Scheltema Matthijs J, Chang John I, Stricker Phillip D, van Leeuwen Pim J, Nguyen Quoc A, Ho Bao, Delprado Warick, Lee Jonathan, Thompson James E, Cusick Thomas, Spriensma Alette S, Siriwardana Amila R, Yuen Carlo, Kooner Raji, Hruby George, O'Neill Gordon, Emmett Louise
Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.
St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.
BJU Int. 2019 Nov;124 Suppl 1:42-49. doi: 10.1111/bju.14794. Epub 2019 Jul 9.
To evaluate the ability of prostate-specific membrane antigen (PSMA)-positron-emission tomography (PET)/computed tomography (CT) to detect intermediate-grade intra-prostatic prostate cancer (PCa), and to determine if PSMA-PET improves the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI).
A total of 56 consecutive patients with International Society of Urological Pathology (ISUP) grade 2-3 PCa after radical prostatectomy, who underwent both mpMRI and PSMA-PET CT (hereafter PSMA-PET) preoperatively, were enrolled in this study. The accuracy of PSMA-PET, mpMRI alone, and the two procedures in combination was analysed for identifying ISUP grades 1-3 within a 12-segment model. The accuracy of a combined predictive model (PSMA-PET and mpMRI) was determined. Receiver-operating characteristic curve analysis to determine the optimal standardized uptake value (SUV ) for PSMA-PET in discriminating between ISUP grades 1 and ≥2 was performed.
On a per-patient basis, the sensitivities for PSMA-PET and mpMRI in identifying ISUP grades 2-3 PCa were 100% and 97%, respectively. Assessing ISUP grade ≥2 PCa using a 12-segment analysis, PSMA-PET demonstrated greater diagnostic accuracy (area under the curve), sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV), with values of 0.91, 88%, 93%, 95% and 85%, respectively, than did mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] 3-5), at 0.79, 68%, 91%, 87%, and 75%, respectively. When used in combination (PSMA-PET and mpMRI PIRADS 4-5), sensitivity, specificity, NPV and PPV were 92%, 90%, 96% and 81%, respectively. The sensitivity for both techniques reduced markedly when assessing ISUP grade 1 PCa (18% for PSMA-PET, 10% for mpMRI). An SUV value of 3.95 resulted in 94% sensitivity and 100% specificity.
PSMA-PET is accurate in detecting segments containing intermediate-grade intra-prostatic PCa (ISUP grade ≥ 2), compared with and complementary to mpMRI. By contrast the detection rate for ISUP grade 1 disease for both PSMA-PET and mpMRI was low.
评估前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）/计算机断层扫描（CT）检测前列腺中级前列腺癌（PCa）的能力，并确定PSMA-PET是否能提高多参数磁共振成像（mpMRI）的诊断准确性。
本研究纳入了56例连续的患者，这些患者在根治性前列腺切除术后病理诊断为国际泌尿病理学会（ISUP）2-3级PCa，术前均接受了mpMRI和PSMA-PET CT（以下简称PSMA-PET）检查。分析了PSMA-PET、单独的mpMRI以及两者联合检查在12分区模型中识别ISUP 1-3级PCa的准确性。确定了联合预测模型（PSMA-PET和mpMRI）的准确性。进行了受试者操作特征曲线分析，以确定PSMA-PET在区分ISUP 1级和≥2级时的最佳标准化摄取值（SUV）。
以患者为基础，PSMA-PET和mpMRI识别ISUP 2-3级PCa的敏感性分别为100%和97%。在12分区分析中评估ISUP≥2级PCa时，PSMA-PET显示出更高的诊断准确性（曲线下面积）、敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV），其值分别为0.91、88%、93%、95%和85%，而mpMRI（前列腺影像报告和数据系统[PI-RADS] 3-5）的相应值分别为0.79、68%、91%、87%和75%。当联合使用时（PSMA-PET和mpMRI PIRADS 4-5），敏感性、特异性、NPV和PPV分别为92%、90%、96%和81%。评估ISUP 1级PCa时，两种技术的敏感性均显著降低（PSMA-PET为18%，mpMRI为10%）。SUV值为3.95时，敏感性为94%，特异性为100%。
与mpMRI相比，PSMA-PET在检测含有中级前列腺内PCa（ISUP≥2级）的区域时具有准确性，且两者具有互补性。相比之下，PSMA-PET和mpMRI对ISUP 1级疾病的检出率均较低。
