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Title: Detection and localisation of primary prostate cancer using 68 Ga-PSMA PET/CT compared with mpMRI and radical prostatectomy specimens.
Austin Authors: Kalapara, Arveen A;Nzenza, Tatenda;Pan, Henry Y C;Ballok, Zita;Ramdave, Shakher;O'Sullivan, Richard;Ryan, Andrew;Cherk, Martin;Hofman, Michael S;Konety, Badrinath R;Lawrentschuk, Nathan;Bolton, Damien M ;Murphy, Declan G;Grummet, Jeremy P;Frydenberg, Mark
Affiliation: Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
Department of Urology, Alfred Hospital, Melbourne, Australia
Australian Urology Associates, Malvern, Australia
Department of Surgery, Monash University, Melbourne, Australia
Department of Nuclear Medicine & PET, Alfred Hospital, Melbourne, Australia
Department of Medicine, Monash University, Melbourne, Australia
Department of Nuclear Medicine & PET, Monash Medical Centre, Bentleigh East, Australia
Healthcare Imaging Services, Richmond, Australia
TissuPath, Mount Waverley, Australia
Department of Urology, Austin Health, Heidelberg, Victoria, Australia
Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
Department of Urology, University of Minnesota, Minneapolis, USA
Issue Date: 1-Jul-2019 2019-07-01
Publication information: BJU International 2019; online first: 1 July
Abstract: To compare the accuracy of 68 Gallium prostate-specific membrane antigen positron emission tomography/computed tomography (68 Ga-PSMA PET/CT) with mpMRI in detecting and localising primary prostate cancer when compared with radical prostatectomy (RP) pathology. Retrospective review of men who underwent 68 Ga-PSMA PET/CT and mpMRI for primary prostate cancer prior to RP across four centres between 2015 and 2018. Patients undergoing imaging for recurrent disease or prior to non-surgical treatment were excluded. We defined pathological index tumour as the lesion with highest ISUP Grade Group (GG) on RP. Our primary outcomes were rates of accurate detection and localisation of RP index tumour using 68 Ga-PSMA PET/CT or mpMRI. We defined tumour detection as imaging lesion corresponding with RP tumour on any imaging plane, and localisation as imaging lesion matching RP index tumour in all sagittal, axial and coronal planes. Secondary outcomes included localisation of clinically significant and transition zone index tumours. We defined clinically significant disease as GG 3-5. We used descriptive statistics and Mann-Whitney U test to define and compare demographic and pathological characteristics between detected, missed and localised tumours using either imaging modality. We used the McNemar test to compare detection and localisation rates using 68Ga-PSMA PET/CT and mpMRI. 205 men were included in our analysis, including 133 with clinically significant disease. There was no significant difference between 68 Ga-PSMA PET/CT and mpMRI in the detection of any tumour (94% vs 95%, p>0.9). There was also no significant difference between localisation of all index tumours (91% vs 89%, p=0.47), clinically significant index tumours (96% vs 91%, p=0.15), or transition zone tumours (85% vs 80%, p>0.9) using 68 Ga-PSMA PET/CT and mpMRI. Limitations include retrospective study design and non-central review of imaging and pathology. We found no significant difference in the detection or localisation of primary prostate cancer between 68 Ga-PSMA PET/CT and mpMRI. Further prospective studies are required to evaluate a combined PET/MRI model in minimising tumours missed by either modality. This article is protected by copyright. All rights reserved.
DOI: 10.1111/bju.14858
ORCID: 0000-0001-8553-5618
PubMed URL: 31260602
Type: Journal Article
Subjects: Prostate cancer
multiparametric MRI
positron emission tomography
prostate-specific membrane antigen
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