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A comparative study of 18F-PSMA-1007 PET/CT and pelvic MRI in newly diagnosed prostate cancer

BMC Medical Imaging volume 24, Article number: 192 (2024) Cite this article

A Correction to this article was published on 17 September 2024

This article has been updated

Abstract

Purpose

To evaluate the difference in the diagnostic efficacy of 18F-PSMA-1007 PET/CT and pelvic MRI in primary prostate cancer, as well as the correlation between the two methods and histopathological parameters and serum PSA levels.

Methods

A total of 41 patients with suspected prostate cancer who underwent 18F-PSMA-1007 PET/CT imaging in our department from 2018 to 2023 were retrospectively collected. All patients underwent 18F-PSMA-1007 PET/CT and MRI scans. The sensitivity, PPV and diagnostic accuracy of MRI and 18F-PSMA-1007 PET/CT in the diagnosis of prostate cancer were calculated after comparing the results of MRI and 18F-PSMA-1007 PET/CT with biopsy. The Spearman test was used to calculate the correlation between 18F-PSMA-1007 PET/CT, MRI parameters, histopathological indicators, and serum PSA levels.

Results

Compared with histopathological results, the sensitivity, PPV and diagnostic accuracy of 18F-PSMA-1007 PET/CT in the diagnosis of prostate cancer were 95.1%, 100.0% and 95.1%, respectively. The sensitivity, PPV and diagnostic accuracy of MRI in the diagnosis of prostate cancer were 82.9%, 100.0% and 82.9%, respectively. There was a mild to moderately positive correlation between Gleason (Gs) score, Ki-67 index, serum PSA level and 18F-PSMA-1007 PET/CT parameters (p < 0.05). There was a moderately negative correlation between the expression of AMACR (P504S) and 18F-PSMA-1007 PET/CT parameters (p < 0.05). The serum PSA level and the Gs score were moderately positively correlated with the MRI parameters (p < 0.05). There was no correlation between histopathological parameters and MRI parameters (p > 0.05).

Conclusion

Compared with MRI, 18F-PSMA-1007 PET/CT has higher sensitivity and diagnostic accuracy in the detection of malignant prostate tumors. In addition, the Ki-67 index and AMACR (P504S) expression were only correlated with 18F-PSMA-1007 PET/CT parameters. Gs score and serum PSA level were correlated with 18F-PSMA-1007 PET/CT and MRI parameters. 18F-PSMA-1007 PET/CT examination can provide certain reference values for the clinical diagnosis, evaluation, and treatment of malignant prostate tumors.

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Background

In the United States, prostate cancer (PCa) is the most common male malignant tumor. According to statistics, the incidence of PCa is 29%. Although the incidence is high, the prognosis of most PCa patients is good, and the overall 5-year survival rate is more than 98% [1]. Serum prostate-specific antigen (PSA) is a specific tumor marker for PCa. Clinically, PCa is often suspected due to an elevated PSA. Subsequently, a pelvic multi-parameter MRI examination is performed to identify whether there were morphological abnormalities. A transrectal ultrasound-guided biopsy (TRUS) [2] is required to confirm the diagnosis. Advances in multi-parameter magnetic resonance imaging (mp-MRI) techniques, including the use of dynamic contrast-enhanced and diffusion-weighted imaging sequences, have improved the accuracy of MRI in the diagnosis of PCa. However, MRI has a 39.0% probability of diagnostic uncertainty (i.e., PI-RADS 3), with 59.2% false positives and 7.4% false negatives [3]. A meta-analysis showed that there was a significant difference in the diagnostic accuracy of MRI in detecting csPCa (44–87%) [4]. Moreover, parallel to these developments, micro-ultrasound has emerged as a novel imaging modality characterized by its high real-time spatial resolution, showing high sensitivity in the diagnosis of clinically significant prostate cancer and comparable effectiveness to mp-MRI-guided biopsy in total prostate cancer detection. However, the available evidence is limited and should be considered preliminary [5].

Prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging is receptor imaging of prostate cancer membrane antigen [6,7,8,9,10,11]. Positron-labeled PSMA can specifically bind to PCa antigen and has high specificity. However, it is not clear whether PSMA PET/CT is superior to MRI in detecting prostate cancer. Rhee et al. found that the sensitivity and specificity of PSMA PET/CT and MRI in detecting prostate cancer lesions were roughly the same (44% vs. 49%, 94% vs. 95%) [12]. However, Baris et al. found that PSMA PET/CT showed a higher positive predictive value (100%) than MRI [13]. At present, the application of PSMA PET/CT in prostate cancer is mostly reported with 68Ga-labeled PET/CT [14,15,16,17,18]. This study aimed to evaluate the diagnostic efficacy of 18F-PSMA-1007 PET/CT and MRI in primary PCa and the correlation between the two methods, histopathological parameters, and serum PSA levels.

