This prospective study aimed to (1) compare the diagnostic performance of 68Ga-PSMA-11 PET/CT with respect to conventional imaging (computed tomography (CT) and bone scintigraphy (BS)) in the primary staging of high-risk prostate cancer (PCa) patients and (2) validate PSMA-PET/CT accuracy in pelvic nodal staging in comparison with postoperative histopathology and assess PSMA-PET/CT's impact on patient management. Sixty castration-sensitive high-risk (ISUP 4-5 and/or PSA > 20 ng/mL and/or cT3) PCa patients eligible for radical prostatectomy were enrolled (median PSA 10.10 [IQR: 6.22-17.95] ng/mL). PSMA-PET/CT, compared with CT, identified nodal (N) and/or distant metastases (M1) in 56.7% (34/60) vs. 13.3% (8/60) (p < 0.001) of patients: N + 45% vs. 13.3% (p < 0.001), M1a 11.7% vs. 1.7% (p = 0.03), M1b 23.3% vs. 1.7% (p < 0.001). Compared with BS, PSMA-PET/CT localized unknown skeletal metastases in 15% (9/60) of cases, with no false negative findings. Overall, PSMA-PET/CT led to a TNM upstaging in 45.0% (27/60) of cases, with no evidence of downstaging, resulting in a change in management in up to 28.8% (17/59) of patients. Compared with histopathology data (n = 32 patients), the per-patient accuracy of PSMA-PET/TC for detecting pelvic nodal metastases was 90.6%. Overall, the above evidence supports the use of PSMA-PET/CT in the diagnostic workup of high-risk prostate cancer staging.
Diagnostics (Basel, Switzerland). 2024 Sep 05*** epublish ***
Guido Rovera, Serena Grimaldi, Marco Oderda, Giancarlo Marra, Giorgio Calleris, Giuseppe Carlo Iorio, Marta Falco, Cristiano Grossi, Roberto Passera, Giuseppe Campidonico, Maria Luce Mangia, Désirée Deandreis, Riccardo Faletti, Umberto Ricardi, Paolo Gontero, Silvia Morbelli
Nuclear Medicine Division, Department of Medical Sciences, University of Turin, 10126 Turin, Italy., Nuclear Medicine Division, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy., Urology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Turin, Italy., Department of Oncology, Radiation Oncology, University of Turin, 10126 Turin, Italy., Nuclear Medicine Division, Gustave Roussy, 94805 Villejuif, France., Radiology Unit, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy.