Abstract
The aim of the present study is to investigate the synergic role of 68Ga-PSMA PET/MRI and 68Ga-DOTA-RM2 PET/MRI in prostate cancer (PCa) staging. We present pilot data on twenty-two patients with biopsy-proven PCa that underwent 68Ga-PSMA PET/MRI for staging purposes, with 19/22 also undergoing 68Gaa-DOTA-RM2 PET/MRI. TNM classification based on image findings was performed and quantitative imaging parameters were collected for each scan. Furthermore, twelve patients underwent radical prostatectomy with the availability of histological data that were used as the gold standard to validate intraprostatic findings. A DICE score between regions of interest manually segmented on the primary tumour on 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and on T2 MRI was computed. All imaging modalities detected the primary PCa in 18/19 patients, with 68Ga-DOTA-RM2 PET not detecting any lesion in 1/19 patients. In the remaining patients, 68Ga-PSMA and MRI were concordant. Seven patients presented seminal vesicles involvement on MRI, with two of these being also detected by 68Ga-PSMA, and 68Ga-DOTA-RM2 PET being negative. Regarding extraprostatic disease, 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and MRI resulted positive in seven, four and five patients at lymph-nodal level, respectively, and at a bone level in three, zero and one patients, respectively. These preliminary results suggest the potential complementary role of 68Ga-PSMA PET, 68Ga-DOTA-RM2 PET and MRI in PCa characterization during the staging phase.
Highlights
Prostate cancer (PCa) is one of the worldwide leading causes of cancer-related death.Approximately 15% of men present with high-risk prostate cancer (PCa), which is characterized by an increased risk of extracapsular extension, locally advanced disease, and/or bone metastases [1]
The current EAU-ESTRO-SIOG guidelines report that Positron Emission Tomography/Computed Tomography (CT) (PET/CT) is a valuable imaging modality that might be considered in men with high-risk diseases undergoing initial staging [3]
The aim of the present study is to report our preliminary experience on the synergic use of 68 Ga-prostate-specific membrane antigen (PSMA) PET/Magnetic ResonanceImaging (MRI) and 68 Ga-RM2 PET/MRI in prostate cancer staging
Summary
Prostate cancer (PCa) is one of the worldwide leading causes of cancer-related death. 15% of men present with high-risk PCa, which is characterized by an increased risk of extracapsular extension, locally advanced disease, and/or bone metastases [1]. At diagnosis, a whole-body staging for high-risk PCa patients is strongly recommended regardless of the surgical or radiation-based treatment decision [2]. The current staging of intermediate and high-risk PCa includes imaging of abdomen and pelvis performed by using Computed Tomography (CT) or Magnetic Resonance. Imaging (MRI) and bone scan to evaluate potential sites of metastatic spread. The current EAU-ESTRO-SIOG guidelines report that Positron Emission Tomography/CT (PET/CT) is a valuable imaging modality that might be considered in men with high-risk diseases undergoing initial staging [3]. As no randomised-control trials demonstrating survival benefit are available yet, its role in guiding therapeutic decisions must be cautious [3]
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