Diagnostic accuracy of 68Ga-PSMA PET/CT versus multiparametric MRI for preoperative pelvic invasion in the patients with prostate cancer.

ObjectiveThe purpose of this study is to further investigate the diagnostic value and precise localization of 68Gallium prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) for preoperative pelvic invasion in prostate cancer (PCa) patients in comparison with multiparametric MRI (mpMRI), in order to explore the better clinical diagnostic recommendations.Patients and methodsThe clinical data of 118 PCa patients who underwent 68Ga-PSMA PET/CT and mpMRI, including the patients with Pelvic invasion (n = 46) and No pelvic invasion (n = 72), was collected from May 2019 to June 2024. The correlation between the maximum standardized uptake value (SUVmax) of 68Ga-PSMA-11 PET/CT, Prostate Imaging Reporting and Data System (PI-RADS) of mpMRI and serum prostate-specific antigen (PSA) levels, and Gleason score was analyzed and explored. Thereafter, both modalities were directly compared for every patient and PCa lesion in the terms of pelvic invasion by all collected and analyzed data. In addition, the sensitivity and specificity of 68Ga-PSMA PET/CT and mpMRI were verified by postoperative hematoxylin-eosin staining and PSMA immunohistochemistry of intraoperative localized microcarcinoma.ResultsAnalyzing the clinical and imaging data of PCa patients, it was found that the SUVmax of 68Ga-PSMA-11 PET/CT and PI-RADS of mpMRI had a positive correlation with the PCa patients' serum PSA and Gleason score. In addition, SUVmax, PI-RADS and PSA, Gleason score of PCa patients with pelvic invasion were significantly higher than those without pelvic invasion. After further data analysis, 68Ga-PSMA-11 PET/CT presented the sensitivity and specificity of 95.56% and 95.89%, respectively. Moreover, mpMRI demonstrated the sensitivity and specificity of 93.18% and 93.24%, respectively. There was no significant statistical difference between them. Meanwhile, the comparison between 68Ga-PSMA PET/CT and mpMRI in the diagnosis of lymph node metastasis was similar.ConclusionsBoth 68Ga-PSMA PET/CT and mpMRI have high sensitivity and specificity in the detection of primary PCa lesions with pelvic invasion. Despite the excellent performance of 68Ga-PSMA PET/CT in the diagnosis of small PCa lesions, it cannot replace the diagnostic value of mpMRI in localization and staging of PCa.