Accuracy of 68Ga-PSMA-11 PET/CT and multiparametric MRI for the detection of local tumor and lymph node metastases in early biochemical recurrence of prostate cancer

Maija Radzina; Mara Tirane; Lilita Roznere; Liene Zemniece; Laura Dronka; Marika Kalnina; Edgars Mamis; Juergen Biederer; Vilnis Lietuvietis; Arvis Freimanis; Egils Vjaters

Accuracy of ⁶⁸Ga-PSMA-11 PET/CT and multiparametric MRI for the detection of local tumor and lymph node metastases in early biochemical recurrence of prostate cancer

Am J Nucl Med Mol Imaging. 2020 Apr 15;10(2):106-118. eCollection 2020.

Authors

Affiliations

¹ Riga Stradins University, Radiology Research Laboratory Riga, Latvia.
² Riga Stradins University Nuclear Medicine Clinic Riga, Latvia.
³ University of Latvia Riga, Latvia.
⁴ Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg Heidelberg, Germany.
⁵ Center of Urology, Riga East University Hospital Riga, Latvia.
⁶ Center of Urology, Pauls Stradins Clinical University Hospital Riga, Latvia.

PMID: 32419979
PMCID: PMC7218697

Abstract

Anatomical and functional imaging plays a decisive role for detection and staging, of prostate cancer both primarily and post-treatment. While multiparametric MRI offers anatomic imaging with excellent soft tissue contrast, hybrid imaging based on positron emission tomography in combination with computed tomography (PET/CT) contributes functional imaging capacities. Since ⁶⁸Ga-PSMA-11 was expected to be more efficient than the prior Choline-based PET radiotracers, it was the aim of the study to evaluate the diagnostic performance of the ⁶⁸Ga-PSMA-11 PET/CT and multiparametric MRI in patients with recurrent prostate cancer and low PSA levels. 32 out of a cohort of 128 prostate cancer patients with biochemical relapse were referred for ⁶⁸Ga-PSMA-11 PET/CT, MRI and bone scintigraphy. According to the histopathologically or clinically defined reference standard all results were classified as true positive, false positive, true negative or false negative. Local recurrence was present in 11/32 patients, lymph node metastases - in 13/32 patients and, bone metastases - in 6/32 patients. Against the standard of reference, sensitivity, specificity and accuracy for local recurrence of PET/CT were 63.6 %; 73.7%; 77.8%, respectively. MRI reached 90.9%; 94.7%; 92.3%, respectively. For local lymph node metastases PET/CT - 83.3%; 80.0% and 90.6%, respectively. MRI - 41.7%; 94.4%; 72.0%, respectively. For evaluation of bone metastases in PET/CT - 83.3%; 92.0%; 71.0%, respectively. Bone scintigraphy - 50.0%; 84.0%; 77.4%, respectively. In conclusion, mpMRI offered the better diagnostic accuracy in the detection of local recurrence and while PSMA PET/CT was superior in the detection of distant and lymph node metastases.

Keywords: 68Ga-PSMA; MRI; PSMA-PET/CT; prostate cancer; recurrence; restaging.