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Advances in Radiotherapy
& Nuclear Medicine 68 Ga-PSMA PET CT/MRI in prostate cancer

Table 1. Summary of the main findings of articles about the role of Ga-PSMA-PET in the initial diagnosis of prostate cancer
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Author and year Sample size Sensitivity Specificity Conclusion
Kawada et al. 10 497 0.89 (95% CI, 0.85 – 0.93) 0.56 (95% CI, 0.29 – 0.80) 68 Ga-PSMA-PET-TB shows promise but needs
more validation in diagnosis.
Evangelista et al. 11 2104 0.949 (95% CI, 0.875 – 0.986) 0.909 (95% CI, 0.437 – 0.789) 68 Ga-PSMA-PET shows promising accuracy in
diagnosing primary prostate cancer.
Satapathy et al. 12 389 0.97 (95% CI, 0.90 – 0.99) 0.66 (95% CI, 0.52 – 0.78) 68 Ga-PSMA-PET/CT is highly sensitive for initial
diagnosis but with moderate specificity.
Caracciolo et al. 14 1379 NR NR 68 Ga PSMA-PET/CT is highly sensitive for initial
prostate cancer diagnosis.
Abbreviations: Ga-PSMA-PET-TB: Gallium-68-prostate-specific membrane antigen-positron emission tomography-targeted biopsy; CT: Computed
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tomography; CI: Confidence interval.
In a retrospective study by Pepe et al. , it was noted Table 2. Summary of the main finding of the articles on the
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that an SUV max >8 indicated the presence of csPCa with relation of Ga-PSMA-PET to histopathology
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a false-positive rate of 4.8%. The use of Ga-PSMA-PET Author and year Parameter Finding
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demonstrates promising potential as a non-invasive
Ga PSMA-
diagnostic tool for PCa, showing strong correlation with Caracciolo et al. 14 68 PET/CT There is a high correlation
between Ga-PSMA-PET/CT
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GS and PSA levels for risk assessment and treatment and histopathology for clinically
planning. The uptake of Ga-PSMA on PET/CT is significant prostate cancer
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notably higher in individuals with PCa who have a GS of identification.
≥8 or PSA levels of ≥10 ng/mL compared to those with GS Sood et al. 15 SUVmax in Higher in patients with GS ≥8 or
≤7 or PSA ≤10 ng/mL. This shows the potential of PET High-Risk PSA level ≥10 ng/mL compared to
findings to reflect the aggressiveness and severity of PCa, Patients those with GS
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as assessed by GS and PSA levels. A review by Jiao et al. Zhao et al. , 68 Ga-PSMA Overexpression in prostate tumors,
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17
has also shown that SUV values are significantly higher Wu et al. 18 Expression associated with higher PSA levels
max
in patients with GS >7 or PSA >10 ng/mL compared to and GS
those with GS ≤7 or PSA ≤10 ng/mL. Table 2 shows the Jiao et al. 19 68 Ga-PSMA- Higher SUVmax values in patients
summary of the main findings of the articles in this section. PET with GS > 7 or PSA > 10 ng/ml,
correlation with nodal involvement
3.3. Performance in TNM staging and primary tumor aggressiveness
Hu et al. 21 Gleason score There is a close correlation between
PSMA-PET imaging, particularly Ga-PSMA-PET/CT, PSA levels and GS
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has emerged as a superior method for N and M staging in Abbreviations: Ga-PSMA-PET/CT: Gallium-68-prostate-specific
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high-risk PCa patients, showing increased sensitivity and membrane antigen-positron emission tomography/computed
accuracy in detecting lymph nodes and distant metastases. tomography; GS: Gleason scores; PSA: Prostate-specific antigen;
In addition, Ga-PSMA-PET demonstrates remarkable SUVmax: Maximum standardized uptake value.
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sensitivity in the early detection of PCa, surpassing
conventional imaging techniques. The integration of analysis revealed comparable diagnostic accuracy for EPE
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68 Ga-PSMA-PET/CT with clinical nomograms enhances detection between Ga-PSMA-PET/MRI and Ga-PSMA-
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the prediction of lymph node metastasis (LNM), PET/CT, with overlapping performance ranges. While
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potentially reducing unnecessary surgeries and improving Ga-PSMA-PET/CT capable in detecting smaller lesions,
nodal staging accuracy. 22-24 Moreover, 68 Ga-PSMA- it is less accurate than mpMRI in T-staging, particularly
PET exhibits moderate sensitivity and outstanding in identifying EPE and SVI. SUV cutoff values ranging
max
specificity in detecting seminal vesicle invasion (SVI) from 3.0 to 4.0 aid in differentiating PCa lesions, with
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and extraprostatic extension (EPE) in newly diagnosed Ga-PSMA-PET showing greater correspondence with
PCa patients undergoing radical prostatectomy. Studies histopathology in detecting gross tumor volume compared
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comparing PET/MRI to PET/CT suggest that PET/MRI to mpMRI. For T staging, Ga-PSMA-PET/MRI offers
offers superior sensitivity in detecting SVI, potentially superior accuracy in identifying T3 PCa, particularly
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attributed to its multiparametric approach, while discerning EPE and SVI.
variability in imaging protocols underscores the need for For the identification of LNM, analyses of diagnostic
standardized assessment criteria to enhance the accuracy accuracy and detection rate indicate potentially better
of Ga-PSMA-PET in local staging. 23,25 However, the performance with Ga-PSMA-PET/MRI compared to
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Volume 2 Issue 4 (2024) 4 doi: 10.36922/arnm.4590