MRI scans can detect prostate cancer more accurately than new imaging technique

A team of researchers in Australia and New Zealand has found that MRI scans can detect prostate cancer more accurately than the newer, prostate-specific PSMA PET/CT scanning technique.

The findings will be presented today at the annual conference of the European Association of Urology (EAU22), in Amsterdam.

Prostate-specific membrane antigen (PSMA) PET/CT scans, approved by the US FDA in 2020, use a radioactive dye to “lighten” areas of PSMA, which are on the surface of prostate cancer cells. They are currently used to treat prostate cancer because they can accurately measure the progression or recurrence of the disease. So in this trial, the researchers set out to see if they could also be used to diagnose prostate cancer.

The PEDAL study recruited 240 patients in five hospital groups at risk for prostate cancer. Each patient received both an MRI scan and a PSMA PET/CT scan. If imaging suggested the presence of prostate cancer, a biopsy was performed by the patient’s urologist.

The MRI scans picked up abnormalities in 141 patients, while the PSMA PET/CT scans picked up abnormalities in 198 patients. A total of 181 patients (75%) underwent a prostate biopsy, and 82 of those patients were subsequently found to have clinically significant prostate cancer.

Because each patient had both types of scans, the researchers were able to assess which type had detected the patients with prostate cancer more accurately. The researchers found that MRI scans were significantly more accurate in detecting any grade of prostate cancer than the PSMA PET scans (0.75% for MRI vs. 0.62% for PSMA PET).

Associate Professor Lih-Ming Wong, consultant uro-oncologist at St Vincent’s Hospital in Melbourne, Australia, led the research team. He said: “Our analysis found that MRI scans were better than PSMA-PET at detecting any grade of prostate cancer. When we looked only at clinically significant prostate cancers, there was no difference in accuracy. As this study was one of the first is that studies using PSMA-PET to diagnose cancer in the prostate, we are still learning and adapting how to improve the use of PSMA-PET in this setting.

While detection thresholds will be refined as diagnostic use develops, Professor Wong believes the study has important lessons for clinicians.

He says: “This study confirms that the existing ‘gold standard’ of pre-biopsy detection – the MRI – is indeed a high yardstick. Even with fine-tuning, we suspect that PSMA PET/CT will not replace MRI as the main method of detecting of prostate cancer, but it will likely be used in the future as an adjunct to MRI, or for people for whom MRI is not appropriate, or as a single combined “diagnostic and staging” scan for appropriately selected patients.”

He continues, “This is why these kinds of robust studies are crucial so that we can better understand the role these technologies can play at each stage of the cancer pathway and advance prostate cancer treatment.”

Professor Peter Albers, Chairman of the Chief Scientific Office of the European Association of Urology, comments: “New diagnostic tools need to be tested just as carefully as new drugs, so we welcome the findings of this remarkable Phase III study, which showed that MRI was superior in the detection of prostate cancer.

“It also showed that PSMA PET/CT was not inferior to MRI in the detection of clinically significant cancers (ISUP 2 and above); and since the ultimate goal of primary staging will be to detect only the more aggressive cancers and avoid unnecessary biopsy This is not the end of the story More research will be needed to investigate the PSMA PET/CT correlation between the standard exposure value (SUV) and cancer aggressiveness, but the first steps towards finding of the best diagnostic approach for clinically significant prostate cancer.”

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