Comparing the diagnostic value of 68Ga-PSMA PET/CT and multiparameter MRI combined with postoperative whole-mount slides pathology in initial prostate cancer diagnosis
Objective To assess the diagnostic performance of68Ga-PSMA PET/CT and mpMRI in initial staging of prostate cancer.Methods A retrospective analysis was conducted on patients with initial diagnosis of prostate cancer who underwent prostatectomy at Fudan University Shanghai Cancer Center from December 2021 to June 2023.All had biopsy-confirmed prostate cancer preoperatively and had not undergone any anti-tumor treatment.Prior to surgery,all patients underwent 68 Ga-PSM A PET/CT and mpMRI scans.The surgical samples were processed by whole-mount slides pathology.Thirty patients were included,with a median age of 68 years(range 67-76 years).The preoperative median PSA level was 17.91 ng/ml(range 9.41-39.53 ng/ml).The median interval between the two examinations was 21.00 days(range 2.75-35.50 days).Based on the postoperative whole-mount slides pathology which was the gold standard,we compared the sensitivity and specificity of 68Ga-PSMA PET/CT and mpMRI in diagnosing extraprostatic extension,seminal vesicle invasion,and intraprostatic tumor lesion.Results According to the postoperative pathology,among the 30 patients,12 had extraprostatic extension(EPE),8 had seminal vesicle invasion(SVI).Among the 50 lesions found before surgery,postoperative pathology showed that 38 of them were clinically significant prostate cancer lesions(76.0％,38/50).Using whole-mount pathology,preoperative mpMRI,and 68 Ga-PSM A PET/CT imaging for triple fusion comparison,the sensitivity and specificity of 68Ga-PSMA PET/CT in diagnosing EPE were 66.7％(8/12)and 88.9％(16/18),respectively.The sensitivity and specificity of mpMRI in diagnosing EPE were 50.0％(6/12)and 83.3％(15/18),respectively.In diagnosing SVI,the sensitivity and specificity of 68Ga-PSMA PET/CT were 50.0％(4/8)and 86.3％(19/22),respectively.The sensitivity and specificity of mpMRI were 75.0％(6/8)and 90.9％(20/22),respectively.When diagnosing clinically significant tumor lesions within the prostate,the sensitivity of 68Ga-PSMA PET/CT was 89.5％(34/38),which was significantly better than the mpMRI of 63.2％(24/38),with no significant difference in specificity.Conclusions The sensitivity of 68Ga-PSMA PET/CT in diagnosing intraprostatic lesions was significantly higher than that of mpMRI,with no significant difference in specificity.
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