Materials and methods

Patients

A total of 41 patients with suspected PCa who underwent 18F-PSMA-1007 PET/CT imaging in our department from 2018 to 2023 were retrospectively collected. All patients underwent 18F-PSMA-1007 PET/CT and MRI scans. The median time between the two examinations was 3.5 days (range: 1 to 7 days). After the completion of the two examinations, patients underwent biopsy based on the comprehensive evaluation of the two examination results, and a biopsy was performed guided by the mp-MRI imaging results to confirm prostate cancer. Clinical information, laboratory examination results, imaging information from MRI and 18F-PSMA-1007 PET/CT, and pathological indicators were collected. Such as: age, serum PSA level, maximum diameter of 18F-PSMA PET/CT lesions, standardized uptake value maximum (SUVmax), standardized uptake value mean(SUVmean), standardized uptake value peak(SUVpeak), metabolic tumor volume (MTV), tumor-to-background ratio (TBR), tumor-to-liver ratio (TLR), maximum diameter of MRI lesions, PI-RADS score, Gleason (Gs) score, alpha-formyl coenzyme A racemase (AMACR (P504S)) status, prostate-specific antigen (PSA) status, Ki-67 proliferation index (Ki-67 index).

Radiopharmaceutical preparation

18F-PSMA-1007 was synthesized by a one-step method using an automated radiosynthesizer (Sumitomo, Japan). 18F was acquired by the (18F)/H218O nuclear reaction and then loaded onto a quaternary methylamine column (Waters, U.S.A.). After being eluted by 0.75 ml of tetrabutylammonium hydrogen carbonate (TBAHCO3) solution (ABX, Radeberg, Germany), it was transferred into a reactor, followed by the addition of 0.4 ml of anhydrous acetonitrile (Sigma, U.S.A.), and then the removal of water at a temperature of 95 °C. 1.2 ml of dimethyl sulfoxide (ABX, Radeberg, Germany), which was dissolved with PSMA-1007 precursor (ABX, Radeberg, Germany), was added to the reactor and performed a fluorination reaction at 85 °C for 10 min. Then diluted with 6 ml of 5% ethanol and loaded onto PS-H + and C18ec (ABX, Radeberg, Germany), followed by 4 ml of 30% ethanol. The final product was eluted with 4 ml of 30% ethanol and added to 0.1 ml of 100 mg/L Vitamin C solution and 36 mL of 0.9% NaCl, then sterilized by a 0.22 μm filter (Millipore, U.S.A.). High-performance liquid chromatography (HPLC, Shimadzu, Japan) was performed to test chemical purity. Further quality control (appearance, color, clarity, PH, and radionuclidic purity) was done in compliance with current pharmacopoeias.

18F-PSMA-1007 PET/CT image acquisition

Patients did not need special preparation on the day of the 18F-PSMA-1007 PET/CT scan. The injection activity of 18F-PSMA-1007 was 330 ± 46 MBq (range 248–429 MBq). Imaging began 180 min after the injection [19]. Siemens Biograph mCT-64 PET/CT (Siemens, Erlangen, Germany) scanning equipment was used for the examination. First CT scan: tube voltage 140 kV, effective current 42 mAs, pitch 0.8, ball tube single-ring rotation time 0.5 s, layer thickness 8 mm. The PET acquisition range was from the top of the skull to the middle of the femur, and 6–7 bed positions were collected using 3D acquisition, 1.5 min/ bed position. The ordered subset expectation maximization OSEM iterative algorithm was used to reconstruct the image, and the image fusion and post-processing were performed on the Siemens MMWP workstation.

MRI image acquisition

MRI scans(Philips Achieva) were collected at 3T. The sequences were: T1-weighted, T2-weighted, ADC, DWI, and DCE. Dobutamine (Gd-DOTA, DOTAREM, Guerbet, France) was administered intravenously with CE-T1 (pre-injection dose, 0.1 mmol/kg) [20].

Image analysis

18F-PSMA PET/CT image evaluation was performed by two experienced nuclear medicine physicians with ten years of experience in prostate tumor imaging. MRI images were evaluated by two physicians with ten years of experience in prostate tumor imaging. Differences were resolved by consultation or a third physician’s assessment with ten years of experience in prostate tumor imaging. Tumor size was defined as the longest diameter of a malignant prostate mass. Intra-prostatic lesions were defined as positive if the tracer uptake was focal and higher than surrounding prostate tissue [21]. SUVmax、SUVmean was quantified using the region of interest (ROI). The MTV was measured by an automatic contouring program based on SUVmax, and the tumor border was outlined on the software at 42% of SUVmax to obtain the MTV value. The maximum ratio of SUVmax of all prostate lesions to the mediastinal blood pool (TBR) and the maximum ratio of SUVmax to the liver (TLR) were calculated.

