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Bagguley D, Harewood L, McKenzie D, Ptasznik G, Ong S, Chengodu T, Woon D, Sim K, Sheldon J, Lawrentschuk N. The CONFIRM trial protocol: the utility of prostate-specific membrane antigen positron emission tomography/computed tomography in active surveillance for prostate cancer. BJU Int 2024; 133 Suppl 4:27-36. [PMID: 37904302 DOI: 10.1111/bju.16214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
OBJECTIVES Primary objectives: To determine the additive value of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the risk stratification of men with newly diagnosed prostate cancer (PCa) who would have otherwise been deemed suitable for active surveillance (AS). Specifically, we aim to determine if PSMA PET/CT can detect a cohort of men on AS that are in fact high risk and likely to experience unfavourable outcomes should they remain on their current treatment pathway. SECONDARY OBJECTIVES to determine the additive value of PSMA PET/CT to repeat multiparametric magnetic resonance imaging (mpMRI) of the prostate and explore whether a confirmatory biopsy may be avoided in men with a negative PSMA PET/CT and a negative repeat mpMRI of the prostate (Prostate Imaging-Reporting and Data System score of <3). Furthermore, to develop a nomogram combining clinical, imaging and biomarker data to predict the likelihood of failure on AS in men with high-risk features. Also, a blood sample will be taken to perform a Prostate Health Index test at the time of confirmatory biopsy. Furthermore, a portion of this blood will be stored at a biobank for up to 5 years if a follow-up study on molecular biomarkers and genetic assays in this cohort of men is indicated, based on the results from the CONFIRM trial. PATIENTS AND METHODS The CONFIRM trial is a prospective, multicentre, pre-test/post-test, cohort study across Victoria, Australia, involving men with newly diagnosed low-risk PCa with high-risk features, considered suitable for AS and undergoing confirmatory biopsy. The trial's goal is to provide high-quality evidence to establish whether PSMA PET/CT has a role in risk-stratifying men deemed suitable for AS despite having high-risk feature(s). RESULTS The CONFIRM trial will measure the proportion of men deemed unsuitable for ongoing AS based on pathological upgrading and multidisciplinary team recommendation due to PSMA PET/CT scan and PSMA-targeted confirmatory biopsy. Additionally, the positive and negative predictive values, sensitivity, and specificity of PSMA PET/CT will be calculated in isolation and combined with repeat mpMRI of the prostate. CONCLUSIONS This trial will provide robust prospective data to determine if PSMA-PET/CT and standard of care (prostate biopsy ± repeat mpMRI) can improve diagnostic certainty in men undergoing confirmatory biopsy for low-grade PCa with high-risk features.
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Affiliation(s)
- Dominic Bagguley
- EJ Whitten Foundation Prostate Cancer Research Centre at Epworth, Richmond, Victoria, Australia
| | - Laurence Harewood
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Urology Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dean McKenzie
- Research Development and Governance Unit, Epworth HealthCare, Richmond, Victoria, Australia
- Health Sciences and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Gideon Ptasznik
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Young Urology Research Organisation, Melbourne, Victoria, Australia
| | - Sean Ong
- EJ Whitten Foundation Prostate Cancer Research Centre at Epworth, Richmond, Victoria, Australia
| | | | - Dixon Woon
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, Victoria, Australia
| | - Kenneth Sim
- Epworth Medical Imaging, Freemasons Hospital, Melbourne, Victoria, Australia
| | - James Sheldon
- Epworth Medical Imaging, Freemasons Hospital, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- EJ Whitten Foundation Prostate Cancer Research Centre at Epworth, Richmond, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Urology Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Research Development and Governance Unit, Epworth HealthCare, Richmond, Victoria, Australia
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Ptasznik G, Kelly BD, Murphy D, Lawrentschuk N, Kasivisvanathan V, Page M, Ong S, Moon D. How prostate-specific membrane antigen positron emission tomography is refining risk calculators in the primary prostate diagnostic pathway. BJU Int 2024; 133 Suppl 3:13-14. [PMID: 37691457 DOI: 10.1111/bju.16175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Gideon Ptasznik
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Young Urology Research Organisation, Melbourne, VIC, Australia
| | - Brian D Kelly
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Declan Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Veeru Kasivisvanathan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Page
- Division of Medical Imaging, St. Vincents Hospital (Melbourne Victoria), Melbourne, VIC, Australia
| | - Sean Ong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Daniel Moon
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
- Royal Melbourne Hospital Clinical School, University of Melbourne, Melbourne, VIC, Australia
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Kelly BD, Ptasznik G, Roberts MJ, Doan P, Stricker P, Thompson J, Buteau J, Chen K, Alghazo O, O'Brien JS, Hofman MS, Frydenberg M, Lawrentschuk N, Lundon D, Murphy DG, Emmett L, Moon D. A Novel Risk Calculator Incorporating Clinical Parameters, Multiparametric Magnetic Resonance Imaging, and Prostate-Specific Membrane Antigen Positron Emission Tomography for Prostate Cancer Risk Stratification Before Transperineal Prostate Biopsy. EUR UROL SUPPL 2023; 53:90-97. [PMID: 37441340 PMCID: PMC10334234 DOI: 10.1016/j.euros.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 07/15/2023] Open
Abstract
