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Prediction of clinically significant prostate cancer by [68 Ga]Ga-PSMA-11 PET/CT: a potential tool for selecting patients for active surveillance

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

An Editorial to this article was published on 12 February 2024

Abstract

Purpose

In our study, our aim was to investigate the role of [68 Ga]Ga-PSMA-11 PET /CT imaging in the diagnosis of clinically significant prostate cancer (csPCa) (ISUP GG 2 and higher) in patients initially diagnosed with ISUP GG 1 and 2 after prostate biopsy.

Materials and methods

We retrospectively reviewed 147 patient records in whom [68 Ga]Ga-PSMA-11 PET/CT imaging was performed preoperatively. All patients were initially diagnosed with ISUP GG 1 and 2 PCa by biopsy. Final pathology reports were obtained after radical prostatectomy. The [68 Ga]Ga-PSMA-11 PET/CT images were evaluated to determine the PRIMARY score. Patients’ mpMRI-PIRADS scores were also recorded when available and analyzed in correlation with the pathology results.

Results

For the 114 patients scored using PRIMARY, 19 out of 37 patients with scores of 1 and 2 (51%) were diagnosed with csPCa. Of the 77 patients with PRIMARY scores between 3 and 5, 64 (83%) had csPCa. Notably, every patient with a PRIMARY score of 5 had csPCa. PRIMARY scoring had a sensitivity of 77% and specificity of 58%, with a positive predictive value of 83%. A moderate correlation was observed between PRIMARY scores and ISUP GG (Rho = 0.54, p < 0.001). In contrast, the PIRADS score displayed a sensitivity and specificity of 86% and 25% respectively, with a positive predictive value of 68%. No substantial correlation was found between PIRADS and ISUP GG. Statistical analysis revealed a significant correlation between PRIMARY and ISUP GG (p < 0.001), but not between PIRADS and ISUP GG (p = 0.281). Comparatively, PRIMARY scoring was significantly more reliable than PIRADS scoring in identifying csPCa.

Conclusion

[68 Ga]Ga-PSMA-11 PET/CT imaging is promising for distinguishing high-risk prostate cancer patients from those apt for active surveillance, potentially aiding in the identification of csPCa.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Yeditepe University Medical Faculty, Koşuyolu Mah. Koşuyolu Cad. No: 168, 34718, Kadıköy/Istanbul, Turkey

    Kaan Akcay, Gamze Beydagi, Turkay Toklu, Nalan Alan Selcuk & Levent Kabasakal

  2. Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul, 34098, Turkey

    Ali Kibar, Onur Erdem Sahin, Sertac Asa, Fuad Aghazada & Levent Kabasakal

  3. Department of Urology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul, 34098, Turkey

    Muhammet Demirbilek & Bulent Onal

Authors
  1. Kaan Akcay
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  2. Ali Kibar
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  3. Onur Erdem Sahin
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  4. Muhammet Demirbilek
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by KA, AK, MD, GB, FA, and LK. The first draft of the manuscript was written by LK, KA, and GB, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Levent Kabasakal.

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Ethics approval

The study was carried out in accordance with the declaration of Helsinki. The study was approved by the local ethical committee (approval number: 666795).

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Written consent was obtained from all patients.

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There is not any patient personal data in this manuscript.

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The authors declare no competing interests.

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Akcay, K., Kibar, A., Sahin, O.E. et al. Prediction of clinically significant prostate cancer by [68 Ga]Ga-PSMA-11 PET/CT: a potential tool for selecting patients for active surveillance. Eur J Nucl Med Mol Imaging 51, 1467–1475 (2024). https://doi.org/10.1007/s00259-023-06556-y

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