Multi-parameter MRI image interpretation was based on PI-RADS V2.1 as the scoring standard. The scoring scheme was as follows: DWI was the scoring sequence for the peripheral zone of the prostate, and the 3-point lesion was determined by T2WI instead of dynamic enhanced MRI to determine the final score. The transition zone was scored according to the PI-RADS V2.1 standard, as shown in Table 1 [20]. PI-RADS score ≥ 4 was considered positive [22,23,24,25,26].

Table 1 Improved two-parameter MRI scoring scheme
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Statistical analysis

We use SPSS (version 22.0; IBM, U.S.A.) for statistical analysis. The measurement data are expressed as mean ± SD, and the categorical variables are expressed as numbers and percentages. The sensitivity, positive predictive value (PPV) and diagnostic accuracy of MRI and 18F-PSMA-1007 PET/CT in the diagnosis of PCa were calculated after comparing the results of MRI and 18F-PSMA-1007 PET/CT with biopsy. The Spearman test was used to calculate the correlation between 18F-PSMA-1007 PET/CT, MRI parameters, histopathological indicators, and serum PSA levels. P < 0.05 was considered statistically significant.

Results

Patient characteristics

A total of 41 patients with PCa were included, with an average age of 70 years and an average PSA level of 136.1 ng/ml. AMACR (P504S) overexpression was found in 16 patients (39.0%), PSA overexpression was found in 15 patients (36.6%), and the Ki-67 index was 11.9 ± 8.7%. The specific characteristics are shown in Table 2.

Table 2 Clinical, radiological and molecular patient characteristics
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MRI images and 18F-PSMA-1007 PET/CT features

The maximum diameter of the PCa detected by MRI was 31.1 ± 17.5 mm. The maximum diameter of PCa detected by 18F-PSMA-1007 PET/CT was 36.0 ± 13.9 mm, SUVmax was 33.2 ± 24.2, SUVmean was 18.7 ± 12.6, SUVpeak was 22.2 ± 16.1, MTV was 10.5 ± 10.3, TBR was 31.8 ± 24.3, and TLR was 20.4 ± 24.4 (Table 2).

Of the 41 patients, 34 (82.9%) had positive results on MRI, and 7 (17.1%) had negative results on MRI, compared with histopathological results. Thirty-nine (95.1%) patients had positive 18F-PSMA-1007 PET/CT results, and two (4.9%) patients had negative 18F-PSMA-1007 PET/CT results. The results of 18F-PSMA-1007 PET/CT and MRI were consistent in 32 cases and inconsistent in 9 cases (Fig. 1). Among them, 7 cases (17.1%) were negative for MRI and positive for 18F-PSMA-1007 PET/CT, and 2 cases (4.9%) were positive for MRI and negative for 18F-PSMA-1007 PET/CT. Table 3 summarizes the detailed information about these inconsistent cases of PSMA and MRI. The sensitivity, PPV and diagnostic accuracy of MRI were 82.9%, 100.0% and 82.9%, respectively. The sensitivity, PPV and diagnostic accuracy of 18F-PSMA-1007 PET/CT were 95.1%, 100.0% and 95.1%, respectively (Table 4). The GS score and Ki-67 index were positively correlated with the maximum diameter of 18F-PSMA-1007 PET/CT mass, SUVmax, SUVmean, SUVpeak, TBR, and TLR (p < 0.05). There was a moderately negative correlation between the expression of AMACR (P504S) and the maximum diameter, SUV, TBR, and TLR of 18F-PSMA-1007 PET/CT (p < 0.05). Serum PSA level was positively correlated with the maximum diameter of 18F-PSMA-1007 PET/CT mass, SUVpeak, MTV, and TLR (p < 0.05). PSA expression was not associated with 18F-PSMA-1007 PET/CT parameters (P > 0.05) (Table 5). Serum PSA level was moderately positively correlated with the maximum diameter of PCa detected by MRI and PI-RADS score (p < 0.05), and PI-RADS score was moderately positively correlated with GS score (p < 0.05) (Table 6).

