The Value of 18F-PSMA-1007 PET/CT in Identifying High-Risk Prostate Cancer

Abstract

Background: Clinical management decisions on prostate cancer (PCa) are often based on a determination of risk. 68Ga-prostate-specific membrane antigen (PSMA)-11-positron-emission-tomography (PET)/ computer-tomography (CT) is an attractive modality to assess biochemical recurrence of PCa, detect metastatic disease and stage of primary PCa, making it a promising strategy for risk stratification. However, due to some limitation of 68Ga-PSMA-11 the development of alternative tracers is of high interest. In this study, we aimed to investigate the value of the new PET trace 18F-PSMA-1007 in identifying high-risk PCa.Methods: 170 patients with primary PCa underwent 18F-PSMA-1007 PET/CT were retrospectively analyzed. According to the European Association of Urology (EAU) guidelines on prostate cancer for PCa, patients were classified into low-intermediate-risk (LMR) group or high-risk (HR) group. The maximum standardized uptake values (SUVmax) of the primary prostate tumor was measured on PET/CT images. The diagnostic performance of PET/CT for LMR and HR PCa were calculated and the relationship between the SUVmax of primary prostate tumor, prostate-specific antigen (PSA) level and Gleason score (GS) were analyzed.Results: Of all 170 patients, 55 patients were classified into LMR group and 115 patients were classified into HR group. There was a significant positive correlation between the PSA level/GS and SUVmax (r = 0.597, r = 0.446, P < 0.001, respectively). Tumors with GS of 6 and 7a showed significantly lower 18F-PSMA-1007 uptake compared to patients with GS of 8, 9, and 10 (P < 0.001). SUVmax in patients of HR was significantly higher than those of LMR (median SUVmax: 20.20 versus 8.40; P < 0.001). In receiver operating characteristic (ROC) curve analysis, the optimal cutoff value of the SUVmax for identifying high-risk PCa was set as 10.78 (area under the curve [AUC]: 0.873; sensitivity: 90.4%; specificity: 69.1%). Conclusion: 18F-PSMA-1007 PET/CT showed the powerful diagnosis efficacy for high-risk PCa, which can be used as an objective imaging reference index for clinical reference.