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68 Ga-PSMA-I/T PET-CT of a 73-year-old patient with PCa (Gleason score 5 + 4 = 9, grade group 5, ISUP 2014 and preoperative PSA 20 ng/mL). a Maximum intensity projection image of pretreatment. b, c Transaxial fused PET-CT and CT images with a gross tumoral lesion (green arrows). d, e Transaxial fused PET-CT and CT images establishing right SVI
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Background/aim:
The objective of this work was to assess the value of 68Ga-DOTAGA-(3-iodo-y)fk(Sub-KuE) positron emission tomography (68Ga-PSMA-I/T PET-CT) and multiparametric magnetic resonance imaging (mp-MRI) for preoperative staging in prostate cancer (PCa) patients who underwent radical prostatectomy (RP) by validating with postoperative hist...
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Citations
... Berger et al 24 suggested that 68 Ga-PSMA PET-CT provide superior detection of pelvic nodal disease over mpMRI alone. Çelen et al 30 reported that PSMA PET-CT had higher sensitivity (100%) and specificity (47.62%) for the detection of LNM. ...
Purpose
Prostate cancer (PCa) is the most common malignancy in men aged 50 years and older and the second cause of cancer death among men. Accurate staging of PCa preoperatively is of high importance for treatment decisions and patient management. Conventional imaging modalities (ultrasound, computed tomography [CT], and magnetic resonance imaging) are inaccurate for the staging of PCa. Newer modality multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scan show promising results for the staging of PCa. Only fewer studies are available for comparison of these modalities with histopathology as reference. The objective of our study is to evaluate the diagnostic accuracy of independent ⁶⁸ gallium PSMA ( ⁶⁸ Ga-PSMA) PET-CT compared with mpMRI for preoperative staging of PCa, using histopathology as the reference standard.
Materials and methods
From August 2021 to December 2022, 30 patients of biopsy-proven PCa were prospectively enrolled as per eligibility criteria. Preoperatively, ⁶⁸ Ga-PSMA PET scan and mpMRI were done in all the patients. Extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymph node metastasis (LNM) were investigated separately. Subsequently, the patients underwent robotic-assisted radical prostatectomy with bilateral pelvic lymph node dissection.
Results
mpMRI prostate was more sensitive (66.66%) but less specific than PSMA PET-CT (55.55%) for ECE. mpMRI and PSMA PET-CT both had similar sensitivity (83.3%) and specificity (87.5%) for SVI. PSMA PET-CT was more sensitive (85.71%) and specific (95.6%) than mpMRI prostate (62.5% and 91.30%, respectively) for LNM.
Conclusion
PSMA PET-CT is more specific for the detection of ECE and more sensitive and specific for the detection of LNM than mpMRI, and similar for the detection of SVI. mpMRI provides only local staging, while PSMA PET-CT provides information about local, regional, and distal staging. Overall, PSMA PET-CT is superior to mpMRI for locoregional staging of PCa.
... with a sensitivity and specificity of 50% and 97%, respectively. 74 Çelen et al. 76 found that both mpMRI and 68 Ga-PSMA-I/T PET-CT were not significantly different in terms of preoperative assessment of seminal vesicle invasion (SVI), bladder neck invasion (BNI), and extracapsular extension (ECE). However, a statistically signifi-cant difference was observed in the assessment of lymph node metastasis (LNM), with mpMRI showing higher overall sensitivity for ECE, SVI, and BNI, as well as a higher positive predictive value for ECE, SVI, and BNI. ...
