Localization of PSMA-avid lesions on PSMA PET-CT on prostate MRI in patients with PI-RADS 3

Hiroaki Takahashi; Hirotsugu Nakai; Karla V. Ballman; Derek J. Lomas; Lance A. Mynderse; Akira Kawashima; Steve Huang; Jordan D. Legout; Jason R. Young; Mattew P. Thorpe; Geoffrey B. Johnson; R. Jeffrey Karnes; Alton O. Sartor; Naoki Takahashi

doi:10.1007/s00261-025-05018-3

Localization of PSMA-avid lesions on PSMA PET-CT on prostate MRI in patients with PI-RADS 3

Hiroaki Takahashi, Hirotsugu Nakai, Karla V. Ballman, Derek J. Lomas, Lance A. Mynderse, Akira Kawashima, Steve Huang, Jordan D. Legout, Jason R. Young, Mattew P. Thorpe, Geoffrey B. Johnson, R. Jeffrey Karnes, Alton O. Sartor, Naoki Takahashi

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: To localize PSMA-avid lesions identified by PSMA PET-CT on separately performed prostate MRI and evaluate imaging findings on fused PET-CT/MRI. Methods: Patients without prior history of clinically significant prostate cancer (csPCa: Gleason score [GS] 3 + 4 or higher) who had (1) PI-RADS 3 on prostate MRI between 2021 and 2023, (2) MRI/US fusion targeted biopsy for PI-RADS 3 lesion(s) and systemic biopsy, and (3) subsequent PSMA PET-CT were identified. PSMA PET-CT images were fused onto prostate MRI. PI-RADS 3 lesions were categorized by PRIMARY score. Discordant PSMA-avid lesions with PRIMARY scores 2–5 outside of PI-RADS 3 lesions were identified. Fisher’s exact test was used to compare the proportion of csPCa on targeted biopsy between PSMA-positive (PRIMARY score 3 or more) and PSMA-negative (PRIMARY score 1 or 2) PI-RADS 3 lesions. P < 0.05 was considered statistically significant. Results: 30 patients (mean age 67 years) with 38 PI-RADS 3 lesions were identified. 29 patients had csPCa, and one patient had GS 6. 22 PI-RADS 3 lesions were PSMA-positive (PRIMARY score 3 or more), of which 18 (81.8%) were csPCa on targeted biopsy; 16 PI-RADS 3 lesions were PSMA-negative, of which 4 (25.0%) were csPCa on targeted biopsy (p < 0.001). Sensitivity and specificity for the presence of csPCa on targeted biopsy was 81.8% and 75.0%. Out of 30 patients, 12 (40.0%) had 16 discordant PSMA-avid (PRIMARY score 2 or more) lesions and 10 patients had 10 discordant PSMA-positive lesions outside PI-RADS 3 lesions In 5 of those 12 (41.7%), discordant PSMA-avid lesions had higher PRIMARY score than PI-RADS 3 lesions. In 4 of those 5 (80%), systemic biopsy showed higher GS than targeted biopsy. Conclusion: Lesion-level analysis showed PSMA-positive PI-RADS 3 lesions had higher probability of csPCa than PSMA-negative PI-RADS 3 lesions. Discordant PSMA-avid lesions with higher PRIMARY score than that of PI-RADS 3 lesions often represented another more aggressive focus not initially identified on MRI.

Original language	English (US)
Journal	Abdominal Radiology
DOIs	https://doi.org/10.1007/s00261-025-05018-3
State	Accepted/In press - 2025

Keywords

Magnetic resonance imaging
PI-RADS
PSMA
Prostate cancer

ASJC Scopus subject areas

Radiological and Ultrasound Technology
Radiology Nuclear Medicine and imaging
Gastroenterology
Urology

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10.1007/s00261-025-05018-3

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Takahashi, H., Nakai, H., Ballman, K. V., Lomas, D. J., Mynderse, L. A., Kawashima, A., Huang, S., Legout, J. D., Young, J. R., Thorpe, M. P., Johnson, G. B., Karnes, R. J., Sartor, A. O., & Takahashi, N. (Accepted/In press). Localization of PSMA-avid lesions on PSMA PET-CT on prostate MRI in patients with PI-RADS 3. Abdominal Radiology. https://doi.org/10.1007/s00261-025-05018-3

