PSMA PET for the Evaluation of Liver Metastases in Castration-Resistant Prostate Cancer Patients: A Multicenter Retrospective Study

Abstract

Background: To evaluate the diagnostic performance of PSMA-PET compared to conventional imaging/liver biopsy in the detection of liver metastases in CRPC patients. Moreover, we evaluated a PSMA-PET/CT-based radiomic model able to identify liver metastases. Methods: Multicenter retrospective study enrolling patients with the following inclusion criteria: (a) proven CRPC patients, (b) PSMA-PET and conventional imaging/liver biopsy performed in a 6 months timeframe, (c) no therapy changes between PSMA-PET and conventional imaging/liver biopsy. PSMA-PET sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for liver metastases were calculated. After the extraction of radiomic features, a prediction model for liver metastases identification was developed. Results: Sixty CRPC patients were enrolled. Within 6 months before or after PSMA-PET, conventional imaging and liver biopsy identified 24/60 (40%) patients with liver metastases. PSMA-PET sensitivity, specificity, PPV, NPV, and accuracy for liver metastases were 0.58, 0.92, 0.82, 0.77, and 0.78, respectively. Either number of liver metastases and the maximum lesion diameter were significantly associated with the presence of a positive PSMA-PET (p < 0.05). On multivariate regression analysis, the radiomic feature-based model combining sphericity, and the moment of inverse difference (Idm), had an AUC of 0.807 (95% CI:0.686-0.920). Conclusion: For liver metastases assessment, [68Ga]Ga-PSMA-11-PET demonstrated moderate sensitivity while high specificity, PPV, and inter-reader agreement compared to conventional imaging/liver biopsy in CRPC patients.

PET/CT and Conventional Imaging for the Assessment of Neuroendocrine Prostate Cancer: A Systematic Review

“…A total of 3427 articles were extrapolated with the computer literature search, and by reviewing the titles and abstracts, 3414 of them were excluded because the reported data were not within the field of interest of this review. Thirteen articles were therefore selected and retrieved in full-text version [28][29][30][31][32][33][34][35][36][37][38][39][40]; no additional studies were found screening the references of these articles (Figure 1). In general, the quality assessment using QUADAS-2 evaluation underlined the presence of a high risk of bias and applicability concerns in some of these studies for patient selection, and this is mainly related to the fact that these studies were characterized by heterogeneous cohorts (Figure 2).…”

“…In general, the quality assessment using QUADAS-2 evaluation underlined the presence of a high risk of bias and applicability concerns in some of these studies for patient selection, and this is mainly related to the fact that these studies were characterized by heterogeneous cohorts (Figure 2). Among the total number of studies included in the systematic review, 10 were of a retrospective nature [28,29,[33][34][35][36][37][38][39][40], whereas 2 had a prospective design [28,29], and in 1 case, it was not specified its nature [32]. Ten studies focused on PET/CT imaging [28,37], while three studies were performed using CI [38][39][40].…”

“…Speaking about radiopharmaceuticals used for PET/CT imaging, 1 of the study was performed with [ 18 F]FDG [29], in 3 cases [ 68 Ga]Ga-DOTANOC was used [28,30,31], in 2 cases [ 68 Ga]Ga-DOTATATE was used [32,36], [ 68 Ga]Ga-FAPI-04 was used in 1 case [34], 1 study was performed with [ 68 Ga]Ga-PSMA-11 [35] and lastly two works used different tracers: 1 with [ 68 Ga]Ga-PSMA, [ 68 Ga]Ga-DOTATATE and [ 18 F]FDG [33] and 1 with [ 18 F]-PSMA-1007, [ 18 F]-AIF-NOTA-octreotide and [ 18 F]FDG [37].…”

“…As previously underlined, different studies evaluated the value of PET/CT imaging for the assessment of NEPC [28][29][30][31][32][33][34][35][36][37], demonstrating some insights into its possible usefulness.…”

“…Sixty patients with liver metastases were evaluated with [ 68 Ga]Ga-PSMA-11 PET/CT, in comparison with CT or MR, by Mattoni et al [35] in a multicentric study and in 2/9 subjects that performed biopsy, the presence of NEPC was demonstrated. The overall detection rate of PET/CT was 92%, with a moderate and positive correlation between PSA and the presence of metastatic disease.…”