Volume 126, Issue 1 p. 83-90
Urological Oncology

Detection and localisation of primary prostate cancer using 68gallium prostate-specific membrane antigen positron emission tomography/computed tomography compared with multiparametric magnetic resonance imaging and radical prostatectomy specimen pathology

Arveen A. Kalapara

Corresponding Author

Arveen A. Kalapara

Department of Surgery, Monash University, Melbourne, VIC, Australia

Australian Urology Associates, Malvern, VIC, Australia

Correspondence: Arveen A. Kalapara, Department of Surgery, Monash University, Melbourne, VIC, Australia.

e-mail: [email protected]

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Tatenda Nzenza

Tatenda Nzenza

Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

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Henry Y.C. Pan

Henry Y.C. Pan

Department of Surgery, Monash University, Melbourne, VIC, Australia

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Zita Ballok

Zita Ballok

Healthcare Imaging Services, Richmond, VIC, Australia

Department of Nuclear Medicine and PET, Monash Medical Centre, Bentleigh East, VIC, Australia

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Shakher Ramdave

Shakher Ramdave

Department of Nuclear Medicine and PET, Monash Medical Centre, Bentleigh East, VIC, Australia

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Richard O'Sullivan

Richard O'Sullivan

Healthcare Imaging Services, Richmond, VIC, Australia

Department of Medicine, Monash University, Melbourne, VIC, Australia

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Andrew Ryan

Andrew Ryan

TissuPath, Mount Waverley, VIC, Australia

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Martin Cherk

Martin Cherk

Department of Nuclear Medicine and PET, Alfred Hospital, Melbourne, VIC, Australia

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Michael S. Hofman

Michael S. Hofman

Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

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Badrinath R. Konety

Badrinath R. Konety

Department of Urology, University of Minnesota, Minnesota, MN, USA

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Nathan Lawrentschuk

Nathan Lawrentschuk

Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

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Damien Bolton

Damien Bolton

Department of Urology, Austin Hospital, Heidelberg, VIC, Australia

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Declan G. Murphy

Declan G. Murphy

Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville, VIC, Australia

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Jeremy P. Grummet

Jeremy P. Grummet

Department of Surgery, Monash University, Melbourne, VIC, Australia

Department of Urology, Alfred Hospital, Melbourne, VIC, Australia

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Mark Frydenberg

Mark Frydenberg

Department of Surgery, Monash University, Melbourne, VIC, Australia

Australian Urology Associates, Malvern, VIC, Australia

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First published: 01 July 2019
Citations: 61

Abstract

Objective

To compare the accuracy of 68gallium prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) with multiparametric MRI (mpMRI) in detecting and localising primary prostate cancer when compared with radical prostatectomy (RP) specimen pathology.

Patients and methods

Retrospective review of men who underwent 68Ga-PSMA PET/CT and mpMRI for primary prostate cancer before RP across four centres between 2015 and 2018. Patients undergoing imaging for recurrent disease or before non-surgical treatment were excluded. We defined pathological index tumour as the lesion with highest International Society of Urological Pathology Grade Group (GG) on RP specimen pathology. Our primary outcomes were rates of accurate detection and localisation of RP specimen pathology index tumour using 68Ga-PSMA PET/CT or mpMRI. We defined tumour detection as imaging lesion corresponding with RP specimen tumour on any imaging plane, and localisation as imaging lesion matching RP specimen index tumour in all sagittal, axial, and coronal planes. Secondary outcomes included localisation of clinically significant and transition zone (TZ) index tumours. We defined clinically significant disease as GG 3–5. We used descriptive statistics and the Mann–Whitney U-test to define and compare demographic and pathological characteristics between detected, missed and localised tumours using either imaging modality. We used the McNemar test to compare detection and localisation rates using 68Ga-PSMA PET/CT and mpMRI.

Results

In all, 205 men were included in our analysis, including 133 with clinically significant disease. There was no significant difference between 68Ga-PSMA PET/CT and mpMRI in the detection of any tumour (94% vs 95%, P > 0.9). There was also no significant difference between localisation of all index tumours (91% vs 89%, P = 0.47), clinically significant index tumours (96% vs 91%, P = 0.15) or TZ tumours (85% vs 80%, P > 0.9) using 68Ga-PSMA PET/CT and mpMRI. Limitations include retrospective study design and non-central review of imaging and pathology.

Conclusion

We found no significant difference in the detection or localisation of primary prostate cancer between 68Ga-PSMA PET/CT and mpMRI. Further prospective studies are required to evaluate a combined PET/MRI model in minimising tumours missed by either modality.

Conflict of Interest

MSH is supported by a Clinical Fellowship Award from the Peter MacCallum Foundation. He research is also support by grants from Movember, Prostate Cancer Foundation (PCF), Prostate Cancer Foundation of Australia (PCFA) and the United States Department of Defence.