Role of 18F-MD-PSMA PET/CT in initial stage of intermediate and high risk prostate cancer

doi:10.3969/j.issn.1674-8115.2023.07.009

Abstract

Abstract:

Objective ·To evaluate the role of ¹⁸F-MD-PSMA PET/CT in the initial stage of patients with moderate and high risk prostate cancer (PCa). Methods ·A total of 67 patients with moderate and high risk PCa who were treated in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to June 2022 were initially staged by ¹⁸F-MD-PSMA PET/CT. Conventional imaging (CI), including multi-parameter magnetic resonance imaging (mp-MRI) and bone scintigraphy (BS), were performed within two weeks before ¹⁸F-MD-PSMA PET/CT. Twenty-five patients underwent ¹⁸F-FDG PET/CT at the same time. The sensitivity (SEN), specificity (SPEC), positive predictive value (PPV), negative predictive value (NPV) and accuracy (ACU) of ¹⁸F-MD-PSMA PET/CT in the initial stage were evaluated, and the results were compared with those of ¹⁸F-FDG PET/CT, mp-MRI and BS. The consistency of ¹⁸F-MD-PSMA PET/CT and CI in terms of primary lesion, regional lymph node metastasis and bone metastasis was evaluated by Kappa consistency test refering to the postoperative pathological T and N staging results and bone metastasis results of clinical follow-up. Kappa coefficient was calculated and compared. Results ·Of the 67 patients with PCa, 38 patients underwent radical prostatectomy and had completed pathological data, with 27 patients undergoing regional lymphadenectomy and 1 patient undergoing expanded pelvic lymphadenectomy at the same time. The pathological results were obtained as gold standard. The detection rates of mp-MRI and ¹⁸F-MD-PSMA PET/CT in diagnosing intrathecal lesions were both 100%. The SENs in diagnosing bilateral intralobular lesions were 26.3% and 63.2%, respctively; the SPECs were both 75.0%.The Kappa consistency test showed that the consistency of ¹⁸F-MD-PSMA PET/CT in diagnosis of extracapsular extension (EPE), seminal vesicle invasion (SVI), and bladder neck invasion (BNI) was higher than that of mp-MRI. Fisher′s exact test showed that there were no statistically significant differences in SEN (P=0.226, P=0.491) and SPEC (P=1.000, P=0.342) between the two methods for diagnosing EPE and SVI, as well as SEN (P=1.000) for diagnosing BNI. In terms of diagnosis of lymph node metastasis, based on the analysis of lymph node numbers, the consistency between ¹⁸F-MD-PSMA PET/CT and pathological results was higher than that of mp-MRI (Kappa coefficients of 0.555 and 0.137, respectively). Fisher′s exact test showed that there were no statistically significant differences in SEN and SPEC between the two examination methods (P=0.562, P=0.829). Based on the patients, the consistency between ¹⁸F-MD-PSMA PET/CT and pathological results was higher than that of mp-MRI (Kappa coefficients of 0.850 and 0.313, respectively). There was no statistically significant difference in SEN between the two methods (P=1.000). In terms of diagnosis of bone metastasis, based on the analysis of bone lesion numbers, the consistency between ¹⁸F-MD-PSMA PET/CT and clinical follow-up results was higher than that of BS (Kappa coefficients of 0.500 and 0.299, respectively). Fisher′s exact test showed that there was no statistically significant difference in SEN between the two methods (P=0.219). Based on the patients, the consistency between ¹⁸F-MD-PSMA PET/CT and clinical follow-up results was higher than that of BS (Kappa coefficients of 0.953 and 0.766, respectively). There was no statistically significant difference in SEN between the two methods (P=1.000). The risks of 21 patients (31.3%) were increased after ¹⁸F-MD-PSMA PET/CT detection, with 1 patient (1.5%) decreasing. The initial stage of 32 cases (47.8%) were changed after ¹⁸F-MD-PSMA PET/CT detection, with 27 cases (40.3%) upstaged and 5 cases (7.5%) downstaged. Conclusion ·¹⁸F-MD-PSMA PET/CT is superior to CI in the diagnosis of bilateral intralobular lesions, EPE, SVI, regional lymph node metastasis and bone metastasis in intermediate and high risk PCa, and on this basis, the diagnosis of clinical stage and metastatic status of some patients has been changed.

