Chen Mengxia, Zhang Qing, Zhang Chengwei, Zhou Yi-Hua, Zhao Xiaozhi, Fu Yao, Gao Jie, Zhang Bing, Wang Feng, Qiu Xuefeng, Guo Hongqian
Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing 210008, China.
Departments of Experimental Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
Transl Androl Urol. 2020 Apr;9(2):382-390. doi: 10.21037/tau.2020.03.06.
To compare the diagnostic performance of Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (Ga-PSMA PET/CT) with multi-parametric magnetic resonance imaging (mpMRI) on extracapsular extension (ECE) and seminal vesicle invasion (SVI) in primary prostate cancer and its impact on therapeutic decisions.
We retrospectively enrolled 54 patients with both PET/CT and mpMRI before radical prostatectomy. Diagnostic performance of mpMRI, PET/CT and their combination (com-MRI/PET) on ECE and SVI on a patient basis were analyzed. The impact of additional PET/CT scanning on therapeutic decisions were presented.
Among the 54 patients, 17 had tumor limited in the prostate gland, 25 only had ECE and 12 patients had both SVI and ECE on pathology. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ECE were 54%, 94%, 95%, 48% on mpMRI, 78%, 94%, 97%, 67% on PET/CT and 83%, 88%, 94%, 71% on com-MRI/PET. Both PET/CT and com-MRI/PET had a higher sensitivity than mpMRI on ECE diagnosis (78% 54%, P<0.05 and 83% 54%, P<0.05). No difference was observed between PET/CT and com-MRI/PET (78% 83%, P=0.17). The Sensitivity, specificity, PPV and NPV of SVI were 67%, 93%, 72%, 91% on mpMRI, 75%, 95%, 82%, 93% on PET/CT and 75%, 88%, 64%, 93% on com-MRI/PET. No difference was found between the three scannings. After the additional evaluation of PET/CT, 18.5% (10/54) turned from nerve-sparing surgery to non-nerve sparing surgery.
Ga-PSMA PET/CT has a higher sensitivity on ECE detection than mpMRI but shows no superiority on SVI.
比较镓-前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（Ga-PSMA PET/CT）与多参数磁共振成像（mpMRI）对原发性前列腺癌包膜外侵犯（ECE）和精囊侵犯（SVI）的诊断性能及其对治疗决策的影响。
我们回顾性纳入了54例在根治性前列腺切除术前行PET/CT和mpMRI检查的患者。分析了mpMRI、PET/CT及其联合检查（com-MRI/PET）在个体患者中对ECE和SVI的诊断性能。阐述了额外的PET/CT扫描对治疗决策的影响。
54例患者中，17例肿瘤局限于前列腺内，25例仅有ECE，12例在病理检查中同时存在SVI和ECE。mpMRI对ECE的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为54%、94%、95%、48%；PET/CT分别为78%、94%、97%、67%；com-MRI/PET分别为83%、88%、94%、71%。PET/CT和com-MRI/PET在ECE诊断方面的敏感性均高于mpMRI（78%＞54%，P＜0.05；83%＞54%，P＜0.05）。PET/CT与com-MRI/PET之间未观察到差异（78%与83%，P = 0.17）。mpMRI对SVI的敏感性、特异性、PPV和NPV分别为67%、93%、72%、91%；PET/CT分别为75%、95%、82%、93%；com-MRI/PET分别为75%、88%、64%、93%。三种检查之间未发现差异。在额外进行PET/CT评估后，18.5%（10/54）的患者从保留神经手术转为不保留神经手术。
Ga-PSMA PET/CT在检测ECE方面比mpMRI具有更高的敏感性，但在SVI方面未显示出优势。