Fig. 1
figure 1

Patient, with elevated PSA (9.72ng/ml), 18 F-PSMA PET/CT (a, MIP; b, local CT; c, local PET/CT) showed enlargement of the prostate, with several nodules of increased uptake, and the SUVmax was 23.6. T2WI (d) showed that the prostate signal was not uniform, and scattered T2WI high signal nodules were seen. TI enhanced image showed (e) uneven enhancement. The histopathological examination (f, g) showed that the Gleason score of prostate acinar adenocarcinoma was 3 + 4 = 7

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Table 3 Patients with discordant magnetic resonance imaging and prostatespecific membrane antigen positron emission tomography/computed tomography findings
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Table 4 Comparison of PSMA PET/CT and mpMRI in diagnosis of primary prostate cancer
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Table 5 Factors affecting the diagnostic efficacy of PSMA PET/CT
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Table 6 Factors influencing the diagnostic efficiency of MRI
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Discussion

In this study, we evaluated the performance of 18F-PSMA-1007 PET/CT and MRI in the diagnosis of newly diagnosed PCa. Our study found that 18F-PSMA-1007 PET/CT provides better detection of prostate lesions, and its sensitivity and diagnostic accuracy are higher than mp-MRI. The sensitivity, PPV and diagnostic accuracy of 18F-PSMA-1007 PET/CT were 95.1%, 100.0% and 95.1%, respectively. The sensitivity, PPV and diagnostic accuracy of MRI were 82.9%, 100.0% and 82.9%, respectively. Berger et al. showed that the PSMA PET scan has a higher NPV and accuracy than mp-MRI in detecting tumor lesions in the prostate [27]. Soni et al. found that the sensitivity and specificity of PSMA PET/CT in the detection of prostate cancer were 94.44% and 100.0%, respectively. The sensitivity and specificity of MRI in the detection of prostate cancer were 100.0% and 92.3%, respectively. PSMA PET/CT showed good sensitivity and specificity detecting PCa, and it was superior to MRI in predicting the presence of PCa [28]. Since the included patients were all diagnosed with prostate cancer and there were no patients with benign prostate diseases, this study lacked specificity and negative predictive value.

In our study, 9 patients had inconsistent results in 18F-PSMA-1007 PET/CT and MRI, with PI-RADS ≤ 4. Among them, patients with a PI-RADS score of 3 were positive in the PSMA PET/CT examination, with a higher SUVmax (33.7) and GS score of 8. PI-RADS 3 lesions on MRI pose a diagnostic challenge because the possibility of clinically significant cancer is ambiguous [22,23,24,25,26]. A recent retrospective analysis evaluated patients with negative MRI findings and found that during a 38-month follow-up, 12.8% of patients had a negative MRI but a biopsy detected PCa, of which 42.3% were diagnosed with clinically significant prostate cancer (csPCa) [29]. A study by Chen et al. showed that in PI-RADS 3, using 4 or higher PI-RADS cutoff values, MRI missed 24.2% of csPCa and 66.7% of csPCa [30]. Men with PI-RADS-3 lesions usually rely on biopsy to rule out invasive diseases. Chandra et al. reported in a recent study that PSMA PET/CT combined with MRI can reduce unnecessary prostate biopsy [31]. A recent study by Zhang et al. showed that PSMA PET/CT can be used as a triage tool for prostate biopsy. In the case of unclear serum PSA levels and MRI, targeted biopsy using PSMA PET/CT may be more beneficial [32]. Limitations of MRI include low specificity and low accuracy in the diagnosis of low-grade prostate tumors. For lumps around the anterior prostate corner, prostatitis or prostatic hyperplasia combined with prostate cancer, MRI may miss these prostate cancer foci [33]. PSMA is 100–1000 times overexpressed in malignant prostate tissue compared to normal tissue. In theory, PSMA PET/CT detection of prostate malignancies is relatively specific compared to mp-MRI, which is not disease-specific. According to our study results, we suggest that patients with PI-RADS ≤ 3 points receive MRI combined with 18F-PSMA PET/CT diagnosis, which can reduce the rate of missed diagnosis of prostate cancer, improve patient prognosis, and provide a better choice for clinical practice, which also needs further research to verify our views.

Our study also found that there was a mild to moderate positive correlation between the GS score and the maximum diameter of 18F-PSMA-1007 PET/CT mass, SUV, TBR, and TLR. There was a mild to moderately positive correlation between serum PSA level and the maximum diameter of 18F-PSMA-1007 PET/CT mass, SUVpeak, MTV, and TLG. The maximum diameter of PCa detected by MRI was moderately positively correlated with the serum PSA level. PI-RADS score was moderately positively correlated with serum PSA level and GS score. Our findings are consistent with previous studies. A recent study by Rowe et al. found a moderate correlation between SUV and tumor Gleason grade [34]. Paterson et al. showed a significant relationship between SUVmax, PSA levels, and GS grades [35]. An Italian team evaluated 45 patients who underwent a 68Ga-PSMA-11 PET/CT-guided biopsy and found that lesions with a GS score of ≥ 7 had a higher SUVmax than lesions with a GS score of ≤ 6 [36]. According to some parameters of PSMA PET/CT and MRI, it may provide some help for clinical GS grouping and serum PSA level evaluation, but its specific application needs to be further proven.