Key words: prostate cancer, initial stage, ¹⁸F-MD-PSMA PET/CT, multi-parameter magnetic resonance imaging, bone scintigraphy

CLC Number:

R445.6

YAN Yeqing, LIANG Sheng, YANG Bin, ZOU Renjian, MA Yufei, CAI Lisheng, WANG Hui, FU Hongliang. Role of ¹⁸F-MD-PSMA PET/CT in initial stage of intermediate and high risk prostate cancer[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(7): 873-881.

Figures/Tables 6

TrendMD

References 29

1	BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424.
2	顾秀瑛, 郑荣寿, 张思维, 等. 2000—2014年中国肿瘤登记地区前列腺癌发病趋势及年龄变化分析[J]. 中华预防医学杂志, 2018, 52(6): 586-592.
	GU X Y, ZHENG R S, ZHANG S W, et al. Analysis on the trend of prostate cancer incidence and age change in cancer registration areas of China, 2000 to 2014[J]. Chinese Journal of Preventive Medicine, 2018, 52(6): 586-592.
3	TROYER J K, BECKETT M L, WRIGHT G L. Detection and characterization of the prostate-specific membrane antigen (PSMA) in tissue extracts and body fluids[J]. Int J Cancer, 1995, 62(5): 552-558.
4	WRIGHT G L, HALEY C, BECKETT M L, et al. Expression of prostate-specific membrane antigen in normal, benign, and malignant prostate tissues[J]. Urol Oncol, 1995, 1(1): 18-28.
5	AFSHAR-OROMIEH A, MALCHER A, EDER M, et al. Reply to Reske et al.: pet imaging with a [⁶⁸Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions[J]. Eur J Nucl Med Mol Imaging, 2013, 40(6): 971-972.
6	WERNER R A, DERLIN T, LAPA C, et al. ¹⁸F-labeled, PSMA-targeted radiotracers: leveraging the advantages of radiofluorination for prostate cancer molecular imaging[J]. Theranostics, 2020, 10(1): 1-16.
7	FDA approves ¹⁸F-DCFPyL PET agent in prostate cancer[J]. J Nucl Med, 2021, 62(8): 11N.
8	KOH W J, ABU-RUSTUM N R, BEAN S, et al. Uterine neoplasms, version 1.2018, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2018, 16(2): 170-199.
9	METSER U, ORTEGA C, PERLIS N, et al. Detection of clinically significant prostate cancer with ¹⁸F-DCFPyL PET/multiparametric MR [J]. Eur J Nucl Med Mol Imaging, 2021, 48(11): 3702-3711.
10	SONNI I, FELKER E R, LENIS A T, et al. Head-to-head comparison of ⁶⁸Ga-PSMA-11 PET/CT and mpMRI with a histopathology gold standard in the detection, intraprostatic localization, and determination of local extension of primary prostate cancer: results from a prospective single-center imaging trial[J]. J Nucl Med, 2022, 63(6): 847-854.
11	DONATO P, ROBERTS M J, MORTON A, et al. Improved specificity with ⁶⁸Ga PSMA PET/CT to detect clinically significant lesions “invisible” on multiparametric MRI of the prostate: a single institution comparative analysis with radical prostatectomy histology[J]. Eur J Nucl Med Mol Imaging, 2019, 46(1): 20-30.
12	CAGLIC I, SUSHENTSEV N, SHAH N, et al. Comparison of biparametric versus multiparametric prostate MRI for the detection of extracapsular extension and seminal vesicle invasion in biopsy naïve patients[J]. Eur J Radiol, 2021, 141: 109804.
13	BOESEN L, CHABANOVA E, LØGAGER V, et al. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology[J]. Eur Radiol, 2015, 25(6): 1776-1785.