... A total of 49 studies were involved in the analysis , of which 29 studies compared the diagnostic performance of PSMA PET and mpMRI in the primary tumor detection [ [71,77], two studies using the 18 F-PSMA-1007 [39,74], one using the 68 Ga-PSMA-I/T [50], one using the 68 Ga-PSMA-617 [54], and three studies only mentioning the 68 [30, 34, 36, 39-41, 43, 58, 66, 72, 77]; and 6 articles did not specify [32,37,38,45,55,65]. Moreover, 41 articles used PIRADS classification to evaluate mpMRI [30-51, 54-57, 59, 60, 62-71, 74-76], while 8 articles did not mention it [29,52,53,58,61,72,73,77]. Out of 41 articles, 33 articles used version 2 of PIRADS classification [31, 32, 34-40, 42-47, 49-51, 55-57, 59, 60, 62-64, 66-71, 74]; 3 articles used version 2.1 of PIRADS classification [33,41,48]; and 5 articles did not mention the version of PIRADS used [30,54,65,75,76]. ...
To compare prostate-specific membrane antigen (PSMA) PET with multiparametric MRI (mpMRI) in the diagnosis of pretreatment prostate cancer (PCa).
Pubmed, Embase, Medline, Web of Science, and Cochrane Library were searched for eligible studies published before June 22, 2022. We assessed risk of bias and applicability by using QUADAS-2 tool. Data synthesis was performed with Stata 17.0 software, using the “midas” and “meqrlogit” packages.
We included 29 articles focusing on primary cancer detection, 18 articles about primary staging, and two articles containing them both. For PSMA PET versus mpMRI in primary PCa detection, sensitivities and specificities in the per-patient analysis were 0.90 and 0.84 (p<0.0001), and 0.66 and 0.60 (p <0.0001), and in the per-lesion analysis they were 0.79 and 0.78 (p <0.0001), and 0.84 and 0.82 (p <0.0001). For the per-patient analysis of PSMA PET versus mpMRI in primary staging, sensitivities and specificities in extracapsular extension detection were 0.59 and 0.66 (p =0.005), and 0.79 and 0.76 (p =0.0074), and in seminal vesicle infiltration (SVI) detection they were 0.51 and 0.60 (p =0.0008), and 0.93 and 0.96 (p =0.0092). For PSMA PET versus mpMRI in lymph node metastasis (LNM) detection, sensitivities and specificities in the per-patient analysis were 0.68 and 0.46 (p <0.0001), and 0.91 and 0.90 (p =0.81), and in the per-lesion analysis they were 0.67 and 0.36 (p <0.0001), and 0.99 and 0.99 (p =0.18).
PSMA PET has higher diagnostic value than mpMRI in the detection of primary PCa. Regarding the primary staging, mpMRI has potential advantages in SVI detection, while PSMA PET has relative advantages in LNM detection.
The integration of prostate-specific membrane antigen (PSMA) PET into the diagnostic pathway may be helpful for improving the accuracy of prostate cancer detection. However, further studies are needed to address the cost implications and evaluate its utility in specific patient populations or clinical scenarios. Moreover, we recommend the combination of PSMA PET and mpMRI for cancer staging.
• Prostate-specific membrane antigen PET has higher sensitivity and specificity for primary tumor detection in prostate cancer compared to multiparametric MRI.
• Prostate-specific membrane antigen PET also has significantly better sensitivity and specificity for lymph node metastases of prostate cancer compared to multiparametric MRI.
• Multiparametric MRI has better accuracy for extracapsular extension and seminal vesicle infiltration compared to ate-specific membrane antigen PET.
... Secondary outcomes Thirteen out of twenty-three papers [7,16,20,21,26,[28][29][30][31][32][33][34][35] were subjected to a quantitative analysis of secondary endpoints. Among these thirteen studies, three [7,29,31] evaluated the pathological T-stage greater than or equal to pT3a (pT-stage ≥ pT3a), nine [20,21,26,28,30,[32][33][34][35] evaluated the detection of pT-stage equal to pT3a, and twelve [16,20,21,26,[28][29][30][31][32][33][34][35] evaluated the diagnostic accuracy for detecting seminal vesicle involvement (pT-stage equal to pT3b). ...
