PSMA PET offers the potential for improved local staging prior to radical prostatectomy (RP). We evaluated PSMA PET versus mpMRI for local and nodal staging for patients with localized NCCN high or very high risk prostate cancer undergoing RP.
A prospective single center pilot study was conducted from 9/2018 to 6/2022. Patients underwent both mpMRI and 18F-DCFPyL PSMA PET with limited MRI sequences, followed by RP with pelvic lymphadenectomy. Patient and side-specific performance of mpMRI and PSMA PET were compared to RP histopathological standard of truth for extraprostatic extension (EPE), seminal vesicle invasion (SVI), and lymph node involvement (LNI).
At RP, 79% (38/48) had EPE, 31% had SVI, and 31% had LNI. At the patient level for EPE, PSMA PET had similar sensitivity (65.8% vs. 84.2%, respectively, P = 0.07) but higher specificity (80% vs. 40%, P = 0.045) compared to mpMRI, respectively. For SVI, PSMA PET had lower sensitivity (62.5% vs. 87.5%, P = 0.046) and similar specificity (87.5% vs. 90.6%, P = 0.56). For side-specific LNI, PSMA PET had higher sensitivity (50% vs. 25%, P = 0.03) and similar specificity (96.1% vs. 94.7%, P = 0.71) compared to mpMRI.
PSMA PET offers higher specificity for EPE and higher sensitivity for LNI compared to mpMRI. PSMA PET may improve overall surgical planning, and may be combined with diagnostic mpMRI and clinicopathological variables through nomograms to further predict EPE, SVI, or LNI.
NCT03392181 https://clinicaltrials.gov/study/NCT03392181 .
European journal of nuclear medicine and molecular imaging. 2025 Feb 10 [Epub ahead of print]
Eric V Li, Edward M Schaeffer, Sai Kaushik Shankar Ramesh Kumar, Ruoji Zhou, Ximing J Yang, Margarita Mana-Ay, Mariavittoria Vescovo, Austin Ho, Mary Kate Keeter, James Carr, David Casalino, Masha Kocherginsky, Hiten D Patel, Ashley E Ross, Hatice Savas
Feinberg School of Medicine, Department of Urology, Northwestern University, 676 N. St. Clair St., Suite 2300, Chicago, IL, 60611, USA. ., Feinberg School of Medicine, Department of Urology, Northwestern University, 676 N. St. Clair St., Suite 2300, Chicago, IL, 60611, USA., Feinberg School of Medicine, Department of Preventative Medicine, Northwestern University, Chicago, IL, 60611, United States of America., Department of Pathology, University of California in Los Angeles, Los Angeles, CA, 90095, United States of America., Feinberg School of Medicine, Department of Pathology, Northwestern University, Chicago, IL, 60611, United States of America., Feinberg School of Medicine, Department of Radiology, Northwestern University, Chicago, IL, 60611, United States of America., Department of Radiology, Georgetown University Medical Center, Washington DC, 20007, United States of America.