Multiparametric magnetic resonance imaging, ⁶⁸Ga prostate-specific membrane antigen positron emission tomography–Computed tomography, and respective quantitative parameters in detection and localization of clinically significant prostate cancer in intermediate- and high-risk group patients: An Indian demographic study

Abstract

Objectives: The objective of this study was to evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) and 68 Ga prostate-specific membrane antigen positron emission tomography–computed tomography (PSMA PET-CT) and respective quantitative parameters (K trans – influx rate contrast, K ep – efflux rate constant, ADC – apparent diffusion coefficient, and SUVmax ratio – prostate SUVmax to background SUVmax ratio) in detection and localization of clinically significant prostate cancer (CSPCa) in D’Amico intermediate- and high-risk group patients (prostate-specific antigen [PSA] >10 ng/ml). Methodology: The study included thirty-three consecutive adult men with serum prostate specific antigen >10ng/ml, and systematic 12 core prostate biopsy proven prostate cancer. All the 33 patients, were evaluated with mpMRI, and 68 Ga PSMA PET-CT. The biopsy specimens and imaging were evaluated for 12 sectors per prostate by a predetermined scheme. Results: MpMRI Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score ≥3 showed higher sensitivity than 68 Ga PSMA PET-CT (96.3% vs. 82.4%), with similar specificity (54.5% vs. 54.5%) ( n = 33 patients, 396 sectors). Combined use of MRI and 68 Ga PSMA PET-CT in parallel increased sensitivity (99.5%) and NPV (98.7%) for detection of CSPCa and combined use of MRI and 68 Ga PSMA PET-CT in series increased specificity (71.8%) and PPV (71.5%) ( n = 33 patients, 396 sectors). ADC showed a strong negative correlation with Gleason score (r = −0.77), and the highest discriminative ability for detection and localization of CSPCa (area under curve [AUC]: 0.91), followed by K trans ( r = 0.74; AUC: 0.89), PI-RADS (0.73; 0.86), SUVmax ratio (0.49; 0.74), and K ep (0.24; 0.66). Conclusion: MpMRI PI-RADS v2 score and 68 Ga PSMA PET-CT (individually as well as in combination) are reliable tool for detection and localization of CSPCa. Quantitative MRI and 68 Ga PSMA PET-CT parameters have potential to predict Gleason score and detect CSPCa.

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

“…28,31,39,49 The injected activity of 68 G-PSMA was 74 to 185 MBq. 23,34,50 In addition to the radiotracer 68 Ga-PSMA, the median median/mean injected activity of 18 F-DCFPyL was 294.6 MBq (range, 250-329.5 MBq), 8,29,38,40 and that of 18 F-PSMA-1007 was 256 MBq. 41 The median of median/ mean interval time between radiotracer injection and PET scanning was 60 minutes (range, 45-180 minutes) 7,8,10,11,21,22,24,[26][27][28][29][30]32,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] (Supplementary Table 1, Supplemental Digital Content, http://links.…”

“…Among the 39 included studies, 3.0 Twas the most commonly used diagnostic equipment for mpMRI (64%), 8,[10][11][12][20][21][22]24,[26][27][28][29]31,32,34,37,39,40,44,45,[47][48][49]52,53 and 69% of the mpMRI sequence used T2-weighted and diffusion-weighted. [8][9][10][11]20,[22][23][24][25]29,34,35,37,39,40,[42][43][44][45][46][47][48][49][50][51][52][53]<...…”

“…All the included studies were verified using histopathological criterion standards. However, tissue sources for pathological analysis involved surgical with radical prostatectomy 7,8,[20][21][22][23][24][25][26]31,36,[39][40][41][42]44,49,51,53 and prostate biopsies by TRUS Bx, MRI-targeted biopsy, MRI-fusion biopsy 9,11,12,[27][28][29][32][33][34][35]37,38,43,[45][46][47][48]50,52,54 (Supplementary Table 1, Supplemental Digital Content, http://links.lww.com/CNM/A420). Finally, mpMRI and PSMA PET were both performed before the biopsy or surgery in 33 of all included studies.…”

“…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]…”

“…There were 14 of 23 studies that evaluated the diagnostic performance of PSMA PET in combination with mpMRI for localized prostatic tumors, 8,10,24,25,28,[32][33][34]41,42,44,45,47,54 of which 9 studies described the sensitivity and specificity of PSMA PET and mpMRI. 8,10,24,28,32,34,44,45,47 In the combination of PSMA PET and mpMRI, the sensitivity and specificity of the examination were 0.82 (0.77-9.55) and 0.77 (0.59-0.92), similar to the sensitivity and specificity of the single imaging tool (Table 3).…”