In:
BJU International, Wiley, Vol. 124, No. S1 ( 2019-11), p. 42-49
Abstract:
To evaluate the ability of prostate‐specific membrane antigen ( PSMA )‐positron‐emission tomography ( PET )/computed tomography ( CT ) to detect intermediate‐grade intra‐prostatic prostate cancer ( PC a), and to determine if PSMA ‐ PET improves the diagnostic accuracy of multiparametric magnetic resonance imaging (mp MRI ). Patients and Methods A total of 56 consecutive patients with International Society of Urological Pathology ( ISUP ) grade 2–3 PC a after radical prostatectomy, who underwent both mp MRI and PSMA ‐ PET CT (hereafter PSMA ‐ PET ) preoperatively, were enrolled in this study. The accuracy of PSMA ‐ PET , mp MRI alone, and the two procedures in combination was analysed for identifying ISUP grades 1–3 within a 12‐segment model. The accuracy of a combined predictive model ( PSMA ‐ PET and mp MRI ) was determined. Receiver‐operating characteristic curve analysis to determine the optimal standardized uptake value ( SUV max ) for PSMA ‐ PET in discriminating between ISUP grades 1 and ≥2 was performed. Results On a per‐patient basis, the sensitivities for PSMA ‐ PET and mp MRI in identifying ISUP grades 2–3 PC a were 100% and 97%, respectively. Assessing ISUP grade ≥2 PC a using a 12‐segment analysis, PSMA ‐ PET demonstrated greater diagnostic accuracy (area under the curve), sensitivity, specificity, negative predictive value ( NPV ) and positive predictive value ( PPV ), with values of 0.91, 88%, 93%, 95% and 85%, respectively, than did mp MRI (Prostate Imaging Reporting and Data System [ PI ‐ RADS ] 3–5), at 0.79, 68%, 91%, 87%, and 75%, respectively. When used in combination ( PSMA ‐ PET and mp MRI PIRADS 4–5), sensitivity, specificity, NPV and PPV were 92%, 90%, 96% and 81%, respectively. The sensitivity for both techniques reduced markedly when assessing ISUP grade 1 PC a (18% for PSMA ‐ PET , 10% for mp MRI ). An SUV max value of 3.95 resulted in 94% sensitivity and 100% specificity. Conclusion PSMA ‐ PET is accurate in detecting segments containing intermediate‐grade intra‐prostatic PC a ( ISUP grade ≥ 2), compared with and complementary to mp MRI . By contrast the detection rate for ISUP grade 1 disease for both PSMA ‐ PET and mp MRI was low.
Type of Medium:
Online Resource
ISSN:
1464-4096
,
1464-410X
Language:
English
Publisher:
Wiley
Publication Date:
2019
detail.hit.zdb_id:
2019983-1
Permalink