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68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is 68Ga-PSMA PET/CT guided biopsy the future?

European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Background

68Ga prostate specific membrane antigen PET/CT (68Ga-PSMA PET/CT) may be superior to multiparametric MRI (mpMRI) for localisation of prostate cancer tumour foci, however the concordance and differences between 68Ga-PSMA PET/CT and mpMRI when applied to all biopsied patients and potential benefit in patients with negative mpMRI is unclear.

Methods

Retrospective analysis of patients undergoing mpMRI, prostate biopsy and 68Ga-PSMA PET/CT over a 3-year period. Diagnostic performance of 68Ga-PSMA PET/CT and mpMRI were assessed using biopsy histopathology for the entire cohort and radical prostatectomy specimen in a subset of patients. Lesion concordance and additional detection of each modality were determined, including in a dedicated cohort of patients with mpMRI PIRADS 2 scans.

Results

A total of 144 patients were included in the study. Index lesion/foci detection was similar between 68Ga-PSMA PET/CT and mpMRI (sensitivity 83.1% vs 90.1%; p = 0.267), however lesions missed by mpMRI were larger (1.66 cm3 vs 0.72 cm3; p = 0.034). Lesion detection rates were similar across the biopsy histopathology and radical prostatectomy specimen subset, with a high concordance for index (80.1%) and a moderate concordance for total (67%) lesions between the 2 imaging modalities. The additional detection yield favoured 68Ga-PSMA PET/CT over mpMRI for index (13.5% vs 4.3%) and total (18.2% vs 5.4%) lesions; both modalities missed 2.1% and 12.3% of index and total lesions, respectively. 68Ga-PSMA PET/CT identified 9 of 11 patients with PIRADS 2 mpMRI but subsequently diagnosed with Gleason ≥ 3 + 4 disease.

Conclusions

Despite high concordance rates, 68Ga-PSMA PET/CT incrementally improved tumour localisation compared with mpMRI. These results suggest that 68Ga-PSMA PET/CT may have an incremental value to that of mpMRI in the diagnostic process for prostate.

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Authors and Affiliations

  1. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Peter Donato, John Yaxley, Sachinka Ranasinghe, Patrick E. Teloken, Geoff Coughlin, Rachel Esler, Nigel Dunglison, Robert A Gardiner & Matthew J Roberts

  2. Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia

    Peter Donato, Andrew Morton, John Yaxley, Sachinka Ranasinghe, Patrick E. Teloken, Samuel Kyle, Robert A Gardiner & Matthew J Roberts

  3. Department of Nuclear Medicine, Royal Brisbane and Women’s Hospital, Herston, Australia

    Samuel Kyle

  4. Griffith University, Brisbane, Queensland, Australia

    Robert A Gardiner

  5. Edith Cowan University, Joondalup, Australia

    Robert A Gardiner

  6. Nepean Urology Research Group, Kingswood, Penrith, New South Wales, Australia

    Matthew J Roberts

  7. Discipline of Surgery, Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia

    Matthew J Roberts

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  1. Peter Donato
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Correspondence to Peter Donato or Matthew J Roberts.

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The study was approved by the Ethics Committee of the Royal Brisbane and Women’s Hospital (RBWH) Human Research Ethics Committee (approval number HREC/17/QRBW/644).

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Donato, P., Morton, A., Yaxley, J. et al. 68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is 68Ga-PSMA PET/CT guided biopsy the future?. Eur J Nucl Med Mol Imaging 47, 1843–1851 (2020). https://doi.org/10.1007/s00259-019-04620-0

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