PET CT had a better detection rate of (lymph) node metastasis that the current PET CT (choline) that was being used (Morigi et al., 2015).
Ongoing projects
Two major prospective multicentre trials on PSMA PET CT that have been initiated by our institute. are currently ongoing. The PIAS study will look at the additional value of PSMA PET CT in patients on active surveillance. The randomized controlled PRIMARY 2 study will look at the additive diagnostic value of PSMA PET in men with negative/equivocal MRI in the diagnosis of significant prostate cancer. In another study we are looking at the ability improve the localisation of prostate cancer by combining PSMA PET CT and MRI.
Future directions
The aim of the PIAS study and PRIMARY 2 study is to establish PSMA PET CT in the clinical pathway of primary prostate cancer diagnosis and/or active surveillance. We hope to gain additional prognostic information from the PET CT and combine this with MRI data to reduce the need for biopsies and optimize patient selection for treatment.
Our Publications on Imaging
Algohary, A., Shiradkar, R., Pahwa, S., Purysko, A., Verma, S., Moses, D., … Madabhushi, A. (2020). Combination of Peri-Tumoral and Intra-Tumoral Radiomic Features on Bi-Parametric MRI Accurately Stratifies Prostate Cancer Risk: A Multi-Site Study. Cancers , 12 (8). https://doi.org/10.3390/cancers12082200
Algohary, A., Viswanath, S., Shiradkar, R., Ghose, S., Pahwa, S., Moses, D., … Madabhushi, A. (2018). Radiomic features on MRI enable risk categorization of prostate cancer patients on active surveillance: Preliminary findings. Journal of Magnetic Resonance Imaging : JMRI . https://doi.org/10.1002/jmri.25983
Emmett, L., Buteau, J., Papa, N., Moon, D., Thompson, J., Roberts, M. J., … Stricker, P. (2021). The Additive Diagnostic Value of Prostate-specific Membrane Antigen Positron Emission Tomography Computed Tomography to Multiparametric Magnetic Resonance Imaging Triage in the Diagnosis of Prostate Cancer (PRIMARY): A Prospective Multicentre Study. European Urology , 80 (6), 682–689. https://doi.org/10.1016/j.eururo.2021.08.002
Emmett, L., Tang, R., Nandurkar, R., Hruby, G., Roach, P., Watts, J. A., … Science, M. (2019). 3 year freedom from progression following 68 GaPSMA PET CT triaged management in men with biochemical recurrence post radical prostatectomy . Results of a prospective multi‐center. Journal of Nuclear Medicine , epub ahead . https://doi.org/10.2967/jnumed.119.235028
Emmett, L., Van Leeuwen, P., Nandurkar, R., Scheltema, M. J., Cusick, T., Hruby, G., … Stricker, P. (2017). Treatment outcomes from 68 GaPSMA PET CT informed salvage radiation treatment in men with rising PSA following radical prostatectomy: Prognostic value of a negative PSMA PET. Journal of Nuclear Medicine , jnumed.117.196683. https://doi.org/10.2967/jnumed.117.196683
Huits, T. H., Luiting, H. B., van der Poel, H. G., Nandurkar, R., Donswijk, M., Schaake, E., … van Leeuwen, P. J. (2020). Distribution of prostate cancer recurrences on gallium-68 prostate-specific membrane antigen ((68) Ga-PSMA) positron-emission/computed tomography after radical prostatectomy with pathological node-positive extended lymph node dissection. BJU International , 125 (6), 876–883. https://doi.org/10.1111/bju.15052
Morigi, J. J., Stricker, P. D., van Leeuwen, P. J., Tang, R., Ho, B., Nguyen, Q., … Emmett, L. (2015). Prospective Comparison of 18F-Fluoromethylcholine Versus 68Ga-PSMA PET/CT in Prostate Cancer Patients Who Have Rising PSA After Curative Treatment and Are Being Considered for Targeted Therapy. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine , 56 (8), 1185–1190. https://doi.org/10.2967/jnumed.115.160382
