CC BY 4.0 · World J Nucl Med 2024; 23(02): 079-087
DOI: 10.1055/s-0044-1779749
Original Article

Comparison of Ga-68 PSMA PET/CT and Multiparametric MRI for Initial Detection and Staging of Prostate Cancer

Dinesh Kumar Gauthaman
1   Department of Nuclear Medicine and PET/CT, Jaslok Hospital, Mumbai, Maharashtra, India
,
Karuna Luthra
1   Department of Nuclear Medicine and PET/CT, Jaslok Hospital, Mumbai, Maharashtra, India
,
Vikram Lele
1   Department of Nuclear Medicine and PET/CT, Jaslok Hospital, Mumbai, Maharashtra, India
› Author Affiliations

Abstract

Background Multiparametric magnetic resonance imaging (mpMRI) is widely used for the evaluation of prostate cancer and is known to have better accuracy. Gallium-68 prostate-specific membrane antigen (Ga-68 PSMA) is a radiotracer that shows high localization in prostate cancer cells.

Purpose The purpose of this study was to assess the sensitivity and utility of Ga-68 PSMA positron emission tomography/computed tomography (PET/CT) in comparison with mpMRI as a noninvasive imaging technique for the initial diagnosis and locoregional staging of prostate cancer using transrectal ultrasound (TRUS)-guided biopsy as gold standard.

Materials and Methods This prospective observational study conducted from August 2017 to April 2020 evaluated 60 men (n = 60) with biopsy-proven prostate carcinoma. They underwent mpMRI and Ga-68 PSMA PET/CT scans within 14 days with TRUS biopsy being gold standard. T staging of disease, N staging of lymph nodes within the pelvis, and M staging of lesions in pelvic bones (within the imaging field of mpMRI) were compared using PSPP version 1.0.1 statistical software.

Results All 60 men with a mean age of 69.9 ± 9.35 years showed Ga-68 PSMA avid disease, whereas 55 were detected by mpMRI. The sensitivity in detection of prostate lesions (with 95% confidence interval) was 99.08% for Ga-68 PSMA PET/CT and 84.40% for mpMRI. Ga-68 PSMA PET/CT detected greater number of patients with regional lymph nodal involvement (19/60) as compared with mpMRI (12/60). Ga-68 PSMA PET/CT showed PSMA avid pelvic skeletal lesions in nine patients, whereas mpMRI detected pelvic lesions in six patients. In addition, four other patients showed extrapelvic skeletal lesions on Ga-68 PSMA PET/CT.

Conclusion Ga-68 PSMA PET/CT has superior sensitivity in detection of primary prostate tumor, as compared with mpMRI. Both modalities correlate well in detection of seminal vesicle involvement. Ga-68 PSMA PET/CT outperformed mpMRI in detection of lymph nodal and skeletal metastases. Hence, Ga-68 PSMA PET/CT should be considered as first-line diagnostic modality for carcinoma prostate.

Summary Statement: Ga-68 PSMA PET/CT shows superior diagnostic performance than mpMRI in the evaluation of prostate cancer.

Previous Presentation

This paper was presented at the Society of Nuclear Medicine and Molecular Imaging 2023 Annual Meeting, Chicago, Illinois, United States of America on June 26, 2023.


Ethical Approval and Informed Consent

The hospital ethics and basic research committee approved the study and an informed written consent to participate in the study was obtained from all the participants.




