Widespread adoption of mpMRI has led to a decrease in the number of patients requiring prostate biopsies.68Ga-PSMA-11 PET/CT has demonstrated added benefits in identifying csPCa. Integrating the use of these imaging techniques may hold promise for predicting the presence of csPCa without invasive biopsy. A retrospective analysis of 42 consecutive patients who underwent mpMRI,68Ga-PSMA-11 PET/CT, prostatic biopsy, and radical prostatectomy (RP) was carried out. A lesion-based model (n= 122) using prostatectomy histopathology as reference standard was used to analyze the accuracy of68Ga-PSMA-11 PET/CT, mpMRI alone, and both in combination to identify ISUP-grade group ≥ 2 lesions.68Ga-PSMA-11 PET/CT demonstrated greater specificity and positive predictive value (PPV), with values of 73.3% (vs. 40.0%) and 90.1% (vs. 82.2%), while the mpMRI Prostate Imaging Reporting and Data System (PI-RADS) 4–5 had better sensitivity and negative predictive value (NPV): 90.2% (vs. 78.5%) and 57.1% (vs. 52.4%), respectively. When used in combination, the sensitivity, specificity, PPV, and NPV were 74.2%, 83.3%, 93.2%, and 51.0%, respectively. Subgroup analysis of PI-RADS 3, 4, and 5 lesions was carried out. For PI-RADS 3 lesions,68Ga-PSMA-11 PET/CT demonstrated a NPV of 77.8%. For PI-RADS 4–5 lesions,68Ga-PSMA-11 PET/CT achieved PPV values of 82.1% and 100%, respectively, with an NPV of 100% in PI-RADS 5 lesions. A combination of68Ga-PSMA-11 PET/CT and mpMRI improved the radiological diagnosis of csPCa. This suggests that avoidance of prostate biopsy prior to RP may represent a valid option in a selected subgroup of high-risk patients with a high suspicion of csPCa on mpMRI and68Ga-PSMA-11 PET/CT.
多参数磁共振成像（mpMRI）的广泛应用已使得需要进行前列腺活检的患者数量有所减少。68Ga-PSMA-11 PET/CT在识别具有临床意义的前列腺癌（csPCa）方面显示出额外的优势。结合使用这些影像学技术有望在不进行侵入性活检的情况下预测csPCa的存在。本研究对连续42例接受了mpMRI、68Ga-PSMA-11 PET/CT、前列腺活检和根治性前列腺切除术（RP）的患者进行了回顾性分析。以前列腺切除术组织病理学为参考标准，采用基于病灶的模型（n=122），分析了68Ga-PSMA-11 PET/CT、单独mpMRI以及两者联合识别国际泌尿病理学会（ISUP）分级组≥2级病灶的准确性。68Ga-PSMA-11 PET/CT显示出更高的特异性和阳性预测值（PPV），分别为73.3%（对比40.0%）和90.1%（对比82.2%），而mpMRI前列腺影像报告和数据系统（PI-RADS）4-5级病灶则具有更好的敏感性和阴性预测值（NPV）：分别为90.2%（对比78.5%）和57.1%（对比52.4%）。联合使用时，敏感性、特异性、PPV和NPV分别为74.2%、83.3%、93.2%和51.0%。研究对PI-RADS 3、4和5级病灶进行了亚组分析。对于PI-RADS 3级病灶，68Ga-PSMA-11 PET/CT的NPV为77.8%。对于PI-RADS 4-5级病灶，68Ga-PSMA-11 PET/CT的PPV分别达到82.1%和100%，并且在PI-RADS 5级病灶中NPV为100%。68Ga-PSMA-11 PET/CT与mpMRI联合使用改善了对csPCa的影像学诊断。这表明，在mpMRI和68Ga-PSMA-11 PET/CT高度怀疑csPCa的特定高危患者亚组中，在RP前避免前列腺活检可能是一个有效的选择。
“Seeing Is Believing”: Additive Utility of68Ga-PSMA-11 PET/CT in Prostate Cancer Diagnosis
肿瘤(癌症)患者之家