Keywords: Prostate, PET/MR, PSMA, prostate cancer, active surveillance, 18F-DCFPyL
Motivation: High interobserver variability and low-to-moderate sensitivity and specificity for detecting clinically significant prostate cancer (PC) limit the utility multiparametric MRI (mpMRI) in men with PC on active surveillance (AS).
Goal(s): To determine the diagnostic accuracy of 18F-DCFPyL PSMA-PET/MRI compared to mpMRI in men with PC on AS.
Approach: Prospective diagnostic trial of 100 men with PC on AS. PI-RADS ≥3 and Likert ≥3 lesions, identified by experienced, blinded radiologists and nuclear medicine physicians, respectively, were targeted for PSMA PET/MRI-US fusion biopsy by an experienced urologic oncologist.
Results: PSMA PET/MRI improves detection of csPC in men on AS while maintaining high negative predictive value.
Impact: Imaging and clinical predictive models that include PSMA PET/MRI may identify low and intermediate-risk men who could potentially avoid prostate biopsy and coincident morbidity, as well as increase the detection rates of csPC missed by MRI-biopsy alone.
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