Time point-independent tumor positivity of (68)Ga-PSMA-PET/CT pre- and post-biopsy in high-risk prostate cancer

OBJECTIVE: Prostate-specific membrane antigen (PSMA)-PET/CT imaging has gained increasing clinical importance for the detection and staging of high-risk primary prostate cancer (PCa). However, it is unclear whether the routine practice of prostate biopsy obscures the image finding of PSMA-PET/CT. This study aimed to compare the tumor positivity rate of PSMA-PET/CT performed pre- (PSMA-PET/CT(pre)) and post-biopsy (PSMA-PET/CT(post)) in high-risk PCa patients. PATIENTS AND METHODS: We matched 58 PSMA-PET/CT(post) with 58 PSMA-PET/CT(pre) studies for primary detection of high-risk PCa according to clinical characteristics. Three subgroups of PSMA-PET/CT(post) were defined by the intervals after biopsy (≤ 1 week, 1 ~ 2 weeks, and 2 ~ 5 weeks). Tumor positivity rates were determined, and SUVmax of primary tumors were compared separately for the two main groups and the related subgroups. Malignant prostate tissues from 20 of these patients were examined by immunohistochemical analysis of PSMA. In addition, the values of PSMA-PET/CT(pre) and PSMA-PET/CT(post) in assessing seminal vesicle invasion (SVI) were evaluated in patients who underwent radical prostatectomy. RESULTS: All the primary tumors were positive on PSMA-PET/CT(post) and PSMA-PET/CT(pre) imaging, resulting in a patient-based positivity rates of 100% (58/58) in both groups. All examined IHC results (20/20) confirmed the high-level expression of PSMA. SUVmax of primary tumors did not differ between the two main groups (16.1, IQR 9.8–26.6 vs. 16.5, IQR 11.0–26.7, p > 0.05). Subgroup analysis of PSMA-PET/CT(post) (≤ 1 week, 1 ~ 2 weeks, and 2 ~ 5 weeks) also showed no significant difference in tumor SUVmax (15.8, IQR 9.5–22.2; 17.8, IQR 9.8–29.2; and 15.4, IQR 10.1–30.3. p > 0.05). PSMA-PET/CT(post) and PSMA-PET/CT(pre) exhibited similar value in SVI detection as well. CONCLUSIONS: The tumor positivity rate was consistently high for PSMA-PET/CT pre- and post-biopsy. A prior biopsy does not seem to affect the tumor positivity rate of PSMA-PET/CT in high-risk PCa. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12149-022-01732-w.