Multiparametric magnetic resonance imaging (mpMRI) is the modality of choice for initial diagnosis of prostate cancer (PCa), including biopsy-naïve patients. Nevertheless, clinicians must be aware of the possibility that up to one-fourth of clinically significant cancers might be missed by the modality. Acknowledgment of this occurrence and the increased availability of 68 Ga-PSMA PET/CT in clinical routine, open the door to new, fascinating, indications for this functional modality in the context of PCa detection. With the case herein illustrated, we report a paradigmatic example of mismatch findings between PET/CT and mpMRI better elucidating the potential indication.

PURPOSE: Prostate cancer is the most frequent cancer in men in Europe. A major focus in urology is the identification of new biomarkers with improved accuracy in patients with low-risk prostate cancer. Here, we evaluated two-dimensional neovascular complexity in prostate tumor and nontumor biopsy cores by use of a computer-aided image analysis system and assessed the correlations between the results and selected clinical and pathological parameters of prostate carcinoma. MATERIALS AND METHODS: A total of 280 prostate biopsy sections from a homogeneous series of 70 patients with low-risk prostate cancer (Gleason score 3+3, prostate-specific antigen [PSA]<10 ng/mL, and clinical stage T1c) who underwent systematic biopsy sampling and subsequent radical prostatectomy were analyzed. For each biopsy, 2-microm sections were treated with CD34 antibodies and were digitized by using an image analysis system that automatically estimates the surface fractal dimension. RESULTS: Our results showed that biopsy sections without cancer were significantly more vascularized than were tumors. No correlations were found between the vascular surface fractal dimension and patient's age, PSA and free-to-total PSA ratios, pathological stage, Gleason score, tumor volume, vascular invasion, capsular penetration, surgical margins, and biochemical recurrence. CONCLUSIONS: The value of angiogenesis in prostate cancer is still controversial. Our findings suggest that low-risk prostate cancer tissues are less vascularized than are nontumor tissues. Further studies are necessary to understand whether angiogenesis is a hallmark of intermediate- and high-risk prostate cancer.
Adult ; Aged ; Biopsy, Needle ; Fractals ; Humans ; Image Processing, Computer-Assisted/methods ; Kallikreins/blood ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Neovascularization, Pathologic/*pathology ; Prostate/*blood supply ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/*blood supply/pathology/surgery ; Retrospective Studies