Oleksii Pisotskyi

Background: Accurate assessment of local tumour stage (T stage) is essential for selecting optimal treatment in patients with prostate cancer. Multiparametric MRI (mpMRI) is currently the reference imaging modality for local staging, while PSMA PET/CT has emerged as a highly sensitive technique for nodal and distant disease. However, its role in evaluating local tumour extent remains unclear. The aim of this prospective study was to compare the accuracy of mpMRI and PSMA PET/CT in preoperative T staging using radical prostatectomy histopathology as the reference standard. Results: A total of 128 patients with biopsy-proven prostate cancer underwent both mpMRI and PSMA PET/CT before treatment. In a subgroup of 51 patients treated with radical prostatectomy, histopathology confirmed ≥pT3 disease in 25 patients (49%), including 20 cases of pT3a and 5 of pT3b. MpMRI correctly identified the pathological T stage in 17 patients (33%), whereas PSMA PET/CT was concordant in 13 patients (26%). Both modalities matched histopathology in 7 cases (14%). MpMRI overstaged disease in 10% of patients and understaged in 57%, while PSMA PET/CT overstaged in 8% and understaged in 67%. For detection of ≥pT3 disease, mpMRI demonstrated a sensitivity of 68% and specificity of 88.5%, compared with 52% and 92.3% for PSMA PET/CT, respectively. MpMRI showed higher sensitivity for detecting extraprostatic extension (70% vs 25%), whereas PSMA PET/CT demonstrated comparable or slightly higher performance for seminal vesicle invasion (80% vs 60%). Conclusions: MpMRI demonstrated higher sensitivity and overall concordance with histopathology in the assessment of local tumour stage, particularly for extraprostatic extension. PSMA PET/CT showed higher specificity but tended to underestimate local disease extent. These findings support mpMRI as the primary imaging modality for local staging, while PSMA PET/CT should be considered a complementary tool, particularly in the context of combined local and systemic staging.

The Central European Journal of Urology is an open access quarterly-issued journal, which provides a forum for the presentation of original clinical, experimental and other research studies...

Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (Ga-68 PSMA-PET/CT) is a diagnostic tool used in urology to detect oligometastatic disease in patients with prostate cancer (PC). Although increasingly popular and extensively studied, it is not considered a standard diagnostic tool for primary PC staging, because it lacks validation when compared to mpMRI.Numerous studies have suggested its promising role in PC diagnostics. Our objective was to comprehensively review and summarize the existing literature on the potential and feasibility of utilizing Ga-68 PSMA-PET/CT as the sole method for primary PC staging and to compare it with currently employed diagnostic tools (mainly mpMRI). The main goal of the study was to consolidate the data on the sensitivity and specificity of PSMA-PET for PCa staging when compared with other diagnostic tools. The use of PSMA-PET/CT as the only diagnostic tool of primary PC in the future might potentially reduce diagnostic time and costs. In addition, we examined the limitations of its use. Ga-68 PSMA-PET/CT demonstrates encouraging outcomes during the initial assessment of PC, potentially leading to a transformative leap in PC diagnosis and treatment, due to the utilization of Ga-68 PSMA, with high affinity to prostate cells.

Objective: The study aims to evaluate the correlation between 68Ga-PSMA uptake in PSMA PET/CT in primary prostate cancer (PC) and its histopathological grading (Gleason Score and ISUP grade). Additionally, we compared preoperative biopsy histopathological findings with definitive pathology results in radical prostatectomy (RP) specimens. Methods: We retrospectively analyzed 86 patients who underwent 68Ga-PSMA PET/CT for primary PC staging, of which 40 patients later underwent radical prostatectomy. PET/CT results, including SUVmax values, were correlated with GS and PSA concentrations. Histopathology reports were analyzed and compared between biopsy and final pathology results following RP. Results: A significant positive correlation was observed between SUVmax and ISUP grades (Pearson's ρ = 0.34, p < 0.001), with higher SUVmax values associated with more advanced grades. A cut-off SUVmax value of 5.64 was determined to predict upstaging in patients, yielding a sensitivity of 76% and a specificity of 60% (AUC = 0.82, 95% CI: 0.70–0.94). Additionally, 57.5% of patients experienced a grade shift following RP, with a 35% upgrade and 22.5% downgrade in ISUP grades. Conclusion: 68Ga-PSMA PET/CT demonstrated high sensitivity in detecting high-risk prostate cancer, particularly in patients with GS > 7 or PSA levels ≥ 10 ng/ml. The findings suggest that this imaging modality may be less effective for staging of patients with lower GS or PSA values, that is low-risk PCa. Further prospective studies are necessary to validate these results.