Comparing mri and psma pet-ct for prediction of extra prostatic extension of prostate cancer and surgical guidance: a prospective trial

You have accessJournal of UrologyCME1 Apr 2023PD27-01 COMPARING MRI AND PSMA PET-CT FOR PREDICTION OF EXTRA PROSTATIC EXTENSION OF PROSTATE CANCER AND SURGICAL GUIDANCE: A PROSPECTIVE TRIAL Isamu Tachibana, Courtney Yong, Katrina Collins, Ronald Boris, Mark Tann, Kevin Rice, Mark Green, Liang Cheng, Justin Sims, Gary Hutchins, Jason Parker, Jordan Swensson, Michael Koch, and Clint Bahler Isamu TachibanaIsamu Tachibana More articles by this author , Courtney YongCourtney Yong More articles by this author , Katrina CollinsKatrina Collins More articles by this author , Ronald BorisRonald Boris More articles by this author , Mark TannMark Tann More articles by this author , Kevin RiceKevin Rice More articles by this author , Mark GreenMark Green More articles by this author , Liang ChengLiang Cheng More articles by this author , Justin SimsJustin Sims More articles by this author , Gary HutchinsGary Hutchins More articles by this author , Jason ParkerJason Parker More articles by this author , Jordan SwenssonJordan Swensson More articles by this author , Michael KochMichael Koch More articles by this author , and Clint BahlerClint Bahler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003305.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Survivors of surgically managed prostate cancer (PCa) may experience side-effects such as urinary incontinence and erectile dysfunction. Currently, Multiparametric MRI (MRI) aids decisions on nerve-sparing approach. We sought to see if 68Ga-PSMA-11 PET CT (PET) scan could better predict and improve surgical approach compared to MRI. METHODS: We prospectively enrolled 50 patients with clinically significant PCa ( >3 cores of Gleason 3+4 or worse) that were scheduled for prostatectomy with a MRI. Patients then underwent PET. Images were read by dedicated radiologists to identify extra-prostatic extension (EPE) at the nerve bundles (NB), apex, and bladder neck and seminal vesicle invasion (SVI). Surgeon questionnaires about approach (non-nerve sparing vs nerve sparing) were prospectively filled based on MRI and PET scan and after surgery for the actual surgical approach. These results were then compared to the final whole mount to determine if the surgical approach was correct. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for MRI and PET scan. Surgeon questionnaires were compared using McNamar’s test. RESULTS: Patients had an average age of 61.5 with biopsy results shown in Table 1. Sensitivity, specificity, PPV and NPV for EPE along the posterior aspect with concern for NB involvement for MRI was 60.0, 76.9, 40.0, 88.2 and PET was 85.7, 73.4, 46.2, 95.1. The correct surgical approach (non-nerve sparing vs. nerve sparing) would have been taken 74% of time using PET findings alone compared to MRI which was correct 66.3% (p=0.01) as shown in Table 2. The ability to correctly select surgical approach (wide vs normal) for the apex and SVI was also captured. No patients had bladder neck invasion. Surgeon choice based on imaging was influenced by other factors such as Gleason score. CONCLUSIONS: We found PET scans were more sensitive with EPE at the NB. PET scans were a better guide to correctly decide nerve sparing approach based on prospective questionnaires. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e741 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Isamu Tachibana More articles by this author Courtney Yong More articles by this author Katrina Collins More articles by this author Ronald Boris More articles by this author Mark Tann More articles by this author Kevin Rice More articles by this author Mark Green More articles by this author Liang Cheng More articles by this author Justin Sims More articles by this author Gary Hutchins More articles by this author Jason Parker More articles by this author Jordan Swensson More articles by this author Michael Koch More articles by this author Clint Bahler More articles by this author Expand All Advertisement PDF downloadLoading ...