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CC BY-NC-ND 4.0 · World J Nucl Med 2018; 17(04): 261-269
DOI: 10.4103/wjnm.WJNM_79_17
Original Article

Initial risk stratification and staging in prostate cancer with prostatic-specific membrane antigen positron emission tomography/computed tomography: A first-stop-shop

Manoj Gupta
Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi
,
Partha Choudhury
Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi
,
Sudhir Rawal
1   Department of Uro-Gynae Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi
,
Harish Goel
2   Amity Centre for Radiation Biology, Amity University, Noida, Uttar Pradesh
,
Vineet Talwar
3   Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi
,
Amitabh Singh
1   Department of Uro-Gynae Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi
,
Saroj Sahoo
Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi
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Current imaging for prostate cancer (PCa) had limitations for risk stratification and staging. Magnetic resonance imaging frequently underestimated lymph node metastasis while bone scintigraphy often had diagnostic dilemmas. Prostatic-specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET/CT) has been remarkable in PCa recurrence. Ninety-seven PSMA PET-CT scans were reanalyzed for tumor node metastases staging and risk stratification of lymph node and distant metastasis proportion. Histopathology of 23/97 patients was available as gold standard. Chi-square test was used for proportion comparison. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overestimation, underestimation, and correct estimation of T and N stages were calculated. Kappa coefficient (κ) was derived for inter-rater agreement. Lymph node or distant metastasis detection on PSMA PET/CT increased significantly with increase in risk category. PSMA PET/CT sensitivity, specificity, PPV, and NPV for extraprostatic extension, seminal vesicle invasion, and lymph node metastases were 63.16%, 100%, 100%, 36.36%; 55%, 100%, 100%, 25%; and 65.62%, 99.31%, 87.50%, and 97.53%, respectively. Kappa coefficient showed substantial agreement between PSMA PET/CT and histopathological lymph node metastases (κ = 0.734); however, it was just in fair agreement (κ = 0.277) with T stage. PSMA PET/CT overestimated, underestimated, and correct estimated T and N stages in 8.71%, 39.13%, 52.17% and 8.71%, 4.35%, and 86.96% cases, respectively. PSMA PET/CT has potential for initial risk stratification with reasonable correct N stage estimation, however underestimates T stage. Hence, we concluded that PSMA PET/CT should be used as “ first-stop-shop” for staging and initial risk stratification of PCa with regional magnetic resonance imaging in surgically resectable cases.

Keywords

Extrapelvic lymph node - first-stop-shop - initial risk stratification - prostatic-specific membrane antigen positron emission tomography-computed tomography - spleen - staging


Publication History

Article published online:
17 May 2022

© 2018. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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