The Ki-67 index is a quantitative index of cell proliferation in the histopathological evaluation of PCa. The Ki-67 index, AMACR (P504S), and PSA expression are related to the survival rate and prognosis of patients with PCa [37]. We found that the Ki-67 index was positively correlated with the maximum diameter of 18F-PSMA-1007 PET/CT mass, SUV, TBR, and TLR. The expression of AMACR (P504S) was negatively correlated with the maximum diameter of 18F-PSMA-1007 PET/CT mass, SUV, TBR, and TLR. PSA expression was not related to 18F-PSMA-1007 PET/CT parameters. However, the Ki-67 index, AMACR (P504S), and PSA expression were not related to MRI parameters. An 18F-PSMA-1007 PET/CT examination can indicate the prognosis of patients to a certain extent. In future studies, larger samples may be needed to further investigate our findings.

Limitations

First, our sample size was limited and subject to the retrospective nature of the study and the potential for selection bias. Secondly, we only included patients with PCa, lacking benign prostate disease. Finally, prostate lesions were not labeled with PSMA in immunohistochemistry, which made it impossible to evaluate the correlation between PSMA expression and PSMA PET/CT parameters. Further research on larger samples is needed to verify our results, especially the correlation findings.

Conclusion

Compared with MRI, 18F-PSMA-1007 PET/CT has higher sensitivity and diagnostic accuracy in the detection of PCa. In addition, the Ki-67 index and AMACR (P504S) expression were only correlated with 18F-PSMA-1007 PET/CT parameters. GS score and serum PSA level were correlated with 18F-PSMA-1007 PET/CT and MRI parameters. 18F-PSMA-1007 PET/CT examination can provide certain reference values for the clinical diagnosis, evaluation, and treatment of PCa.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Change history

Abbreviations

PCa:

Prostate cancer

csPCa:

Clinically significant prostate cancer

PSA:

Prostate-specific antigen

PSMA:

Prostate-specific membrane antigen

PPV:

Positive predictive value

NPV:

Negative predictive value

MRI:

Magnetic resonance imaging

Mp-MRI:

Multi-parameter magnetic resonance imaging

PET:

Positron emission tomography

CT:

Computed tomography

PET/CT:

Positron emission tomography/computerized tomography

PSMA PET:

Prostate-specific membrane antigen positron emission tomography

18F-PSMA-1007 PET/CT:

18F-Prostate-specific membrane antigen-1007 positron emission tomography/computerized tomography

SUV:

Standardized uptake value

SUVmax:

Standardized uptake value Maximum

SUVmean:

Standardized uptake value Mean

SUVpeak:

Standardized uptake value Peak

MTV:

Metabolic tumor volume

TBR:

Tumor-to-background ratio

TLR:

Tumor-to-liver ratio

ROI:

Region of interest

Gs:

Gleason score

Ki-67 index:

Ki-67 proliferation index

References

  1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17–48.

    Article  PubMed  Google Scholar 

  2. Moses KA, Sprenkle PC, Bahler C, Box G, Carlsson SV, Catalona WJ, Dahl DM, Dall’Era M, Davis JW, Drake BF, Epstein JI, Etzioni RB, Farrington TA, Garraway IP, Jarrard D, Kauffman E, Kaye D, Kibel AS, LaGrange CA, Maroni P, Ponsky L, Reys B, Salami SS, Sanchez A, Seibert TM, Shaneyfelt TM, Smaldone MC, Sonn G, Tyson MD, Vapiwala N, Wake R, Washington S, Yu A, Yuh B, Berardi RA, Freedman-Cass DA. NCCN Guidelines® insights: prostate Cancer Early Detection, Version 1.2023. J Natl Compr Canc Netw. 2023;21(3):236–46.

    Article  PubMed  Google Scholar 

  3. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, Collaco-Moraes Y, Ward K, Hindley RG, Freeman A, Kirkham AP, Oldroyd R, Parker C, Emberton M. PROMIS study group. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389(10071):815–22.

    Article  PubMed  Google Scholar 

  4. Fütterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, Taneja SS, Thoeny H, Villeirs G, Villers A. Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol. 2015;68(6):1045–53.

    Article  PubMed  Google Scholar 

  5. Calace FP, Napolitano L, Arcaniolo D, Stizzo M, Barone B, Crocetto F, Olivetta M, Amicuzi U, Cirillo L, Rubinacci A, Lecce A, Pandolfo SD, Langella NA, Persico F, Trama F, Quattrone C, Bottone F, Spirito L, De Sio M, Manfredi C. Micro-ultrasound in the diagnosis and staging of prostate and bladder cancer: a comprehensive review. Med (Kaunas). 2022;58(11):1624.

