Diagnostic Value of ⁶⁸Ga-PSMA PET/CT for Detection of Phosphatase and Tensin Homolog Expression in Prostate Cancer: A Pilot Study.

Abstract

Our purpose was to explore the value of ⁶⁸Ga-prostate-specific membrane antigen (PSMA) PET/CT for detection of phosphatase and tensin homolog (PTEN)-loss prostate cancer. <b>Methods:</b> We retrospectively enrolled 75 patients who underwent multiparametric MRI and ⁶⁸Ga-PSMA PET/CT before radical prostatectomy. Lesions were outlined on pathologic images, and regions of interest were drawn on matched multiparametric MRI and PET/CT images. Imaging parameters, including average apparent diffusion coefficient and SUV_max, were derived. Immunohistochemical staining was performed to evaluate the PTEN status. The diagnostic performance of imaging parameters was analyzed by receiver-operating-characteristic analysis. Univariate logistic regression analyses were used to evaluate the association between clinical and imaging variables and PTEN status. <b>Results:</b> In total, 103 lesions from 75 patients were analyzed. Of these lesions, 38 of 103 (36.9%) showed PTEN-loss status. Our study showed a strong association between SUV_max and PTEN-loss tumors both in the per-patient analysis (<i>P</i> < 0.01) and in the per-lesion analysis (<i>P</i> < 0.01), yielding sensitivity and specificity of 0.80 and 0.77, respectively, in the per-patient analysis and 0.83 and 0.74, respectively, in the per-lesion analysis. Meanwhile, higher pathologic PSMA expression was found in the PTEN-deficiency tumors. However, there was no significant difference between PTEN-loss tumors and PTEN-intact tumors using parameters such as average apparent diffusion coefficient (<i>P</i> > 0.05) and score on the Prostate Imaging Reporting and Data System, version 2 (<i>P</i> > 0.05). Surprisingly, SUV_max was a significant predictor for detection of PTEN-loss tumors (odds ratio of 7.56 and 95% confidence interval of 2.18-26.24 on per-patient analysis; odds ratio of 13.66 and 95% confidence interval of 4.32-43.24 on per-lesion analysis). <b>Conclusion:</b>⁶⁸Ga-PSMA PET/CT could effectively detect aggressive PTEN-loss tumors.