Comparison of 68Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer

Abstract

BackgroundTo evaluate the diagnostic value of 68Ga-PSMA-11 PET-CT with multiparametric magnetic resonance imaging (mpMRI) for lymph node (LN) staging in patients with intermediate- to high-risk prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND).MethodsWe retrospectively identified 42 consecutive patients with intermediate- to high-risk PCa according to D′Amico and without concomitant cancer. Preoperative 68Ga-PSMA-11 PET-CT, pelvic mpMRI and subsequent robot assisted laparoscopic RP with PLND were performed in all patients.ResultsAmong 42 patients assessed, the preoperative PSA value, Gleason score, pT stage and intraprostatic PCa volume of patients with LN metastases were all significantly higher than those without metastases (P = 0.029, 0.028, 0.004, respectively). The average maximum standardized uptake value (SUV) of 68Ga-PSMA-11 PET-CT positive PCa of patients with or without LN metastases were 13.10 (range 6.12–51.75) and 7.22 (range 5.4–11.2), respectively (P < 0.001). 68Ga-PSMA-11 PET-CT and pelvic mpMRI had the ability of succeed on preoperative definite accurate diagnosis and accurate localization of primary PCa in all 42 patients. Fifteen patients (35.71%) had a pN1 stage. 51 positive LN were found. Both 68Ga-PSMA-11 PET-CT and pelvic mpMRI displayed brillient patient-based and region-based sensitivity, specificity, negative predictive value and positive predictive value. There was no statistical difference for the detection of LNMs according to the diameter of the LNMs between 68Ga-PSMA-11 PET-CT and mpMRI in this study.ConclusionsBoth 68Ga-PSMA-11 PET-CT and mpMRI performed great value for LN staging in patients with intermediate- to high-risk PCa undergoing RP with PLND. However, despite excellent performance of 68Ga-PSMA-11 PET-CT, it cannot replace mpMRI that remains excellent for lymph node staging.

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

“…The results of this review highlight the high specificity and positive predictive value of 68 Ga-PSMA PET in detecting pelvic lymph node metastases. Most studies report a perpatient specificity of 90% or higher [10,11,13,[15][16][17]19]. This high specificity is a result of the high expression of PSMA in PCa and lymph node metastases, resulting in a high tumour to background ratio [46][47][48][49].…”

“…Eleven studies were included in this review that presented data on the sensitivity and specificity of 68 Ga-PSMA PET for detection of pelvic lymph node metastases in men with newly diagnosed PCa (Table 1, Fig. 1) [8, [10][11][12][13][14][15][16][17][18][19]. Two prospective studies, including a total of 63 patients, showed a per-patient sensitivity (range) and specificity (range) of 64-100% and 90-95%, respectively.…”

“…Nine retrospective studies, including 696 patients, showed a per-patient sensitivity and specificity of 33.3-100% and 80-100%. The per-node sensitivity and specificity was 24.4-96.1% and 98.6-100%, respectively [8, [10][11][12][13][14]16,17,20].…”

Combination of 68Ga-PSMA PET/CT and Multiparametric MRI Improves the Detection of Clinically Significant Prostate Cancer: A Lesion-by-Lesion Analysis

“…68 Ga-PSMA-11 was synthesized using an ITG semiautomated module as described previously (27). One hour before scanning, all patients were intravenously injected with 68 Ga-PSMA-11 (median, 131.72 MBq; range, 130.6-177.6 MBq).…”

Can 68Ga-prostate specific membrane antigen positron emission tomography / computerized tomography provide an accurate lymph node staging for patients with medium / high risk prostate cancer? A Diagnostic Meta-Analysis

“…Presurgical computerized tomography (CT) scan ormagneticresonance imaging (MRI) is helpful for LN staging, but withlimitedaccuracy [7].Prostate-speci c membrane antigen (PSMA)is a surface protein thatis expressed in almost normal prostatetissues, and its expressionlevel is higher in PCatissues [8]. Inrecent years, PSMA has been introducedinto positron emissiontomography (PET) imaging [9], 68 Gallium-PSMApositron emissiontomography/computerized tomography( 68 Ga-PSMA PET/CT) hasbeen proven to be better thanordinary imaging tests in detectingmetastaticPCa [10]. Relatedstudies have also shown that 68 Ga-PSMA PET/CT is moresensitive for recurrent PCa witha low prostate-speci c antigen(PSA) [11,12].…”