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Simultaneous whole-body PET/MRI with integrated multiparametric MRI for primary staging of high-risk prostate cancer

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Abstract

Purpose

Whole-body positron emission tomography/magnetic resonance imaging (wbPET/MRI) is a promising diagnostic tool of recurrent prostate cancer (PC), but its role in primary staging of high-risk PC (hrPC) is not well defined. Thus, the aim was to compare the diagnostic accuracy for T-staging of PET-blinded reading (PBR) and PET/MRI.

Methods

In this prospective study, hrPC patients scheduled to radical prostatectomy (RPx) with extended lymphadenectomy (eLND) were staged with wbPET/MRI and either 68Ga-PSMA-11 or 11C-choline including simultaneous multiparametric MRI (mpMRI). Images were assessed in two sessions, first as PBR (mpMRI and wbMRI) and second as wbPET/MRI. Prostate Imaging Reporting and Data System criteria (PIRADS v2) were used for T-staging. Results were correlated with the exact anatomical localization and extension as defined by histopathology. Diagnostic accuracy of cTNM stage according to PBR was compared to pathological pTNM stage as reference standard.

Results

Thirty-four patients underwent wbPET/MRI of 68Ga-PSMA-11 (n = 17) or 11C-choline (n = 17). Twenty-four patients meeting the inclusion criteria of localized disease ± nodal disease based on imaging results underwent RPx and eLND, whereas ten patients were excluded from analysis due to metastatic disease. T-stage was best defined by mpMRI with underestimation of tumor lesion size by PET for both tracers. N-stage yielded a per patient sensitivity/specificity comparable to PBR.

Conclusion

MpMRI is the primary modality for T-staging in hrPC as PET underestimated T-stage in direct comparison to final pathology. In this selected study, cohort MRI shows no inferiority compared to wbPET/MRI considering N-staging.

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Funding

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Sascha Kaufmann, Sergios Gatidis, Tobias Hepp, Wolfgang M. Thaiss & Konstantin Nikolaou

  2. Department of Urology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Stephan Kruck, Jörg Hennenlotter, Arnulf Stenzl & Jens Bedke

  3. Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, Otfried-Müller-Straße 14, 72076, Tübingen, Germany

    Johannes Schwenck & Christian la Fougère

  4. Institute of Pathology, Eberhard-Karls-University, Liebermeisterstraße 8, 72076, Tübingen, Germany

    Marcus Scharpf

  5. Department of Preclinical Imaging and Radiopharmacy, University Hospital Tübingen, Röntgenweg 13, 72076, Tübingen, Germany

    Gerald Reischl

  6. Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Tübingen, Germany

    Christian la Fougère

  7. German Cancer Consortium (DKTK), Partner Site Tübingen, Germany

    Christian la Fougère & Jens Bedke

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  1. Sascha Kaufmann
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Contributions

SK: protocol/project development; data collection or management; data analysis; manuscript writing/editing; statistical analysis. SK: protocol/project development; data collection or management; data analysis; manuscript writing/editing. SG: protocol/project development; data collection or management; data analysis; manuscript writing/editing; statistical analysis. TH: data analysis; manuscript writing/editing; statistical analysis. WMT: data analysis; manuscript writing/editing; statistical analysis. JH: data collection or management; manuscript writing/editing. JS: data analysis; manuscript writing/editing. MS: data collection or management; manuscript writing/editing. KN: data analysis; manuscript writing/editing; administrative, technical, or material support; supervision. AS: manuscript writing/editing; supervision. GR: protocol/project development; manuscript writing/editing; administrative, technical, or material support. CF: data analysis; manuscript writing/editing; administrative, technical, or material support; supervision. JB: protocol/project development; data analysis; manuscript writing/editing.

Corresponding author

Correspondence to Wolfgang M. Thaiss.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee, approved by the local institutional review board (241/2012MPG23), and in line with the 1964 Helsinki declaration and its later amendments.

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Kaufmann, S., Kruck, S., Gatidis, S. et al. Simultaneous whole-body PET/MRI with integrated multiparametric MRI for primary staging of high-risk prostate cancer. World J Urol 38, 2513–2521 (2020). https://doi.org/10.1007/s00345-019-03066-1

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