Publication History

Article published online:
01 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Ferlay J, Soerjomataram I, Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136 (05) E359-E386
  • 2 Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J. et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013; 49 (06) 1374-1403
  • 3 Budukh A, Bakshi G, Prakash G. Change in the ranking and increasing trend of the prostate cancer from the population-based cancer registries in India. Indian J Urol 2018; 34 (03) 235-236
  • 4 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65 (01) 5-29
  • 5 Hodolic M. Role of (18)F-choline PET/CT in evaluation of patients with prostate carcinoma. Radiol Oncol 2011; 45 (01) 17-21
  • 6 Horvat A, Kovac V, Strojan P. Radiotherapy in palliative treatment of painful bone metastases. Radiol Oncol 2009; 43: 213-224
  • 7 Makarov DV, Loeb S, Ulmert D, Drevin L, Lambe M, Stattin P. Prostate cancer imaging trends after a nationwide effort to discourage inappropriate prostate cancer imaging. J Natl Cancer Inst 2013; 105 (17) 1306-1313
  • 8 Mottet N, Bellmunt J, Briers J. et al. European Association of Urology Guidelines on Prostate Cancer. . Accessed March 1, 2015 at: https://www.researchgate.net/publication/274064386_European_Association_of_Urology_Guidelines_on_Prostate_Cancer_2015
  • 9 Fütterer JJ, Heijmink SW, Scheenen TW. et al. Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology 2006; 241 (02) 449-458
  • 10 Lim HK, Kim JK, Kim KA, Cho KS. Prostate cancer: apparent diffusion coefficient map with T2-weighted images for detection–a multireader study. Radiology 2009; 250 (01) 145-151
  • 11 Sciarra A, Panebianco V, Ciccariello M. et al. Value of magnetic resonance spectroscopy imaging and dynamic contrast-enhanced imaging for detecting prostate cancer foci in men with prior negative biopsy. Clin Cancer Res 2010; 16 (06) 1875-1883
  • 12 Lewis S, Besa C, Rosen A. et al. Multiparametric magnetic resonance imaging for transition zone prostate cancer: essential findings, limitations, and future directions. Abdom Radiol (NY) 2017; 42 (11) 2732-2744
  • 13 de Rooij M, Hamoen EH, Fütterer JJ, Barentsz JO, Rovers MM. Accuracy of multiparametric MRI for prostate cancer detection: a meta-analysis. AJR Am J Roentgenol 2014; 202 (02) 343-351
  • 14 Hövels AM, Heesakkers RA, Adang EM. et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 2008; 63 (04) 387-395
  • 15 Evans JD, Jethwa KR, Ost P. et al. Prostate cancer-specific PET radiotracers: a review on the clinical utility in recurrent disease. Pract Radiat Oncol 2018; 8 (01) 28-39
  • 16 Fraum TJ, Ludwig DR, Kim EH, Schroeder P, Hope TA, Ippolito JE. Prostate cancer PET tracers: essentials for the urologist. Can J Urol 2018; 25 (04) 9371-9383
  • 17 Calais J, Ceci F, Nguyen K. et al. Prospective head-to-head comparison of 18F-fluciclovine and 68Ga-PSMA-11 PET/CT for localization of prostate cancer biochemical recurrence after primary prostatectomy. J Clin Oncol 2019; 37 (7, suppl): 15
  • 18 Chang SS. Overview of prostate-specific membrane antigen. Rev Urol 2004; 6 (Suppl 10, Suppl 10): S13-S18
  • 19 Troyer JK, Beckett ML, Wright Jr GL. Detection and characterization of the prostate-specific membrane antigen (PSMA) in tissue extracts and body fluids. Int J Cancer 1995; 62 (05) 552-558
  • 20 Zamboglou C, Drendel V, Jilg CA. et al. Comparison of 68Ga-HBED-CC PSMA-PET/CT and multiparametric MRI for gross tumour volume detection in patients with primary prostate cancer based on slice by slice comparison with histopathology. Theranostics 2017; 7 (01) 228-237
  • 21 Fendler WP, Eiber M, Beheshti M. et al. 68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging 2017; 44 (06) 1014-1024
  • 22 Prasad V, Steffen IG, Diederichs G, Makowski MR, Wust P, Brenner W. Biodistribution of [(68)Ga] PSMA –HBED-CC in patients with prostate cancer: characterization of uptake in normal organs and tumor lesions. Mol Imaging Biol 2016; 18 (03) 428-436
  • 23 Kallur KG, Ramachandra PG, Rajkumar K. et al. Clinical utility of gallium-68 PSMA PET/CT scan for prostate cancer. Indian J Nucl Med 2017; 32 (02) 110-117
  • 24 Eiber M, Weirich G, Holzapfel K. et al. Simultaneous 68Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol 2016; 70 (05) 829-836
  • 25 Zhou C, Tang Y, Deng Z. et al. Comparison of Ga-68-PSMA PET/CT and multiparametric MRI for the detection of low-and intermediate-risk prostate cancer. EJNMMI Res 2022; 12 (01) 1-1
  • 26 Satapathy S, Singh H, Kumar R, Mittal BR. Diagnostic accuracy of Ga-68-PSMA PET/CT for initial detection in patients with suspected prostate cancer: a systematic review and meta-analysis. AJR Am J Roentgenol 2021; 216 (03) 599-607
  • 27 Li Y, Han D, Wu P. et al. Comparison of 68Ga-PSMA-617 PET/CT with mpMRI for the detection of PCa in patients with a PSA level of 4-20 ng/ml before the initial biopsy. Sci Rep 2020; 10 (01) 10963
  • 28 Wang X, Wen Q, Zhang H, Ji B. Head-to-Head comparison of 68Ga-PSMA-11 PET/CT and multiparametric MRI for pelvic lymph node staging prior to radical prostatectomy in patients with intermediate to high-risk prostate cancer: A meta-analysis. Front Oncol 2021; 11: 737989
  • 29 Chen M, Zhang Q, Zhang C. et al. Comparison of 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and multi-parametric magnetic resonance imaging (MRI) in the evaluation of tumor extension of primary prostate cancer. Transl Androl Urol 2020; 9 (02) 382-390
  • 30 Ucar T, Gunduz N, Demirci E. et al. Comparison of 68Ga-PSMA PET/CT and mp-MRI in regard to local staging for prostate cancer with histopathological results: a retrospective study. Prostate 2022; 82 (15) 1462-1468
  • 31 Çelen S, Gültekin A, Özlülerden Y. et al. Comparison of Ga-68-PSMA-I/T PET-CT and multiparametric MRI for locoregional staging of prostate cancer patients: a pilot study. Urol Int 2020; 104 (9–10): 684-691