Abstract
Simple SummaryPrecise staging is key for the optimal management of advanced prostate cancer. PSMA PET-CT and WB-MRI outperform standard imaging technology for staging high-risk prostate cancer, but direct comparison between both modalities is lacking. The primary endpoint of our study was to compare the diagnostic accuracy of both techniques in the detection of lymph node, bone and visceral metastases against a best valuable comparator (BVC), defined as a consensus adjudication of all lesions on the basis of baseline and follow-up imaging, biological and clinical data and histopathologic confirmation when available. Knowing the diagnostic accuracy of both next generation imaging modalities might influence the diagnostic and therapeutic strategy in prostate cancer by tailoring therapy. However, the impact on treatment and patient outcome of an improved detection of metastases has not been determined yet.Background: Prostate specific membrane antigen (PSMA) positron emission tomography computed tomography (PET-CT) and whole-body magnetic resonance imaging (WB-MRI) outperform standard imaging technology for the detection of metastasis in prostate cancer (PCa). There are few direct comparisons between both modalities. This paper compares the diagnostic accuracy of PSMA PET-CT and WB-MRI for the detection of metastasis in PCa. One hundred thirty-four patients with newly diagnosed PCa (n = 81) or biochemical recurrence after curative treatment (n = 53) with high-risk features prospectively underwent PSMA PET-CT and WB-MRI. The diagnostic accuracy of both techniques for lymph node, skeletal and visceral metastases was compared against a best valuable comparator (BVC). Overall, no significant difference was detected between PSMA PET-CT and WB-MRI to identify metastatic patients when considering lymph nodes, skeletal and visceral metastases together (AUC = 0.96 (0.92–0.99) vs. 0.90 (0.85–0.95); p = 0.09). PSMA PET-CT, however, outperformed WB-MRI in the subgroup of patients with newly diagnosed PCa for the detection of lymph node metastases (AUC = 0.96 (0.92–0.99) vs. 0.86 (0.79–0.92); p = 0.0096). In conclusion, PSMA PET-CT outperforms WB-MRI for the detection of nodal metastases in primary staging of PCa.
Highlights
Precise staging is key for the optimal management of advanced prostate cancer (PCa)
International guidelines still do not recommend the use of these new imaging techniques, apart for Prostate specific membrane antigen (PSMA) positron emission tomography computed tomography (PET-computed tomography (CT)) which is acknowledged as a standard of care in patients presenting with a PSA recurrence (BCR) after local treatment [7,8,9]
Detection of metastases may reclassify patients with newly diagnosed (ND) PCa from high-risk localized to metastatic with the consequence of omitting local treatment or consolidating systemic treatment with a last generation androgen receptor targeted agent (ARTA)
Summary
Precise staging is key for the optimal management of advanced prostate cancer (PCa) It supports local treatment, and, increasingly, emerging therapies such as metastasis targeted therapies (MDT) [1]. There is compelling evidence that emerging imaging technologies such as 68Ga-PSMA-11 positron emission tomography CT (PSMA PET-CT) and whole-body magnetic resonance imaging (WB-MRI) with diffusion weighted imaging (DWI) outperform bone scintigraphy and thoraco-abdomino-pelvic CT for the detection of PCa metastases [2,3,4,5,6] Despite this evidence, international guidelines still do not recommend the use of these new imaging techniques, apart for PSMA PET-CT which is acknowledged as a standard of care in patients presenting with a PSA recurrence (BCR) after local treatment [7,8,9].
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