Nandurkar, R., van Leeuwen, P., Stricker, P., Woo, H., Kooner, R., Yuen, C., … Emmett, L. (2019). (68)Ga-HBEDD PSMA-11 PET/CT staging prior to radical prostatectomy in prostate cancer patients: Diagnostic and predictive value for the biochemical response to surgery. The British Journal of Radiology , 92 (1095), 20180667. https://doi.org/10.1259/bjr.20180667
Penzias, G., Singanamalli, A., Elliott, R., Gollamudi, J., Shih, N., Feldman, M., … Madabhushi, A. (2018). Identifying the morphologic basis for radiomic features in distinguishing different Gleason grades of prostate cancer on MRI: Preliminary findings. PloS One , 13 (8), e0200730. https://doi.org/10.1371/journal.pone.0200730
Roach, P. J., Francis, R., Emmett, L., Hsiao, E., Kneebone, A., Hruby, G., … Scott, A. M. (2018). The Impact of (68)Ga-PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine , 59 (1), 82–88. https://doi.org/10.2967/jnumed.117.197160
Rusu, M., Purysko, A. S., Verma, S., Kiechle, J., Gollamudi, J., Ghose, S., … Madabhushi, A. (2017). Computational imaging reveals shape differences between normal and malignant prostates on MRI. Scientific Reports , 7 , 41261. https://doi.org/10.1038/srep41261
Thompson, J. E., Van Leeuwen, P. J., Moses, D., Shnier, R., Brenner, P., Delprado, W., … Stricker, P. D. (2016). The diagnostic performance of multiparametric magnetic resonance imaging to detect significant prostate cancer. Journal of Urology , 195 (5), 1428–1435. https://doi.org/10.1016/j.juro.2015.10.140
Thompson, James E., Moses, D., Shnier, R., Brenner, P., Delprado, W., Ponsky, L., … Stricker, P. D. (2014). Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: A prospective study. Journal of Urology , 192 (1), 67–74. https://doi.org/10.1016/j.juro.2014.01.014
Thompson, James E, & Stricker, P. D. (2017). Diagnostic accuracy of multi-parametric MRI and transrectal ultrasound-guided biopsy in prostate cancer. Lancet (London, England) , 389 (10071), 767–768. https://doi.org/10.1016/S0140-6736(17)30121-6
Tran, M., Thompson, J., Böhm, M., Pulbrook, M., Moses, D., Shnier, R., … Stricker, P. D. (2016). Combination of multiparametric MRI and transperineal template-guided mapping biopsy of the prostate to identify candidates for hemi-ablative focal therapy. BJU International , 117 (1), 48–54. https://doi.org/10.1111/bju.13090
van Leeuwen, P. J., Donswijk, M., Nandurkar, R., Stricker, P., Ho, B., Heijmink, S., … Emmett, L. (2019). Gallium-68-prostate-specific membrane antigen ((68) Ga-PSMA) positron emission tomography (PET)/computed tomography (CT) predicts complete biochemical response from radical prostatectomy and lymph node dissection in intermediate- and high-risk prostate c. BJU International , 124 (1), 62–68. https://doi.org/10.1111/bju.14506
van Leeuwen, P. J., Emmett, L., Ho, B., Delprado, W., Ting, F., Nguyen, Q., & Stricker, P. D. (2017). Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU International , 119 (2), 209–215. https://doi.org/10.1111/bju.13540
van Leeuwen, P. J., Hayen, A., Thompson, J. E., Moses, D., Shnier, R., Böhm, M., … Stricker, P. D. (2017). A multiparametric magnetic resonance imaging-based risk model to determine the risk of significant prostate cancer prior to biopsy. BJU International , 120 (6), 774–781. https://doi.org/10.1111/bju.13814
van Leeuwen, P. J., Stricker, P., Hruby, G., Kneebone, A., Ting, F., Thompson, B., … Emmett, L. (2016). (68) Ga-PSMA has a high detection rate of prostate cancer recurrence outside the prostatic fossa in patients being considered for salvage radiation treatment. BJU International , 117 (5), 732–739. https://doi.org/10.1111/bju.13397
'Ongoing projects