    Google Scholar 

  6. Mena E, Lindenberg ML, Shih JH, Adler S, Harmon S, Bergvall E, Citrin D, Dahut W, Ton AT, McKinney Y, Weaver J, Eclarinal P, Forest A, Afari G, Bhattacharyya S, Mease RC, Merino MJ, Pinto P, Wood BJ, Jacobs P, Pomper MG, Choyke PL, Turkbey B. Clinical impact of PSMA-based 18F-DCFBC PET/CT imaging in patients with biochemically recurrent prostate cancer after primary local therapy. Eur J Nucl Med Mol Imaging. 2018;45(1):4–11.

    Article  CAS  PubMed  Google Scholar 

  7. Cook GJR, Kulkarni M, Warbey VS. PSMA PET/CT imaging for primary staging of intermediate and high-risk prostate cancer. BJU Int. 2019;124(3):357–8.

    Article  PubMed  Google Scholar 

  8. García Garzón JR, de Arcocha Torres M, Delgado-Bolton R, Ceci F, Alvarez Ruiz S, Orcajo Rincón J, Caresia Aróztegui AP, García Velloso MJ, García Vicente AM. Oncology task force of Spanish society of nuclear medicine and molecular imaging. 68Ga-PSMA PET/CT in prostate cancer. Rev Esp Med Nucl Imagen Mol (Engl Ed). 2018 Mar-Apr;37(2):130–8.

  9. Hoffmann MA, Wieler HJ, Baues C, Kuntz NJ, Richardsen I, Schreckenberger M. The impact of 68Ga-PSMA PET/CT and PET/MRI on the management of prostate cancer. Urology. 2019;130:1–12.

    Article  PubMed  Google Scholar 

  10. Koerber SA, Will L, Kratochwil C, Haefner MF, Rathke H, Kremer C, Merkle J, Herfarth K, Kopka K, Choyke PL, Holland-Letz T, Haberkorn U, Debus J, Giesel FL. 68Ga-PSMA-11 PET/CT in primary and recurrent prostate carcinoma: implications for radiotherapeutic management in 121 patients. J Nucl Med. 2019;60(2):234–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Budäus L, Leyh-Bannurah SR, Salomon G, Michl U, Heinzer H, Huland H, Graefen M, Steuber T, Rosenbaum C. Initial experience of (68)Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol. 2016;69(3):393–6.

    Article  PubMed  Google Scholar 

  12. Rhee H, Thomas P, Shepherd B, Gustafson S, Vela I, Russell PJ, Nelson C, Chung E, Wood G, Malone G, Wood S, Heathcote P. Prostate specific membrane antigen positron emission tomography may improve the diagnostic accuracy of multiparametric magnetic resonance imaging in localized prostate cancer. J Urol. 2016;196(4):1261–7.

    Article  CAS  PubMed  Google Scholar 

  13. Mottaghy FM, Heinzel A, Verburg FA. Molecular imaging using PSMA PET/CT versus multiparametric MRI for initial staging of prostate cancer: comparing apples with oranges? Eur J Nucl Med Mol Imaging. 2016;43:1397–9.

    Article  PubMed  Google Scholar 

  14. Meißner S, Janssen JC, Prasad V, Diederichs G, Hamm B, Brenner W, Makowski MR. Accuracy of standard clinical 3T prostate MRI for pelvic lymph node staging: comparison to 68Ga-PSMA PET-CT. Sci Rep. 2019;9(1):10727.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Spohn S, Jaegle C, Fassbender TF, Sprave T, Gkika E, Nicolay NH, Bock M, Ruf J, Benndorf M, Gratzke C, Grosu AL, Zamboglou C. Intraindividual comparison between 68Ga-PSMA-PET/CT and mpMRI for intraprostatic tumor delineation in patients with primary prostate cancer: a retrospective analysis in 101 patients. Eur J Nucl Med Mol Imaging. 2020;47(12):2796–803.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Koerber SA, Utzinger MT, Kratochwil C, Kesch C, Haefner MF, Katayama S, Mier W, Iagaru AH, Herfarth K, Haberkorn U, Debus J, Giesel FL. Ga-PSMA-11 PET/CT in newly diagnosed carcinoma of the prostate: correlation of intraprostatic PSMA uptake with several clinical parameters. J Nucl Med. 2017;58(12):1943–8.

    Article  CAS  PubMed  Google Scholar 

  17. Onal C, Torun N, Oymak E, Guler OC, Reyhan M, Yapar AF. Retrospective correlation of 68ga-psma uptake with clinical parameters in prostate cancer patients undergoing definitive radiotherapy. Ann Nucl Med. 2020;34(6):388–96.