@article{2f935a50aec24538a77d134a7f899b3d,

title = "Localization of PSMA-avid lesions on PSMA PET-CT on prostate MRI in patients with PI-RADS 3",

abstract = "Purpose: To localize PSMA-avid lesions identified by PSMA PET-CT on separately performed prostate MRI and evaluate imaging findings on fused PET-CT/MRI. Methods: Patients without prior history of clinically significant prostate cancer (csPCa: Gleason score [GS] 3 + 4 or higher) who had (1) PI-RADS 3 on prostate MRI between 2021 and 2023, (2) MRI/US fusion targeted biopsy for PI-RADS 3 lesion(s) and systemic biopsy, and (3) subsequent PSMA PET-CT were identified. PSMA PET-CT images were fused onto prostate MRI. PI-RADS 3 lesions were categorized by PRIMARY score. Discordant PSMA-avid lesions with PRIMARY scores 2–5 outside of PI-RADS 3 lesions were identified. Fisher{\textquoteright}s exact test was used to compare the proportion of csPCa on targeted biopsy between PSMA-positive (PRIMARY score 3 or more) and PSMA-negative (PRIMARY score 1 or 2) PI-RADS 3 lesions. P < 0.05 was considered statistically significant. Results: 30 patients (mean age 67 years) with 38 PI-RADS 3 lesions were identified. 29 patients had csPCa, and one patient had GS 6. 22 PI-RADS 3 lesions were PSMA-positive (PRIMARY score 3 or more), of which 18 (81.8\%) were csPCa on targeted biopsy; 16 PI-RADS 3 lesions were PSMA-negative, of which 4 (25.0\%) were csPCa on targeted biopsy (p < 0.001). Sensitivity and specificity for the presence of csPCa on targeted biopsy was 81.8\% and 75.0\%. Out of 30 patients, 12 (40.0\%) had 16 discordant PSMA-avid (PRIMARY score 2 or more) lesions and 10 patients had 10 discordant PSMA-positive lesions outside PI-RADS 3 lesions In 5 of those 12 (41.7\%), discordant PSMA-avid lesions had higher PRIMARY score than PI-RADS 3 lesions. In 4 of those 5 (80\%), systemic biopsy showed higher GS than targeted biopsy. Conclusion: Lesion-level analysis showed PSMA-positive PI-RADS 3 lesions had higher probability of csPCa than PSMA-negative PI-RADS 3 lesions. Discordant PSMA-avid lesions with higher PRIMARY score than that of PI-RADS 3 lesions often represented another more aggressive focus not initially identified on MRI.",

keywords = "Magnetic resonance imaging, PI-RADS, PSMA, Prostate cancer",

author = "Hiroaki Takahashi and Hirotsugu Nakai and Ballman, \{Karla V.\} and Lomas, \{Derek J.\} and Mynderse, \{Lance A.\} and Akira Kawashima and Steve Huang and Legout, \{Jordan D.\} and Young, \{Jason R.\} and Thorpe, \{Mattew P.\} and Johnson, \{Geoffrey B.\} and Karnes, \{R. Jeffrey\} and Sartor, \{Alton O.\} and Naoki Takahashi",

note = "Publisher Copyright: {\textcopyright} The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.",

year = "2025",

doi = "10.1007/s00261-025-05018-3",

language = "English (US)",

journal = "Abdominal Radiology",

issn = "2366-004X",

publisher = "Springer",

}

TY - JOUR

T1 - Localization of PSMA-avid lesions on PSMA PET-CT on prostate MRI in patients with PI-RADS 3

AU - Takahashi, Hiroaki

AU - Nakai, Hirotsugu

AU - Ballman, Karla V.

AU - Lomas, Derek J.

AU - Mynderse, Lance A.

AU - Kawashima, Akira

AU - Huang, Steve

AU - Legout, Jordan D.

AU - Young, Jason R.

AU - Thorpe, Mattew P.

AU - Johnson, Geoffrey B.

AU - Karnes, R. Jeffrey

AU - Sartor, Alton O.

AU - Takahashi, Naoki

N1 - Publisher Copyright: © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.

PY - 2025

Y1 - 2025

N2 - Purpose: To localize PSMA-avid lesions identified by PSMA PET-CT on separately performed prostate MRI and evaluate imaging findings on fused PET-CT/MRI. Methods: Patients without prior history of clinically significant prostate cancer (csPCa: Gleason score [GS] 3 + 4 or higher) who had (1) PI-RADS 3 on prostate MRI between 2021 and 2023, (2) MRI/US fusion targeted biopsy for PI-RADS 3 lesion(s) and systemic biopsy, and (3) subsequent PSMA PET-CT were identified. PSMA PET-CT images were fused onto prostate MRI. PI-RADS 3 lesions were categorized by PRIMARY score. Discordant PSMA-avid lesions with PRIMARY scores 2–5 outside of PI-RADS 3 lesions were identified. Fisher’s exact test was used to compare the proportion of csPCa on targeted biopsy between PSMA-positive (PRIMARY score 3 or more) and PSMA-negative (PRIMARY score 1 or 2) PI-RADS 3 lesions. P < 0.05 was considered statistically significant. Results: 30 patients (mean age 67 years) with 38 PI-RADS 3 lesions were identified. 29 patients had csPCa, and one patient had GS 6. 22 PI-RADS 3 lesions were PSMA-positive (PRIMARY score 3 or more), of which 18 (81.8%) were csPCa on targeted biopsy; 16 PI-RADS 3 lesions were PSMA-negative, of which 4 (25.0%) were csPCa on targeted biopsy (p < 0.001). Sensitivity and specificity for the presence of csPCa on targeted biopsy was 81.8% and 75.0%. Out of 30 patients, 12 (40.0%) had 16 discordant PSMA-avid (PRIMARY score 2 or more) lesions and 10 patients had 10 discordant PSMA-positive lesions outside PI-RADS 3 lesions In 5 of those 12 (41.7%), discordant PSMA-avid lesions had higher PRIMARY score than PI-RADS 3 lesions. In 4 of those 5 (80%), systemic biopsy showed higher GS than targeted biopsy. Conclusion: Lesion-level analysis showed PSMA-positive PI-RADS 3 lesions had higher probability of csPCa than PSMA-negative PI-RADS 3 lesions. Discordant PSMA-avid lesions with higher PRIMARY score than that of PI-RADS 3 lesions often represented another more aggressive focus not initially identified on MRI.

AB - Purpose: To localize PSMA-avid lesions identified by PSMA PET-CT on separately performed prostate MRI and evaluate imaging findings on fused PET-CT/MRI. Methods: Patients without prior history of clinically significant prostate cancer (csPCa: Gleason score [GS] 3 + 4 or higher) who had (1) PI-RADS 3 on prostate MRI between 2021 and 2023, (2) MRI/US fusion targeted biopsy for PI-RADS 3 lesion(s) and systemic biopsy, and (3) subsequent PSMA PET-CT were identified. PSMA PET-CT images were fused onto prostate MRI. PI-RADS 3 lesions were categorized by PRIMARY score. Discordant PSMA-avid lesions with PRIMARY scores 2–5 outside of PI-RADS 3 lesions were identified. Fisher’s exact test was used to compare the proportion of csPCa on targeted biopsy between PSMA-positive (PRIMARY score 3 or more) and PSMA-negative (PRIMARY score 1 or 2) PI-RADS 3 lesions. P < 0.05 was considered statistically significant. Results: 30 patients (mean age 67 years) with 38 PI-RADS 3 lesions were identified. 29 patients had csPCa, and one patient had GS 6. 22 PI-RADS 3 lesions were PSMA-positive (PRIMARY score 3 or more), of which 18 (81.8%) were csPCa on targeted biopsy; 16 PI-RADS 3 lesions were PSMA-negative, of which 4 (25.0%) were csPCa on targeted biopsy (p < 0.001). Sensitivity and specificity for the presence of csPCa on targeted biopsy was 81.8% and 75.0%. Out of 30 patients, 12 (40.0%) had 16 discordant PSMA-avid (PRIMARY score 2 or more) lesions and 10 patients had 10 discordant PSMA-positive lesions outside PI-RADS 3 lesions In 5 of those 12 (41.7%), discordant PSMA-avid lesions had higher PRIMARY score than PI-RADS 3 lesions. In 4 of those 5 (80%), systemic biopsy showed higher GS than targeted biopsy. Conclusion: Lesion-level analysis showed PSMA-positive PI-RADS 3 lesions had higher probability of csPCa than PSMA-negative PI-RADS 3 lesions. Discordant PSMA-avid lesions with higher PRIMARY score than that of PI-RADS 3 lesions often represented another more aggressive focus not initially identified on MRI.

KW - Magnetic resonance imaging

KW - PI-RADS

KW - PSMA

KW - Prostate cancer

UR - https://www.scopus.com/pages/publications/105007137578

UR - https://www.scopus.com/inward/citedby.url?scp=105007137578&partnerID=8YFLogxK

U2 - 10.1007/s00261-025-05018-3

DO - 10.1007/s00261-025-05018-3

M3 - Article

AN - SCOPUS:105007137578

SN - 2366-004X

JO - Abdominal Radiology

JF - Abdominal Radiology

ER -

Localization of PSMA-avid lesions on PSMA PET-CT on prostate MRI in patients with PI-RADS 3

Abstract

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