BJMO - volume 19, issue 2, march 2025
E. Donck MD, P. de Visschere MD, PhD, C. Van Praet MD, PhD, S. Verbeke MD, PhD, S. Hendrickx MD, C. Berquin MD, S. Rottey MD, PhD, W. Verla MD, PhD, N. Lumen MD, PhD
Background: Magnetic Resonance Imaging (MRI) is advised for the diagnosis of prostate cancer (PC), and PSMA PET/CT is used for distant staging of PC. Local staging of the primary tumour with PSMA PET/CT is currently not recommended, although the primary lesion can be visualised as well. Recently, two new tumour-assessing scores were developed to optimise the diagnostic accuracy of PSMA PET/CT for the primary tumour: the PSMA-expression score and the PRIMARY score.
Objective: To evaluate the performance of PSMA PET/CT and its PRIMARY and PSMA-expression scores in the assessment of intraprostatic lesions in patients with PC. Patients and methods: This is a retrospective analysis of patients treated with radical prostatectomy for PC in a single tertiary centre between 2019 and 2022. All patients underwent preoperative prostate MRI and 18F- or 68Ga-PSMA-11 PET/CT. The medical images were pseudonymized and retrospectively assessed by two radiologists and a nuclear medicine specialist. The PSMA PET/CTs were scored according to the PSMA-expression score (PROMISE V2 framework) and the PRIMARY score. The MRIs were scored using the PI-RADS system. The accuracy of the three different scores for diagnosing high-grade PC (ISUP grade ≥3) was evaluated.
Results: The PSMA-expression score demonstrated the highest accuracy for detecting high-grade PC, with an AUC of 0.76, outperforming the PI-RADS scores from reader 1 (AUC of 0.59) and reader 2 (AUC of 0.68) and the PRIMARY score (AUC of 0.69). It had a sensitivity of 72%, a specificity of 70%, a positive predictive value of 85%, and a negative predictive value of 51%.
Conclusion: PSMA PET/CT has a promising diagnostic accuracy to detect intraprostatic lesions of high grade in patients with PC. Further validation of the PSMA PET scoring systems is warranted.
Patient summary: In this study, the performance of PSMA PET/CT (the PRIMARY and PSMA-expression scores) to detect malignant lesions in the prostate was evaluated. PSMA PET/CT and these scoring systems seem promising to detect PC and could be of interest in cases where MRI is ambiguous.
(BELG J MED ONCOL 2025;19(2):46–53)
Read moreBJMO - volume 13, issue 6, october 2019
T. Vermassen PhD, T. Roumeguère MD, PhD, Y. Neybuch MD, L. Hoekx MD, I. Fele , B. Sautois MD, PhD, W. Everaerts MD, PhD, D. De Maeseneer MD, F. Lecouvet MD, PhD, N. Lumen MD, PhD, P. Ost MD, PhD, S. Rorive MD, PhD, S. Stroobants MD, PhD, P. Dirix MD, PhD, S. Rottey MD, PhD
Castrate-resistant prostate cancer (CRPC) is characterised by complex strategies for therapy and follow-up. In order to standardise CRPC cancer care on a national basis, an integrated care pathway was devised, based on clinical governance principles and acknowledged best practice, in order to reduce length of hospital stay, reduce costs of patient care, improve patient outcomes (e.g. Quality-of-Life, complications), etc. Therefore, a steering group of Belgian experts, consisting of medical oncologist, urologists, radiation oncologists, oncology nurses, pathologists and nuclear medicines, was assembled to discuss the need for an integrated care pathway for CRPC in Belgium. This was made possible through the financial support of Astellas Belgium. An extensive integrated care pathway was discussed with various stages, depending on the disease status of the patient. Belgian implementation could lead towards further standardisation of cancer care for CRPC patients although several important matters still have to be discussed or adapted. Further assessment and inter-hospital deliberation seems required to ensure a national implementation of the CRPC integrated care pathway.
(BELG J MED ONCOL 2019;13(6): 219–226)
Read moreBJMO - volume 7, issue 4, september 2013
C. Van Praet MD, PhD, D. De Maeseneer MD, N. Lumen MD, PhD, S. Rottey MD, PhD
Since the 1940’s the androgen receptor has been the main target for systemic therapy in prostate cancer. Classic hormonal therapy aims at lowering serum testosterone levels or block the androgen receptor ligand-binding domain. Despite disease progression, castration-resistant prostate cancer remains predominantly androgen-driven as novel secondary hormonal therapy with abiraterone acetate or enzalutamide has demonstrated increased overall survival. Promising androgen synthesis inhibitors (orteronel, galeterone), androgen receptor inhibitors (ARN-509, EPI-001, AZD3514) and heat-shock protein modulators are under investigation. Given the upcoming arsenal of systemic therapies and the molecular heterogeneity of castration-resistant prostate cancer, patient-tailored therapy strategies are being explored.
(BELG J MED ONCOL 2013;7(3):111–8)
Read moreBJMO - volume 6, issue 1, february 2012
V. Kruse MD, PhD, N. Lumen MD, PhD, F. D’Hondt MD, PhD, S. Rottey MD, PhD
Renal cell carcinoma is a common malignancy affecting men and women sporadically or as part of an inherited syndrome. Upregulation of VEGF and other growth factors due to accumulation of HIF in combination with an activation of the mTOR pathway are known to be important parts of the pathogenesis. These signaling pathways are therapeutic targets of monoclonal antibodies, small-molecules kinase inhibitors (TKI’s) and mTOR-pathway inhibitors and currently constitute the mainstay of metastatic RCC treatment. During the last decade, treatment options for patients with advanced renal cell carcinoma, a disease resistant to cytotoxic chemotherapy, have improved significantly with increasing survival rates. Several clinical trials are ongoing and new results are expected in the coming years. In Belgium, three TKI’s, two mTOR-inhibitors and one anti-VEGF monoclonal antibody in combination with IFN-α are reimbursed for the treatment of advanced renal cell carcinoma. Sunitinib can be administered in first line and everolimus from second line on to patients with low- or intermediate risk disease. Therapy with bevacizumab/IFN-α is an alternative first line option. Temsirolimus is an option in first line for patients with high risk disease. Sorafenib has shown positive results in patients pretreated with cytokines. Recently, pazopanib has become available as a first line treatment for patients with advanced renal cell carcinoma.
(BELG J MED ONCOL 2012;6:13–21)
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