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. 2019 Jul-Sep;35(3):202-207.
doi: 10.4103/iju.IJU_91_19.

Comparison of percentage free PSA, MRI and GaPSMA PET scan for diagnosing cancer prostate in men with PSA between 4 and 20 ng/ml

Niraj Kumar  1 , Siddharth Yadav  1 , Sandeep Kumar  1 , Kumar Saurav  1 , Vishnu Prasad  1 , Pawan Vasudeva  1
Affiliations

Comparison of percentage free PSA, MRI and GaPSMA PET scan for diagnosing cancer prostate in men with PSA between 4 and 20 ng/ml

Niraj Kumar et al. Indian J Urol. 2019 Jul-Sep.

Abstract

Introduction: We compared the diagnostic accuracy of percentage free prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and gallium-68 prostate-specific membrane antigen positron emission tomography (Ga-PSMA PET) to detect cancer prostate in men with PSA between 4 and 20 ng/ml in prebiopsy settings.

Materials and methods: This prospective study evaluated men with PSA values between 4 and 20 ng/ml, and all patients underwent percentage free PSA estimation, mpMRI, and Ga-PSMA PET scan, followed by cognitive fusion/registration biopsy along with systematic 12-core biopsy to detect cancer prostate. The diagnostic accuracy of percentage free PSA, mpMRI, and Ga-PSMA PET scan was compared with results of cognitive fusion/registration biopsy.

Results: A total of 15 patients were included, of which 11 had an identifiable lesion on imaging and 9 had malignancy on the final histopathology report. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy of mpMRI were 62.5%, 71.4%, 71.4%, 62.5%, and 66.6%, respectively, and that of Ga-PSMA PET scan were 88.8%, 66.6%, 80%, 80%, and 80%, respectively. The sensitivity of detection of clinically significant cancers for Ga-PSMA was higher (100%) compared to MRI (33.3%). However, Ga-PSMA also detected a greater number of insignificant lesions as compared to MRI.

Conclusion: Ga-PSMA PET scan has high NPV and accuracy in predicting presence of cancer and can also be used to direct specific biopsy cores during systematic biopsy.

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Conflict of interest statement

Conflicts of interest: There are no conflicts of interest.

Figures

Figure 1
Figure 1
Sector maps. The prostate is first divided into right (r) and left (l) lobes by the midsagittal plane (black line) and then into three regions base (a), mid (b), and apex (c). Each lobe is then further divided into medial and lateral parts by a sagittal plane (red line) running across the center of each lobe and into anterior and posterior parts by a coronal plane (blue line) running across the center
Figure 2
Figure 2
(a) Contrast-enhanced magnetic resonance imaging image showing symmetric enhancement of peripheral zone on both sides. (b) Gallium-68 prostate-specific membrane antigen positron emission tomography scan of the same patient at the same level showing focal tracer accumulation in the right peripheral zone
Figure 3
Figure 3
(a) Contrast-enhanced magnetic resonance imaging image showing a suspicious lesion in the left peripheral zone (Prostate Imaging Reporting and Data System III index lesion) and right peripheral zone (Prostate Imaging Reporting and Data System II). (b) Gallium-68 prostate-specific membrane antigen positron emission tomography scan of the same patient at the same level showing focal tracer accumulation in the right peripheral zone (index lesion), with diffuse uptake on both sides
See this image and copyright information in PMC

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