BACKGROUND 68Ga prostate specific membrane antigen PET/CT (68Ga-PSMA PET/CT) may be superior to multiparametric MRI (mpMRI) for localisation of prostate cancer tumour foci, however the concordance and differences between 68Ga-PSMA PET/CT and mpMRI when applied to all biopsied patients and potential benefit in patients with negative mpMRI is unclear. METHODS Retrospective analysis of patients undergoing mpMRI, prostate biopsy and 68Ga-PSMA PET/CT over a 3-year period. Diagnostic performance of 68Ga-PSMA PET/CT and mpMRI were assessed using biopsy histopathology for the entire cohort and radical prostatectomy specimen in a subset of patients. Lesion concordance and additional detection of each modality were determined, including in a dedicated cohort of patients with mpMRI PIRADS 2 scans. RESULTS A total of 144 patients were included in the study. Index lesion/foci detection was similar between 68Ga-PSMA PET/CT and mpMRI (sensitivity 83.1% vs 90.1%; p = 0.267), however lesions missed by mpMRI were larger (1.66 cm3 vs 0.72 cm3; p = 0.034). Lesion detection rates were similar across the biopsy histopathology and radical prostatectomy specimen subset, with a high concordance for index (80.1%) and a moderate concordance for total (67%) lesions between the 2 imaging modalities. The additional detection yield favoured 68Ga-PSMA PET/CT over mpMRI for index (13.5% vs 4.3%) and total (18.2% vs 5.4%) lesions; both modalities missed 2.1% and 12.3% of index and total lesions, respectively. 68Ga-PSMA PET/CT identified 9 of 11 patients with PIRADS 2 mpMRI but subsequently diagnosed with Gleason ≥ 3 + 4 disease. CONCLUSIONS Despite high concordance rates, 68Ga-PSMA PET/CT incrementally improved tumour localisation compared with mpMRI. These results suggest that 68Ga-PSMA PET/CT may have an incremental value to that of mpMRI in the diagnostic process for prostate.

中文翻译：

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68Ga-PSMA PET / CT在MRI和经会阴前列腺活检后可更好地表征局限性前列腺癌：68Ga-PSMA PET / CT引导下的活检是否未来？

背景技术68Ga前列腺特异性膜抗原PET / CT（68Ga-PSMA PET / CT）在定位前列腺癌肿瘤灶方面可能优于多参数MRI（mpMRI），但是68Ga-PSMA PET / CT与mpMRI的一致性和差异对于所有活检患者，mpMRI阴性患者的潜在获益尚不清楚。方法回顾性分析3年内接受mpMRI，前列腺活检和68Ga-PSMA PET / CT的患者。使用活检组织病理学评估了68Ga-PSMA PET / CT和mpMRI在部分患者中整个队列和前列腺癌根治术标本的诊断性能。确定病变的一致性和每种方式的附加检测，包括在专门的mpMRI PIRADS 2扫描患者队列中。结果研究共纳入144例患者。68Ga-PSMA PET / CT和mpMRI之间的指标病变/病灶检测相似（敏感性83.1％vs 90.1％； p = 0.267），但是mpMRI遗漏的病变更大（1.66 cm3 vs 0.72 cm3； p = 0.034）。在活检组织病理学和根治性前列腺切除术标本子集中，病变检出率相似，在这两种成像方式之间，指数的一致性较高（80.1％），总病变的中等一致性（67％）。与mpMRI相比，在病变指数（13.5％对4.3％）和总病变（18.2％对5.4％）方面，额外的检出率有利于68Ga-PSMA PET / CT。两种方式分别遗漏了指标和总病变的2.1％和12.3％。68Ga-PSMA PET / CT在11例PIRADS 2 mpMRI患者中鉴定出9例，但随后被诊断为Gleason≥3 + 4疾病。结论尽管一致性很高，与mpMRI相比，68Ga-PSMA PET / CT逐渐改善了肿瘤的定位。这些结果表明68Ga-PSMA PET / CT在前列腺诊断过程中可能比mpMRI具有更高的价值。