Soeterik Timo F W, Heetman Joris G, Hermsen Rick, Wever Lieke, Lavalaye Jules, Vinken Maarten, Bahler Clinton D, Yong Courtney, Tann Mark, Kesch Claudia, Seifert Robert, Telli Tugce, Chiu Peter Ka-Fung, Wu Kwan Kit, Zattoni Fabio, Evangelista Laura, Bettella Sara, Ceci Francesco, Barone Antonio, Miszczyk Marcin, Matsukawa Akihiro, Rajwa Pawel, Marra Giancarlo, Briganti Alberto, Montorsi Francesco, Scheltema Matthijs J, van Basten Jean-Paul A, van Melick Harm H E, van den Bergh Roderick C N, Gandaglia Giorgio
Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.
Eur Urol Oncol. 2025 Jun;8(3):731-738. doi: 10.1016/j.euo.2024.11.002. Epub 2024 Nov 29.
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.
迄今为止，基于前列腺特异性膜抗原（PSMA）的正电子发射断层扫描（PET）/计算机断层扫描（CT）在前列腺癌（PC）局部分期中除磁共振成像（MRI）之外的作用尚未得到充分研究。我们的目的是评估PSMA PET/CT和MRI单独及联合应用对PC中前列腺外扩展（EPE）和精囊侵犯（SVI）的诊断准确性。
我们进行了一项多中心回顾性研究，评估了在根治性前列腺切除术前行PSMA PET/CT和MRI检查的患者。分别计算了MRI和PSMA PET/CT单独及联合应用检测EPE和SVI的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）以及受试者操作特征曲线下面积（AUC）。
我们纳入了550例患者，其中2%为低风险PC，43%为中风险PC，55%为高风险PC。总体而言，52%的患者在组织病理学检查中有EPE，21%有SVI。基于患者的MRI与PSMA PET/CT检测EPE的比较显示，敏感性分别为60%和41%（p < 0.001），特异性分别为77%和83%（p = 0.075），PPV分别为75%和73%（p = 0.6），NPV分别为64%和56%（p < 0.001），AUC分别为69%和62%（p = 0.01）。与单独使用MRI相比，联合使用这两种检查方法可提高敏感性（73%；p < 0.001）和NPV（69%；p < 0.001），但降低了特异性（67%；p < 0.001）和PPV（71%；p = 0.01）。基于患者的MRI与PSMA PET/CT检测SVI的比较显示，敏感性分别为36%和44%（p = 0.2），特异性分别为96%和96%（p > 0.99），PPV分别为71%和75%（p = 0.6），NPV分别为85%和87%（p = 0.2），AUC分别为66%和70%（p = 0.2）。与单独使用MRI相比，联合使用这两种检查方法可提高敏感性（60%；p < 0.001）、NPV（90%；p < 0.001）和AUC（76%；p < 0.001），但降低了特异性（92%；p < 0.001）。局限性包括研究的回顾性性质、PSMA PET/CT选择了较高风险病例以及缺乏中心复审。
与MRI相比，PSMA PET/CT检测EPE的敏感性较低。然而，将PSMA PET信息添加到MRI中可提高检测EPE和SVI的敏感性。因此，应联合使用这两种检查方法来指导治疗选择。
对于前列腺癌患者，将MRI（磁共振成像）扫描与另一种称为PSMA PET/CT（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）的成像方法相结合，与单独使用MRI相比，能更好地识别前列腺外的癌灶生长情况。这可能会改善前列腺癌治疗方案的选择。