14	POPIŢA C, POPIŢA A R, ANDREI A, et al. Local staging of prostate cancer with multiparametric-MRI: accuracy and inter-reader agreement [J]. Med Pharm Rep, 2020, 93(2): 150-161.
15	YILMAZ B, TURKAY R, COLAKOGLU Y, et al. Comparison of preoperative locoregional Ga-68 PSMA-11 PET-CT and mp-MRI results with postoperative histopathology of prostate cancer[J]. Prostate, 2019, 79(9): 1007-1017.
16	KOSEOGLU E, KORDAN Y, KILIC M, et al. Diagnostic ability of Ga-68 PSMA PET to detect dominant and non-dominant tumors, upgrading and adverse pathology in patients with PIRADS 4-5 index lesions undergoing radical prostatectomy[J]. Prostate Cancer Prostatic Dis, 2021, 24(1): 202-209.
17	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 [J]. Prostate, 2022, 82(15): 1462-1468.
18	ÇELEN S, GÜLTEKIN A, ÖZLÜLERDEN Y, et al. Comparison of 68Ga-PSMA-I/T PET-CT and multiparametric MRI for locoregional staging of prostate cancer patients: a pilot study[J]. Urol Int, 2020, 104(9/10): 684-691.
19	ARSLAN A, KARAARSLAN E, LEVENT GÜNER A, et al. Comparing the diagnostic performance of multiparametric prostate MRI versus 68Ga-PSMA PET-CT in the evaluation lymph node involvement and extraprostatic extension[J]. Acad Radiol, 2022, 29(5): 698-704.
20	HOPE T A, EIBER M, ARMSTRONG W R, et al. Diagnostic accuracy of 68Ga-PSMA-11 PET for pelvic nodal metastasis detection prior to radical prostatectomy and pelvic lymph node dissection: a multicenter prospective phase 3 imaging trial[J]. JAMA Oncol, 2021, 7(11): 1635-1642.
21	MAURER T, GSCHWEND J E, RAUSCHER I, et al. Diagnostic efficacy of ⁶⁸gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer[J]. J Urol, 2016, 195(5): 1436-1443.
22	WOO S, SUH C H, KIM S Y, et al. The diagnostic performance of MRI for detection of lymph node metastasis in bladder and prostate cancer: an updated systematic review and diagnostic meta-analysis [J]. AJR Am J Roentgenol, 2018, 210(3): W95-w109.
23	BUDÄUS L, LEYH-BANNURAH S R, SALOMON G, et al. Initial experience of ⁶⁸Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy [J]. Eur Urol, 2016, 69(3): 393-396.
24	YUMINAGA Y, ROTHE C, KAM J, et al. ⁶⁸Ga-PSMA PET/CT versus CT and bone scan for investigation of PSA failure post radical prostatectomy[J]. Asian J Urol, 2021, 8(2): 170-175.
25	PYKA T, OKAMOTO S, DAHLBENDER M, et al. Comparison of bone scintigraphy and ⁶⁸Ga-PSMA PET for skeletal staging in prostate cancer[J]. Eur J Nucl Med Mol Imaging, 2016, 43(12): 2114-2121.
26	ACAR E, BEKIŞ R, POLACK B. Comparison of bone uptake in bone scan and Ga-68 PSMA PET/CT images in patients with prostate cancer[J]. Curr Med Imaging Rev, 2019, 15(6): 589-594.
27	RUSTHOVEN C G, JONES B L, FLAIG T W, et al. Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer [J]. J Clin Oncol, 2016, 34(24): 2835-2842.
28	SATKUNASIVAM R, KIM A E, DESAI M, et al. Radical prostatectomy or external beam radiation therapy vs no local therapy for survival benefit in metastatic prostate cancer: a SEER-medicare analysis[J]. J Urol, 2015, 194(2): 378-385.
29	OST P, REYNDERS D, DECAESTECKER K, et al. Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence: a prospective, randomized, multicenter phase Ⅱ trial [J]. J Clin Oncol, 2018, 36(5): 446-453.

