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ORIGINAL ARTICLE
Year : 2018  |  Volume : 17  |  Issue : 4  |  Page : 261-269

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


1 Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
2 Department of Uro-Gynae Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
3 Amity Centre for Radiation Biology, Amity University, Noida, Uttar Pradesh, India
4 Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Correspondence Address:
Manoj Gupta
Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi - 110 085
India
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DOI: 10.4103/wjnm.WJNM_79_17

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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.


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