{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:27:00Z","timestamp":1787754420082,"version":"build-2784847793"},"reference-count":42,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Introduction: To evaluate accuracy and costeffectiveness of prostate-specific membrane antigen (PSMA) positron emission tomography\/computed tomography (PET\/CT) as single procedure in diagnosing and staging high grade prostate cancer (PCa).Materials and Methods: From June 2022 to December 2025, 330 men (median age: 65 years) underwent transperineal prostate biopsy for the suspicion of high grade PCa (PSA &gt;20 ng\/ml and\/or suspicious digital rectal examination). All the patients underwent PSMA PET\/CT targeted biopsy of intraprostatic lesions suspicious for PCa (Standard Uptake Value &gt;8) combined with extended prostate biopsy.Results: Median PSA was 30.5 ng\/ml (range: 20-785 ng\/ml) and 135\/330 (41%) men had positive DRE; a csPCa was found in 325\/330 (98.5%) patients and 297\/325 (91.4%) had a Gleason score &gt;8\/ISUP Grade Group &gt;4. Clinical staging by PSMA PET\/CT demonstrated: 130 (40%) cT2PCa vs 195 (60%) cT3PCa cases; in detail, 95\/325 (29.2%) had positive nodes, 60 (18.5%) bone metastases and 40 (12.3%) multiple metastases. The overall reimbursement for diagnosing PCa in the 330 patients submitted to prostate biopsy was 471,883,5 \u20ac.; using PSMA PET\/CT without MRI the cost of this latter procedure could be spared for a total of 71,016 \u20ac.Conclusions: PSMA PET\/CT as a single imaging procedure demonstrated an high accuracy in diagnosing and staging high grade PCa, moreover, improved cost-effectiveness and allowed to start quickly therapy.<\/jats:p>","DOI":"10.4081\/aiua.2026.14797","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T13:50:05Z","timestamp":1772545805000},"source":"Crossref","is-referenced-by-count":4,"title":["PSMA PET\/CT in diagnosing and staging high grade prostate cancer: accuracy and cost-effectiveness"],"prefix":"10.4081","volume":"98","author":[{"given":"Pietro","family":"Pepe","sequence":"first","affiliation":[{"name":"Urology Unit, Cannizzaro Hospital, Catania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Pepe","sequence":"additional","affiliation":[{"name":"Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Pepe","sequence":"additional","affiliation":[{"name":"Health Economics and Management - Ministry of Health, Rome"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Fiorentino","sequence":"additional","affiliation":[{"name":"Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"216849","doi-asserted-by":"crossref","unstructured":"1. Roobol MJ, de Vos II, M\u00e5nsson M, et al. European study of prostate cancer screening-23-year follow-up. N Engl J Med 2025 30; 393:1669-80.","DOI":"10.1056\/NEJMoa2503223"},{"key":"216850","doi-asserted-by":"crossref","unstructured":"2. Pepe P, Aragona F. Incidence of insignificant prostate cancer using free\/total PSA: results of a case-finding protocol on 14,453 patients. Prostate Cancer Prostatic Dis 2010; 13:316-319.","DOI":"10.1038\/pcan.2010.29"},{"key":"216851","doi-asserted-by":"crossref","unstructured":"3. Pepe P, Fraggetta F, Galia A, et al. PCA3 score and prostate cancer diagnosis at repeated saturation biopsy. Which cut-off: 20 or 35? Int Braz J Urol 2012; 38:489-495.","DOI":"10.1590\/S1677-55382012000400008"},{"key":"216852","unstructured":"4. Pepe P, Aragona F. PCA3 score vs PSA free\/total accuracy in prostate cancer diagnosis at repeat saturation biopsy. Anticancer Res 2011; 31:4445-4449."