PDF(Pubmed)
Abstract：
Widespread adoption of mpMRI has led to a decrease in the number of patients requiring prostate biopsies. 68Ga-PSMA-11 PET/CT has demonstrated added benefits in identifying csPCa. Integrating the use of these imaging techniques may hold promise for predicting the presence of csPCa without invasive biopsy. A retrospective analysis of 42 consecutive patients who underwent mpMRI, 68Ga-PSMA-11 PET/CT, prostatic biopsy, and radical prostatectomy (RP) was carried out. A lesion-based model (n = 122) using prostatectomy histopathology as reference standard was used to analyze the accuracy of 68Ga-PSMA-11 PET/CT, mpMRI alone, and both in combination to identify ISUP-grade group ≥ 2 lesions. 68Ga-PSMA-11 PET/CT demonstrated greater specificity and positive predictive value (PPV), with values of 73.3% (vs. 40.0%) and 90.1% (vs. 82.2%), while the mpMRI Prostate Imaging Reporting and Data System (PI-RADS) 4-5 had better sensitivity and negative predictive value (NPV): 90.2% (vs. 78.5%) and 57.1% (vs. 52.4%), respectively. When used in combination, the sensitivity, specificity, PPV, and NPV were 74.2%, 83.3%, 93.2%, and 51.0%, respectively. Subgroup analysis of PI-RADS 3, 4, and 5 lesions was carried out. For PI-RADS 3 lesions, 68Ga-PSMA-11 PET/CT demonstrated a NPV of 77.8%. For PI-RADS 4-5 lesions, 68Ga-PSMA-11 PET/CT achieved PPV values of 82.1% and 100%, respectively, with an NPV of 100% in PI-RADS 5 lesions. A combination of 68Ga-PSMA-11 PET/CT and mpMRI improved the radiological diagnosis of csPCa. This suggests that avoidance of prostate biopsy prior to RP may represent a valid option in a selected subgroup of high-risk patients with a high suspicion of csPCa on mpMRI and 68Ga-PSMA-11 PET/CT.
摘要：
mpMRI的广泛采用导致需要前列腺活检的患者数量减少。68Ga-PSMA-11PET/CT已证明在鉴定csPCa方面具有额外的益处。整合这些成像技术的使用可能有望在没有侵入性活检的情况下预测csPCa的存在。回顾性分析连续42例接受mpMRI的患者，68Ga-PSMA-11PET/CT,前列腺活检,并进行了根治性前列腺切除术（RP）。使用前列腺切除术组织病理学作为参考标准的基于病变的模型（n=122）用于分析68Ga-PSMA-11PET/CT的准确性，仅MPMRI,两者结合起来识别ISUP分级组≥2个病灶。68Ga-PSMA-11PET/CT表现出更高的特异性和阳性预测值（PPV），值为73.3%(与40.0%）和90.1%（与82.2%)，而mpMRI前列腺成像报告和数据系统（PI-RADS）4-5具有更好的灵敏度和阴性预测值（NPV）：90.2％（vs.78.5%）和57.1%（与52.4%），分别。当组合使用时，灵敏度,特异性，PPV,净现值为74.2%，83.3%,93.2%,51.0%，分别。对PI-RADS3、4和5个病灶进行亚组分析。对于PI-RADS3个病变，68Ga-PSMA-11PET/CT显示77.8%的NPV。对于PI-RADS4-5病变，68Ga-PSMA-11PET/CT实现了82.1%和100%的PPV值，分别,PI-RADS5个病变的NPV为100%。68Ga-PSMA-11PET/CT和mpMRI的组合改善了csPCa的放射学诊断。这表明，在选择的高风险患者亚组中，在mpMRI和68Ga-PSMA-11PET/CT上高度怀疑csPCa的情况下，避免在RP之前进行前列腺活检可能是一种有效的选择。