... Secondary outcomes Thirteen out of twenty-three papers [7,16,20,21,26,[28][29][30][31][32][33][34][35] were subjected to a quantitative analysis of secondary endpoints. Among these thirteen studies, three [7,29,31] evaluated the pathological T-stage greater than or equal to pT3a (pT-stage ≥ pT3a), nine [20,21,26,28,30,[32][33][34][35] evaluated the detection of pT-stage equal to pT3a, and twelve [16,20,21,26,[28][29][30][31][32][33][34][35] evaluated the diagnostic accuracy for detecting seminal vesicle involvement (pT-stage equal to pT3b). ...
... Secondary outcomes Thirteen out of twenty-three papers [7,16,20,21,26,[28][29][30][31][32][33][34][35] were subjected to a quantitative analysis of secondary endpoints. Among these thirteen studies, three [7,29,31] evaluated the pathological T-stage greater than or equal to pT3a (pT-stage ≥ pT3a), nine [20,21,26,28,30,[32][33][34][35] evaluated the detection of pT-stage equal to pT3a, and twelve [16,20,21,26,[28][29][30][31][32][33][34][35] evaluated the diagnostic accuracy for detecting seminal vesicle involvement (pT-stage equal to pT3b). ...
Purpose
The current clinical recommendations posit the deployment of specific approved radiolabeled prostate-specific membrane antigen-ligand positron emission tomography (PSMA PET) for detecting metastatic prostate cancer during primary staging. Nevertheless, the precise efficacy of such ligands in localizing intraprostatic tumours (index tumour) and T-staging is not well established. Consequently, the objective of this inquiry is to ascertain the diagnostic accuracy of PSMA-PET in the tumour staging of newly diagnosed prostate cancer by means of a meta-analysis that integrates studies utilizing histological confirmation as the reference standard.
Methods
In this study, we conducted a systematic literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases using a predefined collection of search terms. These terms included ‘PSMA PET’, ‘primary staging’, and ‘prostate cancer’. Subsequently, two independent reviewers evaluated all the studies based on predetermined inclusion criteria, extracted pertinent data, and assessed the quality of evidence. Any disparities were resolved by a third reviewer. A random effects Sidik-Jonkman model was applied to conduct a meta-analysis and estimate the diagnostic accuracy on a per-patient basis, along with 95% confidence intervals. Moreover, an appraisal regarding the likelihood of publication bias and the impact of small-study effects was performed utilizing both Egger’s test and a graphical examination of the funnel plot.
Results
The present analysis comprised a total of twenty-three scientific papers encompassing 969 patients and involved their analysis by both qualitative and quantitative approaches. The results of this study demonstrated that the estimated diagnostic accuracy of PSMA PET/CT and PSMA PET/MRI, for the detection of intraprostatic tumours, regardless of the type of PSMA-ligand, was 86% (95% CI: 76–96%) and 97% (95% CI: 94–100%), respectively. Furthermore, the diagnostic accuracy for the detection of extraprostatic extension (EPE) was 73% (95% CI: 64–82%) and 77% (95% CI: 69–85%), while the diagnostic accuracy for the detection of seminal vesicle involvement (SVI) was 87% (95% CI: 80–93) and 90% (95% CI: 82–99%), respectively.
Conclusion
The present investigation has demonstrated that PSMA PET/MRI surpasses currently recommended multiparametric magnetic resonance imaging (mpMRI) in terms of diagnostic accuracy as inferred from a notable data trajectory, whereas PSMA-PET/CT exhibited comparable diagnostic accuracy for intraprostatic tumour detection and T-staging compared to mpMRI. Nevertheless, the analysis has identified certain potential limitations, such as small-study effects and a potential for publication bias, which may impact the overall conclusions drawn from this study.
... The current meta-analysis included a total of 39 studies comprising 3630 patients, published between 2016 and 2022, 7,8,10-12,20-53 with 38.5% (15 studies) of the studies being prospective studies. 12,22,23,28,29,34,35,[37][38][39][45][46][47]49,50 In all included studies, the 68 Ga-PSMA radiotracer was predominantly used (82.1%), whereas 68 Ga-PSMA-11 was the major radiotracer (n = 23). ...
