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 16, issue 7, november 2022
S. Verbeke MD, PhD, S. Verschuere MD, PhD, M-D. Martín-Martinez MD, B. Lelie MD, L. Libbrecht MD, PhD, M. Baldewijns MD, PhD, S. Rorive MD, PhD, G. Beniuga MD, J. Eben MD, M-A. van Caillie MD, N. D’Haene MD, PhD, C. Gabriel MD, F. Dedeurwaerdere MD, Ir A. Hébrant PhD, H.L. Gijs , K.B.M. Claes PhD, D. De Maeseneer MD, B. Tombal MD, PhD, P. Pauwels MD, PhD
The recent approval of the poly(ADP-ribose) polymerase (PARP) inhibitor olaparib for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) harbouring pathogenic variants of BRCA2 or BRCA1 marks the start of molecularly guided precision medicine in prostate cancer. In parallel with this approval comes the need to embed molecular diagnostics in the clinical management of patients with mCRPC. To date, however, there are no established protocols in Belgium for the use of mutation testing in this setting. This article will therefore provide practical guidance for sample preparation and handling, pre-analytic processing, and pathogenic variant analysis in mCRPC. Across the different phases of this process, a multidisciplinary approach involving urologists, oncologists, radiologists, pathologists, molecular biologists, technicians, nurses, and geneticists will be key to safeguard adequate sample selection to perform molecular analyses at the time of metastatic disease. It will also facilitate high-quality molecular testing with a minimal failure rate. Only by optimising this process will physicians be able to adequately select mCRPC patients that are most likely to benefit from PARP inhibition, or other future targeted therapies, allowing to use these agents in the correct patient groups.
(BELG J MED ONCOL 2022;16(7):343–54)
Read moreBJMO - volume 12, issue 6, october 2018
T. Gevaert MD, PhD, L. Libbrecht MD, PhD, E. Lerut MD, PhD, B. Weynand MD, PhD, M. Lammens MD, PhD, S. Verschuere MD, PhD, C. Mattelaer MD, B. Lelie MD, J. Eben MD, L. Martinez , M-A. van Caillie MD, S. Rorive MD, PhD, S. Verbeke MD, PhD, M. Baldewijns MD, PhD
The Belgian Working Group on Uropathology has agreed upon a dataset for prostate core needle biopsy reporting, based on existing international guidelines, recent scientific insights, national survey analysis and panel discussion, with the focus on a user- and receptor-friendly format. This dataset should encourage standardised structured reporting of prostate biopsies in the Belgian healthcare system, aiming to improve the quality of individual pathology reports and to provide real benefit for the clinical management of patients and secondary users. Therefore the Belgian Working Group on Uropathology recommends implementing this dataset in each Belgian pathology lab, in close consultation with the entire clinical team involved in the treatment of the prostate cancer patient.
(BELG J MED ONCOL 2018;12(6):279–286)
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