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Diagnostic performance of 68Ga-PSMA PET/CT in the detection of prostate cancer prior to initial biopsy: comparison with cancer-predicting nomograms

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Abstract

Purpose

To assess the diagnostic performance of 68Ga-PSMA PET/CT for detecting suspected prostate cancer (PCa) and to compare it with that of two cancer-predicting nomograms.

Methods

We performed a retrospective analysis of 146 consecutive patients with suspected PCa based on symptoms or elevated total prostate-specific antigen (tPSA) levels who underwent 68Ga-PSMA PET/CT and histopathologic examinations from April 2017 to April 2018 in a large tertiary care hospital in China. The 68Ga-PSMA PET/CT results (PCa or benignancy) were evaluated by two experienced nuclear medicine specialists. The risk of positive PCa was evaluated using ERSPC and PCPT nomograms. The diagnostic performances of 68Ga-PSMA PET/CT and that of the two nomograms were compared via receiver operating characteristic (ROC) curve analysis, decision curve analysis, and logistic regression.

Results

A total of 58 patients with tPSA of 0.4–50 ng/ml were included in the final analysis; PCa diagnosis was confirmed in 37 patients and excluded in 21 patients. ROC analysis showed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 68Ga-PSMA PET/CT were 91.67, 81.82, 89.19, and 85.71%, respectively, in per-patient analyses. 68Ga-PSMA PET/CT exhibited a higher AUC (0.867) than those of ERSPC-RC3 (0.855) and PCPT-RC (0.770). The net benefit of 68Ga-PSMA PET/CT was greatest for patients within threshold probabilities of 15–90%. Among the 58 patients, 11 (19%) biopsies suggested by ERSPC-RC3 were unnecessary and could have been avoided if judged by the 68Ga-PSMA PET/CT results. Multivariate analysis revealed that the maximum standardised uptake value (SUVmax) and prostate volume were significant predictive factors for positive PCa results.

Conclusion

In suspected PCa patients with tPSA of 0.4–50 ng/ml, 68Ga-PSMA PET/CT outperformed the nomograms in predicting cancer and reducing unnecessary biopsies. In addition, the risk of PCa was positively correlated with a higher SUVmax and lower prostate volume, which could help clinicians in making preliminary estimates of individual cancer risk, monitoring 68Ga-PSMA PET/CT false-positive results and making biopsy decisions in daily medical practice.

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Funding

This study was funded by the National Natural Science Foundation of China (grant nos. 81372771, 81772734, 81871379, 816771713), the Shaanxi Science and Technology Co-ordination and Innovation Project (grant no. 2016KTCQ03–09), the National Key R&D Program of China (grant no. 2016YFC0103804), the Natural Science Foundation of Shaanxi Province (grant no. 2018SF-228, 2018PT-08), and the International Cooperation Program of Xijing Hospital (grant no. XJZT15G01).

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Author notes

  1. Jingliang Zhang, Shuai Shao and Peng Wu contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China

    Jingliang Zhang, Peng Wu, Bo Yang, Donghui Han, Yu Li, Xiaoyu Lin, Wei Song, Milin Cao & Weijun Qin

  2. Department of Health Services, Health Service Training Base, Fourth Military Medical University, Xi’an, 710032, China

    Jingliang Zhang

  3. Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China

    Shuai Shao

  4. Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China

    Daliang Liu, Fei Kang & Jing Wang

  5. Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, China

    Jing Zhang

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  1. Jingliang Zhang
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Correspondence to Fei Kang, Weijun Qin or Jing Wang.

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Zhang, J., Shao, S., Wu, P. et al. Diagnostic performance of 68Ga-PSMA PET/CT in the detection of prostate cancer prior to initial biopsy: comparison with cancer-predicting nomograms. Eur J Nucl Med Mol Imaging 46, 908–920 (2019). https://doi.org/10.1007/s00259-018-4255-1

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