For the detection of clinically vital prostate most cancers (csPCa), rising analysis confirmed the usage of 18F-PSMA-1007 positron emission tomography/computed tomography (PET/CT) precisely differentiated 65 % of PI-RADS 3 lesions.
That is likely one of the findings from a brand new potential examine, just lately printed in Radiology, which examined the usage of 18F-PSMA-1007 PET/CT in 75 males (median age of 67) with elevated prostate-specific antigen (PSA) ranges (median 7 ng/mL) who beforehand had multiparametric magnetic resonance imaging (mpMRI) exams. Out of 102 detected lesions, 68 had been PI-RADS 3 or larger lesions, based on the examine.
On a per-participant foundation, the researchers discovered that 18F-PSMA-1007 PET/CT offered a 91 % sensitivity price compared to 95 % for mpMRI in detecting csPCa. The examine authors additionally famous that 18F-PSMA-1007 PET/CT had a 62 % specificity price in distinction to 45 % for mpMRI.
Right here one can see pre-biopsy imaging, together with mpMRI and 18F-PSMA-1007 PET/CT scans, revealing clinically vital prostate most cancers (csPCa) with a PI-RADS 3 lesion. A current potential examine discovered that 18F-PSMA-1007 PET/CT had a 91 % sensitivity price for diagnosing csPCa and a 93 % detrimental predictive worth (NPV) for ruling out csPCa in PI-RADS 3 lesions. (Photos courtesy of Radiology.)
For PI-RADS 3 lesions, the researchers famous a 93 % detrimental predictive worth (NPV) for 18F-PSMA-1007 PET/CT as use of the agent led to upgrading or downgrading of those lesions in 17 of 26 examine individuals (65 %).
“ … For PI-RADS 3 lesions, the place radiologists are unsure concerning the presence of PCa, 18F-PSMA-1007 PET/CT appeared helpful, as PET was capable of assist appropriately distinguish between tumor tissue and benign illness in 65% of lesions resulting from a very excessive NPV of greater than 90%,” wrote lead examine writer Bastiaan M. Prive, M.D., Ph.D., who’s affiliated with the Division of Medical Imaging and Nuclear Drugs with the Radboud College Medical Heart on the Radboud Institute for Well being Sciences in Nijmegen, the Netherlands, and colleagues.
The researchers additionally famous key attributes with 18F-PSMA-1007 PET/CT that will make it a viable different to different PET/CT imaging brokers.
“On this setting, fluorine 18 (18F) PSMA-1007, a novel radiolabeled PSMA ligand, is especially enticing resulting from its low renal excretion, bettering the visibility of PSMA-positive foci in proximity to the urinary tract (i.e., the prostate) in contrast with different PSMA tracers. Furthermore, the decrease positron vitality of 18F provides larger decision than gallium 68 (68Ga)–labeled compounds (e.g., Ga-PSMA-11),” added Prive and colleagues.
Three Key Takeaways
- Excessive NPV for PI-RADS 3 lesions. The examine highlights the numerous utility of 18F-PSMA-1007 PET/CT in distinguishing between tumor tissue and benign illness in PI-RADS 3 lesions, with a excessive detrimental predictive worth (NPV) of 93 %. Because of this the usage of this imaging methodology can successfully rule out clinically vital prostate most cancers (csPCa) in circumstances the place radiologists are unsure.
- Comparative diagnostic efficiency: The analysis exhibits that 18F-PSMA-1007 PET/CT has a sensitivity price of 91 % and a specificity price of 62 % for detecting csPCa, in comparison with 95 % sensitivity and 45 % specificity for mpMRI. This means that whereas mpMRI has a barely larger sensitivity, 18F-PSMA-1007 PET/CT provides improved specificity, making it a worthwhile complementary instrument in prostate most cancers prognosis.
- Benefits of 18F-PSMA-1007: The examine factors out that 18F-PSMA-1007 has helpful properties akin to low renal excretion and better decision resulting from decrease positron vitality, making it simpler for visualizing PSMA-positive foci close to the urinary tract. These attributes counsel that 18F-PSMA-1007 PET/CT may supply improved visualization in comparison with different PET tracers like gallium 68-labeled compounds.
In an accompanying editorial, Baris Turkbey, M.D., emphasised the adjunctive prospects of 18F-PSMA-1007 PET/CT in mitigating the challenges of indeterminate PI-RADS 3 lesions.
“The examine by Prive et al confirms the potential of 18F-PSMA-1007 PET/CT as a instrument that’s complementary to mpMRI within the prognosis of PCa. Whereas demonstrating good sensitivity and reasonable specificity, this hybrid method notably excels in ruling out clinically vital PCa in PI-RADS 3 lesions,” stated Dr. Turkbey, a senior clinician with the Molecular Imaging Department of the Nationwide Most cancers Institute on the Nationwide Institutes of Well being (NIH).
(Editor’s observe: For associated content material, see “PET/CT or mpMRI: Which is Higher for Detecting Biochemical Recurrence of Prostate Most cancers?,” “Examine: PET/MRI Could Stop As much as 83 P.c of Pointless Biopsies in Males with PI-RADS 3 Lesions” and “New Analysis Evaluates PI_RADS Upgrading Guidelines in MRI Exams for Prostate Most cancers.”)
In regard to review limitations, the authors famous inconsecutive affected person enrollment, an underpowered pattern measurement and doable affirmation bias resulting from consciousness of mpMRI findings by the nuclear medication physicians. The researchers additionally conceded that efficiency of the examine at a MRI referral facility could restrict extrapolation of the examine findings to a broader inhabitants.
