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Prospective comparison of whole-body MRI and 68Ga-PSMA PET/CT for the detection of biochemical recurrence of prostate cancer after radical prostatectomy

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Abstract

Purpose

To assess whole-body magnetic resonance imaging (wb-MRI) for detection of biochemical recurrence in comparison to 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) in prostate cancer (Pca) patients after radical prostatectomy.

Methods

This was a prospective trial including 28 consecutive patients (mean age 65.3 ± 9.0 years) with newly documented biochemical recurrence of Pca (mean prostate-specific antigen, PSA, 2.09 ± 1.95 ng/ml) following radical prostatectomy. All patients underwent both wb-MRI including a dedicated pelvic imaging protocol and PET/CT with 166 ± 35 MBq 68Ga-PSMA within a time window of 11 ± 10 days. PET/CT and MRI datasets were separately evaluated regarding Pca lesion count, type, localization and diagnostic confidence (three-point Likert scale, 1–3) by two nuclear medicine specialists and two radiologists, respectively. The reference standard was based on histopathological results, PSA levels following targeted salvage irradiation and follow-up imaging. Lesion-based and patient-based detection rates were compared using the chi-squared test. Differences in diagnostic confidence were assessed using the Welch test.

Results

A total of 56 Pca lesions were detected in 20 of the 28 patients. 68Ga-PSMA PET/CT detected 56 of 56 lesions (100%) in 20 patients (71.4%), while wb-MRI detected 13 lesions (23.2%) in 11 patients (39.3%). The higher detection rate with 68Ga-PSMA PET/CT was statistically significant on both a per-lesion basis (p < 0.001) and a per-patient basis (p = 0.0167). In 8 patients (28.6%) no relapse was detectable by either modality. All lesions detected by wb-MRI were also detected by 68Ga-PSMA PET/CT. Additionally, 68Ga-PSMA PET/CT provided superior diagnostic confidence in identifying Pca lesions (2.7 ± 0.7 vs. 2.3 ± 0.6, p = 0.044).

Conclusion

68Ga-PSMA PET/CT significantly out-performed wb-MRI in the detection of biochemical recurrence in Pca patients after radical prostatectomy.

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Acknowledgments

We thank Mrs. Erika Rädisch for carrying out the MRI scans.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, 40225, Dusseldorf, Germany

    Lino M. Sawicki, Julian Kirchner, Tim Ullrich, Lars Schimmöller, Johannes Boos, Christoph Schleich, Benedikt M. Schaarschmidt, Christian Buchbender, Philipp Heusch & Gerald Antoch

  2. Department of Urology, University Dusseldorf, Medical Faculty, 40225, Dusseldorf, Germany

    Carolin Buddensieck, Robert Rabenalt & Peter Albers

  3. Department of Nuclear Medicine, University Dusseldorf, Medical Faculty, 40225, Dusseldorf, Germany

    Christina Antke, Hans-Wilhelm Müller & Hubertus Hautzel

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  1. Lino M. Sawicki
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Correspondence to Johannes Boos.

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All procedures performed were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments.

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Sawicki, L.M., Kirchner, J., Buddensieck, C. et al. Prospective comparison of whole-body MRI and 68Ga-PSMA PET/CT for the detection of biochemical recurrence of prostate cancer after radical prostatectomy. Eur J Nucl Med Mol Imaging 46, 1542–1550 (2019). https://doi.org/10.1007/s00259-019-04308-5

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