Asian journal of urology · 2025
Development and validation of prostate-specific membrane antigen-adjusted Prostate Imaging Reporting and Data System: A new approach to enhancing the accuracy of diagnosing treatment-naïve primary prostate cancer.
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Li Xiaoyuan, Song Jieping, Yao Xiaochen, Zhao Zhenyu, Zhang Qing, Li Rushuai, Zhang Pengjun, Wu Wenyu, Sun Hongwei, Ai Shuyue, Yang Fengjiao, Guo Hongqian, Shi Kuangyu, Afshar-Oromieh Ali, Zhang Longjiang, Lu Guangming, Civelek Ali Cahid, Wang Feng
Аннотация
OBJECTIVE: The diagnostic efficacy of hybrid positron emission tomography (PET)/MRI in detecting primary prostate cancer (PCa) is limited due to the lack of a quantitative integrated analysis. A new Prostate Imaging Reporting and Data System (PI-RADS) incorporating prostate-specific membrane antigen (PSMA) PET for PET/MRI has been introduced to improve primary detection of PCa.
METHODS: One hundred and twenty consecutive patients with high clinical suspicion of PCa were enrolled in this prospective study to assess the diagnostic performance of PSMA-adjusted PI-RADS (PAPI-RADS) using 68Ga-PSMA-11 PET/MRI. Tumor PSMA uptake was assessed semi-quantitatively using the maximum and peak standardized uptake values. The PAPI-RADS was obtained by combining tumor PSMA uptake with PI-RADS. Patients were divided into two groups: a training group (90 patients) and a validation group (30 patients). The cutoff value of PSMA intensity was determined via receiver operating characteristic analysis. PAPI-RADS was then applied to the validation group. Histopathology was used as the gold standard to verify the diagnostic efficacy.
RESULTS: In the training group, PAPI-RADS detected more cases of PCa than PI-RADS. PAPI-RADS had a sensitivity of 99%, specificity of 100%, negative predictive value of 92%, and overall accuracy of 99%. PI-RADS had a sensitivity of 94%, specificity of 75%, negative predictive value of 64%, and overall accuracy of 90%. PAPI-RADS was significantly better than PI-RADS in detecting PCa (χ 2 =6.57, p=0.010). The external validation of this study confirmed the diagnostic efficacy of PAPI-RADS in PCa patients.
CONCLUSION: PAPI-RADS is significantly better than PI-RADS in detecting PCa. PAPI-RADS can improve the diagnostic accuracy of PCa detection, especially in patients with a PI-RADS score <3 lesions. PAPI-RADS can improve the accuracy of PCa diagnosis and avoid unnecessary biopsies.
METHODS: One hundred and twenty consecutive patients with high clinical suspicion of PCa were enrolled in this prospective study to assess the diagnostic performance of PSMA-adjusted PI-RADS (PAPI-RADS) using 68Ga-PSMA-11 PET/MRI. Tumor PSMA uptake was assessed semi-quantitatively using the maximum and peak standardized uptake values. The PAPI-RADS was obtained by combining tumor PSMA uptake with PI-RADS. Patients were divided into two groups: a training group (90 patients) and a validation group (30 patients). The cutoff value of PSMA intensity was determined via receiver operating characteristic analysis. PAPI-RADS was then applied to the validation group. Histopathology was used as the gold standard to verify the diagnostic efficacy.
RESULTS: In the training group, PAPI-RADS detected more cases of PCa than PI-RADS. PAPI-RADS had a sensitivity of 99%, specificity of 100%, negative predictive value of 92%, and overall accuracy of 99%. PI-RADS had a sensitivity of 94%, specificity of 75%, negative predictive value of 64%, and overall accuracy of 90%. PAPI-RADS was significantly better than PI-RADS in detecting PCa (χ 2 =6.57, p=0.010). The external validation of this study confirmed the diagnostic efficacy of PAPI-RADS in PCa patients.
CONCLUSION: PAPI-RADS is significantly better than PI-RADS in detecting PCa. PAPI-RADS can improve the diagnostic accuracy of PCa detection, especially in patients with a PI-RADS score <3 lesions. PAPI-RADS can improve the accuracy of PCa diagnosis and avoid unnecessary biopsies.