Evaluating extraprostatic extension of prostate cancer: pragmatic integration of MRI and PSMA-PET/CT.
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| Title: | Evaluating extraprostatic extension of prostate cancer: pragmatic integration of MRI and PSMA-PET/CT. |
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| Authors: | Woo S; Department of Radiology, NYU Langone Health, New York, USA. sungmin.woo@nyulangone.org., Freedman D; Department of Radiology, NYU Langone Health, New York, USA., Becker AS; Department of Radiology, NYU Langone Health, New York, USA., Leithner D; Department of Radiology, NYU Langone Health, New York, USA., Charbel C; Department of Radiology, NYU Langone Health, New York, USA., Mayerhoefer ME; Department of Radiology, NYU Langone Health, New York, USA., Friedman KP; Department of Radiology, NYU Langone Health, New York, USA., Tong A; Department of Radiology, NYU Langone Health, New York, USA., Wise DR; Department of Medicine, Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA., Taneja SS; Department of Urology, NYU Langone Health, New York, USA., Zelefsky MJ; Department of Radiation Oncology, NYU Grossman School of Medicine, New York, USA., Vargas HA; Department of Radiology, NYU Langone Health, New York, USA. |
| Source: | Abdominal radiology (New York) [Abdom Radiol (NY)] 2025 Nov; Vol. 50 (11), pp. 5274-5282. Date of Electronic Publication: 2025 Apr 19. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Springer Country of Publication: United States NLM ID: 101674571 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2366-0058 (Electronic) NLM ISO Abbreviation: Abdom Radiol (NY) Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [New York] : Springer, [2016]- |
| MeSH Terms: | Prostatic Neoplasms*/diagnostic imaging , Prostatic Neoplasms*/pathology , Prostatic Neoplasms*/surgery , Positron Emission Tomography Computed Tomography*/methods , Magnetic Resonance Imaging*/methods , Multimodal Imaging*/methods, Humans ; Male ; Aged ; Middle Aged ; Retrospective Studies ; Neoplasm Invasiveness/diagnostic imaging ; Prostatectomy ; Multiparametric Magnetic Resonance Imaging ; Glutamate Carboxypeptidase II ; Radiopharmaceuticals |
| Abstract: | Competing Interests: Declarations. Competing interests: M.E.M. received honoraria for lectures from Siemens, GE, and BM but unrelated to the current work. K.P.F. is a co-investigator on “Optimizing timing of rhPSMA-7.3 (18F), for assessing site(s) of recurrent disease following radical prostatectomy” (PI Herbert Lepor) but does not receive any salary support and is unrelated to the current work. D.R.W. has received consulting fees from Leap Therapeutics, Foundation Medicine, Pfizer, Janssen, Sanofi, Lilly, Labcorp, Myovant, Bayer, AstraZeneca, Accutar and has received travel funding from Pfizer and Bayer but unrelated to the current work. The other authors have nothing to disclose. Purpose: To explore pragmatic approaches integrating MRI and PSMA-PET/CT for evaluating extraprostatic extension (EPE) of prostate cancer (PCa). Methods: Consecutive patients with newly-diagnosed PCa that underwent multiparametric MRI and PSMA-PET/CT, followed by radical prostatectomy in 2021-2024 were included. Imaging parameters assessed on both modalities were: size, length of capsular contact (LCC), Likert scales (MRI EPE grade/PSMA Likert scale), PI-RADS/PRIMARY scores, and SUV Results: 67 men (median age, 66 years) with EPE in 76.1% (51/67) were included. Area under ROC curves (AUC) were 0.61-0.82; MRI-based LCC yielded the highest AUC 0.82 (0.71-0.92) with cutoff of ≥ 1.7 cm. Integrated Likert scale (MRI EPE grade/PSMA Likert scale) showed sensitivity of 80.4% (41/51) and specificity of 31.3% (5/16). P score (PI-RADS/PRIMARY) demonstrated sensitivity of 31.3% (16/51) and specificity of 87.5% (14/16). Combining morphological MRI information with functional PSMA-PET/CT yielded sensitivity and specificity of 80.4% (41/51) and 81.2% (13/16), respectively, which demonstrated significantly higher sensitivity but non-significantly different specificity compared with MRI-based LCC alone (66.7% [34/51, p = 0.02] and 87.5% [14/16, p > 0.99]). This approach upgraded suspicion in 8 patients with LCC < 1.7 cm due to SUV Conclusion: Several pragmatic approaches were explored for integrating MRI and PSMA-PET/CT to assess EPE in PCa. Combining morphological information from MRI and PSMA expression on PET/CT demonstrated good diagnostic performance and may be a simple pragmatic integrated method that can be used. (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.) |
