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Comparing Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen-Positron Emission Tomography for Prediction of Extraprostatic Extension of Prostate Cancer and Surgical Guidance: A Prospective Nonrandomized Clinical Trial.
- Source :
-
The Journal of urology [J Urol] 2024 Aug; Vol. 212 (2), pp. 290-298. Date of Electronic Publication: 2024 May 24. - Publication Year :
- 2024
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Abstract
- Purpose: Survivors of surgically managed prostate cancer may experience urinary incontinence and erectile dysfunction. Our aim was to determine if <superscript>68</superscript> Ga-prostate-specific membrane antigen-11 positron emission tomography CT (PSMA-PET) in addition to multiparametric (mp) MRI scans improved surgical decision-making for nonnerve-sparing or nerve-sparing approach.<br />Materials and Methods: We prospectively enrolled 50 patients at risk for extraprostatic extension (EPE) who were scheduled for prostatectomy. After mpMRI and PSMA-PET images were read for EPE prediction, surgeons prospectively answered questionnaires based on mpMRI and PSMA-PET scans on the decision for nerve-sparing or nonnerve-sparing approach. Final whole-mount pathology was the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic curves were calculated and McNemar's test was used to compare imaging modalities.<br />Results: The median age and PSA were 61.5 years and 7.0 ng/dL. The sensitivity for EPE along the posterior neurovascular bundle was higher for PSMA-PET than mpMRI (86% vs 57%, P = .03). For MRI, the specificity, positive predictive value, negative predictive value, and area under the curve for the receiver operating characteristic curves were 77%, 40%, 87%, and 0.67, and for PSMA-PET were 73%, 46%, 95%, and 0.80. PSMA-PET and mpMRI reads differed on 27 nerve bundles, with PSMA-PET being correct in 20 cases and MRI being correct in 7 cases. Surgeons predicted correct nerve-sparing approach 74% of the time with PSMA-PET scan in addition to mpMRI compared to 65% with mpMRI alone ( P = .01).<br />Conclusions: PSMA-PET scan was more sensitive than mpMRI for EPE along the neurovascular bundles and improved surgical decisions for nerve-sparing approach. Further study of PSMA-PET for surgical guidance is warranted in the unfavorable intermediate-risk or worse populations.<br />Clinicaltrials.gov Identifier: NCT04936334.
- Subjects :
- Humans
Male
Prospective Studies
Middle Aged
Aged
Multiparametric Magnetic Resonance Imaging
Positron Emission Tomography Computed Tomography methods
Predictive Value of Tests
Magnetic Resonance Imaging methods
Neoplasm Invasiveness diagnostic imaging
Gallium Radioisotopes
Prostate diagnostic imaging
Prostate surgery
Prostate innervation
Prostate pathology
Gallium Isotopes
Prostatic Neoplasms surgery
Prostatic Neoplasms diagnostic imaging
Prostatic Neoplasms pathology
Prostatectomy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1527-3792
- Volume :
- 212
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of urology
- Publication Type :
- Academic Journal
- Accession number :
- 38785259
- Full Text :
- https://doi.org/10.1097/JU.0000000000004032