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68Ga-PSMA PET/CT vs. mpMRI for locoregional prostate cancer staging: correlation with final histopathology

Prostate Cancer and Prostatic Diseases volume 21, pages 204–211 (2018)Cite this article

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Abstract

Background

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) can be used to locate lesions based on PSMA avidity, however guidelines on its use are limited by its infancy. We aimed to compare multiparametric magnetic resonance imaging (mpMRI) and PSMA PET/CT to prostatectomy histopathology.

Methods

We conducted a chart review from February 2015 to January 2017 of 50 male patients staged for prostate cancer using PSMA PET/CT and mpMRI who then underwent radical prostatectomy. Pre-operative PSMA PET/CT and mpMRI were paired with corresponding histopathology. Correlations, sensitivity, and specificity were used for comparisons.

Results

A total of 81 lesions were confirmed by histopathology. Fifty index lesions were detected by histopathology, all of which were detected by PSMA PET/CT (100% detection), and 47 by mpMRI (94% detection). Thirty-one histologically confirmed secondary lesions were detected, 29 of which were detected by PSMA PET/CT (93.5% detection), and 16 by mpMRI (51.6% detection). PSMA had better sensitivity for index lesion localization than mpMRI (81.1 vs. 64.8%). Specificity was similar for PSMA PET/CT and mpMRI (84.6 vs. 82.7%).

SUVmax of index lesions ranged from 2.9 to 39.6 (M = 9.27 ± 6.41). Index lesion SUVmax was positively correlated with PSA (rho = 0.48, p < 0.001) and ISUP grade (rho = 0.51, p < 0.001).

Conclusions

PSMA-PET/CT provided superior detection of prostate cancer lesions with better sensitivity than mpMRI. PSMA-PET/CT can be used to enhance locoregional mpMRI to provide improved detection and characterization of lesions.

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Acknowledgements

Versions of this manuscript were presented at The Royal Australian and New Zealand College of Radiologists (RANZCR) 67th Annual Scientific Meeting (2016), the Australian and New Zealand Urological and Prostate Cancer Trial Group Cancer Trials Group (ANZUP) Annual Scientific Meeting (2017), the Urological Society of Australia and New Zealand (USANZ) NSW Section Meeting (2017), and the USANZ Annual Scientific Meeting (2018). Dr Annabattula received conference registration from the Nepean Hospital Medical Imaging Department and travel and accommodation from Ipsen to attend the RANZCR ASM. The University of Sydney provided accommodation and conference registration for Dr Berger to attend the USANZ NSW Section Meeting.

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Authors and Affiliations

  1. Nepean Urology Research Group, Nepean Hospital, Penrith, NSW, Australia

    I. Berger, C. Annabattula, J. Lewis, J. Kam, M. Arianayagam, B. Canagasingham, R. Ferguson, M. Khadra, R. Ko, M. Winter & C. Varol

  2. University of Sydney, Sydney, NSW, Australia

    I. Berger & M. Khadra

  3. Department of Medical Imaging, Nepean Hospital, Penrith, NSW, Australia

    C. Annabattula, D. V. Shetty & H. Loh

  4. Douglass Hanly Moir Pathology, North Ryde, NSW, Australia

    F. Maclean

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  1. I. Berger
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Correspondence to I. Berger.

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Berger, I., Annabattula, C., Lewis, J. et al. 68Ga-PSMA PET/CT vs. mpMRI for locoregional prostate cancer staging: correlation with final histopathology. Prostate Cancer Prostatic Dis 21, 204–211 (2018). https://doi.org/10.1038/s41391-018-0048-7

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