PI-RADS-Based Segmented Threshold of PSMA-PET SUVmax Is Better than Traditional Fixed Threshold for Diagnosing Clinically Significant Prostate Cancer Especially for PI-RADS 3 Lesions

Xiaoli Meng; Wenhui Ma; Jingliang Zhang; Zhiyong Quan; Mingru Zhang; Jiajun Ye; Jun Shu; Jing Ren; Weijun Qin; Fei Kang; Jing Wang

doi:10.1007/s11307-023-01841-6

PI-RADS-Based Segmented Threshold of PSMA-PET SUVmax Is Better than Traditional Fixed Threshold for Diagnosing Clinically Significant Prostate Cancer Especially for PI-RADS 3 Lesions

Mol Imaging Biol. 2023 Oct;25(5):887-896. doi: 10.1007/s11307-023-01841-6. Epub 2023 Jul 25.

Authors

Xiaoli Meng^#¹, Wenhui Ma^#¹, Jingliang Zhang², Zhiyong Quan¹, Mingru Zhang¹, Jiajun Ye¹, Jun Shu³, Jing Ren³, Weijun Qin^#⁴, Fei Kang^#⁵, Jing Wang^#⁶

Affiliations

¹ Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
² Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
³ Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
⁴ Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. qinwj@fmmu.edu.cn.
⁵ Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China. fmmukf@qq.com.
⁶ Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China. 13909245902@163.com.

^# Contributed equally.

PMID: 37490189
DOI: 10.1007/s11307-023-01841-6

Abstract

Objectives: Our purpose was to compare the performance of prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) traditional fixed threshold (FT) and newly established Prostate Imaging Reporting and Data System (PI-RADS)-based segmented threshold (ST) for diagnosing clinically significant prostate cancer (csPCa).

Methods: The study retrospectively included 218 patients who underwent multiparametric magnetic resonance imaging (mpMRI) and PSMA-PET examination for suspected prostate cancer (PCa) from January 2018 to November 2021. Lesions with Gleason score ≥ 3 + 4 were diagnosed as csPCa. In PSMA-PET maximum standardized uptake value (SUVmax), the FT for all the lesions and STs for lesions with different PI-RADS score for diagnosing csPCa were determined by receiver operating characteristic (ROC) curves analysis and compared with Z test. The McNemar test was used to compare sensitivity and specificity.

Results: Among the 218 patients, there were 113 csPCa and 105 non-csPCa. The PSMA-PET FT was SUVmax > 5.3 (area under the curve, AUC = 0.842) and STs for PI-RADS 3/4/5 were SUVmax > 4.2/5.7/6.0 (AUCs = 0.870/0.867/0.882), respectively. The AUC of PSMA-PET ST was higher than that of PSMA-PET FT (0.872 vs. 0.842), especially for PI-RADS 3 (0.870 vs. 0.653). Multimodality diagnostic criteria combining PSMA-PET ST and PI-RADS scores of mpMRI was established and its AUC was higher than that of PSMA-PET ST (0.893 vs. 0.872) and significantly higher than that of PSMA-PET FT (0.893 vs. 0.842) with an improvement in sensitivity (93% vs. 78%, p < 0.05) without significantly sacrificing specificity (86% vs. 91%, p > 0.05).

Conclusions: For diagnosing csPCa, PI-RADS-based PSMA-PET segmented threshold achieved better performance than traditional fixed threshold, especially for PI-RADS 3 lesions. Multimodality diagnostic criteria demonstrated higher diagnostic performance than segmented threshold and significantly better than PSMA-PET fixed threshold for detecting csPCa.

Keywords: Multi-parametric MRI; Positron emission tomography; Prostate cancer; Prostate-specific membrane antigen.

Abstract

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