Comparison of percentage free PSA, MRI and GaPSMA PET scan for diagnosing cancer prostate in men with PSA between 4 and 20 ng/ml

Abstract

Introduction: We compared the diagnostic accuracy of percentage free prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and gallium-68 prostate-specific membrane antigen positron emission tomography (Ga-PSMA PET) to detect cancer prostate in men with PSA between 4 and 20 ng/ml in prebiopsy settings. Materials and Methods: This prospective study evaluated men with PSA values between 4 and 20 ng/ml, and all patients underwent percentage free PSA estimation, mpMRI, and Ga-PSMA PET scan, followed by cognitive fusion/registration biopsy along with systematic 12-core biopsy to detect cancer prostate. The diagnostic accuracy of percentage free PSA, mpMRI, and Ga-PSMA PET scan was compared with results of cognitive fusion/registration biopsy. Results: A total of 15 patients were included, of which 11 had an identifiable lesion on imaging and 9 had malignancy on the final histopathology report. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy of mpMRI were 62.5%, 71.4%, 71.4%, 62.5%, and 66.6%, respectively, and that of Ga-PSMA PET scan were 88.8%, 66.6%, 80%, 80%, and 80%, respectively. The sensitivity of detection of clinically significant cancers for Ga-PSMA was higher (100%) compared to MRI (33.3%). However, Ga-PSMA also detected a greater number of insignificant lesions as compared to MRI. Conclusion: Ga-PSMA PET scan has high NPV and accuracy in predicting presence of cancer and can also be used to direct specific biopsy cores during systematic biopsy.

New Screening Test Improves Detection of Prostate Cancer Using Circulating Tumor Cells and Prostate-Specific Markers

“…The superior diagnostic accuracy of the PSMA-PET scan compared to MRI and PET imaging alone in the detection of primary prostate cancer, its usefulness in screening, as well as guiding biopsies have been described in several independent studies (37)(38)(39).…”

The Role of [68Ga]PSMA PET/CT for Clinical Suspicion of Prostate Cancer in Patients with or without Previous Negative Biopsy: A Systematic Review

“…After initial screening according to titles, eligible criteria, and removal of duplicates, a total of 25 articles were selected. Of these, 18 were finally included and downloaded in a full-text version [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. No further studies were added after examination of the references of these articles ( Figure 1 : PRISMA flowchart of the study).…”

“…Two experienced nuclear medicine specialists always interpreted results by consensus. In 8 articles, there was a direct comparison with MRI [ 22 , 23 , 26 , 28 , 31 , 32 , 33 , 35 ]. In 7 of them, MRI scans were acquired on 3.0 Tesla (T) MRI by four sequences: T1-weighted imaging, T2-weighted imaging, fat-suppression presaturation-attenuated inversion recovery, and diffusion-weighted imaging (DWI); PI-RADS v2.0 was used for reporting images in all of them.…”

“…Total prostatectomy or prostate biopsy defining csPCa as Gleason score ≥ 7 or based on the International Society of Urological Pathology (ISUP) grade system represented the standard reference. In particular, 12 out of 18 articles used TRUS-guided biopsy as gold standard [ 22 , 23 , 24 , 25 , 26 , 29 , 31 , 33 , 35 , 36 , 37 , 39 ], 4 PET/TRUS fusion–guided prostate biopsy [ 27 , 30 , 32 , 38 ], and 2 radical prostatectomy specimen [ 28 , 34 ].…”

Comparison of Multiparametric Magnetic Resonance Imaging and Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Detecting Carcinoma Prostate in Patients with Serum Prostate-Specific Antigen between 4 and 20 ng/ml

“…However, another recent study showed that Ga-PSMA PET scan has a higher NPV and accuracy than mpMRI in detecting tumor foci within the prostate. [ 16 ] There are reports where targeted biopsy using PSMA PET/CT is being explored with success. [ 17 ] This may be more beneficial in cases which are equivocal on serum PSA and mpMRI.…”