... Of the 39 included studies, 3 studies did not mention ISUP grade, 33,37,49 and in 1 study, 29 mainly the lesions had the ISUP grade. In the other 35 studies, 3022 patients were pathologically verified of having malignant tumors, of which ISUP grades 2 and 3 accounted for 64%, with a median of 3 (range, 1-5) [7][8][9][10][11][12][20][21][22][23][24][26][27][28]32,33,[35][36][37][39][40][41][42][43][44][45][46][47][48][49][51][52][53] (Table 1). ...
... 28,31,39,49 The injected activity of 68 G-PSMA was 74 to 185 MBq. 23,34,50 In addition to the radiotracer 68 Ga-PSMA, the median median/mean injected activity of 18 F-DCFPyL was 294.6 MBq (range, 250-329.5 MBq), 8,29,38,40 and that of 18 F-PSMA-1007 was 256 MBq. 41 The median of median/ mean interval time between radiotracer injection and PET scanning was 60 minutes (range, 45-180 minutes) 7 Among the 39 included studies, 3.0 Twas the most commonly used diagnostic equipment for mpMRI (64%), 8,[10][11][12][20][21][22]24,[26][27][28][29]31,32,34,37,39,40,44,45,[47][48][49]52,53 and 69% of the mpMRI sequence used T2-weighted and diffusion-weighted. ...
Purpose:
Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68Ga-PSMA-11, 18F-DCFPyL, and 18F-PSMA-1007 applied PET/CT imaging was an emerging diagnostic tool in prostate cancer patients for staging or posttreatment follow-up, even early detecting. Many studies have used PSMA PET for comparison with mpMRI to test the diagnostic ability for early prostate cancer. Unfortunately, these studies have shown conflicting results. This meta-analysis aimed to compare the differences in diagnostic performance between PSMA PET and mpMRI for detecting and T staging localized prostatic tumors.
Methods:
This meta-analysis involved a systematic literature search of PubMed/MEDLINE and Cochrane Library databases. The pooling sensitivity and specificity of PSMA and mpMRI verified by pathological analysis were calculated and used to compare the differences between the 2 imaging tools.
Results:
Overall, 39 studies were included (3630 patients in total) from 2016 to 2022 in the current meta-analysis and found that the pooling sensitivity values for localized prostatic tumors and T staging T3a and T3b of PSMA PET were 0.84 (95% confidence interval [CI], 0.83-0.86), 0.61 (95% CI, 0.39-0.79), and 0.62 (95% CI, 0.46-0.76), respectively, whereas those of mpMRI were found to be 0.84 (95% 0.78-0.89), 0.67 (95% CI, 0.52-0.80), and 0.60 (95% CI, 0.45-0.73), respectively, without significant differences (P > 0.05). However, in a subgroup analysis of radiotracer, the pooling sensitivity of 18F-DCFPyL PET was higher than mpMRI (relative risk, 1.10; 95% CI, 1.03-1.17; P < 0.01).
Conclusions:
This meta-analysis found that whereas 18F-DCFPyL PET was superior to mpMRI at detecting localized prostatic tumors, the detection performance of PSMA PET for localized prostatic tumors and T staging was comparable to that of mpMRI.
... However, the diagnostic performance for regional and distant metastases between these modalities is expected to differ. Few studies have quantified these variances, which were mainly based on 68 Ga-PSMA-11 and mpMRI comparison [8][9][10][11][12][13]. There is very limited data with intraindividual comparison of pelvic mpMRI and 18 F-DCFPyL PET/CT. ...
Purpose:
To directly compare the performance of pelvic mpMRI versus recently approved and increasingly used PSMA-based 18F-DCFPyL PET/CT in intermediate-high risk and biochemical recurrent prostate cancer patient cohort while exploring their potential differing applications in specific clinical scenarios.
