Cancers (May 2024)

“Seeing Is Believing”: Additive Utility of <sup>68</sup>Ga-PSMA-11 PET/CT in Prostate Cancer Diagnosis

  • Joel Chin,
  • Yu Guang Tan,
  • Alvin Lee,
  • Tze Kiat Ng,
  • Ruoyu Shi,
  • Charlene Yu Lin Tang,
  • Sue Ping Thang,
  • Jeffrey Kit Loong Tuan,
  • Christopher Wai Sam Cheng,
  • Kae Jack Tay,
  • Henry Sun Sien Ho,
  • Hung-Jen Wang,
  • Peter Ka-Fung Chiu,
  • Jeremy Yuen-Chun Teoh,
  • Winnie Wing-Chuen Lam,
  • Yan Mee Law,
  • John Shyi Peng Yuen,
  • Kenneth Chen

DOI
https://doi.org/10.3390/cancers16091777
Journal volume & issue
Vol. 16, no. 9
p. 1777

Abstract

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Widespread adoption of mpMRI has led to a decrease in the number of patients requiring prostate biopsies. 68Ga-PSMA-11 PET/CT has demonstrated added benefits in identifying csPCa. Integrating the use of these imaging techniques may hold promise for predicting the presence of csPCa without invasive biopsy. A retrospective analysis of 42 consecutive patients who underwent mpMRI, 68Ga-PSMA-11 PET/CT, prostatic biopsy, and radical prostatectomy (RP) was carried out. A lesion-based model (n = 122) using prostatectomy histopathology as reference standard was used to analyze the accuracy of 68Ga-PSMA-11 PET/CT, mpMRI alone, and both in combination to identify ISUP-grade group ≥ 2 lesions. 68Ga-PSMA-11 PET/CT demonstrated greater specificity and positive predictive value (PPV), with values of 73.3% (vs. 40.0%) and 90.1% (vs. 82.2%), while the mpMRI Prostate Imaging Reporting and Data System (PI-RADS) 4–5 had better sensitivity and negative predictive value (NPV): 90.2% (vs. 78.5%) and 57.1% (vs. 52.4%), respectively. When used in combination, the sensitivity, specificity, PPV, and NPV were 74.2%, 83.3%, 93.2%, and 51.0%, respectively. Subgroup analysis of PI-RADS 3, 4, and 5 lesions was carried out. For PI-RADS 3 lesions, 68Ga-PSMA-11 PET/CT demonstrated a NPV of 77.8%. For PI-RADS 4–5 lesions, 68Ga-PSMA-11 PET/CT achieved PPV values of 82.1% and 100%, respectively, with an NPV of 100% in PI-RADS 5 lesions. A combination of 68Ga-PSMA-11 PET/CT and mpMRI improved the radiological diagnosis of csPCa. This suggests that avoidance of prostate biopsy prior to RP may represent a valid option in a selected subgroup of high-risk patients with a high suspicion of csPCa on mpMRI and 68Ga-PSMA-11 PET/CT.

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