AUA 2022: Update From the PEDAL Trial: A Prospective Single Arm Paired Comparison of Ability To Diagnose and Locate Prostate Cancer Between Multiparametric MRI and 18F-PSMA-PET/CT

( In a podium presentation at the American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Tran presented an update on the PEDAL trial comparing multiparametric MRI and 18F-DCFPyl prostate-specific membrane antigen (PSMA)-PET/CT in the diagnosis and localization of prostate cancer. While mpMRI has rapidly become the standard of care in the evaluation of patients suspected of having prostate cancer and is widely used, PSMA-PET/CT has for the most part been using in distant staging and the localization of recurrent disease following local therapy.

The authors performed a prospective single arm paired comparison of mpMRI and 18F-DCFPyL-PSMA PET/CT to diagnose and localize prostate cancer. Detection and localization of suspicious prostate lesions were compared between mpMRI, PET/CT and fused PET/MR images. Following targeted prostate biopsy, the radiological findings were correlated with histological findings.

The authors included 139 men who completed both imaging arms. The median age of included men was 58 years and median prostate specific antigen (PSA) level was 6.3ng/ml.

Prostate mpMRI detected 70 index lesions (PIRADS≥3), compared to 72 index lesions on PET/CT (SUVmax ≥7.0). Among these lesions, 54 index lesions were detected on both mpMRI and PET/CT, with an additional 16 lesions identified by PET/CT alone.

Following targeted prostate biopsy, prostate cancer was detected in 59 of 92 men (64.1%). Among the 43 men diagnosed with clinically significant prostate cancer (Grade group ≥2), 35 lesions (81.4%) were visualized on both imaging arms. PET/CT visualized 4 (9.3%) clinically significant lesions that were undetected by mpMRI, and identified 21 patients with metastatic disease. One clinically significant lesion was detected by mpMRI alone.


The authors, therefore, conclude that, in the pre-diagnosis setting, 18F-DCFPyl PSMA-PET/CT appears to detect lesions seen on mpMRI prostate, as well as identify additional clinically significant prostate lesions. Further, the ability of PSMA-PET/CT to provide staging and diagnose metastatic disease also saves the need for further investigations following diagnosis. This approach will be further assessed in a fully-powered trial to follow.

Presented by: Vy Tran, MD, St Vincent's Hospital in Melbourne, Australia

Written by: Christopher J.D. Wallis, University of Toronto, Twitter: @WallisCJD during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.



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