Chin Joel, Tan Yu Guang, Lee Alvin, Ng Tze Kiat, Shi Ruoyu, Tang Charlene Yu Lin, Thang Sue Ping, Tuan Jeffrey Kit Loong, Cheng Christopher Wai Sam, Tay Kae Jack, Ho Henry Sun Sien, Wang Hung-Jen, Chiu Peter Ka-Fung, Teoh Jeremy Yuen-Chun, Lam Winnie Wing-Chuen, Law Yan Mee, Yuen John Shyi Peng, Chen Kenneth
Department of Urology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Department of Anatomical Pathology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Cancers (Basel). 2024 May 5;16(9):1777. doi: 10.3390/cancers16091777.
Widespread adoption of mpMRI has led to a decrease in the number of patients requiring prostate biopsies. Ga-PSMA-11 PET/CT has demonstrated added benefits in identifying csPCa. Integrating the use of these imaging techniques may hold promise for predicting the presence of csPCa without invasive biopsy. A retrospective analysis of 42 consecutive patients who underwent mpMRI, Ga-PSMA-11 PET/CT, prostatic biopsy, and radical prostatectomy (RP) was carried out. A lesion-based model ( = 122) using prostatectomy histopathology as reference standard was used to analyze the accuracy of Ga-PSMA-11 PET/CT, mpMRI alone, and both in combination to identify ISUP-grade group ≥ 2 lesions. Ga-PSMA-11 PET/CT demonstrated greater specificity and positive predictive value (PPV), with values of 73.3% (vs. 40.0%) and 90.1% (vs. 82.2%), while the mpMRI Prostate Imaging Reporting and Data System (PI-RADS) 4-5 had better sensitivity and negative predictive value (NPV): 90.2% (vs. 78.5%) and 57.1% (vs. 52.4%), respectively. When used in combination, the sensitivity, specificity, PPV, and NPV were 74.2%, 83.3%, 93.2%, and 51.0%, respectively. Subgroup analysis of PI-RADS 3, 4, and 5 lesions was carried out. For PI-RADS 3 lesions, Ga-PSMA-11 PET/CT demonstrated a NPV of 77.8%. For PI-RADS 4-5 lesions, Ga-PSMA-11 PET/CT achieved PPV values of 82.1% and 100%, respectively, with an NPV of 100% in PI-RADS 5 lesions. A combination of Ga-PSMA-11 PET/CT and mpMRI improved the radiological diagnosis of csPCa. This suggests that avoidance of prostate biopsy prior to RP may represent a valid option in a selected subgroup of high-risk patients with a high suspicion of csPCa on mpMRI and Ga-PSMA-11 PET/CT.
多参数磁共振成像（mpMRI）的广泛应用导致需要进行前列腺活检的患者数量减少。镓-前列腺特异性膜抗原-11（Ga-PSMA-11）正电子发射断层扫描/计算机断层扫描（PET/CT）在识别临床显著前列腺癌（csPCa）方面已显示出额外的益处。整合使用这些成像技术可能有望在不进行侵入性活检的情况下预测csPCa的存在。对42例连续接受mpMRI、Ga-PSMA-11 PET/CT、前列腺活检和根治性前列腺切除术（RP）的患者进行了回顾性分析。使用以前列腺切除术后组织病理学为参考标准的基于病变的模型（n = 122）来分析Ga-PSMA-11 PET/CT、单独的mpMRI以及两者联合用于识别国际泌尿病理学会（ISUP）分级组≥2级病变的准确性。Ga-PSMA-11 PET/CT显示出更高的特异性和阳性预测值（PPV），分别为73.3%（vs. 40.0%）和90.1%（vs. 82.2%），而mpMRI前列腺影像报告和数据系统（PI-RADS）4 - 5级具有更好的敏感性和阴性预测值（NPV）：分别为90.2%（vs. 78.5%）和57.1%（vs. 52.4%）。联合使用时，敏感性、特异性、PPV和NPV分别为74.2%、