    Article  CAS  PubMed  Google Scholar 

  18. Kalapara AA, Ballok ZE, Ramdave S, O’Sullivan R, Ryan A, Konety B, Grummet JP, Frydenberg M. Combined utility of Ga-prostate-specific membrane antigen positron emission tomography/computed tomography and multiparametric magnetic resonance imaging in predicting prostate biopsy pathology. Eur Urol Oncol. 2022;5(3):314–20.

    Article  PubMed  Google Scholar 

  19. Giesel FL, Hadaschik B, Cardinale J, Radtke J, Vinsensia M, Lehnert W, Kesch C, Tolstov Y, Singer S, Grabe N, Duensing S, Schäfer M, Neels OC, Mier W, Haberkorn U, Kopka K, Kratochwil C. F-18 labelled PSMA-1007: biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. Eur J Nucl Med Mol Imaging. 2017;44(4):678–88.

    Article  CAS  PubMed  Google Scholar 

  20. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, Tempany CM, Choyke PL, Cornud F, Margolis DJ, Thoeny HC, Verma S, Barentsz J, Weinreb JC. Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol. 2019;76(3):340–51. .

  21. Uprimny C, Kroiss AS, Decristoforo C, Fritz J, von Guggenberg E, Kendler D, Scarpa L, di Santo G, Roig LG, Maffey-Steffan J, Horninger W, Virgolini IJ. Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Med Mol Imaging. 2017;44(6):941–9.

    Article  CAS  PubMed  Google Scholar 

  22. Sathianathen NJ, Konety BR, Soubra A, Metzger GJ, Spilseth B, Murugan P, Weight CJ, Ordonez MA, Warlick CA. Which scores need a core? An evaluation of MR-targeted biopsy yield by PIRADS score across different biopsy indications. Prostate Cancer Prostatic Dis. 2018;21(4):573–8.

    Article  PubMed  Google Scholar 

  23. Venderink W, van Luijtelaar A, Bomers JGR, van der Leest M, Hulsbergen-van de Kaa C, Barentsz JO, Sedelaar JPM, Fütterer JJ. Results of targeted biopsy in men with magnetic resonance imaging lesions classified equivocal, likely or highly likely to be clinically significant prostate cancer. Eur Urol. 2018;73(3):353–60.

    Article  PubMed  Google Scholar 

  24. Sathianathen NJ, Butaney M, Bongiorno C, Konety BR, Bolton DM, Lawrentschuk N. Accuracy of the magnetic resonance imaging pathway in the detection of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2019;22(1):39–48.

    Article  PubMed  Google Scholar 

  25. Ting F, Van Leeuwen PJ, Thompson J, Shnier R, Moses D, Delprado W, Stricker PD. Assessment of the performance of magnetic resonance imaging/ultrasound fusion guided prostate biopsy against a combined targeted plus systematic biopsy approach using 24-core transperineal template saturation mapping prostate biopsy. Prostate Cancer. 2016;2016:3794738.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hansen NL, Kesch C, Barrett T, Koo B, Radtke JP, Bonekamp D, Schlemmer HP, Warren AY, Wieczorek K, Hohenfellner M, Kastner C, Hadaschik B. Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image-fusion guided transperineal prostate biopsy in patients with a previous negative biopsy. BJU Int. 2017;120(5):631–8.

    Article  CAS  PubMed  Google Scholar 

  27. Berger I, Annabattula C, Lewis J, Shetty DV, Kam J, Maclean F, Arianayagam M, Canagasingham B, Ferguson R, Khadra M, Ko R, Winter M, Loh H, Varol C. 68Ga-PSMA PET/CT vs. mpMRI for locoregional prostate cancer staging: correlation with final histopathology. Prostate Cancer Prostatic Dis. 2018;21(2):204–11.

    Article  CAS  PubMed  Google Scholar 

  28. Soni BK, Verma P, Shah AK, Singh R, Sonawane S, Asopa RV. Comparison of multiparametric magnetic resonance imaging and gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography for detecting carcinoma prostate in patients with serum prostate-specific antigen between 4 and 20 ng/ml. Indian J Nucl Med. 2021;36(3):245–51.

  29. Panebianco V, Barchetti G, Simone G, Del Monte M, Ciardi A, Grompone MD, Campa R, Indino EL, Barchetti F, Sciarra A, Leonardo C, Gallucci M, Catalano C. Negative multiparametric magnetic resonance imaging for prostate cancer: what’s Next? Eur Urol. 2018;74(1):48–54.

