¹⁸F-Choline PET/mpMRI for Detection of Clinically Significant Prostate Cancer: Part 1. Improved Risk Stratification...

Area of Science:

• Oncology
• Radiology
• Nuclear Medicine

Background:

• Multiparametric MRI (mpMRI) is used for prostate cancer detection.
• Improving the specificity of mpMRI for clinically significant prostate cancer (Gleason ≥ 3+4) remains a challenge.
• ¹⁸F-choline PET/CT is a potential adjunct imaging modality.

Purpose of the Study:

• To evaluate if ¹⁸F-choline PET/mpMRI improves the specificity of mpMRI for detecting Gleason ≥ 3+4 prostate cancer.
• To compare the diagnostic performance of mpMRI alone versus combined ¹⁸F-choline PET/mpMRI.

Main Methods:

• Prospective single-arm clinical trial involving 56 evaluable subjects.
• mpMRI and ¹⁸F-choline PET/CT were performed prior to biopsy on 90 target lesions (Likert score 3-5).
• A ¹⁸F-choline target-to-background ratio > 1.58 indicated a positive result; mixed-effects logistic regression analyzed performance.

Main Results:

• mpMRI alone showed per-lesion accuracy of 67.8% (Likert 4-5) and 70.0% (PI-RADS 3-5).
• The combined ¹⁸F-choline PET/mpMRI approach significantly improved per-lesion accuracy to 88.9% (Likert, AUC 0.90) and 91.1% (PI-RADS, AUC 0.92).
• Per-patient accuracy improved to 92.9% (Likert, AUC 0.93) and 91.1% (PI-RADS, AUC 0.91) with the combined method.

Conclusions:

• ¹⁸F-choline PET/mpMRI significantly enhances the identification of Gleason ≥ 3+4 prostate cancer.
• The primary benefit lies in improved risk stratification of intermediate-risk lesions identified by mpMRI.
• This combined imaging approach offers superior diagnostic performance compared to mpMRI alone for clinically significant prostate cancer.