Background Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) can detect multiparametric magnetic resonance imaging (mpMRI)-invisible prostate tumours and improve the sensitivity of detection of prostate cancer (PCa) in comparison to mpMRI alone. Numerous risk calculators have been validated as tools for stratification of men at risk of being diagnosed with clinically significant (cs)PCa. Objective To develop a novel risk calculator using clinical parameters and imaging parameters from mpMRI and PSMA PET/CT in a cohort of patients undergoing mpMRI and PSMA PET/CT before biopsy. Design setting and participants A total of 291 men from the PRIMARY prospective trial underwent mpMRI and PSMA PET/CT before transperineal prostate biopsy with sampling of systematic and targeted cores. Outcome measurements and statistical analysis Novel risk calculators were developed using multivariable logistic regression analysis to predict detection of overall PCa (International Society of Urological Pathology grade group [GG] ≥1) and csPCa (GG ≥2). The risk calculators were then compared with the European Randomised Study of Screening for Prostate Cancer risk calculator incorporating mpMRI (ERSPC-MRI). Resampling methods were used to evaluate the discrimination and calibration of the risk calculators and to perform decision curve analysis. Results and limitations Age, prostate-specific antigen, prostate volume, and mpMRI Prostate Imaging-Reporting and Data System scores were included in the MRI risk calculator, resulting in area under the receiver operating characteristic curve (AUC) values of 0.791 for overall PCa (GG ≥1) and 0.812 for csPCa (GG ≥2). Addition of the maximum standardised uptake value (SUVmax) on PSMA PET/CT for the prostate lesion, and of SUVmax for the mpMRI lesions for the MRI-PSMA risk calculator resulted in AUCs of 0.831 for overall PCa and 0.876 for csPCa (≥ISUP2).The ERSPC-MRI risk calculator had AUCs of 0.758 (p = 0.02) for overall PCa and 0.805 (p = 0.001) for csPCa. Both the MRI and MRI-PSMA risk calculators were superior to the ERSPC-MRI for both overall PCa and csPCa. Conclusions These novel risk calculators incorporate clinical and radiological parameters for stratification of men at risk of csPCa. The risk calculator including PSMA PET/CT data is superior to a calculator incorporating mpMRI data alone. Patient summary We evaluated a new risk calculator that uses clinical information and results from two types of scan to predict the risk of clinically significant prostate cancer on prostate biopsy. This risk model can guide patients and clinicians in shared decision-making and may help in avoiding unnecessary prostate biopsies.
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Affiliation(s)
- Brian D. Kelly
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Urology, Eastern Health, Melbourne, Australia
| | - Gideon Ptasznik
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Paul Doan
- Garvan Institute of Medical Research, Darlinghurst, Australia
| | | | | | - James Buteau
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging and Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer, Melbourne, Australia
| | - Kenneth Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Omar Alghazo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jonathan S. O'Brien
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael S. Hofman
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging and Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer, Melbourne, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University and Cabrini Institute, Cabrini Health, Melbourne, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Dara Lundon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Declan G. Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital Sydney, Darlinghurst, Australia
| | - Daniel Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Ptasznik G, Papa N, Kelly BD, Thompson J, Stricker P, Roberts MJ, Hofman MS, Buteau J, Murphy DG, Emmett L, Moon D. High prostate-specific membrane antigen (PSMA) positron emission tomography (PET) maximum standardized uptake value in men with PI-RADS score 4 or 5 confers a high probability of significant prostate cancer. BJU Int 2022; 130 Suppl 3:5-7. [PMID: 35362659 PMCID: PMC9790460 DOI: 10.1111/bju.15736] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/04/2022] [Accepted: 03/30/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Gideon Ptasznik
- Division of Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVic.Australia
| | - Nathan Papa
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVic.Australia
| | - Brian D. Kelly
- Division of Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVic.Australia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVic.Australia
| | - James Thompson
- St Vincent's Prostate Cancer CentreDarlinghurstNSWAustralia,Garvan Institute of Medical ResearchDarlinghurstNSWAustralia,The Kinghorn Cancer CentreDarlinghurstNSWAustralia
| | - Phillip Stricker
- School of Public Health and Community MedicineKensingtonNSWAustralia
| | - Matthew J. Roberts
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQldAustralia,Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchBrisbaneQldAustralia
| | - Michael S. Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC) and Cancer ImagingPeter MacCallum Cancer CentreMelbourneVic.Australia
| | - James Buteau
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC) and Cancer ImagingPeter MacCallum Cancer CentreMelbourneVic.Australia
| | - Declan G. Murphy
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVic.Australia
| | - Louise Emmett
- Department of Theranostics and Nuclear MedicineSt Vincent's Hospital SydneyDarlinghurstNSWAustralia,Garvan Institute of Medical ResearchDarlinghurstNSWAustralia,St Vincent's Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Daniel Moon
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVic.Australia,Royal Melbourne Hospital Clinical SchoolUniversity of MelbourneMelbourneVic.Australia
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