Abstract
PurposeTo assess 68Ga-PSMA PET/CT for detection of low- and intermediate-risk prostate cancer (PCa), high-risk PCa in comparison with mpMRI, respectively, and to determine which of low- and intermediate-risk PCa are more likely to be detected by 68Ga-PSMA PET/CT.MethodsWe conducted a retrospective analysis of patients who had undergone a prostate biopsy and/or radical prostatectomy and who were scanned with 68Ga-PSMA PET/CT and mpMRI between June 2019 and March 2021. The mpMRI images were scored with the Prostate Imaging-Reporting and Data System Version 2.1 (PI-RADS) and were classified as either negative (PI-RADS 1–3) or positive (PI-RADS 4–5). Suspicious 68Ga-PSMA PET/CT lesions were reviewed for each relevant patient and classified by double-trained board-certified nuclear medicine physicians. The results were evaluated with the histopathological outcome. All patients were classified according to the D’Amico classification, and the clinical data were combined for stratified analysis.ResultA total of 101 patients who were pathologically diagnosed with PCa were analyzed. Of the 101 patients, 88 (80.6%) patients presented with a pathologic mpMRI, and 85 (79.1%) with a pathologic 68Ga-PSMA PET/CT. In the high-risk PCa cohort, 68Ga-PSMA PET/CT was positive in 64/66 (97.0%) patients and yielded a higher detection rate than that for the mpMRI patients (58/66, 87.9%; p < 0.05). However, mpMRI provided superior diagnostic confidence in identifying low- and intermediate-risk PCa (30/35, 85.7% vs. 21/35, 60.0%; p < 0.05). When the age threshold exceeded 62.5 years and the serum prostate specific antigen (PSA) threshold exceeded 9.4 ng/ml, a higher uptake of PSMA was more likely to occur in the lesions of low- and intermediate-risk PCa.ConclusionThe diagnostic performance of 68Ga-PSMA PET/CT was superior to that of mpMRI in the high-risk PCa cohort, which was consistent with prior studies. Furthermore, in the initial diagnosis of low- and intermediate-risk PCa, we found that mpMRI showed a higher diagnostic accuracy than 68Ga-PSMA PET/CT did. Low- and intermediate-risk PCa patients with a PSA ≥ 9.4 ng/ml and age ≥ 62.5 years were more likely to have a positive 68Ga-PSMA PET/CT result.
Highlights
Prostate cancer (PCa) remains one of the most prevalent cancers in the world and a significant cause of death in many regions [1]
The diagnostic performance of 68Ga-PSMA PET/CT was superior to that of multiparametric magnetic resonance imaging (mpMRI) in the high-risk PCa cohort, which was consistent with prior studies
Patients were excluded from the study if their Gleason score (GS) or mpMRI results were not available (n = 40); the interval between the PET/CT and mpMRI was over 3 months (n = 16); or because they underwent treatments such as androgen deprivation therapy (ADT) (n = 30), chemotherapy (n = 2), and radiotherapy (n = 4) prior to PET/CT and magnetic resonance imaging (MRI)
Summary
Prostate cancer (PCa) remains one of the most prevalent cancers in the world and a significant cause of death in many regions [1]. The early detection of PCa is of great importance for proper disease management and is dependent on the accuracy of imaging to quantify the extent and location of lesions [4, 5]. Prostate multiparametric magnetic resonance imaging (mpMRI) is a readily available and well-established technique for the evaluation of PCa, which has favorable diagnostic accuracy in PCa detection, and can decrease unnecessary biopsies and instances of nonsignificant PCa diagnoses [6, 7]. MpMRI is evaluated using the Prostate Imaging-Reporting and Data System (PI-RADS) and is currently revolutionizing the PCa diagnostic pathway [8]. MpMRI has a high specificity, it has a poor and heterogeneous sensitivity for local PCa staging, which is important for clinical decision-making and patient counseling [9, 10]
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