},{"key":"216853","unstructured":"5. Pepe P, Aragona F. Prostate cancer detection rate at repeat saturation biopsy: PCPT risk calculator versus PCA3 score versus case finding protocol. Can J Urol 2013; 20:6620-6624."},{"key":"216854","doi-asserted-by":"crossref","unstructured":"6. Salemi M, Pettinato A, Fraggetta F, et al Expression of miR-132 and miR-212 in prostate cancer and metastatic lymph node: Case report and revision of the literature. Arch Ital Urol Androl 2020;92:209.","DOI":"10.4081\/aiua.2020.3.209"},{"key":"216855","doi-asserted-by":"crossref","unstructured":"7. Pepe P, Cimino S, Garufi A, et al. Confirmatory biopsy of men under active surveillance: extended versus saturation versus multiparametric magnetic resonance imaging\/transrectal ultrasound fusion prostate biopsy. Scand J Urol 2017; 51:260-263.","DOI":"10.1080\/21681805.2017.1313310"},{"key":"216856","doi-asserted-by":"crossref","unstructured":"8. Schr\u00f6der FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet 2014; 384:2027-2035.","DOI":"10.1016\/S0140-6736(14)60525-0"},{"key":"216857","doi-asserted-by":"crossref","unstructured":"9. Checcucci E, Bauckneht M, Cisero E, et al. PSMA PET-targeted biopsy for prostate cancer diagnosis: initial experience from a multicenter cohort. Urology 2025;196: 178-185.","DOI":"10.1016\/j.urology.2024.10.026"},{"key":"216858","doi-asserted-by":"crossref","unstructured":"10. Bodar YJL, Boev\u00e9 LMS, van Leeuwen PJ, et al. Using prostatespecific membrane antigen positron-emission tomography to guide prostate biopsies and stage men at high-risk of prostate cancer. BJU Int 2023; 132:705-712.","DOI":"10.1111\/bju.16167"},{"key":"216859","unstructured":"11. Emmett L, Papa N, Buteau J, et al. The PRIMARY score: using intraprostatic 68Ga-PSMA PET\/CT patterns to optimize prostate cancer diagnosis. J Nucl Med 2022; 63:1644-1650."},{"key":"216860","doi-asserted-by":"crossref","unstructured":"12. Heetman JG, Paulino Pereira LJ, et al. The additional value of 68Ga-PSMA PET\/CT SUVmax in predicting ISUP GG \u2265 2 and ISUP GG \u2265 3 prostate cancer in biopsy. Prostate 2024; 84:1025-1032.","DOI":"10.1002\/pros.24716"},{"key":"216861","doi-asserted-by":"crossref","unstructured":"13. Exterkate L, Hermsen R, Ku\u0308sters-Vandevelde HVN, et al. Head-to-head comparison of 18F-PSMA-1007 positron emission tomography\/computed tomography and multiparametric magnetic resonance imaging with whole-mount histopathology as reference in localisation and staging of primary prostate cancer. Eur Urol Oncol 2023; 6:574-581.","DOI":"10.1016\/j.euo.2023.04.006"},{"key":"216862","doi-asserted-by":"crossref","unstructured":"14. Pepe P, Pepe L, Cignoli D, Roscigno M. PSMA PET\/CT in the diagnosis of prostate cancer: why and when? Arch Ital Urol Androl. 2025; 97:13746.","DOI":"10.4081\/aiua.2025.13746"},{"key":"216863","doi-asserted-by":"crossref","unstructured":"15. Pepe P, Pepe L, Fiorentino V, et al. PSMA PET\/CT accuracy in diagnosing prostate cancer nodes metastases. In Vivo 2024;38:2880-2885.","DOI":"10.21873\/invivo.13769"},{"key":"216864","doi-asserted-by":"crossref","unstructured":"16. Emmett L, Papa N, Counter W, et al. Reproducibility and accuracy of the PRIMARY score on PSMA PET and of PI-RADS on multiparametric MRI for prostate cancer diagnosis within a real-world database. J Nucl Med 2024; 65:94-99.","DOI":"10.2967\/jnumed.123.266164"},{"key":"216865","doi-asserted-by":"crossref","unstructured":"17. Pepe P, Pepe L, Tamburo M, et al. 68Ga-PSMA PET\/CT and prostate cancer diagnosis: which SUVmax value? In Vivo 