A Prospective Comparison of 18F-prostate-specific Membrane Antigen-1007 Positron Emission Tomography Computed Tomography, Whole-body 1.5 T Magnetic Resonance Imaging with Diffusion-weighted Imaging, and Single-photon Emission Computed Tomography/Computed Tomography with Traditional Imaging in Primary Distant Metastasis Staging of Prostate Cancer (PROSTAGE)

• DOI: 10.1016/j.euo.2020.06.012
• Publication Date: 2020-07-13T12:13:13Z
• Authors: Mikael Anttinen; Otto Ettala; Simona Malaspina; Ivan Jambor; Minna Sandell; Sami Kajander; Irina Rinta-Kiikka; Jukka Schildt; Ekaterina Saukko; Pentti Rautio; Kirsi L. Timonen; Tuomas Matikainen; Tommi Noponen; Jani Saunavaara; Eliisa Löyttyniemi; Pekka Taimen; Jukka Kemppainen; Peter B. Dean; Roberto Blanco Se...; Hannu J. Aronen; Marko Seppänen; Peter J. Boström
• Keywords: Emission computed tomography; Bone scintigraphy; Whole body imaging

Computed tomography (CT) and bone scintigraphy (BS) are the imaging modalities currently used for distant metastasis staging of prostate cancer (PCa).To compare standard with newer potentially more accurate modalities.This prospective, single-centre trial (NCT03537391) enrolled 80 patients newly diagnosed high-risk PCa (International Society Urological Pathology grade group ≥3 and/or prostate-specific antigen [PSA] ≥20 cT ≥ T3; March 2018-June 2019) to undergo primary two three advanced modalities.The participants underwent following five examinations within 2 wk enrolment without a prespecified sequence: BS, CT, 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) single-photon emission computed (SPECT)-CT, 1.5 T whole-body magnetic resonance (WBMRI) using diffusion-weighted imaging, 18F-prostate-specific membrane antigen-1007 (18F-PSMA-1007) positron tomography(PET)-CT. Each modality was reviewed by independent experts blinded results prior studies, who classified lesions as benign, equivocal, or malignant. Pessimistic optimistic analyses were performed resolve each equivocal diagnosis. The reference diagnosis defined all available information accrued during at least 12 mo clinical follow-up. Patients diagnoses MRI CT search development anatomical correspondence. PSMA PET-avid histopathological verification rated be malignant only if there corresponding finding suspicious malignancy follow-up imaging.Seventy-nine men except one case interrupted MRI. median interval per patient between first last study 8 d (interquartile range [IQR]: 6-9). mean age 70 yr (standard deviation: 7) PSA ng/mL (IQR:7-23). 435 (IQR: 378-557). Metastatic disease detected in 20 (25%) patients. 18F-PSMA-1007 PET-CT had superior sensitivity highest inter-reader agreement. area under receiver-operating characteristic curve (AUC) values detection 0.90 (95% confidence [CI]: 0.85-0.95) 0.91 CI: 0.87-0.96) readers 1 2, respectively, while AUC SPECT-CT, WBMRI 0.71 0.58-0.84) 0.8 0.67-0.92), 0.53 0.39-0.67) 0.66 0.54-0.77), 0.77 0.65-0.89) 0.75 0.62-0.88), 0.85 0.74-0.96) 0.67 0.54-0.80), other four pairs readers. method metastatic 11/20 whom negative influenced decision making 14/79 (18%) In 12/79 cases, false positive reported PET-CT. Limitations included nonrandomised setting few histopathologically validated lesions.Despite risk lesions, outperformed methods studied PCa.In this report, we compared diagnostic performance conventional imaging. It found that tomography/computed (18F-PSMA-1007 PET-CT) time initial cancer. also appears detect some nonmetastatic lesions.