Abstract
Purpose18F-DCFPyL prostate-specific membrane antigen (PSMA) PET/CT is commonly applied to locate lesions of prostate cancer (PCa), but its diagnostic function of quantitative parameters is ignored. Our study evaluates the parameters of intraprostatic PSMA uptake in patients newly diagnosed with PCa and explores their predictive value in risk classification, which is similar to D’Amico criteria.Materials and MethodsWe quantified the maximal standardized uptake value (SUVmax), mean SUV (SUVmean), total lesion (TL)-PSMA, prostate/muscle (P/M) ratio of the primary tumor, and PSMA-derived tumor volume (PSMA-TV) from 62 patients with histologically proven PCa. Patients newly diagnosed with PCa were allocated into risk groups (at low, intermediate, and high risk, respectively) in accordance with D’Amico criteria. Afterwards, the five parameters mentioned above among three different risk groups were compared, and their predictive values in the risk classification of PCa were explored.ResultsSignificantly decreased levels of SUVmax, SUVmean, TL-PSMA, and P/M ratio were observed in the risk groups of low or intermediate or both, compared with the high-risk group. However, only the P/M ratio significantly elevated in patients with intermediate risk [mean ± SD (median): 46.58 ± 9.74 (45.27), P = 0.042] or high risk [98.95 ± 38.83 (97.52), P < 0.001], compared with low-risk patients [12.33 ± 5.93 (9.81)]. When P/M ratio was used to distinguish between low-risk and intermediate-risk patients, its c-statistics was 0.660. On the other hand, when distinguishing between intermediate-risk and high-risk groups, the c-statistics of P/M ratio was 0.667. Finally, when P/M ratio was used to distinguish between low-risk and high-risk patients, the c-statistics was 0.969. P/M ratio had a positive correlation with prostate-specific antigen in all enrolled PCa patients.ConclusionThe quantitative parameters of 18F-DCFPyL PET/CT, including SUVmax, SUVmean, and P/M ratio, might assist in distinguishing low-risk or intermediate-risk groups from the high-risk group. Of these parameters, P/M ratio appears to be the better promising parameter for risk classification of prostate cancer than SUVmax.
Highlights
Prostate cancer (PCa) is a common male malignancy worldwide and is the second leading cause in men who die of cancer in the Western world [1]
Decreased levels of SUVmax, SUVmean, total lesion (TL)-prostate-specific membrane antigen (PSMA), and prostate/ muscle (P/M) ratio were observed in the low- or intermediate-risk groups or both, compared with the high-risk group
The five commonly used parameters of intraprostatic PSMA uptake were compared in different PCa risk groups, and
Summary
Prostate cancer (PCa) is a common male malignancy worldwide and is the second leading cause in men who die of cancer in the Western world [1]. It is reported that men have a 14% possibility of developing prostate cancer in their lifetime [2] It is important for newly diagnosed patients to diagnose prostate cancer correctly and rank its severity. A previous meta-analysis has pointed out that conventional imaging techniques like CT and magnetic resonance imaging (MRI) have a sensitivity of 39%–42% and a specificity of 82% [3] when used in the diagnosis of prostate cancer. In this regard, prostate-specific membrane antigen (PSMA) PET/CT becomes an advantageous imaging method to detect prostate cancer lesions, which has a sensitivity of 67% to 97% [4]. It even changed 50% to 87% of clinical treatment plans, which were previously based on the results of choline PET/CT examination [5, 6]
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