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| Contributed Indexing: | Keywords: Extraprostatic extension; Magnetic resonance imaging; Positron emission tomography; Prostate cancer; Prostate specific membrane antigen |
| Substance Nomenclature: | EC 3.4.17.21 (Glutamate Carboxypeptidase II) 0 (Radiopharmaceuticals) |
| Entry Date(s): | Date Created: 20250419 Date Completed: 20251028 Latest Revision: 20251028 |
| Update Code: | 20251029 |
| DOI: | 10.1007/s00261-025-04948-2 |
| PMID: | 40252100 |
| Database: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Competing Interests: Declarations. Competing interests: M.E.M. received honoraria for lectures from Siemens, GE, and BM but unrelated to the current work. K.P.F. is a co-investigator on “Optimizing timing of rhPSMA-7.3 (18F), for assessing site(s) of recurrent disease following radical prostatectomy” (PI Herbert Lepor) but does not receive any salary support and is unrelated to the current work. D.R.W. has received consulting fees from Leap Therapeutics, Foundation Medicine, Pfizer, Janssen, Sanofi, Lilly, Labcorp, Myovant, Bayer, AstraZeneca, Accutar and has received travel funding from Pfizer and Bayer but unrelated to the current work. The other authors have nothing to disclose.<br />Purpose: To explore pragmatic approaches integrating MRI and PSMA-PET/CT for evaluating extraprostatic extension (EPE) of prostate cancer (PCa).<br />Methods: Consecutive patients with newly-diagnosed PCa that underwent multiparametric MRI and PSMA-PET/CT, followed by radical prostatectomy in 2021-2024 were included. Imaging parameters assessed on both modalities were: size, length of capsular contact (LCC), Likert scales (MRI EPE grade/PSMA Likert scale), PI-RADS/PRIMARY scores, and SUV <subscript>max</subscript> . Three pragmatic integrated approaches were tested: (1) Integration of Likert scales (positive if either or both MRI and PSMA-PET/CT were positive); (2) P score (framework combining PI-RADS + PRIMARY); and (3) combining MRI morphological information with PSMA-PET/CT functional information (upgrading suspicion of lesions with LCC below cutoff if SUV <subscript>max</subscript> >12). Diagnostic performance was tested with receiver operating characteristic (ROC) curves and compared using DeLong and McNemar tests.<br />Results: 67 men (median age, 66 years) with EPE in 76.1% (51/67) were included. Area under ROC curves (AUC) were 0.61-0.82; MRI-based LCC yielded the highest AUC 0.82 (0.71-0.92) with cutoff of ≥ 1.7 cm. Integrated Likert scale (MRI EPE grade/PSMA Likert scale) showed sensitivity of 80.4% (41/51) and specificity of 31.3% (5/16). P score (PI-RADS/PRIMARY) demonstrated sensitivity of 31.3% (16/51) and specificity of 87.5% (14/16). Combining morphological MRI information with functional PSMA-PET/CT yielded sensitivity and specificity of 80.4% (41/51) and 81.2% (13/16), respectively, which demonstrated significantly higher sensitivity but non-significantly different specificity compared with MRI-based LCC alone (66.7% [34/51, p = 0.02] and 87.5% [14/16, p > 0.99]). This approach upgraded suspicion in 8 patients with LCC < 1.7 cm due to SUV <subscript>max</subscript> >12 among which 87.5% (7/8) were corrected upgraded and had pathological EPE.<br />Conclusion: Several pragmatic approaches were explored for integrating MRI and PSMA-PET/CT to assess EPE in PCa. Combining morphological information from MRI and PSMA expression on PET/CT demonstrated good diagnostic performance and may be a simple pragmatic integrated method that can be used.<br /> (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.) |
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| ISSN: | 2366-0058 |
| DOI: | 10.1007/s00261-025-04948-2 |