"Seeing Is Believing": Additive Utility of 68 Ga-PSMA-11 PET/CT in Prostate Cancer Diagnosis.

Autor:	Chin, Joel, Tan, Yu Guang, Lee, Alvin, Ng, Tze Kiat, Shi, Ruoyu, Tang, Charlene Yu Lin, Thang, Sue Ping, Tuan, Jeffrey Kit Loong, Cheng, Christopher Wai Sam, Tay, Kae Jack, Ho, Henry Sun Sien, Wang, Hung-Jen, Chiu, Peter Ka-Fung, Teoh, Jeremy Yuen-Chun, Lam, Winnie Wing-Chuen, Law, Yan Mee, Yuen, John Shyi Peng, Chen, Kenneth
Předmět:	BIOPSY PREDICTIVE tests PROSTATE-specific antigen DIAGNOSTIC imaging RADICAL prostatectomy PROSTATE tumors POSITRON emission tomography computed tomography RETROSPECTIVE studies PROSTATE PROSTATECTOMY MEDICAL records ACQUISITION of data SENSITIVITY & specificity (Statistics)
Zdroj:	Cancers; May2024, Vol. 16 Issue 9, p1777, 11p
Abstrakt:	Simple Summary: This study investigates the effectiveness of combining two imaging techniques, multiparametric magnetic resonance imaging (mpMRI) and 68Ga-Prostate-specific membrane antigen (PSMA-11) positron emission tomography/computed tomography (PET/CT), to diagnose clinically significant prostate cancer (csPCa). While mpMRI is commonly used, it has limitations in its accuracy, requires further confirmation with prostatic biopsy. This study explores whether adding 68Ga-PSMA-11 PET/CT enhances diagnostic accuracy. The results show that the combined approach significantly improves the detection of csPCa compared to using either modality alone. Specifically, when both imaging methods are able to detect suspicious lesions, the likelihood of csPCa is high. This study suggests that, in select cases with convincing imaging results, it may be possible to forgo biopsy before surgical treatment. However, further research is needed to validate these findings and develop predictive models for accurate diagnosis without biopsy. Widespread adoption of mpMRI has led to a decrease in the number of patients requiring prostate biopsies. 68Ga-PSMA-11 PET/CT has demonstrated added benefits in identifying csPCa. Integrating the use of these imaging techniques may hold promise for predicting the presence of csPCa without invasive biopsy. A retrospective analysis of 42 consecutive patients who underwent mpMRI, 68Ga-PSMA-11 PET/CT, prostatic biopsy, and radical prostatectomy (RP) was carried out. A lesion-based model (n = 122) using prostatectomy histopathology as reference standard was used to analyze the accuracy of 68Ga-PSMA-11 PET/CT, mpMRI alone, and both in combination to identify ISUP-grade group ≥ 2 lesions. 68Ga-PSMA-11 PET/CT demonstrated greater specificity and positive predictive value (PPV), with values of 73.3% (vs. 40.0%) and 90.1% (vs. 82.2%), while the mpMRI Prostate Imaging Reporting and Data System (PI-RADS) 4–5 had better sensitivity and negative predictive value (NPV): 90.2% (vs. 78.5%) and 57.1% (vs. 52.4%), respectively. When used in combination, the sensitivity, specificity, PPV, and NPV were 74.2%, 83.3%, 93.2%, and 51.0%, respectively. Subgroup analysis of PI-RADS 3, 4, and 5 lesions was carried out. For PI-RADS 3 lesions, 68Ga-PSMA-11 PET/CT demonstrated a NPV of 77.8%. For PI-RADS 4–5 lesions, 68Ga-PSMA-11 PET/CT achieved PPV values of 82.1% and 100%, respectively, with an NPV of 100% in PI-RADS 5 lesions. A combination of 68Ga-PSMA-11 PET/CT and mpMRI improved the radiological diagnosis of csPCa. This suggests that avoidance of prostate biopsy prior to RP may represent a valid option in a selected subgroup of high-risk patients with a high suspicion of csPCa on mpMRI and 68Ga-PSMA-11 PET/CT. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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