Comparing Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen–Positron Emission Tomography for Prediction of Extraprostatic Extension of Prostate Cancer and Surgical Guidance: A Prospective Nonrandomized Clinical Trial

No AccessJournal of UrologyAdult Urology24 May 2024Comparing Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen–Positron Emission Tomography for Prediction of Extraprostatic Extension of Prostate Cancer and Surgical Guidance: A Prospective Nonrandomized Clinical Trial Clinton D. Bahler, Isamu Tachibana, Mark Tann, Katrina Collins, Jordan K. Swensson, Mark A. Green, Carla J. Mathias, Yan Tong, Courtney Yong, Ronald S. Boris, Eric Brocken, Gary D. Hutchins, Justin B. Sims, Danielle V. Hill, Nathaniel Smith, Christopher Ferari, Harrison Love, and Michael O. Koch Clinton D. BahlerClinton D. Bahler Corresponding Author: Clinton D. Bahler, MD, MS, Department of Urology, Indiana University School of Medicine, 535 N Barnhill Dr, STE 420, Indianapolis, IN 46202 ([email protected]) , Isamu TachibanaIsamu Tachibana , Mark TannMark Tann , Katrina CollinsKatrina Collins , Jordan K. SwenssonJordan K. Swensson , Mark A. GreenMark A. Green , Carla J. MathiasCarla J. Mathias , Yan TongYan Tong , Courtney YongCourtney Yong , Ronald S. BorisRonald S. Boris , Eric BrockenEric Brocken , Gary D. HutchinsGary D. Hutchins , Justin B. SimsJustin B. Sims , Danielle V. HillDanielle V. Hill , Nathaniel SmithNathaniel Smith , Christopher FerariChristopher Ferari , Harrison LoveHarrison Love , and Michael O. KochMichael O. Koch View All Author Informationhttps://doi.org/10.1097/JU.0000000000004032AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Survivors of surgically managed prostate cancer may experience urinary incontinence and erectile dysfunction. Our aim was to determine if 68Ga–prostate-specific membrane antigen–11 positron emission tomography CT (PSMA-PET) in addition to multiparametric (mp) MRI scans improved surgical decision-making for nonnerve-sparing or nerve-sparing approach. Materials and Methods: We prospectively enrolled 50 patients at risk for extraprostatic extension (EPE) who were scheduled for prostatectomy. After mpMRI and PSMA-PET images were read for EPE prediction, surgeons prospectively answered questionnaires based on mpMRI and PSMA-PET scans on the decision for nerve-sparing or nonnerve-sparing approach. Final whole-mount pathology was the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic curves were calculated and McNemar's test was used to compare imaging modalities. Results: The median age and PSA were 61.5 years and 7.0 ng/dL. The sensitivity for EPE along the posterior neurovascular bundle was higher for PSMA-PET than mpMRI (86% vs 57%, P = .03). For MRI, the specificity, positive predictive value, negative predictive value, and area under the curve for the receiver operating characteristic curves were 77%, 40%, 87%, and 0.67, and for PSMA-PET were 73%, 46%, 95%, and 0.80. PSMA-PET and mpMRI reads differed on 27 nerve bundles, with PSMA-PET being correct in 20 cases and MRI being correct in 7 cases. Surgeons predicted correct nerve-sparing approach 74% of the time with PSMA-PET scan in addition to mpMRI compared to 65% with mpMRI alone (P = .01). Conclusions: PSMA-PET scan was more sensitive than mpMRI for EPE along the neurovascular bundles and improved surgical decisions for nerve-sparing approach. Further study of PSMA-PET for surgical guidance is warranted in the unfavorable intermediate-risk or worse populations. ClinicalTrials.gov Identifier: NCT04936334. REFERENCES 1. . An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. 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Data analysis and interpretation: Tachibana, Swensson, Green, Mathias, Tong, Yong, Hutchins, Sims, Smith, Love, Koch. Data acquisition: Bahler, Tachibana, Collins, Swensson, Green, Mathias, Yong, Brocken, Hutchins, Hill, Love, Koch. Critical revision of the manuscript for scientific and factual content: Tachibana, Collins, Swensson, Green, Mathias, Yong, Hutchins, Sims, Smith, Love, Koch. Drafting the manuscript: Bahler, Tachibana, Mathias, Tong, Yong, Brocken, Hill, Smith. Statistical analysis: Bahler, Tachibana, Tong, Hutchins, Smith. Supervision: Collins, Swensson, Green, Mathias, Yong, Hutchins, Sims, Koch. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySiemens D and Routh J Editors' ChoiceJournal of Urology, Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.KeywordspathologyPET scanprostate cancerprostatectomyquality of lifeMetrics Author Information Clinton D. Bahler Corresponding Author: Clinton D. Bahler, MD, MS, Department of Urology, Indiana University School of Medicine, 535 N Barnhill Dr, STE 420, Indianapolis, IN 46202 ([email protected]) Co-first authors. More articles by this author Isamu Tachibana Co-first authors. More articles by this author Mark Tann More articles by this author Katrina Collins More articles by this author Jordan K. Swensson More articles by this author Mark A. Green More articles by this author Carla J. Mathias More articles by this author Yan Tong More articles by this author Courtney Yong More articles by this author Ronald S. Boris More articles by this author Eric Brocken More articles by this author Gary D. Hutchins More articles by this author Justin B. Sims More articles by this author Danielle V. Hill More articles by this author Nathaniel Smith More articles by this author Christopher Ferari More articles by this author Harrison Love More articles by this author Michael O. Koch More articles by this author Expand All Funding/Support: This study was funded by donations from Al Christy Jr to the Indiana University Foundation prostate cancer research fund (Dr Bahler), American Cancer Society IRG Grant 16-192-31 (Dr Bahler), and NIH-NCI Grant R01CA202695 (Drs Bahler, Mathias, Hutchins, and Koch). Conflict of Interest Disclosures: Drs Mathias and Green reported receiving funding from Five Eleven Pharmaceuticals. No other disclosures were reported. Ethics Statement: This study received Institutional Review Board approval (IRB No. 11330). Author Contributions: Conception and design: Bahler, Tachibana, Green, Brocken, Hutchins, Koch. Data analysis and interpretation: Tachibana, Swensson, Green, Mathias, Tong, Yong, Hutchins, Sims, Smith, Love, Koch. Data acquisition: Bahler, Tachibana, Collins, Swensson, Green, Mathias, Yong, Brocken, Hutchins, Hill, Love, Koch. Critical revision of the manuscript for scientific and factual content: Tachibana, Collins, Swensson, Green, Mathias, Yong, Hutchins, Sims, Smith, Love, Koch. Drafting the manuscript: Bahler, Tachibana, Mathias, Tong, Yong, Brocken, Hill, Smith. Statistical analysis: Bahler, Tachibana, Tong, Hutchins, Smith. Supervision: Collins, Swensson, Green, Mathias, Yong, Hutchins, Sims, Koch. Advertisement PDF downloadLoading ...