2023;37:1318-1322.","DOI":"10.21873\/invivo.13211"},{"key":"216866","doi-asserted-by":"crossref","unstructured":"18. Gillessen S, Turco F, Davis ID, et al. Management of patients with advanced prostate cancer. Report from the 2024 Advanced Prostate Cancer Consensus Conference (APCCC). Eur Urol 2025; 87:157-216.","DOI":"10.1016\/j.eururo.2024.09.017"},{"key":"216867","doi-asserted-by":"crossref","unstructured":"19. Pepe P, Pennisi M. Should 68Ga-PSMA PET\/CT replace CT and bone scan in clinical staging of high-risk prostate cancer? Anticancer Res 2022; 42:1495-1498.","DOI":"10.21873\/anticanres.15621"},{"key":"216868","doi-asserted-by":"crossref","unstructured":"20. Mohan P, Wadhwa P, Mahajan H, et al. Detection accuracy of [68 Ga] PSMA PET\/CT with rising PSA in prostate cancer. World J Nucl Med 2025; 24:144-154.","DOI":"10.1055\/s-0045-1804894"},{"key":"216869","doi-asserted-by":"crossref","unstructured":"21. Pepe P, Roscigno M, Pepe L, et al. Could 68Ga-PSMA PET\/CT evaluation reduce the number of scheduled prostate biopsies in men enrolled in active surveillance protocols? J Clin Med 2022; 11:3473.","DOI":"10.3390\/jcm11123473"},{"key":"216870","doi-asserted-by":"crossref","unstructured":"22. Pepe P, Pepe L, Tamburo M, et al. 68Ga-PSMA PET\/CT evaluation in men enrolled in prostate cancer Active Surveillance. Arch Ital Urol Androl 2023;95:11322.","DOI":"10.4081\/aiua.2023.11322"},{"key":"216871","doi-asserted-by":"crossref","unstructured":"23. Pepe P, Pepe L, Pennisi M. Negative biopsy histology in men with PI-RADS score 5: is it useful PSMA PET\/CT evaluation? Arch Ital Urol Androl 2024;96:12358.","DOI":"10.4081\/aiua.2024.12358"},{"key":"216872","doi-asserted-by":"crossref","unstructured":"24. Aragona F, Pepe P, Motta M, et al. Incidence of prostate cancer in Sicily: results of a multicenter case-findings protocol. Eur Urol 2005;47:569-574.","DOI":"10.1016\/j.eururo.2004.11.007"},{"key":"216873","doi-asserted-by":"crossref","unstructured":"25. Pepe P, Panella P, Savoca F, et al. Prevalence and clinical significance of prostate cancer among 12,682 men with normal digital rectal examination, low PSA levels (<or =4 ng\/ml) and percent free PSA cutoff values of 15 and 20%. Urol Int 2007;78:308-312.","DOI":"10.1159\/000100833"},{"key":"216874","doi-asserted-by":"crossref","unstructured":"26. Pepe P, Pepe L, Cosentino S, et al. Detection rate of 68Ga-PSMA PET\/CT vs. mpMRI targeted biopsy for clinically significant prostate cancer. Anticancer Res 2022; 42:3011-3015.","DOI":"10.21873\/anticanres.15785"},{"key":"216875","doi-asserted-by":"crossref","unstructured":"27. Pepe P, Pennisi M. Morbidity following transperineal prostate biopsy: Our experience in 8.500 men. Arch Ital Urol Androl 2022;94:155-159.","DOI":"10.4081\/aiua.2022.2.155"},{"key":"216876","doi-asserted-by":"crossref","unstructured":"28. Pepe P, Pennisi M. Targeted biopsy in men high risk for prostate cancer: 68Ga-PSMA PET\/CT versus mpMRI. Clin Genitourin Cancer 2023; 21:639-642.","DOI":"10.1016\/j.clgc.2023.06.007"},{"key":"216877","doi-asserted-by":"crossref","unstructured":"29. Pepe P, Garufi A, Priolo G, Pennisi M: Transperineal vs. transrectal MRI\/TRUS fusion biopsy: detection rate of clinically significant prostate cancer. Clin Genitourin Cancer. 2017; 15:e33-e36.","DOI":"10.1016\/j.clgc.2016.07.007"},{"key":"216878","unstructured":"30. Regione Siciliana, Assessorato della Salute: Catalogo Regionale del 30\/12\/2024; Gazzetta Ufficiale no. 302."},{"key":"216879","doi-asserted-by":"crossref","unstructured":"31. Pepe P, Fraggetta F, Galia A, et al. Is quantitative histologic examination useful to predict nonorgan-confined prostate cancer when saturation biopsy is performed? Urology. 