Medical University of Vienna / Hartenbach M*
Abstract
PURPOSE:
Primary staging of prostate cancer relies on modalities, which are limited. We evaluate simultaneous [68Ga]Ga-PSMA-11 PET (PSMA-PET)/MRI as a new diagnostic method for primary tumor-node-metastasis staging compared with histology and its impact on therapeutic decisions.
EXPERIMENTAL DESIGN:
We investigated 122 patients with PSMA-PET/MRI prior to planned radical prostatectomy (RP). Primary endpoint was the accuracy of PSMA-PET/MRI in tumor staging as compared with staging-relevant histology. In addition, a multidisciplinary team reassessed the initial therapeutic approach to evaluate its impact on the therapeutic management.
RESULTS:
PSMA-PET/MRI correctly identified prostate cancer in 119 of 122 patients (97.5%). Eighty-one patients were treated with RP and pelvic lymphadenectomy. The accuracy for T staging was 82.5% [95% confidence interval (CI), 73-90; P < 0.001], for T2 stage was 85% (95% CI, 71-94; P < 0.001), for T3a stage was 79% (95% CI, 43-85; P < 0.001), for T3b stage was 94% (95% CI, 73-100; P < 0.001), and for N1 stage was 93% (95% CI, 84-98; P < 0.001). PSMA-PET/MRI changed the therapeutic strategy in 28.7% of the patients with either the onset of systemic therapy/radiotherapy (n = 16) or active surveillance (n = 19).
CONCLUSIONS:
PSMA-PET/MRI can provide an accurate staging of newly diagnosed prostate cancer. In addition, treatment strategies were changed in almost a third of the patients due to the information of this hybrid imaging technique.
Author information
Grubmüller B1, Baltzer P2, Hartenbach S3, D'Andrea D1, Helbich TH2, Haug AR4, Goldner GM5, Wadsak W4,6, Pfaff S4, Mitterhauser M4,7, Balber T4, Berroteran-Infante N4, Grahovac M4, Babich J8, Seitz C1, Kramer G1, Susani M9, Mazal P9, Kenner L9,10,11,12, Shariat SF1,13,14, Hacker M4, Hartenbach M15.
1
Department of Urology, Medical University of Vienna, Vienna, Austria.
2
Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria.
3
HistoConsultingHartenbach, Ulm, Germany.
4
Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria.
5
Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.
6
Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria.
7
Ludwig Boltzmann Institute for Applied Diagnostics, Vienna, Austria.
8
Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Medical College of Cornell University, New York, New York.
9
Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
10
Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.
11
Department of Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria.
12
Institute of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria.
13
Department of Urology, University of Texas Southwestern, Dallas, Texas.
14
Department of Urology and Division of Medical Oncology, Weill Medical College of Cornell University, New York, New York.
15
Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria. markus.hartenbach@me.com.