    Article  PubMed  Google Scholar 

  30. Chen M, Zhang Q, Zhang C, Zhao X, Marra G, Gao J, Lv X, Zhang B, Fu Y, Wang F, Qiu X, Guo H. Combination of Ga-PSMA PET/CT and multiparametric MRI improves the detection of clinically significant prostate Cancer: a lesion-by-lesion analysis. J Nucl Med. 2019;60(7):944–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Chandra P, Rajaian S, Krishnamurthy K, Murugasen L, Chandran G, Kumar JS, Nath S. Diagnostic accuracy of Prebiopsy Ga-68 PSMA PET/CT in detecting primary prostate carcinomas with prostate-specific antigen < 50 ng/ml. Indian J Nucl Med. 2020 Oct-Dec;35(4):283–90.

  32. Zhang LL, Li WC, Xu Z, Jiang N, Zang SM, Xu LW, Huang WB, Wang F, Sun HB. Ga-PSMA PET/CT targeted biopsy for the diagnosis of clinically significant prostate cancer compared with transrectal ultrasound guided biopsy: a prospective randomized single-centre study. Eur J Nucl Med Mol Imaging. 2021;48(2):483–92.

    Article  CAS  PubMed  Google Scholar 

  33. Kim M, Choi SK, Park M, Shim M, Song C, Jeong IG, Hong JH, Kim CS, Ahn H. Characteristics of anteriorly located prostate cancer and the usefulness of multiparametric magnetic resonance imaging for diagnosis. J Urol. 2016;196(2):367–73.

    Article  PubMed  Google Scholar 

  34. Rowe SP, Gage KL, Faraj SF, Macura KJ, Cornish TC, Gonzalez-Roibon N, Guner G, Munari E, Partin AW, Pavlovich CP, Han M, Carter HB, Bivalacqua TJ, Blackford A, Holt D, Dannals RF, Netto GJ, Lodge MA, Mease RC, Pomper MG, Cho SY. ¹⁸F-DCFBC PET/CT for PSMA-based detection and characterization of primary prostate cancer. J Nucl Med. 2015;56(7):1003–10.

    Article  CAS  PubMed  Google Scholar 

  35. Paterson F, Nottage M, Kitchener M, Jarvis M, Reid J, Oakden-Rayner L. Assessing the accuracy of Ga-PSMA PET/CT compared with MRI in the initial diagnosis of prostate malignancy: a cohort analysis of 114 consecutive patients. J Med Imaging Radiat Oncol. 2022;66(3):319–23.

    Article  PubMed  Google Scholar 

  36. Lopci E, Saita A, Lazzeri M, Lughezzani G, Colombo P, Buffi NM, Hurle R, Marzo K, Peschechera R, Benetti A, Zandegiacomo S, Pasini L, Lista G, Cardone P, Castello A, Maffei D, Balzarini L, Chiti A, Guazzoni G, Casale P. Ga-PSMA positron emission tomography/computerized tomography for primary diagnosis of prostate cancer in men with contraindications to or negative multiparametric magnetic resonance imaging: a prospective observational study. J Urol. 2018;200(1):95–103.

    Article  PubMed  Google Scholar 

  37. Humphrey PA. Histological variants of prostatic carcinoma and their significance. Histopathology. 2012;60(1):59–74.

    Article  PubMed  Google Scholar 

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Acknowledgements

Not applicable.

Funding

This study was funded by Sichuan Provincial Science and Technology Department Project (No.2022YFS0068).This study was funded by Sichuan Cancer Hospital Outstanding Youth Funding (YB 2023022).This study was funded by Sichuan Cancer Hospital outstanding youth Fund (YB.2021029).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China

    Zhenyan Ye, Ying Kou, Jiaqi Shen, Jun Dang, Xiaofei Tan, Xiao Jiang, Xiaoxiong Wang, Hao Lu, Shirong Chen & Zhuzhong Cheng

  2. Guang’an District People’s Hospital, Guangan, China

    Zhenyan Ye

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  1. Zhenyan Ye
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Contributions

YZY, KY identified research directions, collected data and prepared preliminary manuscripts; KY, SJQ, and CZZ revised the manuscript; DJ and TXF helped collect and analyze data; JX, WXX, LH, CSR provided technical and material support.

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Correspondence to Zhuzhong Cheng.

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The study was conducted in accordance to the local regulations of China and was ethically approved by Ethics Committee of Sichuan Cancer Hospital (JS-2017–01–02). This article does not contain any studies with human participants performed by any of the authors.

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The original version of this article was revised: Table 2 and 3 contained incorrect data.

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Ye, Z., Kou, Y., Shen, J. et al. A comparative study of 18F-PSMA-1007 PET/CT and pelvic MRI in newly diagnosed prostate cancer. BMC Med Imaging 24, 192 (2024). https://doi.org/10.1186/s12880-024-01376-4

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Keywords

BMC Medical Imaging

ISSN: 1471-2342

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