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. 2024 Sep 5;14(17):1964.
doi: 10.3390/diagnostics14171964.

Comparative Performance of 68Ga-PSMA-11 PET/CT and Conventional Imaging in the Primary Staging of High-Risk Prostate Cancer Patients Who Are Candidates for Radical Prostatectomy

Guido Rovera  1 , Serena Grimaldi  2 , Marco Oderda  3 , Giancarlo Marra  3 , Giorgio Calleris  3 , Giuseppe Carlo Iorio  4 , Marta Falco  4 , Cristiano Grossi  4 , Roberto Passera  1   2 , Giuseppe Campidonico  2 , Maria Luce Mangia  2 , Désirée Deandreis  5 , Riccardo Faletti  6 , Umberto Ricardi  4 , Paolo Gontero  3 , Silvia Morbelli  1   2
Affiliations

Comparative Performance of 68Ga-PSMA-11 PET/CT and Conventional Imaging in the Primary Staging of High-Risk Prostate Cancer Patients Who Are Candidates for Radical Prostatectomy

Guido Rovera et al. Diagnostics (Basel). .

Abstract

This prospective study aimed to (1) compare the diagnostic performance of 68Ga-PSMA-11 PET/CT with respect to conventional imaging (computed tomography (CT) and bone scintigraphy (BS)) in the primary staging of high-risk prostate cancer (PCa) patients and (2) validate PSMA-PET/CT accuracy in pelvic nodal staging in comparison with postoperative histopathology and assess PSMA-PET/CT's impact on patient management. Sixty castration-sensitive high-risk (ISUP 4-5 and/or PSA > 20 ng/mL and/or cT3) PCa patients eligible for radical prostatectomy were enrolled (median PSA 10.10 [IQR: 6.22-17.95] ng/mL). PSMA-PET/CT, compared with CT, identified nodal (N) and/or distant metastases (M1) in 56.7% (34/60) vs. 13.3% (8/60) (p < 0.001) of patients: N + 45% vs. 13.3% (p < 0.001), M1a 11.7% vs. 1.7% (p = 0.03), M1b 23.3% vs. 1.7% (p < 0.001). Compared with BS, PSMA-PET/CT localized unknown skeletal metastases in 15% (9/60) of cases, with no false negative findings. Overall, PSMA-PET/CT led to a TNM upstaging in 45.0% (27/60) of cases, with no evidence of downstaging, resulting in a change in management in up to 28.8% (17/59) of patients. Compared with histopathology data (n = 32 patients), the per-patient accuracy of PSMA-PET/TC for detecting pelvic nodal metastases was 90.6%. Overall, the above evidence supports the use of PSMA-PET/CT in the diagnostic workup of high-risk prostate cancer staging.

Keywords: PSMA PET; conventional imaging; hormone-sensitive prostate cancer; positron emission tomography; primary staging; prostate cancer.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Clinical case: 82-year-old patient, iPSA 11.4 ng/mL, Gleason score 9 (5 + 4), with no pathologic findings at CT (a) and bone scintigraphy (b). (c,d) 68Ga-PSMA-11 PET/CT: left external iliac lymph node metastasis (5 mm) (arrowhead).
Figure 2
Figure 2
Clinical case: 65-year-old patient, iPSA 28 ng/mL, Gleason score 8 (4 + 4). Multimetastatic nodal (a) and skeletal (b) dissemination (arrowheads) at PSMA-PET/CT, with negative CT (a,b) and bone scintigraphy. (c) PSMA-PET/CT findings were confirmed at subsequent CT and bone scintigraphy exams performed during follow-up.
Figure 3
Figure 3
Comparison of the diagnostic performance of conventional (CT + BS) and molecular imaging (PSMA-PET/CT): patients with pathologic findings detected by PSMA-PET/CT and conventional imaging, stratified by anatomical region.
Figure 4
Figure 4
Comparison of the diagnostic performance of conventional (CT + BS) and molecular imaging (PSMA-PET/CT): TNM staging and tumor burden evaluation.
See this image and copyright information in PMC

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