Methods:
A retrospective analysis was performed on patients who had 18F-DCFPyL PET/CT and pelvic mpMRI done from September 2021 to January 2022 at a single institution. The inclusion criteria were paired exams within a 3-month interval. Exclusion criteria were intervening treatment between exams, a change in PSA by more than 50% and absolute difference more than 1 ng/mL, or concurrent history of other malignancy. Abnormal lesions on these 2 imaging exams were reviewed with the identification of concordant and discordant imaging findings. The findings were verified by pathology or other imaging techniques within minimal 5-month clinical follow-up.
Results:
A total of 57 patients with 57 paired exams were included. The rate of concordant exams was 43/57 or 75.4%. Lesion-based analyses of sensitivity, specificity, PPV and NPV for mpMRI and 18F-DCFPyL PET/CT in the prostate bed were 96%, 94%, 98%, 89% and 96%, 100%, 100%, 90% respectively. For pelvic lymph node metastases, the sensitivity, specificity, PPV and NPV for mpMRI and 18F-DCFPyL PET/CT were 52%, 100%, 100%, 55% and 100%, 100%, 100%, 100% respectively. For bone metastases, the sensitivity, specificity, PPV and NPV for mpMRI and 18F-DCFPyL PET/CT were 86%, 73%, 50%, 94% and 100%, 98%, 95%, 100% respectively. Exact McNemar's test for paired data suggested that in diagnostic performance between 18F-DCFPyL PET/CT and mpMRI was not statistically significant in prostate bed (p-value = 1.00), but significantly in pelvic lymph nodes (p-value < 0.0001) and bone lesions (p-value = 0.0026).
Conclusion:
Our study demonstrated that PSMA-based 18F-DCFPyL PET/CT and pelvic mpMRI have a good concordance rate in the detection of primary or recurrence prostate disease and can have complementary roles in the clinical assessment of the prostate bed lesions. However, there are key differences in their performance, with the notably superior performance of PSMA-based 18F-DCFPyL PET/CT in the detection of small metastatic nodal disease and bone metastases.
... However, the benefit of PSMA PET imaging in the primary diagnosis and staging of PCa is still unclear [6,7]. Recently, published data indicate that the use of PSMA PET imaging might enhance the visualization and detection rate of PCa [8]. Therefore, the PRIMARY trial investigating the detection of clinically significant PCa by a combination of PSMA PET-CT with multiparametric MRI compared to targeted biopsies and the probability of avoiding unnecessary prostate biopsies will provide conclusions in the future [9]. ...
Introduction:
Prostate-specific membrane antigen (PSMA)-based imaging and theranostics have played an important role in the diagnosis, staging, and treatment of prostate cancer (PCa). We aimed to evaluate the acceptance and use of PSMA theranostics among German urologists.
Methods:
An anonymous online questionnaire was sent via survio.com to the members of the German Society of Urology (DGU).
Results:
Seventy-two percent of participants performed PSMA positron emission tomography (PET) imaging regularly in biochemically recurrent PCa. Overall, 61% of participants considered PSMA-radioligand therapy to be very useful or extremely useful. PSMA PET imaging in high-risk PCa is more often considered by urologists working in a university setting than in nonuniversity settings or medical practices (51% vs. 25%, p < 0.001). Most perform PSMA-radioligand therapy as an option after all approved systemic treatments for metastatic castration-resistant PCa (56%) or after cabazitaxel (14%). A total of 93.9% and 70.3% of respondents consider the lack of reimbursement by health insurance to be the main obstacle to using PSMA PET imaging or radioligand therapy, respectively.
Discussion/conclusion:
PSMA-based imaging/theranostics are already widely applied but would find even more widespread use if reimbursement is clearly regulated by health insurance in Germany.
... Of the 68 Ga-PSMA PET/CT studies, four were prospective [30,31,33,38] No per-patient data (n = 10) Different study population (n = 6) Inclusion of <10 patients (n = 2) Table 3. ...
