Intraindividual Comparison of 18F-PSMA-1007 PET/CT, Multiparametric MRI, and Radical Prostatectomy Specimens in Patients with Primary Prostate Cancer: A Retrospective, Proof-of-Concept Study.

68Ga-prostate-specific membrane antigen (PSMA)-11 PET/CT represents an advanced method for the staging of primary prostate cancer (PCa) and diagnosis of recurrent or metastatic PCa. However, because of the narrow availability of 68Ga the development of alternative tracers is of high interest. The objective of this study was to examine the value of the new PET tracer 18F-PSMA-1007 for the staging of local disease by comparing it with multiparametric MRI (mpMRI) and radical prostatectomy (RP) histopathology. Methods: In 2016, 18F-PSMA-1007 PET/CT was performed in 10 men with biopsy-confirmed high-risk PCa. Nine patients underwent mpMRI in the process of primary diagnosis. Consecutively, RP was performed in all 10 men. Agreement analysis was performed retrospectively. PSMA staining was added for representative sections in RP specimen slices. Localization and agreement analysis of 18F-PSMA-1007 PET/CT, mpMRI, and RP specimens was performed by dividing the prostate into 38 sections as described in the prostate imaging reporting and data system (PI-RADS) (version 2). Sensitivity, specificity, positive predictive values, negative predictive values (NPVs), and accuracy were calculated for total and near-total agreement. Results:18F-PSMA-1007 PET/CT had an NPV of 68% and an accuracy of 75%, and mpMRI had an NPV of 88% and an accuracy of 73% for total agreement. Near-total agreement analysis resulted in an NPV of 91% and an accuracy of 93% for 18F-PSMA-1007 PET/CT and 91% and 87% for mpMRI, respectively. Retrospective combination of mpMRI and PET/CT had an accuracy of 81% for total and 93% for near-total agreement. Conclusion: Comparison with RP histopathology demonstrates that 18F-PSMA-1007 PET/CT is promising for accurate local staging of PCa.

Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2017 May 04 [Epub]

Claudia Kesch, Maria Vinsensia, Jan P Radtke, Heinz P Schlemmer, Martina Heller, Elena Ellert, Tim Holland-Letz, Stefan Duensing, Nils Grabe, Ali Afshar-Oromieh, Kathrin Wieczorek, Martin Schäfer, Oliver C Neels, Jens Cardinale, Clemens Kratochwil, Markus Hohenfellner, Klaus Kopka, Uwe Haberkorn, Boris A Hadaschik, Frederik L Giesel

Department of Urology, University Hospital Heidelberg, Heidelberg, Germany., Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany., Division of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany., Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Medical Faculty Heidelberg, Heidelberg, Germany., Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany., Division of Biostatistics, German Cancer Research Center (dkfz), Heidelberg, Germany., Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany., Division of Radiopharmaceutical Chemistry, German Cancer Research Center (dkfz), Heidelberg, Germany., Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany .