Purpose of the Report: Although multiparametric magnetic resonance imaging (mpMRI) is commonly used for the primary staging of prostate cancer, it may miss non-enlarged metastatic lymph nodes. Positron emission tomography-computed tomography targeting the prostate-specific membrane antigen (PSMA PET-CT) is a promising method to detect non-enlarged metastatic lymph nodes, but more data are needed. Materials and Methods: In this single-center, prospective study, we enrolled patients with intermediate-to-high-risk prostate cancer scheduled for radical prostatectomy with pelvic node dissection. Before surgery, prostate imaging with mpMRI and PSMA PET-CT was used to assess lymph node involvement (LNI), extra-prostatic extension (EPE), and seminal vesicle involvement (SVI). Additionally, we used clinical nomograms to estimate the risk of these three outcomes. Results: Of the 74 patients included, 61 (82%) had high-risk prostate cancer, and the rest had intermediate-risk cancer. Histopathology revealed LNI in 20 (27%) patients, SVI in 26 (35%), and EPE in 52 (70%). PSMA PET-CT performed better than mpMRI at detecting LNI (area under the curve (AUC, 95% confidence interval): 0.779 (0.665–0.893) vs. 0.655 (0.529–0.780)), but mpMRI was better at detecting SVI (AUC: 0.775 (0.672–0.878) vs. 0.585 (0.473–0.698)). The MSKCC nomogram performed well at detecting both LNI (AUC: 0.799 (0.680–0.918)) and SVI (0.772 (0.659–0.885)). However, when the nomogram was used to derive binary diagnoses, decision curve analyses showed that the MSKCC nomogram provided less net benefit than mpMRI and PSMA PET-CT for detecting SVI and LNI, respectively. Conclusions: mpMRI and [68Ga]Ga-PSMA-11 PET-CT are complementary techniques to be used in conjunction for the primary T and N staging of prostate cancer.
报告目的：尽管多参数磁共振成像（mpMRI）常用于前列腺癌的初步分期，但可能遗漏未增大的转移性淋巴结。靶向前列腺特异性膜抗原的正电子发射断层扫描-计算机断层扫描（PSMA PET-CT）是检测未增大转移性淋巴结的一种有前景的方法，但需要更多数据支持。材料与方法：在这项单中心前瞻性研究中，我们纳入了计划接受根治性前列腺切除术及盆腔淋巴结清扫的中高危前列腺癌患者。术前采用mpMRI和PSMA PET-CT进行前列腺成像，评估淋巴结侵犯（LNI）、前列腺外侵犯（EPE）及精囊侵犯（SVI）。同时使用临床列线图评估这三种结局的风险。结果：在纳入的74例患者中，61例（82%）为高危前列腺癌，其余为中危癌。组织病理学显示20例（27%）存在LNI，26例（35%）存在SVI，52例（70%）存在EPE。PSMA PET-CT在检测LNI方面优于mpMRI（曲线下面积（AUC，95%置信区间）：0.779（0.665–0.893）对比0.655（0.529–0.780）），而mpMRI在检测SVI方面表现更佳（AUC：0.775（0.672–0.878）对比0.585（0.473–0.698））。MSKCC列线图在检测LNI（AUC：0.799（0.680–0.918））和SVI（0.772（0.659–0.885））方面均表现良好。然而，当使用列线图进行二元诊断时，决策曲线分析显示，在检测SVI和LNI方面，MSKCC列线图分别提供的净收益低于mpMRI和PSMA PET-CT。结论：mpMRI与[68Ga]Ga-PSMA-11 PET-CT是互补技术，应联合用于前列腺癌的初步T和N分期。
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