Evaluating the value of 18F-PSMA-1007 PET/CT in the detection and identification of prostate cancer using histopathology as the standard

• Published in: Cancer imaging 2023-11, Vol.23 (1), p.1-108, Article 108
• Main Authors: Luo, Liang, Zheng, Anqi, Chang, Ruxi, Li, Yunxuan, Gao, Jungang, Wang, Zhuonan, Duan, Xiaoyi
• Format: Article
• Language: English
• Subjects: Accuracy; Antigens; Biopsy; Cancer therapies; Chromatography; Clinical outcomes; Consistency tests; Fluorine isotopes; Histochemistry; Histopathology; Lesions; Ligands; Medical diagnosis; Medical imaging; Pathology; Patients; Performance evaluation; PET/CT; Positron emission; Prostate cancer; Prostate-specific membrane antigen; Radioisotopes; Sensitivity; Software; Surgical techniques; SUVmax cutoff; Tomography
• ISSN: 1470-7330; 1740-5025; 1470-7330
• DOI: 10.1186/s40644-023-00627-x

Background Prostate-specific membrane antigen (PSMA) PET/CT is a highly regarded radionuclide imaging modality for prostate cancer (PCa). This study aimed to evaluate the diagnostic performance of .sup.18F-PSMA-1007 PET/CT in detecting intraprostatic lesions of PCa using radical prostatectomy (RP) specimens as a reference standard and to establish an optimal maximum standardized uptake value (SUVmax) cutoff for distinguishing between PCa and non-PCa lesions. Methods We retrospectively collected 117 patients who underwent .sup.18F-PSMA-1007 PET/CT before RP. The uptake of the index tumor and contralateral non-PCa lesion was assessed. Histopathology of RP specimens was used as the gold standard. Kappa test was used to evaluate the consistency of preoperative PSMA PET/CT staging and postoperative pathological staging. Finally, an SUVmax cutoff value was identified by receiver operating characteristic (ROC) curve analysis to distinguish PCa lesions from non-PCa lesions. A prospective cohort including 76 patients was used to validate the results. Results The detection rate of .sup.18F-PSMA-1007 PET/CT for prostate cancer was 96.6% (113/117). .sup.18F-PSMA-1007 had a sensitivity of 91.2% and a positive predictive value (PPV) of 89.8% for the identification of intraprostatic lesions. The consistency test (Kappa = 0.305) indicated poor agreement between the pathologic T-stage and PSMA PET/CT T-stage. Based on ROC curve analysis, the appropriate SUVmax to diagnose PCa lesions was 8.3 (sensitivity of 71.3% and specificity 96.8%) with an area under the curve (AUC) of 0.93 (P < 0.001). This SUVmax cutoff discriminated PCa lesions from non-PCa lesions with a sensitivity of 74.4%, a specificity of 95.8% in the prospective validation group. Conclusions .sup.18F-PSMA-1007 PET/CT demonstrated excellent performance in detecting PCa. An optimal SUVmax threshold (8.3) could be utilized to identify lesions of PCa by .sup.18F-PSMA-1007 PET/CT. Trial registration ClinicalTrials.gov Identifier: NCT04521894, Registered: August 17, 2020. Keywords: Prostate cancer, Prostate-specific membrane antigen, PET/CT, SUVmax cutoff