The role of prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) in addition to magnetic resonance imaging (MRI) for local staging of prostate cancer (PC) has been poorly addressed so far. Our aim was to assess the diagnostic accuracy of PSMA PET/CT and MRI, alone and combined, for detection of extraprostatic extension (EPE) and seminal vesicle invasion (SVI) in PC.
We conducted a multicenter retrospective study evaluating patients undergoing PSMA PET/CT and MRI before radical prostatectomy. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) for detection of EPE and SVI were calculated for MRI and PSMA PET/CT alone and combined.
We included 550 patients, of whom 2%, had low-risk, 43% had intermediate-risk, and 55% had high-risk PC. Overall, 52% of patients had EPE and 21% had SVI at histopathology. Patient-based comparison of MRI versus PSMA PET/CT for detection of EPE revealed sensitivity of 60% versus 41% (p < 0.001), specificity of 77% versus 83% (p = 0.075), PPV of 75% versus 73% (p = 0.6), NPV of 64% versus 56% (p < 0.001), and AUC of 69% versus 62% (p = 0.01). Combining the modalities increased the sensitivity (73%; p < 0.001) and NPV (69%; p < 0.001) and decreased the specificity (67%; p < 0.001) and PPV (71%; p = 0.01) over MRI alone. Patient-based comparison of MRI versus PSMA PET/CT for detection of SVI revealed sensitivity of 36% versus 44% (p = 0.2), specificity of 96% versus 96% (p > 0.99), PPV of 71% versus 75% (p = 0.6), NPV of 85% versus 87% (p = 0.2), and AUC of 66% versus 70% (p = 0.2). Combining the modalities increased the sensitivity (60%; p < 0.001), NPV (90%; p < 0.001), and AUC (76%; p < 0.001) and decreased the specificity (92%; p < 0.001) over MRI alone. Limitations include the retrospective nature of the study, selection of higher-risk cases for PSMA PET/CT, and lack of central review.
PSMA PET/CT has lower sensitivity for EPE detection in comparison to MRI. However, addition of PSMA PET information to MRI improved the sensitivity for EPE and SVI detection. Thus, the two modalities should be combined to guide treatment selection.
Combining MRI (magnetic resonance imaging) scans with another type of imaging called PSMA PET/CT (prostate-specific membrane antigen positron emission tomography/computed tomography) for patients with prostate cancer leads to better identification of cancer growth outside the prostate in comparison to MRI alone. This could potentially improve the choice of prostate cancer treatment.
European urology oncology. 2024 Nov 28 [Epub ahead of print]
Timo F W Soeterik, Joris G Heetman, Rick Hermsen, Lieke Wever, Jules Lavalaye, Maarten Vinken, Clinton D Bahler, Courtney Yong, Mark Tann, Claudia Kesch, Robert Seifert, Tugce Telli, Peter Ka-Fung Chiu, Kwan Kit Wu, Fabio Zattoni, Laura Evangelista, Sara Bettella, Francesco Ceci, Antonio Barone, Marcin Miszczyk, Akihiro Matsukawa, Pawel Rajwa, Giancarlo Marra, Alberto Briganti, Francesco Montorsi, Matthijs J Scheltema, Jean-Paul A van Basten, Harm H E van Melick, Roderick C N van den Bergh, Giorgio Gandaglia, European Association of Urology Young Academic Urologists Prostate Cancer Working Party
Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: ., Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands., Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands., Department of Urology, Indiana University Medical Center, Indianapolis, IN, USA., Department of Radiology and Imaging Sciences, Indiana University Medical Center, Indianapolis, IN, USA., Department of Urology, University Hospital Essen, Essen German Cancer Consortium (DKTK) University Hospital Essen, Essen, Germany., Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Nuclear Medicine, University Hospital Essen, Essen, Germany., Department of Nuclear Medicine, University Hospital Essen, Essen, Germany., S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Department of Nuclear Medicine and PET, Hong Kong Sanatorium and Hospital, Hong Kong, China., Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy; Department of Medicine - DIMED, University of Padua, Padua, Italy., Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Division of Nuclear Medicine, IRCCS Humanitas Research Hospital, Milan, Italy., Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy., Division of Nuclear Medicine and Theranostics, IRCCS European Institute of Oncology, Milan, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum, WSB University, Dąbrowa Górnicza, Poland., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland., Department of Urology, University Hospital S. Giovanni Battista, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy., Division of Oncology/Unit of Urology, Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.