Combination of MRI prostate and 18F‐DCFPyl PSMA PET/CT detects all clinically significant prostate cancers in treatment‐naive patients: An international multicentre retrospective study

Abstract

Introduction Clinical and biochemical assessment and biopsies can miss clinically significant prostate cancers (csPCa) in up to 20% of patients and diagnose clinically insignificant tumours leading to overtreatment. This retrospective study analyses the accuracy of 18F‐DCFPyL PET/CT in detecting csPCa as a primary diagnostic tool and directly compares it with mpMRI prostate in treatment‐naive patients. The two modalities are then correlated to determine whether they are better in combination, than either alone. Methods This is a retrospective dual‐institution study of patients who underwent contemporaneous MRI and PSMA‐PET between January 2017 and March 2020 with histologic confirmation. The images were re‐reviewed and concordance between modalities assessed. Results were compared with histopathology to determine the ability of MRI and PSMA‐PET to detect csPCA. Results MRI and PSMA‐PET detected the same index lesion in 90.8% of cases with a kappa of 0.82. PET detected an additional 6.2% of index lesions which were MRI occult. MRI detected an additional 3.1% which were PET occult. No additional csPCa was identified on pathology which was not seen on imaging. The sensitivity of PSMA‐PET in detecting csPCa is 96.7% and that of MRI is 93.4% with no statistically significant difference between the two (P = 0.232). Both modalities detected all four cases of non‐csPCa with these being considered false positives. Conclusion Both mpMRI and 18F‐DCFPyL‐PSMA‐PET/CT have high sensitivity for detecting csPCa with high agreement between modalities. There were no synchronous csPCa lesions detected on pathology that were not detected on imaging too.

The diagnostic performance of 18F-DCFPyL PET in patients with suspected prostate cancer: A systemic review and meta-analysis

“…After reading the full text of the remaining 74 articles that may meet the requirements, 63 articles met the exclusion criteria after reading the full text, and six articles could not directly or indirectly extract the four-grid table data. Finally, five papers were selected ( 16 – 20 ) ( Figure 1 ).…”

Comparing the Detection Performance Between Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen PET/CT in Patients With Localized Prostate Cancer

“…Of the 39 included studies, 3 studies did not mention ISUP grade, 33,37,49 and in 1 study, 29 mainly the lesions had the ISUP grade. In the other 35 studies, 3022 patients were pathologically verified of having malignant tumors, of which ISUP grades 2 and 3 accounted for 64%, with a median of 3 (range, 1-5) [7][8][9][10][11][12][20][21][22][23][24][26][27][28]32,33,[35][36][37][39][40][41][42][43][44][45][46][47][48][49][51][52][53] (Table 1).…”

“…28,31,39,49 The injected activity of 68 G-PSMA was 74 to 185 MBq. 23,34,50 In addition to the radiotracer 68 Ga-PSMA, the median median/mean injected activity of 18 F-DCFPyL was 294.6 MBq (range, 250-329.5 MBq), 8,29,38,40 and that of 18 F-PSMA-1007 was 256 MBq. 41 The median of median/ mean interval time between radiotracer injection and PET scanning was 60 minutes (range, 45-180 minutes) 7,8,10,11,21,22,24,[26][27][28][29][30]32,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] (Supplementary Table 1, Supplemental Digital Content, http://links.…”

“…Among the 39 included studies, 3.0 Twas the most commonly used diagnostic equipment for mpMRI (64%), 8,[10][11][12][20][21][22]24,[26][27][28][29]31,32,34,37,39,40,44,45,[47][48][49]52,53 and 69% of the mpMRI sequence used T2-weighted and diffusion-weighted. [8][9][10][11]20,[22][23][24][25]29,34,35,37,39,40,[42][43][44][45][46][47][48][49][50][51][52][53]<...…”

“…All 39 included studies were pathologically verified, but only 31 of them clearly estimated the number of lesions that were TP/FP and negative, including localized tumors (23 studies) 8,10,11,[20][21][22]24,[26][27][28][29]32,34,35,37,38,40,[44][45][46]49,52,53 and T staging (8 studies). 7,8,23,25,33,39,41 For localized prostate tumors, the pooled sensitivity and specificity of PSMA PET were 0.84 (95% CI, 0.83-0.86) and 0.72 (95% CI, 0.57-0.83), whereas those of mpMRI were 0.84 (95% CI, 2).…”