Staging patients with high-risk prostate cancer (HRPCa) with conventional imaging of computed tomography (CT) and bone scintigraphy (BS) is suboptimal. Therefore, we aimed to compare the accuracy of whole-body magnetic resonance imaging (WBMRI) with conventional imaging to stage patients with HRPCa.
We prospectively enrolled patients with newly diagnosed HRPCa (prostate-specific antigen ≥20 ng/ml and/or Grade Group ≥4). Patients underwent BS, CT of the abdomen and pelvis, and WBMRI within 30 days of evaluation. The primary endpoint was the diagnostic performances of detecting metastatic disease to the lymph nodes and bone for WBMRI and conventional imaging. The reference standard was defined by histopathology or by all available clinical information at 6 months of follow-up. To compare diagnostic tests, Exact McNemar's test and area under the curve (AUC) of the receiver operating characteristics curves were utilized.
Among 92 patients enrolled, 15 (16.3%) and 8 (8.7%) patients were found to have lymphatic and bone metastases, respectively. The sensitivity, specificity, and accuracy of WBMRI in detecting lymphatic metastases were 0.60 (95% confidence interval 0.32-0.84), 0.84 (0.74-0.92), and 0.80 (0.71-0.88), respectively, while CT were 0.20 (0.04-0.48), 0.92 (0.84-0.97), and 0.80 (0.71-0.88). The sensitivity, specificity, and accuracy of WBMRI to detect bone metastases were 0.25 (0.03-0.65), 0.94 (0.87-0.98), and 0.88 (0.80-0.94), respectively, while CT and BS were 0.12 (0-0.53), 0.94 (0.87-0.98), and 0.87 (0.78-0.93). For evaluating lymphatic metastases, WBMRI demonstrated a higher sensitivity (p = 0.031) and discrimination compared to CT (0.72 versus 0.56, p = 0.019).
For staging patients with HRPCa, WBMRI outperforms CT in the detection of lymphatic metastases and performs as well as CT and BS in the detection of bone metastases. Further studies are needed to assess the cost effectiveness of WBMRI and the utility of combined PSMA PET and WBMRI.
Prostate cancer and prostatic diseases. 2024 Sep 17 [Epub ahead of print]
Andrew M Fang, Brian F Chapin, Charles W Shi, Jia Sun, Aliya Qayyum, Vikas Kundra, Paul G Corn, Deborah A Kuban, Gregory C Ravizzini, Devaki Shilpa S Surasi, Jingfei Ma, Tharakeswara K Bathala
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. ., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa Bay, FL, USA., Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA., Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Genitourinary Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.