Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, 4006, Australia.
The University of Queensland, Faculty of Medicine, Brisbane, Australia.
Eur J Nucl Med Mol Imaging. 2019 Jan;46(1):20-30. doi: 10.1007/s00259-018-4160-7. Epub 2018 Sep 19.
Positron emission tomography (PET) for prostate-specific membrane antigen (PSMA) represents a promising method for prostate cancer diagnosis and staging. Comparisons of PSMA-based tumour characterisation to multiparametric MRI (mpMRI) are limited, hence this study sought to compare the diagnostic accuracy of Ga-PSMA PET/CT to mpMRI against radical prostatectomy (RP) whole gland histopathology.
A retrospective cohort study of consecutive patients who underwent pre-operative mpMRI and Ga-PSMA PET/CT followed by a RP was performed. Standard clinical parameters were collected. "Per patient" and "per lesion" analyses for image-based detection according to RP histopathology were described using sensitivity, specificity and other measures of diagnostic accuracy.
Fifty-eight patients (median age 65.5 years, median PSA 7.35 ng/mL) underwent RP, resulting in a high-risk cohort (≥pT3 69%). Sensitivities for identification of index lesion, bilateral and multifocal disease were 90%, 21%, 19% for mpMRI and 93%, 42%, 34% for Ga-PSMA PET/CT. Histology analyses revealed 88 cancer foci of Gleason grades 3 + 3 (4%), 3 + 4 (64%), 4 + 3 (19%), 4 + 4 (3%) and ≥ 4 + 5 (10%), of which Ga-PSMA PET/CT correctly detected more foci (78%, AUC 0.817) than mpMRI (69%, AUC 0.729).
Ga-PSMA PET/CT may better reflect RP histopathology compared to mpMRI when considering multifocal and bilateral disease. These findings may influence surgical planning, targeted biopsy and focal therapy strategies and require further research.
前列腺特异性膜抗原（PSMA）的正电子发射断层扫描（PET）是一种有前途的前列腺癌诊断和分期方法。基于 PSMA 的肿瘤特征与多参数 MRI（mpMRI）的比较有限，因此本研究旨在比较 Ga-PSMA PET/CT 与 mpMRI 对根治性前列腺切除术（RP）全腺组织病理学的诊断准确性。
对接受术前 mpMRI 和 Ga-PSMA PET/CT 检查后行 RP 的连续患者进行了回顾性队列研究。收集了标准临床参数。根据 RP 组织病理学，通过“每位患者”和“每个病灶”分析，描述了图像检测的敏感性、特异性和其他诊断准确性指标。
58 例患者（中位年龄 65.5 岁，中位 PSA 7.35ng/mL）接受了 RP，导致高危队列（≥pT3 69%）。mpMRI 对指数病灶、双侧和多灶性疾病的检出率分别为 90%、21%、19%，Ga-PSMA PET/CT 分别为 93%、42%、34%。组织学分析显示，88 个前列腺癌灶为 Gleason 分级 3+3（4%）、3+4（64%）、4+3（19%）、4+4（3%）和≥4+5（10%），其中 Ga-PSMA PET/CT 正确检测到更多病灶（78%，AUC 0.817），而 mpMRI 为 69%（AUC 0.729）。
与 mpMRI 相比，Ga-PSMA PET/CT 考虑多灶性和双侧疾病时可能更好地反映 RP 组织病理学。这些发现可能会影响手术计划、靶向活检和局灶性治疗策略，需要进一步研究。
