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Local staging of de novo prostate cancer using mpMRI, PSMA-PET and PSMA-PET/mpMRI – a comparative study

Grefve, Josefine ; Strandberg, Sara N. ; Jonsson, Joakim ; Lindberg, Angsana Keeratijarut ; Nilsson, Erik ; Bergh, Anders ; Söderkvist, Karin ; Karlsson, Camilla Thellenberg ; Nedar, Lennart and Løgager, Vibeke Berg , et al. (2025) In EJNMMI Research 15(1).
Abstract

Background: Accurate diagnosis and staging are essential for optimal treatment planning of prostate cancer. By combining functional and anatomical imaging, PSMA-PET/mpMRI offers a potential to improve lesion detection and enhance staging accuracy. This study aimed to evaluate the diagnostic performance of lesion detection and local staging of prostate cancer using combined PSMA-PET/mpMRI compared to standalone mpMRI or PSMA-PET. Results: Fifty-five patients with intermediate- to high-risk prostate cancer scheduled for robot-assisted laparoscopic radical prostatectomy were included. All patients underwent [68Ga]PSMA-PET/mpMRI prior to surgery. Whole-mount histopathology and surgical report served as reference standard. Two... (More)

Background: Accurate diagnosis and staging are essential for optimal treatment planning of prostate cancer. By combining functional and anatomical imaging, PSMA-PET/mpMRI offers a potential to improve lesion detection and enhance staging accuracy. This study aimed to evaluate the diagnostic performance of lesion detection and local staging of prostate cancer using combined PSMA-PET/mpMRI compared to standalone mpMRI or PSMA-PET. Results: Fifty-five patients with intermediate- to high-risk prostate cancer scheduled for robot-assisted laparoscopic radical prostatectomy were included. All patients underwent [68Ga]PSMA-PET/mpMRI prior to surgery. Whole-mount histopathology and surgical report served as reference standard. Two radiologists independently evaluated mpMRI, while two nuclear medicine physicians assessed PSMA-PET. For the PSMA-PET/mpMRI analysis, a consensus evaluation was performed by a new set of readers in two teams, each comprising one radiologist and one nuclear medicine physician. Lesion localization was reported based on the PI-RADS v2.1 sector map and compared to histopathology. Among 130 histopathologically confirmed lesions, mean detection rates were 38% (49.5/130) for PSMA-PET/mpMRI, 32% (41/130) for mpMRI and 32% (41/130) for PSMA-PET. For clinically significant prostate cancer (csPC) (≥0.5 ml, ≥ISUP 2; 42 lesions), mean detection rates were 85% (35.5/42) for PSMA-PET/mpMRI, 75% (31.5/42) for mpMRI and 70% (29.5/42) for PSMA-PET. The mean false discovery rates were 8% (PSMA-PET/mpMRI), 15% (mpMRI) and 12% (PSMA-PET). The likelihood of extraprostatic extension (EPE) and seminal vesicle invasion (SVI) were scored using a 5-point Likert scale, where scores of 1–3 were classified as negative and scores of 4–5 were considered positive. Sensitivity for EPE was 32% for PSMA-PET/mpMRI, 37% for mpMRI and 7% for PSMA-PET, with a specificity of 100%, 96% and 98%, respectively. For SVI, sensitivity was 50% for PSMA-PET/mpMRI and 38% for mpMRI and PSMA-PET, with a specificity of 100%, 95% and 97% respectively. Conclusions: PSMA-PET/mpMRI provided higher and a more consistent performance in localized prostate cancer detection and staging without increasing false-positive findings.

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Contribution to journal
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published
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EJNMMI Research
volume
15
issue
1
article number
135
publisher
Springer Science and Business Media B.V.
external identifiers
  • scopus:105022085601
  • pmid:41247538
ISSN
2191-219X
DOI
10.1186/s13550-025-01334-3
language
English
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yes
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Publisher Copyright: © The Author(s) 2025.
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896d59af-a6c3-4bf0-9561-511c27181146
date added to LUP
2026-01-16 16:20:43
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2026-01-17 03:34:18
@article{896d59af-a6c3-4bf0-9561-511c27181146,
  abstract     = {{<p>Background: Accurate diagnosis and staging are essential for optimal treatment planning of prostate cancer. By combining functional and anatomical imaging, PSMA-PET/mpMRI offers a potential to improve lesion detection and enhance staging accuracy. This study aimed to evaluate the diagnostic performance of lesion detection and local staging of prostate cancer using combined PSMA-PET/mpMRI compared to standalone mpMRI or PSMA-PET. Results: Fifty-five patients with intermediate- to high-risk prostate cancer scheduled for robot-assisted laparoscopic radical prostatectomy were included. All patients underwent [<sup>68</sup>Ga]PSMA-PET/mpMRI prior to surgery. Whole-mount histopathology and surgical report served as reference standard. Two radiologists independently evaluated mpMRI, while two nuclear medicine physicians assessed PSMA-PET. For the PSMA-PET/mpMRI analysis, a consensus evaluation was performed by a new set of readers in two teams, each comprising one radiologist and one nuclear medicine physician. Lesion localization was reported based on the PI-RADS v2.1 sector map and compared to histopathology. Among 130 histopathologically confirmed lesions, mean detection rates were 38% (49.5/130) for PSMA-PET/mpMRI, 32% (41/130) for mpMRI and 32% (41/130) for PSMA-PET. For clinically significant prostate cancer (csPC) (≥0.5 ml, ≥ISUP 2; 42 lesions), mean detection rates were 85% (35.5/42) for PSMA-PET/mpMRI, 75% (31.5/42) for mpMRI and 70% (29.5/42) for PSMA-PET. The mean false discovery rates were 8% (PSMA-PET/mpMRI), 15% (mpMRI) and 12% (PSMA-PET). The likelihood of extraprostatic extension (EPE) and seminal vesicle invasion (SVI) were scored using a 5-point Likert scale, where scores of 1–3 were classified as negative and scores of 4–5 were considered positive. Sensitivity for EPE was 32% for PSMA-PET/mpMRI, 37% for mpMRI and 7% for PSMA-PET, with a specificity of 100%, 96% and 98%, respectively. For SVI, sensitivity was 50% for PSMA-PET/mpMRI and 38% for mpMRI and PSMA-PET, with a specificity of 100%, 95% and 97% respectively. Conclusions: PSMA-PET/mpMRI provided higher and a more consistent performance in localized prostate cancer detection and staging without increasing false-positive findings.</p>}},
  author       = {{Grefve, Josefine and Strandberg, Sara N. and Jonsson, Joakim and Lindberg, Angsana Keeratijarut and Nilsson, Erik and Bergh, Anders and Söderkvist, Karin and Karlsson, Camilla Thellenberg and Nedar, Lennart and Løgager, Vibeke Berg and Thimansson, Erik and Trägårdh, Elin and Bengtsson, Johan and Hvittfeldt, Erland and Axelsson, Jan and Nyholm, Tufve and Riklund, Katrine and Sandgren, Kristina}},
  issn         = {{2191-219X}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Springer Science and Business Media B.V.}},
  series       = {{EJNMMI Research}},
  title        = {{Local staging of de novo prostate cancer using mpMRI, PSMA-PET and PSMA-PET/mpMRI – a comparative study}},
  url          = {{http://dx.doi.org/10.1186/s13550-025-01334-3}},
  doi          = {{10.1186/s13550-025-01334-3}},
  volume       = {{15}},
  year         = {{2025}},
}