Prostate Specific Membrane Antigen Positron Emission Tomography May Improve the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Localized Prostate Cancer

Abstract

A significant proportion of cancers are potentially missed and underestimated by both imaging modalities. Prostate specific membrane antigen positron emission tomography may be used in addition to multiparametric magnetic resonance imaging to help improve local staging in those patients undergoing retropubic radical prostatectomy.

Clinical impact of 68Ga‐prostate‐specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer with rising prostate‐specific antigen after treatment with curative intent: preliminary analysis of a multidisciplinary approach

“…In the present study, 68 Ga‐PSMA PET/CT detected at least one lesion suspicious for prostate cancer recurrence in 75% of our patients. This is consistent with previously reported data in men with recurrent prostate cancer, with detection rates ranging from 71 to 89.5% , although detection remains dependent on PSA levels at the time of PET examination . Of note, 20% of our present patients had PSA levels of <0.5 ng/mL, and half of those who overall presented a negative scan were within this group.…”

“…Fendler et al evaluated the test in the local staging of prostate cancer, and found that 68 Ga‐PSMA PET detected seminal vesicle invasion with a 86% accuracy and extracapsular extension with a 71% accuracy. Moreover, 68 Ga‐PSMA PET/CT may be used in combination with multi‐parametric MRI in the local staging of prostate cancer, increasing specificity and positive predictive value for significant cancer, as reported by Rhee et al . Concerning clinical management and decision making, Dewes et al analysed 15 patients who were scheduled to undergo definitive local radiotherapy.…”

Comparison of 68Ga-HBED-CC PSMA-PET/CT and multiparametric MRI for gross tumour volume detection in patients with primary prostate cancer based on slice by slice comparison with histopathology

“…The specificity was slightly higher for PSMA PET than for mpMRI or GTV-union (87%, 82%, 67% respectively). This finding is similar to three recent studies 6, 11, 22, which reported higher specificities for PSMA PET (94-96%) than for mpMRI (82-94%). The range for sensitivity and specificity is likely due to a lack of standardization in data acquisition and in data analysis.…”

“…Two studies reported lower sensitivities for PSMA PET (64% and 49%), mpMRI (58% and 44%) and PSMA PET/MRI (76%, only 11), although the relationship between the observed sensitivities is similar 11, 22. In total, 225 segments involved PCa.…”

18F-DCFBC Prostate-Specific Membrane Antigen–Targeted PET/CT Imaging in Localized Prostate Cancer

“…In a study of 20 patients who underwent both mpMRI, 68 Ga-PSMA-HBED-CC the sensitivity, specificity, positive predictive value and negative predictive value for mpMRI and 68 Ga-PSMA-HBED-CC PET were approximately equal (for mpMRI: 44%, 94%, 81% and 76%, and for 68 Ga-PSMA-HBED-CC PET 49%, 95%, 85% and 88%, respectively). Based on these low sensitivity values in both imaging techniques, authors suggested potential complementarity of mpMRI and PSMA PET imaging (14). However, this is different from what we observed in the current study, where 18 F-DCFBC PET imaging detected only 61.5% of index lesions while mpMRI detected 95% of index lesions.…”