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Improved specificity with 68Ga PSMA PET/CT to detect clinically significant lesions “invisible” on multiparametric MRI of the prostate: a single institution comparative analysis with radical prostatectomy histology

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Positron emission tomography (PET) for prostate-specific membrane antigen (PSMA) represents a promising method for prostate cancer diagnosis and staging. Comparisons of PSMA-based tumour characterisation to multiparametric MRI (mpMRI) are limited, hence this study sought to compare the diagnostic accuracy of 68Ga-PSMA PET/CT to mpMRI against radical prostatectomy (RP) whole gland histopathology.

Methods

A retrospective cohort study of consecutive patients who underwent pre-operative mpMRI and 68Ga-PSMA PET/CT followed by a RP was performed. Standard clinical parameters were collected. “Per patient” and “per lesion” analyses for image-based detection according to RP histopathology were described using sensitivity, specificity and other measures of diagnostic accuracy.

Results

Fifty-eight patients (median age 65.5 years, median PSA 7.35 ng/mL) underwent RP, resulting in a high-risk cohort (≥pT3 69%). Sensitivities for identification of index lesion, bilateral and multifocal disease were 90%, 21%, 19% for mpMRI and 93%, 42%, 34% for 68Ga-PSMA PET/CT. Histology analyses revealed 88 cancer foci of Gleason grades 3 + 3 (4%), 3 + 4 (64%), 4 + 3 (19%), 4 + 4 (3%) and ≥ 4 + 5 (10%), of which 68Ga-PSMA PET/CT correctly detected more foci (78%, AUC 0.817) than mpMRI (69%, AUC 0.729).

Conclusions

68Ga-PSMA PET/CT may better reflect RP histopathology compared to mpMRI when considering multifocal and bilateral disease. These findings may influence surgical planning, targeted biopsy and focal therapy strategies and require further research.

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Acknowledgements

Sachinka Ranasinghe for assistance with data collection and Max Stephens for assistance with PET access and interpretation.

Author information

Author notes

  1. Peter Donato and Matthew J. Roberts contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, 4006, Australia

    Peter Donato, Matthew J. Roberts, Geoff Coughlin, Rachel Esler, Nigel Dunglison, Robert A. Gardiner & John Yaxley

  2. The University of Queensland, Faculty of Medicine, Brisbane, Australia

    Matthew J. Roberts, Andrew Morton, Samuel Kyle, Robert A. Gardiner & John Yaxley

  3. Department of Nuclear Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Samuel Kyle

  4. Griffith University, Brisbane, Queensland, Australia

    Robert A. Gardiner

  5. Edith Cowan University, Joondalup, Western Australia

    Robert A. Gardiner

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  1. Peter Donato
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Correspondence to John Yaxley.

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Conflict of interest

All authors declare to have no conflict of interest.

Ethical approval

The study received ethical approval from the Royal Brisbane and Women’s Hospital (RBWH) Human Research Ethics Committee (Approval number HREC/17/QRBW/644). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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An informed consent waiver was approved by the institutional ethics board for this retrospective study using pre-existing clinical data.

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Donato, P., Roberts, M.J., Morton, A. et al. Improved specificity with 68Ga PSMA PET/CT to detect clinically significant lesions “invisible” on multiparametric MRI of the prostate: a single institution comparative analysis with radical prostatectomy histology. Eur J Nucl Med Mol Imaging 46, 20–30 (2019). https://doi.org/10.1007/s00259-018-4160-7

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  • DOI: https://doi.org/10.1007/s00259-018-4160-7

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