Comparison of 68Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer

J Transl Med. 2017 Nov 7;15(1):230. doi: 10.1186/s12967-017-1333-2.


Background: To evaluate the diagnostic value of 68Ga-PSMA-11 PET-CT with multiparametric magnetic resonance imaging (mpMRI) for lymph node (LN) staging in patients with intermediate- to high-risk prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND).

Methods: We retrospectively identified 42 consecutive patients with intermediate- to high-risk PCa according to D'Amico and without concomitant cancer. Preoperative 68Ga-PSMA-11 PET-CT, pelvic mpMRI and subsequent robot assisted laparoscopic RP with PLND were performed in all patients.

Results: Among 42 patients assessed, the preoperative PSA value, Gleason score, pT stage and intraprostatic PCa volume of patients with LN metastases were all significantly higher than those without metastases (P = 0.029, 0.028, 0.004, respectively). The average maximum standardized uptake value (SUV) of 68Ga-PSMA-11 PET-CT positive PCa of patients with or without LN metastases were 13.10 (range 6.12-51.75) and 7.22 (range 5.4-11.2), respectively (P < 0.001). 68Ga-PSMA-11 PET-CT and pelvic mpMRI had the ability of succeed on preoperative definite accurate diagnosis and accurate localization of primary PCa in all 42 patients. Fifteen patients (35.71%) had a pN1 stage. 51 positive LN were found. Both 68Ga-PSMA-11 PET-CT and pelvic mpMRI displayed brillient patient-based and region-based sensitivity, specificity, negative predictive value and positive predictive value. There was no statistical difference for the detection of LNMs according to the diameter of the LNMs between 68Ga-PSMA-11 PET-CT and mpMRI in this study.

Conclusions: Both 68Ga-PSMA-11 PET-CT and mpMRI performed great value for LN staging in patients with intermediate- to high-risk PCa undergoing RP with PLND. However, despite excellent performance of 68Ga-PSMA-11 PET-CT, it cannot replace mpMRI that remains excellent for lymph node staging.

Keywords: Lymph node staging; PET-CT; PSMA; Prostate cancer; mpMRI.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Edetic Acid / analogs & derivatives*
  • Edetic Acid / chemistry
  • Gallium Isotopes
  • Gallium Radioisotopes
  • Humans
  • Lymph Node Excision
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis / diagnosis
  • Lymphatic Metastasis / diagnostic imaging
  • Lymphatic Metastasis / pathology
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Oligopeptides / chemistry*
  • Positron Emission Tomography Computed Tomography*
  • Prostatic Neoplasms / diagnostic imaging
  • Prostatic Neoplasms / pathology*
  • Risk Factors


  • Gallium Isotopes
  • Gallium Radioisotopes
  • Oligopeptides
  • gallium 68 PSMA-11
  • Edetic Acid