Comparative analysis of multiparametric prostate MRI and 68Ga-PSMA PET/MRI with radical prostatectomy specimens in prostate cancer staging.

Abstract

Objective: Because of low mortality rates and high treatment-related adverse effects in patients diagnosed early, active surveillance, focused treatments, and watchful waiting are currently advocated, emphasizing the importance of proper prostate cancer (Pca) staging using imaging techniques. We aimed to comparatively investigate the success rates of multiparametric prostate magnetic resonance imaging (MRI) and prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/MRI in predicting tumoral regions, seminal vesicle invasion, and extraprostatic extension.

Subjects and methods: Twenty six patients with a biopsy diagnosis of prostate cancer who underwent radical prostatectomy between January 2021 and September 2022 were included in the study. Preoperative evaluation was conducted through a combination of multi-parametric (Mp)MR and PSMA PET/MRI. Findings such as tumoral regions, seminal vesicle invasion, and extra-prostatic extension in prostatectomy specimens were compared with the MpMRI and PSMA PET/MRI images.

Results: Prostate cancer was present in 103 foci of a total of 156 segments. In the context of identifying the aforementioned foci, the sensitivity of MpMRI was determined to be 74.8%, coupled with a specificity of 94.3%. Similarly, the sensitivity of PSMA PET/MRI was established at 70.9%, accompanied by a specificity rate of 90.6%. In the prediction of extraprostatic extension, MpMRI exhibited a sensitivity of 33.33% alongside a specificity of 78.57%. In contrast, PSMA PET/MRI displayed a sensitivity of 25% but achieved a higher specificity of 100%. Concerning the prediction of seminal vesicle invasion, MpMRI demonstrated a sensitivity of 40% and a specificity of 95.24%. Conversely, PSMA PET/MRI yielded a sensitivity of 60%, which was slightly superior to MpMRI's sensitivity with a close specificity rate of 95.24%.

Conclusion: MRI and PSMA PET/MRI are reliable methods for the local staging of prostate cancer and the prediction of tumor localization. No statistically significant advantage of either method was discerned in the course of our study.