2008; 72:1198-202.","DOI":"10.1016\/j.urology.2008.05.045"},{"key":"216880","doi-asserted-by":"crossref","unstructured":"32. Fiorentino V, Pepe L, Pizzimenti C, et al. PD-L1 expression in prostate cancer and Gleason Grade Group: Is there any relationship? Findings from a multi-institutional cohort. Pathol Res Pract. 2025;269:155916.","DOI":"10.1016\/j.prp.2025.155916"},{"key":"216881","unstructured":"33. Cornford P, Tilki D, van den Bergh RCN, et al. EAU-EANM-ESTRO ESUR-ISUP-SIOG Guidelines on Prostate Cancer. 2025. Arnhem, European Association of Urology."},{"key":"216882","unstructured":"34. Demirci E, Kabasakal L, Sahin OE, et al. Can SUVmax values of Ga-68-PSMA PET\/CT scan predict the clinically significant prostate cancer? Nucl Med Commun 2019; 40:86-91."},{"key":"216883","doi-asserted-by":"crossref","unstructured":"35. Bodar YJL, Boev\u00e9 LMS, van Leeuwen PJ, et al. Using prostatespecific membrane antigen positron-emission tomography to guide prostate biopsies and stage men at high-risk of prostate cancer. BJU Int 2023; 132:705-712.","DOI":"10.1111\/bju.16167"},{"key":"216884","doi-asserted-by":"crossref","unstructured":"36. Pepe P, Pepe L, Curduman M, et al. Ductal prostate cancer staging: Role of PSMA PET\/CT. Arch Ital Urol Androl. 2024; 96:12132.","DOI":"10.4081\/aiua.2024.12132"},{"key":"216885","doi-asserted-by":"crossref","unstructured":"37. Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 2020;395:1208-16.","DOI":"10.1016\/S0140-6736(20)30314-7"},{"key":"216886","doi-asserted-by":"crossref","unstructured":"38. Pepe P, Pepe G, Pepe L, et al. Cost-effectiveness of multiparametric MRI in 800 men submitted to repeat prostate biopsy: results of a public health model. Anticancer Res 2018; 38:2395-8.","DOI":"10.21873\/anticanres.12489"},{"key":"216887","doi-asserted-by":"crossref","unstructured":"39. Mazzone E, Cannoletta D, Quarta L, et al. A comprehensive systematic review and meta-analysis of the role of prostate-specific membrane antigen positron emission tomography for prostate cancer diagnosis and primary staging before definitive treatment. Eur Urol 2025; 87:654-71.","DOI":"10.1016\/j.eururo.2025.03.003"},{"key":"216888","doi-asserted-by":"crossref","unstructured":"40. Miller SR, Chung DH, Gonzalez RT, et al. Impact of PSMA PET staging on initial treatment in newly diagnosed prostate cancer. J Nucl Med 2025; 66:1891-7.","DOI":"10.2967\/jnumed.124.268555"},{"key":"216889","doi-asserted-by":"crossref","unstructured":"41. Fandella A, Scattoni V, Galosi A, et al. Italian Prostate Biopsies Group: 2016 updated guidelines insights. Anticancer Res. 2017;37:413-424.","DOI":"10.21873\/anticanres.11333"},{"key":"216890","doi-asserted-by":"crossref","unstructured":"42. Fandella A. Analysis of costs of transrectal prostate biopsy. Urologia. 2011;78:288-92.","DOI":"10.5301\/RU.2011.8875"}],"container-title":["Archivio Italiano di Urologia e Andrologia"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14797\/13872","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14797\/13872","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:01:40Z","timestamp":1775001700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/view\/14797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3,31]]}},"URL":"https:\/\/doi.org\/10.4081\/aiua.2026.14797","relation":{},"ISSN":["2282-4197","1124-3562"],"issn-type":[{"value":"2282-4197","type":"electronic"},{"value":"1124-3562","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3,3]]}}}