... Five 68 Ga-PSMA PET/CT studies [31,34,41,42,45] were scored as unclear for patient selection as there was no information on whether a consecutive or random sample of patients was included and/or inappropriate exclusions were avoided. Overall for the 68 Ga-PSMA PET/CT studies, the risk of bias was assessed as unclear for the index test in nine studies [25,29,32,33,35,36,[42][43][44] and for the reference standard in 17 studies [26][27][28][30][31][32][34][35][36][37][38][39]41,42,[44][45][46] because it was not reported whether 68 Ga-PSMA PET was evaluated without knowledge of the histopathology and vice versa. ...
... Among the 68 Ga-PSMA PET/CT studies, most of the scans were performed using 68 Ga-PSMA-11 with injected activity between 92 and 240 MBq. Four studies did not specify the PSMA ligand [27,40,43,45] and two studies used 68 Ga-PSMA-I&T as the radiotracer [34,38]. The injection time was between 45 and 97 min before the scan. ...
Context
In December 2020, the US Food and Drug Administration approved a ⁶⁸Ga-labeled prostate-specific membrane antigen ligand (⁶⁸Ga-PSMA-11) for positron emission tomography (PET) in patients with suspected prostate cancer (PCa) metastasis who are candidates for initial definitive therapy. ⁶⁸Ga-PSMA PET is increasingly performed for these patients and is usually combined with computed tomography (CT). In recent years, ⁶⁸Ga-PSMA PET has been combined with high-resolution magnetic resonance imaging (MRI), which is beneficial for T staging and may further enhance the staging of primary PCa.
Objective
To compare the diagnostic accuracy of ⁶⁸Ga-PSMA PET/MRI with ⁶⁸Ga-PSMA PET/CT for staging of primary PCa.
Evidence acquisition
A comprehensive literature search was performed using Embase, PubMed/Medline, Web of Science, Cochrane Library, and Google Scholar up to June 24, 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the QUADAS-2 tool.
Evidence synthesis
The search identified 2632 articles, of which 27 were included. The diagnostic accuracy of ⁶⁸Ga-PSMA PET/MRI, measured as the pooled natural logarithm of diagnostic odds ratio (lnDOR), was 2.27 (95% confidence interval [CI] 1.21–3.32) for detection of extracapsular extension (ECE), 3.50 (95% CI 2.14–4.86) for seminal vesicle invasion (SVI), and 4.73 (95% CI 2.93–6.52) for lymph node metastasis (LNM). For ⁶⁸Ga-PSMA PET/CT, the analysis showed lnDOR of 2.45 (95% CI 0.75–4.14), 2.94 (95% CI 2.26–3.63), and 2.42 (95% CI 2.07–2.78) for detection of ECE, SVI, and LNM, respectively. The overall risk of bias and applicability concerns were assessed as moderate and low, respectively.
Conclusions
⁶⁸Ga-PSMA PET/MRI shows high diagnostic accuracy equivalent to that of ⁶⁸Ga-PSMA PET/CT for detection of ECE, SVI, and LNM in staging of PCa. There is an urgent need for direct comparison of the two diagnostic tests in future research.
Patient summary
The use of radioactively labeled molecules that bind to prostate-specific membrane antigen (⁶⁸Ga-PSMA) for positron emission tomography (PET) scans combined with either computed tomography (CT) or magnetic resonance imaging (MRI) is increasing for prostate cancer diagnosis. There is a need for direct comparison of the two tests to demonstrate the benefit of ⁶⁸Ga-PSMA PET/MRI for determining tumor stage in prostate cancer.
Take Home Message
After the recent US Food and Drug Administration approval of ⁶⁸Ga-labeled prostate-specific membrane antigen ligand (⁶⁸Ga-PSMA) positron emission tomography (PET) for staging of primary prostate cancer (PCa), it is expected that the use of this imaging modality will increase rapidly. Our review of the literature shows that ⁶⁸Ga-PSMA PET/magnetic resonance imaging has high diagnostic accuracy equivalent to that of ⁶⁸Ga-PSMA PET/computed tomography in primary PCa staging. There is an urgent need for direct head-to-head comparison of the two diagnostic tests in future research.
