Abstract
The study was aimed at assessing the diagnostic performance of 68Ga-PSMA-617 PET/CT in the detection of prostate cancer (PCa) in patients with a prostate-specific antigen (PSA) level of 4–20 ng/ml and to compare its efficacy with that of multiparametric MRI (mpMRI). We analyzed the data of 67 consecutive patients with PSA levels of 4–20 ng/ml who almost simultaneously underwent 68Ga-PSMA-617 PET/CT and mpMRI. 68Ga-PSMA-617 PET/CT and mpMRI diagnostic performances were compared via receiver operating characteristic (ROC) curve analysis. Of the 67 suspected PCa cases, 33 had pathologically confirmed PCa. 68Ga-PSMA-617 PET/CT showed a patient-based sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) of 87.88%, 88.24%, 87.88%, and 88.24%, respectively. The corresponding values for mpMRI were 84.85%, 52.94%, 63.64%, and 78.26%. The area under the curve values for 68Ga-PSMA-617 PET/CT and mpMRI were 0.881 and 0.689, respectively. 68Ga-PSMA-617 PET/CT showed a better diagnostic performance than mpMRI in the detection of PCa in patients with PSA levels of 4–20 ng/ml.
Highlights
Abbreviations 68Ga Gallium-68 Areas under the receiver operating characteristic (ROC) curves (AUCs) Area under the curve confidence intervals (CIs) Confidence intervals decision curve analysis (DCA) Decision curve analysis digital rectal examination (DRE) Digital rectal examination DWI Diffusion-weighted imaging GS Gleason score mpMRI Multiparametric magnetic resonance imaging NCCN National Comprehensive Cancer Network PCa Prostate cancer PET/CT Positron emission tomography/computerized tomography Prostate Imaging Reporting and Data System (PI-RADS) Prostate imaging reporting and data system PSA Prostate-specific antigen prostate-specific membrane antigen (PSMA) Prostate-specific membrane antigen robot-assisted laparoscopic radical prostatectomy (RALRP) Robot-assisted laparoscopic radical prostatectomy
Our data support the hypothesis that 68Ga-PSMA-617 PET/CT can more accurately differentiate primary PCa with PSA levels of 4–20 ng/ml than mpMRI, and that 68Ga-PSMA-617 uptake is positively correlated with the clinical risk parameters GS and PSA level
Our study systematically evaluated the potential of 68Ga-PSMA-617 PET/CT for the detection of primary PCa with PSA levels of 4–20 ng/ml, and the findings indicated the excellent diagnostic performance of 68GaPSMA-617 PET/CT in comparison with mpMRI
Summary
Abbreviations 68Ga Gallium-68 AUC Area under the curve CIs Confidence intervals DCA Decision curve analysis DRE Digital rectal examination DWI Diffusion-weighted imaging GS Gleason score mpMRI Multiparametric magnetic resonance imaging NCCN National Comprehensive Cancer Network PCa Prostate cancer PET/CT Positron emission tomography/computerized tomography PI-RADS Prostate imaging reporting and data system PSA Prostate-specific antigen PSMA Prostate-specific membrane antigen RALRP Robot-assisted laparoscopic radical prostatectomy. The most prominent diagnostic difficulty associated with PSA screening is the detection of PCa in patients with PSA levels of 4–20 ng/ml, which is mainly reflected by relatively high false-positive and false-negative rates. It was reported that in patients with PSA levels of < 20 ng/ ml, the detection rate of PSA screening were less than 36% and the specificity was only approximately 10.27%6. The high false-positive rate of PSA screening may lead to unnecessary repeated prostate biopsies to verify or exclude the risk of malignancy, resulting in higher costs and adverse effects, such as infection, bleeding, and tissue damage. Multiparametric magnetic resonance imaging (mpMRI) is a modern non-invasive diagnostic tool for PCa detection, with high sensitivity and specificity, affording an improved diagnostic p erformance[7]. Thompson et al.[9] and Kim et al.[10] showed that mpMRI sensitivity for the detection of PCa was up to 96% while the specificity was only 36–58%, indicating a relatively high falsepositive rate
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