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Title: The Contribution of Multiparametric Pelvic and Whole-Body MRI to Interpretation of 18F-Fluoromethylcholine or 68Ga-HBED-CC PSMA-11 PET/CT in Patients with Biochemical Failure After Radical Prostatectomy.
Austin Authors: Metser, Ur;Chua, Sue;Ho, Bao;Punwani, Shonit;Johnston, Edward;Pouliot, Frederic;Tau, Noam;Hawsawy, Asmaa;Anconina, Reut;Bauman, Glenn;Hicks, Rodney J;Weickhardt, Andrew J ;Davis, Ian D;Pond, Greg;Scott, Andrew M ;Tunariu, Nina;Sidhu, Harbir;Emmett, Louise
Affiliation: University of Toronto, Toronto, Canada.
Université Laval, Quebec, Canada
St. Vincent's Hospital, Sydney, Australia
Austin Health, Heidelberg, Victoria, Australia
Peter MacCallum Cancer Centre, Melbourne, Australia
Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
Royal Marsden Hospital, London, United Kingdom
University College London, London, United Kingdom
University of Toronto, Toronto, Canada
London Health Sciences Centre, Ontario, Canada
McMaster University, Hamilton, Ontario Canada
Royal Marsden Hospital, London, United Kingdom..
University College London, London, United Kingdom
Issue Date: Sep-2019
Date: 2019-03-22
Publication information: Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2019; 60(9): 1253-1258
Abstract: Our purpose was to assess whether the addition of data from multiparametric pelvic MRI (mpMR) and whole-body MRI (wbMR) to the interpretation of 18F-fluoromethylcholine (18F-FCH) or 68Ga-HBED-CC PSMA-11 (68Ga-PSMA) PET/CT (=PET) improves the detection of local tumor recurrence or of nodal and distant metastases in patients after radical prostatectomy with biochemical failure. Methods: The current analysis was performed as part of a prospective, multicenter trial on 18F-FCH or 68Ga-PSMA PET, mpMR, and wbMR. Eligible men had an elevated level of prostate-specific antigen (PSA) (>0.2 ng/mL) and high-risk features (Gleason score > 7, PSA doubling time < 10 mo, or PSA > 1.0 ng/mL) with negative or equivocal conventional imaging results. PET was interpreted with mpMR and wbMR in consensus by 2 radiologists and compared with prospective interpretation of PET or MRI alone. Performance measures of each modality (PET, MRI, and PET/mpMR-wbMR) were compared for each radiotracer and each individual patient (for 18F-FCH, or 68Ga-PSMA for patients who had 68Ga-PSMA PET) and to a composite reference standard. Results: There were 86 patients with PET (18F-FCH [n = 76] and/or 68Ga-PSMA [n = 26]) who had mpMR and wbMR. Local tumor recurrence was detected in 20 of 76 (26.3%) on 18F-FCH PET/mpMR, versus 11 of 76 (14.5%) on 18F-FCH PET (P = 0.039), and in 11 of 26 (42.3%) on 68Ga-PSMA PET/mpMR, versus 6 of 26 (23.1%) on 68Ga-PSMA PET (P = 0.074). Per patient, PET/mpMR was more often positive for local tumor recurrence than PET (P = 0.039) or mpMR (P = 0.019). There were 20 of 86 patients (23.3%) with regional nodal metastases on both PET/wbMR and PET (P = 1.0) but only 12 of 86 (14%) on wbMR (P = 0.061). Similarly, there were more nonregional metastases detected on PET/wbMR than on PET (P = 0.683) or wbMR (P = 0.074), but these differences did not reach significance. Compared with the composite reference standard for the detection of disease beyond the prostatic fossa, PET/wbMR, PET, and wbMR had sensitivity of 50%, 50%, and 8.3%, respectively, and specificity of 97.1%, 97.1%, and 94.1%, respectively. Conclusion: Interpretation of PET/mpMR resulted in a higher detection rate for local tumor recurrence in the prostatic bed in men with biochemical failure after radical prostatectomy. However, the addition of wbMR to 18F-FCH or 68Ga-PSMA PET did not improve detection of regional or distant metastases.
DOI: 10.2967/jnumed.118.225185
ORCID: 0000-0002-6656-295X
Journal: Journal of nuclear medicine : official publication, Society of Nuclear Medicine
PubMed URL: 30902875
Type: Journal Article
Subjects: MR
biochemical recurrence
Prostate cancer
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