Organ/region examined	TP/n	FP/n	TN/n	FN/n	SEN/%	SPEC/%	PPV/%	NPV/%	ACU/%
EPE
mp-MRI	13	1	9	15	46.4	90.0	92.9	37.5	57.9
¹⁸F-MD-PSMA PET/CT	25	6	4	3	89.3	40.0	80.6	57.1	76.3
SVI
mp-MRI	3	2	25	8	27.3	92.6	60.0	75.8	73.7
¹⁸F-MD-PSMA PET/CT	8	5	22	3	72.7	81.4	61.5	88.0	78.9
BNI
mp-MRI	3	1	30	4	42.9	96.8	75.0	88.2	86.8
¹⁸F-MD-PSMA PET/CT	3	0	31	4	42.9	100.0	100.0	88.6	86.8
Regional lymph nodes (N1)
Per-lesion
mp-MRI	5	6	387	42	10.6	98.5	45.5	90.2	89.1
¹⁸F-MD-PSMA PET/CT	25	11	381	22	53.2	96.9	70.3	94.5	92.5
¹⁸F-FDG PET/CT	12	6	213	32	29.2	99.5	66.7	86.7	87.6
Per-patient
mp-MRI	3	0	17	8	27.3	100.0	100.0	68.0	71.4
¹⁸F-MD-PSMA PET/CT	10	1	16	1	90.9	94.1	90.9	94.1	92.9
¹⁸F-FDG PET/CT	5	3	6	0	62.5	96.3	66.7	100.0	78.6
Skeleton (M1b)
Per-patient
BS	13	2	32	3	81.3	94.1	86.7	91.4	90.0
¹⁸F-MD-PSMA PET/CT	15	0	34	1	93.8	100.0	100.0	97.1	98.0
Per-lesion
BS	11	8	366	34	25.0	97.9	57.9	91.5	90.0
¹⁸F-MD-PSMA PET/CT (per lesion)	24	18	356	21	54.5	95.2	57.1	94.4	90.7

Organ/region examined	TP/n	FP/n	TN/n	FN/n	SEN/%	SPEC/%	PPV/%	NPV/%	ACU/%
EPE
mp-MRI	13	1	9	15	46.4	90.0	92.9	37.5	57.9
¹⁸F-MD-PSMA PET/CT	25	6	4	3	89.3	40.0	80.6	57.1	76.3
SVI
mp-MRI	3	2	25	8	27.3	92.6	60.0	75.8	73.7
¹⁸F-MD-PSMA PET/CT	8	5	22	3	72.7	81.4	61.5	88.0	78.9
BNI
mp-MRI	3	1	30	4	42.9	96.8	75.0	88.2	86.8
¹⁸F-MD-PSMA PET/CT	3	0	31	4	42.9	100.0	100.0	88.6	86.8
Regional lymph nodes (N1)
Per-lesion
mp-MRI	5	6	387	42	10.6	98.5	45.5	90.2	89.1
¹⁸F-MD-PSMA PET/CT	25	11	381	22	53.2	96.9	70.3	94.5	92.5
¹⁸F-FDG PET/CT	12	6	213	32	29.2	99.5	66.7	86.7	87.6
Per-patient
mp-MRI	3	0	17	8	27.3	100.0	100.0	68.0	71.4
¹⁸F-MD-PSMA PET/CT	10	1	16	1	90.9	94.1	90.9	94.1	92.9
¹⁸F-FDG PET/CT	5	3	6	0	62.5	96.3	66.7	100.0	78.6
Skeleton (M1b)
Per-patient
BS	13	2	32	3	81.3	94.1	86.7	91.4	90.0
¹⁸F-MD-PSMA PET/CT	15	0	34	1	93.8	100.0	100.0	97.1	98.0
Per-lesion
BS	11	8	366	34	25.0	97.9	57.9	91.5	90.0
¹⁸F-MD-PSMA PET/CT (per lesion)	24	18	356	21	54.5	95.2	57.1	94.4	90.7

