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Updated: Nov 9, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Detection of clinically significant prostate cancer with 18F-DCFPyL PET/multiparametric MR
Ur Metser1, Claudia Ortega2, Nathan Perlis3
1Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada. Ur.metser@uhn.ca.
Purpose:
To assess whether 18F-DCFPyL PET/multiparametric (mp)MR contributes to the diagnosis of clinically significant (cs) prostate cancer (PCa) compared to mpMR in patients with suspicion of PCa, or patients being considered for focal ablative therapies (FT).
Patients And Methods:
This ethics review board-approved, prospective study included 55 men with suspicion of PCa and negative systematic biopsies or clinically discordant low-risk PCa (n = 21) or those being considered for FT (n = 34) who received 18F-DCFPyL PET/mpMR. Each modality, PET, mpMR, and PET/MR (using the PROMISE classification), was assessed independently. All suspicious lesions underwent PET/MR-ultrasound fusion biopsies.
Results:
There were 45/55 patients (81.8%) that had histologically proven PCa and 41/55 (74.5%) were diagnosed with csPCa. Overall, 61/114 lesions (53.5%) identified on any modality were malignant; 49/61 lesions (80.3%) were csPCa. On lesion-level analysis, for detection of csPCa, the sensitivity of PET was higher than that of mpMR and PET/MR (86% vs 67% and 69% [p = 0.027 and 0.041, respectively]), but at a lower specificity (32% vs 85% and 86%, respectively [p < 0.001]). The performance of MR and PET/MR was comparable. For identification of csPCa in PI-RADS ≥ 3 lesions, the AUC (95% CI) for PET, mpMR, and PET/MR was 0.75 (0.65-0.86), 0.69 (0.56-0.82), and 0.78 (0.67-0.89), respectively. The AUC for PET/MR was significantly larger than that of mpMR (p = 0.04).
Conclusion:
PSMA PET detects more csPCa than mpMR, but at low specificity. The performance PET/MR is better than mpMR for detection of csPCa in PI-RADS ≥ 3 lesions.
Clinical Registration:
NCT03149861.
Insights
18F-DCFPyL PET/multiparametric MRI (mpMR) shows higher sensitivity for detecting clinically significant prostate cancer (csPCa) than mpMR alone. However, PET/mpMR demonstrates improved performance over mpMR for identifying csPCa in PI-RADS ≥ 3 lesions.
Area of Science:
- Oncology
- Radiology
- Nuclear Medicine
Background:
- Multiparametric MRI (mpMR) is a key tool for prostate cancer (PCa) diagnosis.
- 18F-DCFPyL, a PSMA-targeted PET tracer, offers potential for improved PCa detection.
- Assessing the combined diagnostic value of 18F-DCFPyL PET and mpMR is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate if 18F-DCFPyL PET combined with mpMR enhances the diagnosis of clinically significant (cs) prostate cancer (PCa).
- To compare the diagnostic performance of 18F-DCFPyL PET/mpMR against mpMR alone in patients with suspected PCa or those considered for focal therapies (FT).
Main Methods:
- Prospective study of 55 men with suspected PCa or considered for FT.
- Patients underwent both 18F-DCFPyL PET/mpMR imaging.
- Independent assessment of PET, mpMR, and combined PET/MR using PROMISE classification.
- PET/MR-ultrasound fusion biopsies were performed on suspicious lesions.
Main Results:
- 81.8% of patients had histologically proven PCa; 74.5% had csPCa.
- 18F-DCFPyL PET showed higher sensitivity (86%) for csPCa detection than mpMR (67%) but lower specificity (32% vs 85%).
- PET/mpMR demonstrated a significantly larger AUC (0.78) than mpMR (0.69) for identifying csPCa in PI-RADS ≥ 3 lesions (p=0.04).
Conclusions:
- 18F-DCFPyL PET detects more csPCa than mpMR but with lower specificity.
- The combined PET/mpMR approach shows superior performance compared to mpMR alone for detecting csPCa in PI-RADS ≥ 3 lesions.
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