“Seeing Is Believing”: Additive Utility of 68Ga-PSMA-11 PET/CT in Prostate Cancer Diagnosis

• Published in: Cancers Vol. 16; no. 9; p. 1777
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 05.05.2024
• Subjects: Accuracy; Antigens; Biopsy; Computed tomography; Diagnosis; Histopathology; Lesions; Magnetic resonance imaging; mpMRI; Patients; Positron emission tomography; Prediction models; Prostate cancer; prostate cancer diagnosis; Prostatectomy; PSMA PET; Risk groups; Tomography; United States > US
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16091777

Widespread adoption of mpMRI has led to a decrease in the number of patients requiring prostate biopsies. 68Ga-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, 68Ga-PSMA-11 PET/CT, prostatic biopsy, and radical prostatectomy (RP) was carried out. A lesion-based model (n = 122) using prostatectomy histopathology as reference standard was used to analyze the accuracy of 68Ga-PSMA-11 PET/CT, mpMRI alone, and both in combination to identify ISUP-grade group ≥ 2 lesions. 68Ga-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, 68Ga-PSMA-11 PET/CT demonstrated a NPV of 77.8%. For PI-RADS 4–5 lesions, 68Ga-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 68Ga-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 68Ga-PSMA-11 PET/CT.