Role of 68Ga prostate-specific membrane antigen-targeted PET/CT imaging in primary tumour assessment: improved detection of multifocal disease on whole gland histology compared to multiparametric MRI
BAUS ePoster online library. Donato P.
Jun 26, 2018; 211339
Dr. Peter Donato
Dr. Peter Donato
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Introduction: Positron emission tomography (PET) for Prostate-Specific Membrane Antigen (PSMA) has emerged as a promising method for prostate cancer staging. Evidence regarding PSMA-based tumour characterisation compared to multiparametric MRI (mpMRI) is limited, hence this study sought to compare the diagnostic accuracy of 68Ga-PSMA PET/CT to mpMRI against radical prostatectomy (RP) whole gland histopathology.

Patients and Methods: A retrospective cohort study of consecutive patients who underwent pre-operative mpMRI and 68Ga-PSMA PET/CT followed by a RP was performed. We performed a “per patient” and “per lesion” analysis for imaging detection and other variables including the apparent diffusion coefficient, according to RP histopathology. Sensitivity, specificity and other measures of diagnostic accuracy were performed.

Results: 57 patients with mean age 64.8±5.9 years and PSA 11±13.6 ng/ml underwent RP (70% pT3 disease). mpMRI and PSMA PET/CT correctly identified the index lesion in 91.2% and 94.7% respectively. Considering “per lesion” analysis, 94 cancer foci were identified of Gleason grades 3+3 (5%), 3+4 (63%), 4+3 (18%), 4+4/3+5 (3%) and ≥4+5 (10%). PSMA-PET/CT (80%) detected more lesions than mpMRI (66%). Considering “per patient” analysis, PSMA PET/CT (70%) correctly identified all tumour foci more reliably than mpMRI (49%) due to superior characterisation of multifocal disease in 31 patients (52% vs 19%), equating to a sensitivity/specificity of 52%/85% and 18%/81% respectively.

Conclusions: 68Ga-PSMA PET/CT better reflects RP histopathology compared to mpMRI and may improve pre-operative characterisation of multifocal prostate cancer. These findings have implications for targeted biopsy strategies, focal therapies and surgical planning.
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