Primary staging of prostate cancer (PC) relies on modalities, which are limited. We evaluate simultaneous [68Ga]Ga-PSMA-11positron emission tomography (PSMA-PET)/magnetic resonance imaging (MRI) as a new diagnostic method for primary TNM-staging compared to histology and its impact on therapeutic decisions.
We investigated 122 patients with PSMA-PET/MRI prior to planned radical prostatectomy (RP). Primary endpoint was the accuracy of PSMA-PET/MRI in tumor staging as compared to staging-relevant histology. Additionally, a multidisciplinary team reassessed the initial therapeutic approach to evaluate its impact on the therapeutic management.
PSMA-PET/MRI correctly identified PC in 119 of 122 patients (97.5%). 81 patients were treated with RP and pelvic lymphadenectomy. The accuracy for T-staging was 82.5% (95%CI 73-90; P<0.001), for T2-stage: 85% (95%CI 71-94; P<0.001), T3a-stage: 79% (95%CI 43-85; P<0.001), T3b-stage: 94% (95%CI 73-100; P<0.001) and 93% (95%CI 84-98) for N1-stage (P<0.001). PSMA-PET/MRI changed the therapeutic strategy in 28.7% of the patients with either the onset of systemic therapy/radiotherapy (n=16) or active surveillance (n=19).
PSMA-PET/MRI can provide an accurate staging of newly diagnosed PC. Additionally, treatment strategies were changed in almost a third of the patients due to the information of this hybrid imaging technique.
Clinical cancer research : an official journal of the American Association for Cancer Research. 2018 Aug 23 [Epub ahead of print]
Bernhard Grubmüller, Pascal A Baltzer, Sabrina Hartenbach, David D'Andrea, Thomas Hans Helbich, Alexander Haug, Gregor Goldner, Wolfgang Wadsak, Sarah Pfaff, Markus Mitterhauser, Theresa Balber, Neydher Berroterán-Infante, Marko Grahovac, John W Babich, Christian Seitz, Gero Kramer, Martin Susani, Peter Mazal, Lukas Kenner, Shahrokh Francois Shariat, Marcus Hacker, Markus Hartenbach
Medical University of Vienna., Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna., Pathology, HistoConsultingHartenbach., Department of Urology, Medical University of Vienna., Division of Nuclear Medicine, Medical University of Vienna., Radiooncology, Medical University of Vienna., Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna., Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna., Radiology, Weill Cornell Medicine., Department of Clinical Pathology, medical university of Viena., Department of Pathology, Medical University of Vienna., Department of Clinical Pathology, Medical University of Vienna., Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital., Department of Biomedical Imaging and Image guided Therapy, Medical University of Vienna .