Background Multiparametric magnetic resonance imaging (mpMRI) is widely used for the evaluation of prostate cancer and is known to have better accuracy. Gallium-68 prostate-specific membrane antigen (Ga-68 PSMA) is a radiotracer that shows high localization in prostate cancer cells.
Purpose The purpose of this study was to assess the sensitivity and utility of Ga-68 PSMA positron emission tomography/computed tomography (PET/CT) in comparison with mpMRI as a noninvasive imaging technique for the initial diagnosis and locoregional staging of prostate cancer using transrectal ultrasound (TRUS)-guided biopsy as gold standard.
Materials and Methods This prospective observational study conducted from August 2017 to April 2020 evaluated 60 men (n = 60) with biopsy-proven prostate carcinoma. They underwent mpMRI and Ga-68 PSMA PET/CT scans within 14 days with TRUS biopsy being gold standard. T staging of disease, N staging of lymph nodes within the pelvis, and M staging of lesions in pelvic bones (within the imaging field of mpMRI) were compared using PSPP version 1.0.1 statistical software.
Results All 60 men with a mean age of 69.9 ± 9.35 years showed Ga-68 PSMA avid disease, whereas 55 were detected by mpMRI. The sensitivity in detection of prostate lesions (with 95% confidence interval) was 99.08% for Ga-68 PSMA PET/CT and 84.40% for mpMRI. Ga-68 PSMA PET/CT detected greater number of patients with regional lymph nodal involvement (19/60) as compared with mpMRI (12/60). Ga-68 PSMA PET/CT showed PSMA avid pelvic skeletal lesions in nine patients, whereas mpMRI detected pelvic lesions in six patients. In addition, four other patients showed extrapelvic skeletal lesions on Ga-68 PSMA PET/CT.
Conclusion Ga-68 PSMA PET/CT has superior sensitivity in detection of primary prostate tumor, as compared with mpMRI. Both modalities correlate well in detection of seminal vesicle involvement. Ga-68 PSMA PET/CT outperformed mpMRI in detection of lymph nodal and skeletal metastases. Hence, Ga-68 PSMA PET/CT should be considered as first-line diagnostic modality for carcinoma prostate.
Summary Statement: Ga-68 PSMA PET/CT shows superior diagnostic performance than mpMRI in the evaluation of prostate cancer.
b> Introduction: Prostate cancer (PCa) is a common and leading course of cancer-related death in men. Although there are studies on multiparametric magnetic resonance imaging (MpMRI) with good diagnostic results in detecting clinically significant PCa, new methods have been investigated due to the low positive predictive values. In this context, prostate-specific membrane antigen positron emission tomography (PSMA PET) emerges as an alternative imaging method to MpMRI. This study aimed to compare <sup>68</sup>Ga PSMA I&T-PET/CT and MpMRI in determining tumor location. Methods: Preoperative MpMRI and <sup>68</sup>Ga PSMA I&T-PET/CT scans and pathology specimens of patients who underwent radical prostatectomy for PCa at our clinic between 2018 and 2021 were retrospectively evaluated. PSMA I&T-PET/CT, MpMRI, combined imaging were compared for tumor localization according to histopathological data. Results: In terms of tumor localization, MpMRI demonstrated overall accuracy rates of 75.9% ( p kappa [κ] 0.0001* [0.525]). <sup>68</sup>Ga PSMA I&T-PET/CT showed 71.5% ( p κ 0.0001* [0.438]). For the combined imaging approach, the overall accuracy rate was calculated as 79.2% ( p κ 0.0001* [0.576]). Additionally, high diagnostic accuracy was achieved for the combined imaging approach, particularly in the intermediate ISUP group. Moreover, SUVmax was calculated as 6.37. Conclusion: The combined use of <sup>68</sup>Ga PSMA I&T-PET/CT and MpMRI has high diagnostic rates. However, the high cost is a significant disadvantage that limits their routine combined use.
