Comparison of 68Ga-PSMA PET/CT and multiparametric MRI for the detection of low- and intermediate-risk prostate cancer

Chuanchi Zhou; Yongxiang Tang; Zhihe Deng; Jinhui Yang; Ming Zhou; Long Wang; Shuo Hu

doi:10.1186/s13550-022-00881-3

Comparison of ⁶⁸Ga-PSMA PET/CT and multiparametric MRI for the detection of low- and intermediate-risk prostate cancer

EJNMMI Res. 2022 Feb 11;12(1):10. doi: 10.1186/s13550-022-00881-3.

Authors

Chuanchi Zhou^#^{1

2}, Yongxiang Tang^#³, Zhihe Deng^#⁴, Jinhui Yang³, Ming Zhou³, Long Wang⁵, Shuo Hu^{6

7

8}

Affiliations

¹ Department of Urology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China.
² Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
³ Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
⁴ Department of Vascular Surgery, The Second Affiliated Hospital of University of South China, Hengyang, China.
⁵ Department of Urology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China. wanglong@csu.edu.cn.
⁶ Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. hushuo2018@163.com.
⁷ Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China. hushuo2018@163.com.
⁸ National Clinical Research Center for Geriatric Disorders (XIANGYA), Changsha, China. hushuo2018@163.com.

^# Contributed equally.

Abstract

Purpose: To assess ⁶⁸Ga-PSMA PET/CT for detection of low- and intermediate-risk prostate cancer (PCa), high-risk PCa in comparison with mpMRI, respectively, and to determine which of low- and intermediate-risk PCa are more likely to be detected by ⁶⁸Ga-PSMA PET/CT.

Methods: We conducted a retrospective analysis of patients who had undergone a prostate biopsy and/or radical prostatectomy and who were scanned with ⁶⁸Ga-PSMA PET/CT and mpMRI between June 2019 and March 2021. The mpMRI images were scored with the Prostate Imaging-Reporting and Data System Version 2.1 (PI-RADS) and were classified as either negative (PI-RADS 1-3) or positive (PI-RADS 4-5). Suspicious ⁶⁸Ga-PSMA PET/CT lesions were reviewed for each relevant patient and classified by double-trained board-certified nuclear medicine physicians. The results were evaluated with the histopathological outcome. All patients were classified according to the D'Amico classification, and the clinical data were combined for stratified analysis.

Result: A total of 101 patients who were pathologically diagnosed with PCa were analyzed. Of the 101 patients, 88 (80.6%) patients presented with a pathologic mpMRI, and 85 (79.1%) with a pathologic ⁶⁸Ga-PSMA PET/CT. In the high-risk PCa cohort, ⁶⁸Ga-PSMA PET/CT was positive in 64/66 (97.0%) patients and yielded a higher detection rate than that for the mpMRI patients (58/66, 87.9%; p < 0.05). However, mpMRI provided superior diagnostic confidence in identifying low- and intermediate-risk PCa (30/35, 85.7% vs. 21/35, 60.0%; p < 0.05). When the age threshold exceeded 62.5 years and the serum prostate specific antigen (PSA) threshold exceeded 9.4 ng/ml, a higher uptake of PSMA was more likely to occur in the lesions of low- and intermediate-risk PCa.

Conclusion: The diagnostic performance of ⁶⁸Ga-PSMA PET/CT was superior to that of mpMRI in the high-risk PCa cohort, which was consistent with prior studies. Furthermore, in the initial diagnosis of low- and intermediate-risk PCa, we found that mpMRI showed a higher diagnostic accuracy than ⁶⁸Ga-PSMA PET/CT did. Low- and intermediate-risk PCa patients with a PSA ≥ 9.4 ng/ml and age ≥ 62.5 years were more likely to have a positive ⁶⁸Ga-PSMA PET/CT result.

Keywords: MRI; PET/CT; PSMA; Prostate cancer; Prostate-specific membrane antigen.

Abstract

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