You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-18 PRIMARY METASTASIS STAGING USING 18F-PSMA-1007 PET-CT IN HIGH-RISK PROSTATE CANCER Mikael Anttinen*, Otto Ettala, Simona Malaspina, Ivan Jambor, Minna Sandell, Sami Kajander, Irina Rinta-Kiikka, Jukka Schildt, Ekaterina Saukko, Pentti Rautio, Kirsi L. Timonen, Tommi Noponen, Jani Saunavaara, Eliisa Löyttyniemi, Pekka Taimen, Jukka Kemppainen, Peter B. Dean, Roberto Sequeiros Blanco, Hannu J. Aronen, Marko Seppänen, and Peter J. Boström Mikael Anttinen*Mikael Anttinen* More articles by this author , Otto EttalaOtto Ettala More articles by this author , Simona MalaspinaSimona Malaspina More articles by this author , Ivan JamborIvan Jambor More articles by this author , Minna SandellMinna Sandell More articles by this author , Sami KajanderSami Kajander More articles by this author , Irina Rinta-KiikkaIrina Rinta-Kiikka More articles by this author , Jukka SchildtJukka Schildt More articles by this author , Ekaterina SaukkoEkaterina Saukko More articles by this author , Pentti RautioPentti Rautio More articles by this author , Kirsi L. TimonenKirsi L. Timonen More articles by this author , Tommi NoponenTommi Noponen More articles by this author , Jani SaunavaaraJani Saunavaara More articles by this author , Eliisa LöyttyniemiEliisa Löyttyniemi More articles by this author , Pekka TaimenPekka Taimen More articles by this author , Jukka KemppainenJukka Kemppainen More articles by this author , Peter B. DeanPeter B. Dean More articles by this author , Roberto Sequeiros BlancoRoberto Sequeiros Blanco More articles by this author , Hannu J. AronenHannu J. Aronen More articles by this author , Marko SeppänenMarko Seppänen More articles by this author , and Peter J. BoströmPeter J. Boström More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Computed tomography (CT) and bone scintigraphy are currently the mainly used imaging modalities for primary metastasis staging of high-risk prostate cancer (PCa). This trial was designed to compare these standard staging modalities with three potentially more accurate imaging modalities: single photon emission computed tomography-CT (SPECT-CT), magnetic resonance imaging (MRI), prostate specific membrane antigen positron emission tomography (PSMA PET). METHODS: This prospective, registered (NCT03537391), ethics committee -approved, single-centre, open-label, single-arm trial enrolled patients with primary high-risk PCa. Results of standard bone scintigraphy and CT (chest, abdomen and pelvis) were compared with 99mTc-HMDP SPECT-CT, 1.5T WBMRI using diffusion weighted imaging and 18F-PSMA-1007 PET-CT. Each imaging modality was reviewed by two separate modality-based specialists blinded for the other modalities. The lesions were initially classified as benign, equivocal or malignant. Pessimistic and optimistic analyses were performed to resolve equivocal lesion status. Based on clinical data, including follow-up investigations (imaging, PSA kinetics, and histopathological specimens) the best valuable comparator was defined at lesion level in multidisciplinary consensus meetings. The lesions reported from each modality were rated according to this comparator, which was either benign or malignant. RESULTS: 79 men were included and underwent all imaging modalities, except for one MRI, which was cancelled due to claustrophobia. Mean age was 70 years and median PSA 12 ng/ml (range: 3-2000). Metastatic disease was detected in 27 patients. In pessimistic and optimistic analysis at patient, region (bone) and lesion levels, PSMA PET-CT was superior to all other modalities concerning sensitivity and the AUC values at the bone region (pessimistic analysis) [PET reader 1:0·94 (95%CI;0·90-0·99), PET reader 2: 0·96 (95%CI;0·92-0·99)], while maintaining high specificity and demonstrating the highest inter-reader agreement (PSMA PET κ=0.82;95%CI 0.69-0.95). The sensitivity values in pessimistic analysis at patient level were 0.93 (95%CI;0.77-0.98) and 0.96 (95%CI;0.82-0.99) for PSMA PET reader 1 and reader 2, respectively. PSMA PET-CT revealed metastatic disease in 18/27 patients where standard imaging was negative and 11/27 patients where all other imaging were negative. CONCLUSIONS: 18F-PSMA-1007 PET-CT significantly outperformed all other imaging methods in primary metastasis staging of high-risk PCa. We recommend further evaluation of this method as a new reference standard. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e952-e952 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mikael Anttinen* More articles by this author Otto Ettala More articles by this author Simona Malaspina More articles by this author Ivan Jambor More articles by this author Minna Sandell More articles by this author Sami Kajander More articles by this author Irina Rinta-Kiikka More articles by this author Jukka Schildt More articles by this author Ekaterina Saukko More articles by this author Pentti Rautio More articles by this author Kirsi L. Timonen More articles by this author Tommi Noponen More articles by this author Jani Saunavaara More articles by this author Eliisa Löyttyniemi More articles by this author Pekka Taimen More articles by this author Jukka Kemppainen More articles by this author Peter B. Dean More articles by this author Roberto Sequeiros Blanco More articles by this author Hannu J. Aronen More articles by this author Marko Seppänen More articles by this author Peter J. Boström More articles by this author Expand All Advertisement PDF downloadLoading ...