TY - JOUR
T1 - Diagnostic accuracy of 68Ga-prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) and multiparametric (mp)MRI to detect intermediate-grade intra-prostatic prostate cancer using whole-mount pathology: impact of the addition of 68Ga-PSMA PET to mpMRI
AU - Scheltema, Matthijs J.
AU - Chang, John I.
AU - Stricker, Phillip D.
AU - van Leeuwen, Pim J.
AU - Nguyen, Quoc A.
AU - Ho, Bao
AU - Delprado, Warick
AU - Lee, Jonathan
AU - Thompson, James E.
AU - Cusick, Thomas
AU - Spriensma, Alette S.
AU - Siriwardana, Amila R.
AU - Yuen, Carlo
AU - Kooner, Raji
AU - Hruby, George
AU - O'Neill, Gordon
AU - Emmett, Louise
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Objective: To evaluate the ability of prostate-specific membrane antigen (PSMA)-positron-emission tomography (PET)/computed tomography (CT) to detect intermediate-grade intra-prostatic prostate cancer (PCa), and to determine if PSMA-PET improves the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI). Patients and Methods: A total of 56 consecutive patients with International Society of Urological Pathology (ISUP) grade 2–3 PCa after radical prostatectomy, who underwent both mpMRI and PSMA-PET CT (hereafter PSMA-PET) preoperatively, were enrolled in this study. The accuracy of PSMA-PET, mpMRI alone, and the two procedures in combination was analysed for identifying ISUP grades 1–3 within a 12-segment model. The accuracy of a combined predictive model (PSMA-PET and mpMRI) was determined. Receiver-operating characteristic curve analysis to determine the optimal standardized uptake value (SUVmax) for PSMA-PET in discriminating between ISUP grades 1 and ≥2 was performed. Results: On a per-patient basis, the sensitivities for PSMA-PET and mpMRI in identifying ISUP grades 2–3 PCa were 100% and 97%, respectively. Assessing ISUP grade ≥2 PCa using a 12-segment analysis, PSMA-PET demonstrated greater diagnostic accuracy (area under the curve), sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV), with values of 0.91, 88%, 93%, 95% and 85%, respectively, than did mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] 3–5), at 0.79, 68%, 91%, 87%, and 75%, respectively. When used in combination (PSMA-PET and mpMRI PIRADS 4–5), sensitivity, specificity, NPV and PPV were 92%, 90%, 96% and 81%, respectively. The sensitivity for both techniques reduced markedly when assessing ISUP grade 1 PCa (18% for PSMA-PET, 10% for mpMRI). An SUVmax value of 3.95 resulted in 94% sensitivity and 100% specificity. Conclusion: PSMA-PET is accurate in detecting segments containing intermediate-grade intra-prostatic PCa (ISUP grade ≥ 2), compared with and complementary to mpMRI. By contrast the detection rate for ISUP grade 1 disease for both PSMA-PET and mpMRI was low.
AB - Objective: To evaluate the ability of prostate-specific membrane antigen (PSMA)-positron-emission tomography (PET)/computed tomography (CT) to detect intermediate-grade intra-prostatic prostate cancer (PCa), and to determine if PSMA-PET improves the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI). Patients and Methods: A total of 56 consecutive patients with International Society of Urological Pathology (ISUP) grade 2–3 PCa after radical prostatectomy, who underwent both mpMRI and PSMA-PET CT (hereafter PSMA-PET) preoperatively, were enrolled in this study. The accuracy of PSMA-PET, mpMRI alone, and the two procedures in combination was analysed for identifying ISUP grades 1–3 within a 12-segment model. The accuracy of a combined predictive model (PSMA-PET and mpMRI) was determined. Receiver-operating characteristic curve analysis to determine the optimal standardized uptake value (SUVmax) for PSMA-PET in discriminating between ISUP grades 1 and ≥2 was performed. Results: On a per-patient basis, the sensitivities for PSMA-PET and mpMRI in identifying ISUP grades 2–3 PCa were 100% and 97%, respectively. Assessing ISUP grade ≥2 PCa using a 12-segment analysis, PSMA-PET demonstrated greater diagnostic accuracy (area under the curve), sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV), with values of 0.91, 88%, 93%, 95% and 85%, respectively, than did mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] 3–5), at 0.79, 68%, 91%, 87%, and 75%, respectively. When used in combination (PSMA-PET and mpMRI PIRADS 4–5), sensitivity, specificity, NPV and PPV were 92%, 90%, 96% and 81%, respectively. The sensitivity for both techniques reduced markedly when assessing ISUP grade 1 PCa (18% for PSMA-PET, 10% for mpMRI). An SUVmax value of 3.95 resulted in 94% sensitivity and 100% specificity. Conclusion: PSMA-PET is accurate in detecting segments containing intermediate-grade intra-prostatic PCa (ISUP grade ≥ 2), compared with and complementary to mpMRI. By contrast the detection rate for ISUP grade 1 disease for both PSMA-PET and mpMRI was low.
KW - #PCSM
KW - #ProstateCancer
KW - diagnostic imaging
KW - mpMRI
KW - PET-CT
KW - prostate cancer
KW - PSMA
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85068710152&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31287613
U2 - 10.1111/bju.14794
DO - 10.1111/bju.14794
M3 - Article
C2 - 31287613
VL - 124
SP - 42
EP - 49
JO - BJU International
JF - BJU International
SN - 1464-4096
IS - S1
ER -