Abstract
BackgroundTo evaluate the diagnostic value of 68Ga-PSMA-11 PET-CT with multiparametric magnetic resonance imaging (mpMRI) for lymph node (LN) staging in patients with intermediate- to high-risk prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND).MethodsWe retrospectively identified 42 consecutive patients with intermediate- to high-risk PCa according to D′Amico and without concomitant cancer. Preoperative 68Ga-PSMA-11 PET-CT, pelvic mpMRI and subsequent robot assisted laparoscopic RP with PLND were performed in all patients.ResultsAmong 42 patients assessed, the preoperative PSA value, Gleason score, pT stage and intraprostatic PCa volume of patients with LN metastases were all significantly higher than those without metastases (P = 0.029, 0.028, 0.004, respectively). The average maximum standardized uptake value (SUV) of 68Ga-PSMA-11 PET-CT positive PCa of patients with or without LN metastases were 13.10 (range 6.12–51.75) and 7.22 (range 5.4–11.2), respectively (P < 0.001). 68Ga-PSMA-11 PET-CT and pelvic mpMRI had the ability of succeed on preoperative definite accurate diagnosis and accurate localization of primary PCa in all 42 patients. Fifteen patients (35.71%) had a pN1 stage. 51 positive LN were found. Both 68Ga-PSMA-11 PET-CT and pelvic mpMRI displayed brillient patient-based and region-based sensitivity, specificity, negative predictive value and positive predictive value. There was no statistical difference for the detection of LNMs according to the diameter of the LNMs between 68Ga-PSMA-11 PET-CT and mpMRI in this study.ConclusionsBoth 68Ga-PSMA-11 PET-CT and mpMRI performed great value for LN staging in patients with intermediate- to high-risk PCa undergoing RP with PLND. However, despite excellent performance of 68Ga-PSMA-11 PET-CT, it cannot replace mpMRI that remains excellent for lymph node staging.
Highlights
To evaluate the diagnostic value of 68Ga-prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET)-computed tomograph (CT) with multiparametric magnetic resonance imaging for lymph node (LN) staging in patients with intermediate- to high-risk prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND)
Patients From March 2017 to July 2017, forty-two consecutive patients with intermediate- to high-risk PCa according to D′Amico and without concomitant cancer who underwent 68Ga-PSMA-11 PET-CT imaging, pelvic multiparametric magnetic resonance imaging (mpMRI) and subsequent robot assisted laparoscopic RP with PLND at our institution were included into the study
68GaPSMA-11 PET-CT and pelvic mpMRI succeed on preoperative definite diagnosis and accurate localization of primary PCa in all 42 patients
Summary
To evaluate the diagnostic value of 68Ga-PSMA-11 PET-CT with multiparametric magnetic resonance imaging (mpMRI) for lymph node (LN) staging in patients with intermediate- to high-risk prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND). Current guidelines recommend computed tomograph (CT) or conventional magnetic resonance imaging (MRI, T1W and T2W sequences) to evaluate metastatic spread to LN prior to RP, especially for intermediate- or high-risk PCa [4]. These staging modalities depend solely on morphologic information and LN involvement is mainly assessed by size [5]. These techniques yielded relatively poor specificity for evaluating LN status
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