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Purpose <p>To explore pragmatic approaches integrating MRI and PSMA-PET/CT for evaluating extraprostatic extension (EPE) of prostate cancer (PCa).</p> Methods <p>Consecutive patients with newly-diagnosed PCa that underwent multiparametric MRI and PSMA-PET/CT, followed by radical prostatectomy in 2021–2024 were included. Imaging parameters assessed on both modalities were: size, length of capsular contact (LCC), Likert scales (MRI EPE grade/PSMA Likert scale), PI-RADS/PRIMARY scores, and SUV<sub>max</sub>. Three pragmatic integrated approaches were tested: (1) Integration of Likert scales (positive if either or both MRI and PSMA-PET/CT were positive); (2) P score (framework combining PI-RADS + PRIMARY); and (3) combining MRI morphological information with PSMA-PET/CT functional information (upgrading suspicion of lesions with LCC below cutoff if SUV<sub>max</sub>&gt;12). Diagnostic performance was tested with receiver operating characteristic (ROC) curves and compared using DeLong and McNemar tests.</p> Results <p>67 men (median age, 66 years) with EPE in 76.1% (51/67) were included. Area under ROC curves (AUC) were 0.61–0.82; MRI-based LCC yielded the highest AUC 0.82 (0.71–0.92) with cutoff of ≥ 1.7&#xa0;cm. Integrated Likert scale (MRI EPE grade/PSMA Likert scale) showed sensitivity of 80.4% (41/51) and specificity of 31.3% (5/16). P score (PI-RADS/PRIMARY) demonstrated sensitivity of 31.3% (16/51) and specificity of 87.5% (14/16). Combining morphological MRI information with functional PSMA-PET/CT yielded sensitivity and specificity of 80.4% (41/51) and 81.2% (13/16), respectively, which demonstrated significantly higher sensitivity but non-significantly different specificity compared with MRI-based LCC alone (66.7% [34/51, <i>p</i> = 0.02] and 87.5% [14/16, <i>p</i> &gt; 0.99]). This approach upgraded suspicion in 8 patients with LCC &lt; 1.7&#xa0;cm due to SUV<sub>max</sub>&gt;12 among which 87.5% (7/8) were corrected upgraded and had pathological EPE.</p> Conclusion <p>Several pragmatic approaches were explored for integrating MRI and PSMA-PET/CT to assess EPE in PCa. Combining morphological information from MRI and PSMA expression on PET/CT demonstrated good diagnostic performance and may be a simple pragmatic integrated method that can be used.</p> Graphical abstract <p></p>

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Evaluating extraprostatic extension of prostate cancer: pragmatic integration of MRI and PSMA-PET/CT

  • 期刊论文

  • 发表日期：

    2025年4月19日

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  • Sungmin Woo,
  • Daniel Freedman,
  • Anton S. Becker,
  • Doris Leithner,
  • Charlotte Charbel,
  • Marius E. Mayerhoefer,
  • Kent P. Friedman,
  • Angela Tong,
  • David R. Wise,
  • Samir S. Taneja,
  • Michael J. Zelefsky,
  • Hebert Alberto Vargas

摘要

Purpose

To explore pragmatic approaches integrating MRI and PSMA-PET/CT for evaluating extraprostatic extension (EPE) of prostate cancer (PCa).

Methods

Consecutive patients with newly-diagnosed PCa that underwent multiparametric MRI and PSMA-PET/CT, followed by radical prostatectomy in 2021–2024 were included. Imaging parameters assessed on both modalities were: size, length of capsular contact (LCC), Likert scales (MRI EPE grade/PSMA Likert scale), PI-RADS/PRIMARY scores, and SUVmax. Three pragmatic integrated approaches were tested: (1) Integration of Likert scales (positive if either or both MRI and PSMA-PET/CT were positive); (2) P score (framework combining PI-RADS + PRIMARY); and (3) combining MRI morphological information with PSMA-PET/CT functional information (upgrading suspicion of lesions with LCC below cutoff if SUVmax>12). Diagnostic performance was tested with receiver operating characteristic (ROC) curves and compared using DeLong and McNemar tests.

Results

67 men (median age, 66 years) with EPE in 76.1% (51/67) were included. Area under ROC curves (AUC) were 0.61–0.82; MRI-based LCC yielded the highest AUC 0.82 (0.71–0.92) with cutoff of ≥ 1.7 cm. Integrated Likert scale (MRI EPE grade/PSMA Likert scale) showed sensitivity of 80.4% (41/51) and specificity of 31.3% (5/16). P score (PI-RADS/PRIMARY) demonstrated sensitivity of 31.3% (16/51) and specificity of 87.5% (14/16). Combining morphological MRI information with functional PSMA-PET/CT yielded sensitivity and specificity of 80.4% (41/51) and 81.2% (13/16), respectively, which demonstrated significantly higher sensitivity but non-significantly different specificity compared with MRI-based LCC alone (66.7% [34/51, p = 0.02] and 87.5% [14/16, p > 0.99]). This approach upgraded suspicion in 8 patients with LCC < 1.7 cm due to SUVmax>12 among which 87.5% (7/8) were corrected upgraded and had pathological EPE.

Conclusion

Several pragmatic approaches were explored for integrating MRI and PSMA-PET/CT to assess EPE in PCa. Combining morphological information from MRI and PSMA expression on PET/CT demonstrated good diagnostic performance and may be a simple pragmatic integrated method that can be used.

Graphical abstract