Role of 18F-PSMA PET/MRI in Prostate Cancer Recurrence After Prostatectomy.

18F-PSMA PET/CT and pelvic MRI are useful for assessing biochemical recurrence of prostate cancer after prostatectomy. We evaluated the role of 18F-PSMA PET/MRI in a 1-stop-shop protocol combining a single injection of 18F-PSMA, followed by pelvic PET/multiparametric MRI (mpMRI) and whole-body PET/CT acquisitions for the detection of recurrent disease.

Methods

We evaluated 106 consecutive patients referred to our institute for biochemical recurrence after prostatectomy using a 1-stop-shop protocol comprising whole-body 18F-PSMA PET/CT and pelvic 18F-PSMA PET/mpMRI. Each imaging modality was reviewed in a blinded manner by 2 independent, experienced readers. 18F-PSMA PET/MRI, with positivity on either MRI or PSMA PET, served as the reference standard.

Results

18F-PSMA PET/MRI detected more local recurrences (n = 52, 49.06%) compared with 18F-PSMA PET/CT (n = 42, 39.62%) and mpMRI (n = 46, 43.00%). Discordant cases accounted for 18 patients (17%): 10% were positive only on MRI and 7% only on PSMA PET. Compared with 18F-PSMA PET/MRI, both mpMRI and 18F-PSMA PET demonstrated similar performance, with sensitivities of 88.5% and 78.8% and specificities of 100% and 98.1%, respectively.

Conclusion

18F-PSMA PET/MRI outperformed PET/CT and mpMRI in the detection of local recurrences of prostate cancer.