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Background <p>PSMA PET is the standard imaging modality for biochemically recurrent prostate cancer (BCR PCa). However, the role of whole-body MRI (wb-MRI) remains unclear. This study presents an intra-individual comparison of PSMA PET and wb-MRI in patients with BCR PCa.</p> Materials and methods <p>This post-hoc analysis of a prospective, single-center trial included patients with BCR PCa, who underwent hybrid [<sup>68</sup>Ga]Ga-PSMA-11 or [<sup>18</sup>F]PSMA-1007 PET/MRI. Inclusion required at least two years of follow-up data after the PET/MRI, including histopathological results, imaging, and post-treatment serum PSA response. PSMA PET and wb-MRI scans were independently assessed for suspicious malignant lesions at patient and region level. Lesion verification was based on follow-up data to classify true positive (TP) and false positive findings. We compared the TP detection rate, positive predictive value (PPV), and number of TP malignant lesions between PSMA PET and wb-MRI.</p> Results <p>A total of 82 patients were included. At patient level, PSMA PET had significantly higher TP detection rate than wb-MRI (100% vs. 66%,<i>p</i> = 0.0005) and detected more TP lesions (mean 2.2 vs. 1.3,<i>p</i> = 0.0021). At overall region level, PSMA PET outperformed wb-MRI in TP detection rate (90% vs. 60%,<i>p</i> = 0.0042) and number of TP lesions (mean 2.0 vs. 1.0, p = &lt; 0.0001). Organ-specific analysis revealed significantly higher number of TP lesions on PSMA PET for pelvic lymph nodes (mean 2.0 vs. 1.2,<i>p</i> = 0.016) and all lymph nodes (mean 2.9 vs. 1.2,<i>p</i> = 0.028). For all distant regions, PSMA PET showed higher TP detection rate (95% vs. 60%,<i>p</i> = 0.039). No significant differences were observed in PPV between PSMA PET and wb-MRI at patient level and all region levels.</p> Conclusion <p>In patients with BCR PCa, wb-MRI (i) demonstrates a significantly lower TP detection rate than PSMA PET, (ii) shows equivalent PPV and (iii) detects significantly fewer TP lesions.</p> Trial registration <p>ClinicalTrials.gov identifier NCT03327675.</p>

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Intra-individual comparison of PSMA PET and whole-body MRI in patients with biochemically recurrent prostate cancer

  • 期刊论文

  • 发表日期：

    2025年7月3日

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  • Anika Nys,
  • Niloefar Ahmadi Bidakhvidi,
  • Sander Jentjens,
  • Annouschka Laenen,
  • Gaëtan Devos,
  • Christophe M. Deroose,
  • Wouter Everaerts,
  • Steven Joniau,
  • Karolien Goffin

摘要

Background

PSMA PET is the standard imaging modality for biochemically recurrent prostate cancer (BCR PCa). However, the role of whole-body MRI (wb-MRI) remains unclear. This study presents an intra-individual comparison of PSMA PET and wb-MRI in patients with BCR PCa.

Materials and methods

This post-hoc analysis of a prospective, single-center trial included patients with BCR PCa, who underwent hybrid [68Ga]Ga-PSMA-11 or [18F]PSMA-1007 PET/MRI. Inclusion required at least two years of follow-up data after the PET/MRI, including histopathological results, imaging, and post-treatment serum PSA response. PSMA PET and wb-MRI scans were independently assessed for suspicious malignant lesions at patient and region level. Lesion verification was based on follow-up data to classify true positive (TP) and false positive findings. We compared the TP detection rate, positive predictive value (PPV), and number of TP malignant lesions between PSMA PET and wb-MRI.

Results

A total of 82 patients were included. At patient level, PSMA PET had significantly higher TP detection rate than wb-MRI (100% vs. 66%,p = 0.0005) and detected more TP lesions (mean 2.2 vs. 1.3,p = 0.0021). At overall region level, PSMA PET outperformed wb-MRI in TP detection rate (90% vs. 60%,p = 0.0042) and number of TP lesions (mean 2.0 vs. 1.0, p = < 0.0001). Organ-specific analysis revealed significantly higher number of TP lesions on PSMA PET for pelvic lymph nodes (mean 2.0 vs. 1.2,p = 0.016) and all lymph nodes (mean 2.9 vs. 1.2,p = 0.028). For all distant regions, PSMA PET showed higher TP detection rate (95% vs. 60%,p = 0.039). No significant differences were observed in PPV between PSMA PET and wb-MRI at patient level and all region levels.

Conclusion

In patients with BCR PCa, wb-MRI (i) demonstrates a significantly lower TP detection rate than PSMA PET, (ii) shows equivalent PPV and (iii) detects significantly fewer TP lesions.

Trial registration

ClinicalTrials.gov identifier NCT03327675.