[1]	TANG Kairan, FENG Chengling, HAN Bangmin. Integrated single-cell and transcriptome sequencing to construct a prognostic model of M2 macrophage-related genes in prostate cancer [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(5): 549-561.
[2]	DUN Yiting, ZHAO Jing, FENG Chengling, LI Xingjian, CUI Di, HAN Bangmin. Online risk calculator and nomogram prediction model for urinary incontinence after robot-assisted laparoscopic radical prostatectomy [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(10): 1361-1371.
[3]	CAI Renjie, XU Ming. KHSRP regulates the responsiveness of prostate cancer cells to androgens through ANK3 [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(4): 417-426.
[4]	YANG Wanli, SONG Juan, LI Bing, LAO Yimin. Deciphering the suppressive effects of CBX8 on prostate cancer cell invasion [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(12): 1507-1519.
[5]	WANG Hui, ZHAO Ying, WEN Lirong, CAO Jun, YANG Jiping, YUAN Yongming. Diagnostic value of PSA, TAP and MACC1 expression in blood of patients with prostate cancer [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(4): 496-501.
[6]	SONG Xu-jia, ZHANG Shi-jun, Lü Wen-xin, HUANG Lin, ZHANG Yan, WU Ming-gui, XIE Shao-wei. Synergistic chemo-photothermal therapy of castration-resistant prostate cancersingle-walled carbon nanotube [J]. , 2020, 40(4): 450-.
[7]	HONG Xi1, LIU Li-jie1, HUANG Xian-yu2, LUO Jing2, YU Jian-jun1. Effects of BRD4 inhibitor on histone crotonylation, proliferation and migration of prostate cancer cells [J]. , 2019, 39(7): 721-.
[8]	XIE Shao-wei,DONG Bai-jun,XIA Jian-guo,WANG Yan-qing,LI Hong-li,ZHANG Shi-jun,YANG Wen-qi,LI Feng-hua. Value of prostate anterior horn biopsy in the diagnosis of prostate cancer [J]. , 2019, 39(5): 518-.
[9]	FANG Xiao1, 2, GUO Jian-gong1, HUANG Jin-ming1, FAN Lian-cheng2. Prediction of prognostic nutritional index for the primary resistance to abiraterone and the prognosis in metastatic castration-resistant prostate cancer patients [J]. , 2019, 39(3): 316-.
[10]	CHEN Ming, FU Xiao-hong, WU Shu, WAN Yong-lin. Risk estimation of prostate cancer in patients with serum prostate-specific antigen level of 4–10 ng/mL [J]. , 2019, 39(2): 217-.
[11]	LIU Li-jie1, HONG Xi1, HUANG Xian-yu3, LUO Jing3, YU Jian-jun1, 2. Global levels of lysine crotonylation in prostate cancer and its correlation with clinical stages and pathologic grades [J]. , 2018, 38(7): 788-.
[12]	PAN Yu-long1, QI Jun2, ZHOU Liang1, ZHANG Tong-tong1, LI Qiang1. Ribosomal protein 16 overexpresses in prostate cancer and promotes tumor progression [J]. , 2018, 38(4): 394-.
[13]	PAN Jia-hua, CHI Chen-fei, DONG Bai-jun, ZHU Yin-jie, SHAO Xiao-guang, WANG Yan-qing, XU Fan, SHA Jian-jun, HUANG Yi-ran, XUE Wei . Safety of neoadjuvant chemo-hormonal therapy by the combination of docetaxel and maximal androgen blockage for locally advanced prostate cancer [J]. , 2017, 37(6): 797-.
[14]	FAN Lian-cheng, DONG Bai-jun, CHI Chen-fei, PAN Jia-hua, WANG Yan-qing, SHAO Xiao-guang, XU Fan, SHANGGUAN Xun, ZHOU Li-xin#, XUE Wei# . Efficacy and prognostic factors of abiraterone combined with prednisone treating metastatic castration- resistant prostate cancer patients#br# [J]. , 2017, 37(11): 1483-.
[15]	FU Shi, ZHOU Juan, WANG Zhong . Research progresses on the role of adiponectin and its receptors in prostate cancer#br# [J]. , 2017, 37(10): 1434-.

Role of ¹⁸F-MD-PSMA PET/CT in initial stage of intermediate and high risk prostate cancer

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

TrendMD

References 29

Related Articles 15

Recommended Articles

Metrics

Comments

Imaging method	Pathologic diagnosis of EPE		Pathologic diagnosis of SVI		Pathologic diagnosis of BNI
Imaging method	+	-	+	-	+	-
mp-MRI
+	13	1	3	2	3	1
-	15	9	8	25	4	30
¹⁸F-MD-PSMA PET/CT
+	25	6	8	5	3	0
-	3	4	3	22	4	31