The PSMA PET/CT + mpMRI PCa Effect

There’s been a growing number of studies comparing 68Ga-PSMA PET/CT and mpMRI’s effectiveness along the prostate cancer pathway, but new research suggests that the modalities might be particularly effective if used together early in the diagnostic process.

The Study – A team of Australian researchers reviewed pre-operative mpMRI and 68Ga-PSMA PET/CT exams from 1,123 men (median PSA = 6), comparing their imaging results and histology findings. Here’s what they discovered:

  • mpMRI identified tumors in 93 men (8%) that were missed by 68Ga-PSMA PET/CT
  • 68Ga-PSMA PET/CT spotted tumors in 117 men (10%) that mpMRI missed
  • The combined modalities identified index tumors with Gleason Scores of ≥3+4 in 92% of men (vs. 80% w/ only mpMRI & 82% w/ only PSMA PET/CT)
  • 68Ga-PSMA PET/CT and mpMRI performed similarly for lesion/tumor detection and localization

Better Assessments and Decisions – In addition to identifying more tumors, mpMRI and 68Ga-PSMA PET/CT’s combined localization accuracy might improve biopsy targeting, leading to more accurate tumor grading and better management decisions.

More Necessary Biopsies – Meanwhile, patients with negative mpMRI and 68Ga-PSMA PET/CT findings would likely have a low risk of clinically significant prostate cancer, making them solid candidates for active PSA monitoring and allowing them to avoid unnecessary biopsies.

The Takeaway – This approach needs a lot more research and PSMA tracers currently only have FDA approval for patients with metastatic prostate cancer or biochemical recurrence, so 68Ga-PSMA PET/CT won’t be combined with mpMRI in early diagnostic exams very soon. That said, this study suggests that we’ll see more future efforts to combine and evaluate mpMRI + 68Ga-PSMA PET/CT as an early diagnostic step.

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-- The Imaging Wire team