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. 2021 Jul-Sep;36(3):245-251.
doi: 10.4103/ijnm.ijnm_243_20. Epub 2021 Sep 23.

Comparison of Multiparametric Magnetic Resonance Imaging and Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Detecting Carcinoma Prostate in Patients with Serum Prostate-Specific Antigen between 4 and 20 ng/ml

Brijesh Kumar Soni  1 , Priyanka Verma  2 , Amit Kumar Shah  3 , Rajendra Singh  4 , Sunita Sonawane  2 , Ramesh V Asopa  2
Affiliations

Comparison of Multiparametric Magnetic Resonance Imaging and Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Detecting Carcinoma Prostate in Patients with Serum Prostate-Specific Antigen between 4 and 20 ng/ml

Brijesh Kumar Soni et al. Indian J Nucl Med. 2021 Jul-Sep.

Abstract

Introduction: We carried out this study to compare the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) and gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (Ga-68 PSMA PET/CT) to detect prostatic carcinoma in patients with serum prostate-specific antigen (PSA) between 4 and 20 ng/ml in prebiopsy setting.

Materials and methods: This prospective study evaluated men with serum PSA values between 4 and 20 ng/ml. All patients underwent mpMRI and Ga-68 PSMA PET/CT, followed by 12-core transrectal ultrasonography (TRUS)-guided biopsy to detect prostatic carcinoma. The diagnostic accuracy of mpMRI and PSMA PET/CT scan was compared with histopathological findings.

Results: There were thirty patients included in the study with a median age of 73 years (age range: 69-79 years). The median total serum PSA was 8.0 ng/ml (5.0-19.9 ng/ml). Of these, 18 had an identifiable lesion on imaging and had histopathological findings suggestive of carcinoma prostate. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI were 100%, 92.30%, 94.73%, and 100%, respectively, and that of PSMA PET scan were 94.44%, 100%, 100%, and 92.31%, respectively. The diagnostic accuracy of both was 96.67%.

Conclusion: PSMA PET scan showed higher PPV and specificity while mpMRI showed higher sensitivity and NPV. The accuracy in predicting presence of carcinoma was the same for both. PSMA PET showed higher specificity and PPV and predicted the subsequent need of biopsy. In our study, the NPV of PET, though good, was lower than mpMRI. Prospective trials with larger sample size are needed. In combination, PET/MRI may achieve greater accuracy and may serve as investigation of choice.

Keywords: Carcinoma prostate; gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography; guided biopsy; multiparametric magnetic resonance imaging; prostate-specific antigen.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The images of patient 1.Gallium 68 PSMA PET/CT (maximum intensity projection) (a), axial fused PET/CT (b), axial CT (c) and axial PET (d) do not show any abnormal focal prostate-specific membrane antigen tracer uptake. Magnetic resonance imaging images (e and f) T2-weighted image showed hypointense lesions and diffusion-weighted image showing focal, marked hypointensity on apparent diffusion coefficient mapping in right transitional zone. Histopathology section (g) at ×40 showed benign gland with preserved basal layer in fibromuscular stroma suggestive of benign prostatic hyperplasia
Figure 2
Figure 2
The images of patient 7. Gallium 68 PSMA PET/CT (maximum intensity projection) (a), axial fused PET/CT (b), axial CT (c) and axial PET (d) do not show any abnormal focal tracer uptake. MRI (e) T2 weighted image showed focal mild to moderate hypointense lesion in peripheral zone bilaterally and diffusion weighted image (f) showed subtle areas of restriction of diffusion in peripheral zone bilaterally. Histopathology (g) at × 40 showed show atypical cells arranged in glands and cribriform pattern, highly pleomorphic suggestive of adenocarcinoma
Figure 3
Figure 3
The images of patient 15. Gallium-68 PSMA PET/CT (maximum intensity projection) (a), axial fused PET/CT (b), axial CT (c) and axial PET (d) showed abnormal focal tracer uptake standardized uptake value 22.9 in right peripheral zone of enlarged prostate. MRI images (e) T2-weighted image showed discrete focal hypointense lesion in peripheral zone on right side causing mass effect on capsule and diffusion-weighted images (f and g) show restriction of diffusion in the lesion. Histopathology (h) at ×40 showed malignant cells suggestive of adenocarcinoma
Figure 4
Figure 4
Receiver-operator characteristic curve of serum prostate-specific antigen and prostate-specific membrane antigen positron emission tomography standardized uptake value maximum for the prediction of prostate carcinoma
See this image and copyright information in PMC

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