Is cribriform pattern in prostate biopsy a risk factor for metastatic disease on 68Ga-PSMA-11 PET/CT?

Introduction Cribriform growth pattern (CP) in prostate cancer (PCa) has been associated with different unfavourable oncological outcomes. This study addresses if CP in prostate biopsies is an independent risk factor for metastatic disease on PSMA PET/CT. Methods Treatment-naive patients with ISUP GG ≥ 2 staged with 68 Ga-PSMA-11 PET/CT diagnosed from 2020 to 2021 were retrospectively enrolled. To test if CP in biopsies was an independent risk factor for metastatic disease on 68 Ga-PSMA PET/CT, regression analyses were performed. Secondary analyses were performed in different subgroups. Results A total of 401 patients were included. CP was reported in 252 (63%) patients. CP in biopsies was not an independent risk factor for metastatic disease on the 68 Ga-PSMA PET/CT ( p = 0.14). ISUP grade group (GG) 4 ( p = 0.006), GG 5 ( p = 0.003), higher PSA level groups per 10 ng/ml until > 50 ( p -value between 0.02 and > 0.001) and clinical EPE ( p > 0.001) were all independent risk factors. In the subgroups with GG 2 ( n = 99), GG 3 ( n = 110), intermediate-risk group ( n = 129) or the high-risk group ( n = 272), CP in biopsies was also not an independent risk factor for metastatic disease on 68 Ga-PSMA PET/CT. If the EAU guideline recommendation for performing metastatic screening was applied as threshold for PSMA PET/CT imaging, in 9(2%) patients, metastatic disease was missed, and 18% fewer PSMA PET/CT would have been performed. Conclusion This retrospective study found that CP in biopsies was not an independent risk factor for metastatic disease on 68Ga-PSMA PET/CT.