Comparison of 68Ga-PSMA-I/T PET-CT and Multiparametric MRI for Locoregional Staging of Prostate Cancer Patients: A Pilot Study

Abstract

Background/Aim: The objective of this work was to assess the value of 68 Ga-DOTAGA-(3-iodo-y)fk(Sub-KuE) positron emission tomography (68 Ga-PSMA-I/T PET-CT) and multiparametric magnetic resonance imaging (mp-MRI) for preoperative staging in prostate cancer (PCa) patients who underwent radical prostatectomy (RP) by validating with postoperative histopathology data. Materials and Methods: We prospectively investigated 30 consecutive PCa patients who had both mp-MRI and 68 Ga-PSMA-I/T PET-CT before laparoscopic RP. The seminal vesicle invasion (SVI), lymph node metastasis (LNM), bladder neck invasion (BNI), and extracapsular extension (ECE) were investigated separately. The diagnostic performances of mp-MRI and 68 Ga-PSMA-I/T PET-CT were assessed using histopathological results. Results: Both mp-MRI and 68 Ga-PSMA-I/T PET-CT were not statistically significant in the evaluation of SVI, BNI, and ECE preoperatively but had statistically significant results in the assessment of LNM. mp-MRI had higher overall sensitivity for ECE, overall specificity for SVI, ECE, and BNI, and positive predictive value for ECE, SVI, BNI. 68 Ga-PSMA-I/T PET-CT had higher overall sensitivity for BNI, and negative predictive value for BNI and LNM. Conclusion: mp-MRI has superior specificity, sensitivity, and accuracy for assessing ECE and SVI. Both imaging modalities had similar specificity, sensitivity, and accuracy for determining BNI. However, both imaging modalities had low diagnostic accuracy for LNM on histopathology.

Comparing the Detection Performance Between Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen PET/CT in Patients With Localized Prostate Cancer

“…4, Supplemental Digital Content, http://links.lww.com/CNM/ A420). [7][8][9][10][11][12][20][21][22][23][24][25][26][27][28][29] Following this, the sensitivity and specificity after combining PSMA PET/CT and mpMRI were also not superior to the single imaging tool alone (Table 3). 8,10,24,28,32,34,44,45,47 It is noticed that PSMA PET/CT imaging was more sensitive than mpMRI for localized tumor lesions in a subgroup analysis of PSAvalues less than 10 ng/mL, despite similar specificity in current meta-analysis (Supplementary Fig.…”

“…The current meta-analysis included a total of 39 studies comprising 3630 patients, published between 2016 and 2022, 7,8,[10][11][12] with 38.5% (15 studies) of the studies being prospective studies. 12,22,23,28,29,34,35,[37][38][39][45][46][47]49,50 In all included studies, the 68 Ga-PSMA radiotracer was predominantly used (82.1%), whereas 68 Ga-PSMA-11 was the major radiotracer (n = 23). 7,[20][21][22][24][25][26][27][28][30][31][32]35,36,39,[42][43][44][46][47][48][49]51,52 Only a few studies used the radiotracers 18 F-DCFPyL 8,11,29,38,…”

“…Finally, mpMRI and PSMA PET were both performed before the biopsy or surgery in 33 of all included studies. 7,8,[10][11][12][20][21][22][23][24][25][26]28,29,31,[33][34][35][36][37][38][39][40][41][42]44,46,47,49,[51][52][53]…”

“…All 39 included studies were pathologically verified, but only 31 of them clearly estimated the number of lesions that were TP/FP and negative, including localized tumors (23 studies) 8,10,11,[20][21][22]24,[26][27][28][29]32,34,35,37,38,40,[44][45][46]49,52,53 and T staging (8 studies). 7,8,23,25,33,39,41 For localized prostate tumors, the pooled sensitivity and specificity of PSMA PET were 0.84 (95% CI, 0.83-0.86) and 0.72 (95% CI, 0.57-0.83), whereas those of mpMRI were 0.84 (95% CI, 2).…”

The Role of PSMA PET Imaging in Prostate Cancer Theranostics: A Nationwide Survey

“…However, the benefit of PSMA PET imaging in the primary diagnosis and staging of PCa is still unclear [6, 7]. Recently, published data indicate that the use of PSMA PET imaging might enhance the visualization and detection rate of PCa [8]. Therefore, the PRIMARY trial investigating the detection of clinically significant PCa by a combination of PSMA PET-CT with multiparametric MRI compared to targeted biopsies and the probability of avoiding unnecessary prostate biopsies will provide conclusions in the future [9].…”