Pd13-07 Preliminary Results of the Confirm Trial: Role of Psma Pet/Ct in Newly Diagnosed Prostate Cancer in Active Surveillance Prior to Confirmatory Biopsy

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD13)1 May 2024PD13-07 PRELIMINARY RESULTS OF THE CONFIRM TRIAL: ROLE OF PSMA PET/CT IN NEWLY DIAGNOSED PROSTATE CANCER IN ACTIVE SURVEILLANCE PRIOR TO CONFIRMATORY BIOPSY Jianliang Liu, Laurence Harewood, and Nathan Lawrentschuk Jianliang LiuJianliang Liu , Laurence HarewoodLaurence Harewood , and Nathan LawrentschukNathan Lawrentschuk View All Author Informationhttps://doi.org/10.1097/01.JU.0001009552.62973.71.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) remains a treatment option for selected low to intermediate-grade prostate cancer (PCa) patients. In order to detect disease progression, active surveillance patients undergo a repeat multiparametric magnetic resonance imaging (mpMRI) and confirmatory biopsy. Recent studies have demonstrated prostate-specific membrane antigen positron emission tomography and computed tomography (PSMA PET/CT) ability to assess intraprostatic lesion. This study aims to evaluate the utility of PSMA PET/CT in active surveillance. METHODS: This is the preliminary results from our prospective non-randomised crossover clinical trial that was registered on Australian New Zealand Clinical Trials Registry (ANZCTR) under the ID ACTRN12621001648819. Any male on AS for newly diagnosed low-grade PCa with 'high-risk' features were included. High risk features were defined as either of the following: Group A (low volume grade group (GG) 1 with high PSA), Group B (high volume GG 1), Group C (GG1 with PIRADS 4 or 5 lesion on the MRI), or Group D (GG 2 cancers with<10% Gleason pattern 4). Six to nine months from initial diagnosis, these patients undergo mpMRI and 18F PSMA PET/CT prior to confirmatory biopsy with targets if any positive imgaging. These results were then discussed at a multidisciplinary team meeting (MDT) to determine if the addition of PSMA PET/CT altered management. RESULTS: Between November 2021 to June 2023, 50 patients were enrolled and their median age was 64 years old (ranged between 43 to 77). Their high-risk features were as follows: Group A (n=3), Group B (n=5), Group C (n=30), Group D (n=12). During pre-confirmatory biopsy imaging, 36 (72%) of patients had PSMA avid lesions. Target biopsy of the PSMA avid lesions were positive in 31 (86.1%). 22(61%) of these PSMA avid lesions were MRI negative, and 10(28%) of these MRI occult lesions had upstaging of ISUP GG. During MDT, 18 (36%) had progression of disease where active treatment was recommended, of which 10(28%) were detected by PSMA PET/CT. Of the 32 patients who was recommended to continue active surveillance, 12(24%) had negative PSMA PET/CT, which reaffirmed the decision. CONCLUSIONS: PSMA PET/CT is a useful tool for active surveillance as it can detect MRI occult lesions in 61% of patients, of which 28% harboured higher grade disease during target biopsy. PSMA PET/CT improves our risk stratification of active surveillance patients, and improves our detection of clinically significant PCa. Source of Funding: Grant has been awarded by the Epworth Medical Foundation. No conflict of interest to disclose © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e265 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jianliang Liu More articles by this author Laurence Harewood More articles by this author Nathan Lawrentschuk More articles by this author Expand All Advertisement PDF downloadLoading ...