Prostate specific membrane antigen positron emission tomography for lesion-directed high-dose-rate brachytherapy dose escalation

Christopher W. Smith, Ryan Alfano, Douglas Hoover, Kathleen Surry, David D'Souza, Jonathan Thiessen, Irina Rachinsky, John Butler, Jose A. Gomez, Mena Gaed, Madeleine Moussa, Joseph Chin, Stephen Pautler, Glenn S. Bauman, Aaron D. Ward

Research output: Contribution to journalArticlepeer-review


Background and purpose: Prostate specific membrane antigen positron emission tomography imaging (PSMA-PET) has demonstrated potential for intra-prostatic lesion localization. We leveraged our existing database of co-registered PSMA-PET imaging with cross sectional digitized pathology to model dose coverage of histologically-defined prostate cancer when tailoring brachytherapy dose escalation based on PSMA-PET imaging. Materials and methods: Using a previously-developed automated approach, we created segmentation volumes delineating underlying dominant intraprostatic lesions for ten men with co-registered pathology-imaging datasets. To simulate realistic high-dose-rate brachytherapy (HDR-BT) treatments, we registered the PSMA-PET-defined segmentation volumes and underlying cancer to 3D trans-rectal ultrasound images of HDR-BT cases where 15 Gray (Gy) was delivered. We applied dose/volume optimization to focally target the dominant intraprostatic lesion identified on PSMA-PET. We then compared histopathology dose for all high-grade cancer within whole-gland treatment plans versus PSMA-PET-targeted plans. Histopathology dose was analyzed for all clinically significant cancer with a Gleason score of 7or greater. Results: The standard whole-gland plans achieved a median [interquartile range] D98 of 15.2 [13.8–16.4] Gy to the histologically-defined cancer, while the targeted plans achieved a significantly higher D98 of 16.5 [15.0–19.0] Gy (p = 0.007). Conclusion: This study is the first to use digital histology to confirm the effectiveness of PSMA-PET HDR-BT dose escalation using automatically generated contours. Based on the findings of this study, PSMA-PET lesion dose escalation can lead to increased dose to the ground truth histologically defined cancer.

Original languageEnglish
Pages (from-to)102-107
Number of pages6
JournalPhysics and Imaging in Radiation Oncology
StatePublished - 1 Jul 2021
Externally publishedYes


  • Dominant intraprostatic lesion
  • High dose rate brachytherapy
  • Positron emission tomography
  • Prostate cancer
  • Targeted radiation therapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging


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