Comparative study of 18F-PSMA-1007,18F-FDG PET/CT and mpMRI in the diagnosis of prostate cancer
Objective To compare the diagnostic efficacy of 18F-prostate specific membrane anti-gen(PSMA)-1007 PET/CT,18F-FDG PET/CT and multi-parameter MRI(mpMRI)in prostate cancer(PCa).Methods Retrospective analysis was conducted on data from 22 patients((72.6±6.2)years)with pathologically confirmed PCa in the Affiliated Taizhou People's Hospital of Nanjing Medical University between April 2021 and September 2022.All patients underwent 18F-PSMA-1007 PET/CT,18F-FDG PET/CT,and mpMRI examination within 30 d,and the imaging parameters were collected,including PSMA-SUVmax,FDG-SUVmax,minimum apparent diffusion coefficient(ADCmin),mean apparent diffusion coeffi-cient(ADCmean),PSMA-SUVmax/ADCmin,PSMA-SUVmax/ADCmem,FDG-SUVmax/ADCmin,FDG-SUVmax/ADCmean.Patients were divided into groups based on the International Society of Urological Pathology(ISUP)grading(≤3 vs＞3)and serum total prostate specific antigen(TPSA;≤20 μg/L vs＞20 μg/L),and differences of imaging parameters between groups were compared(Mann-Whitney U test or independent-sample t test).ROC curves were generated to evaluate the diagnostic ability of each parameter for different levels of PCa.x2 test and ROC curve analysis were used to compare the detection rate and diagnostic efficien-cy of three imaging methods for primary focus,lymph node metastasis,and bone metastasis in PCa.Results Differences were found between ISUP≤3(n=6)and＞3(n=16)groups in PSMA-SUVmax/ADCmin,PSMA-SUV/ADCmean,PSMA-SUVmax,and ADC min(z values:from-2.65 to-2.36,t=3.60,P values:0.002-0.018).But there was no significant difference found between TPSA≤20 µg/L(n=5)and＞20 μg/L(n=17)groups in all indices(z values:from-1.76 to-1.45,t values:-1.19 and 1.28,all P＞0.05).The op-timal cut-off value for PSMA-SUVmax/ADCmin in differentiating high-grade and low-grade PCa was deter-mined to be 22.628×103.In the patient-based analysis,no statistical difference was found in the detection rate of PCa primary tumors among 18F-PSMA-1007 PET/CT,18F-FDG PET/CT,and mpMRI(x2=1.91,P=0.767).However,the detection rates of lymph node and bone metastasis among three imaging methods were significantly different(72.73％(16/22),59.09％(13/22),36.36％(8/22)and 81.82％(18/22),63.64％(14/22),45.45％(10/22);x2 values:6.03,6.29;P values:0.049,0.043).18F-PSMA-1007 PET/CT resulted in a 36.36％(8/22)increase in N stage and the 40.91％(9/22)increase in M stage com-pared to mpMRI.Conclusions PSMA-SUVmax/ADCmin is a valuable parameter for differentiating high-grade and low-grade PCa.18F-PSMA-1007 PET/CT demonstrates superior detection rate of PCa lymph node and bone metastasis compared to 18F-FDG PET/CT and mpMRI,and exhibits higher diagnostic efficiency,so it can be recommended for NM staging in patients with PCa.
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