Background 68Ga-PSMA PET/CT may represent the most promising imaging modality for identification and risk stratification of prostate cancer (PCa) in patients with contraindications to or negative multiparametric MRI (mpMRI). Methods This prospective observational study analyzed 68Ga-PSMA PET/CT in a selected group of patients with persistently elevated PSA and/or PHI (prostate health index) suspicious for PCa, negative digital rectal examination, and at least one negative biopsy. The cohort comprised men with either an equivocal mpMRI (PI-RADSv2. ≤2) or an absolute or relative contraindication to mpMRI. Sensitivities, specificities, and confidence intervals (CIs) were calculated compared to histopathology. ROC analysis was applied to determine optimal cut-off values of 68Ga-PSMA uptake for the identification of clinically significant PCa (Gleason score ≥7). Results Between January and August 2017, 45 patients (median age 64years) were referred to 68Ga-PSMA PET/CT. Twenty-five subjects (55.5%) were considered having a positive PET and underwent software-assisted fusion biopsy. Uptake values of regions of interest (ROIs) were as follows: median SUVmax 5.34 (range2.25-30.41) and ratio of SUVmax to background (SUVratio) 1.99 (range1.06-14.42). Mean and median uptake values on 68Ga-PSMA PET/CT (i.e.SUVmax or SUVratio) were significantly higher in GS 7 lesions than in GS 6 or benign lesions (p<0.001). On ROC analysis, a SUVmax of 5.4 and a SUVratio of 2 could discriminate clinically relevant PCa with an overall sensitivity of 100% in both cases and a specificity of 76% and 88%, respectively. Conclusion Our findings support the use of 68Ga-PSMA PET/CT for primary detection of PCa in a specific subset of men.
|Titolo:||68Ga-PSMA PET/CT for primary diagnosis of prostate cancer in men with contraindications to or negative mpMRI: a prospective observational study|
|Data di pubblicazione:||2018|
|Appare nelle tipologie:||1.1 Articolo in rivista|