The Contribution of Multiparametric Pelvic and Whole-Body MRI to Interpretation of ¹⁸F-Fluoromethylcholine or ⁶⁸Ga-HBED-CC PSMA-11 PET/CT in Patients with Biochemical Failure After Radical Prostatectomy

Our purpose was to assess whether the addition of data from multiparametric pelvic MRI (mpMR) and whole-body MRI (wbMR) to the interpretation of ¹⁸F-fluoromethylcholine (¹⁸F-FCH) or ⁶⁸Ga-HBED-CC PSMA-11 (⁶⁸Ga-PSMA) PET/CT (=PET) improves the detection of local tumor recurrence or of nodal and distant metastases in patients after radical prostatectomy with biochemical failure. <b>Methods:</b> The current analysis was performed as part of a prospective, multicenter trial on ¹⁸F-FCH or ⁶⁸Ga-PSMA PET, mpMR, and wbMR. Eligible men had an elevated level of prostate-specific antigen (PSA) (&gt;0.2 ng/mL) and high-risk features (Gleason score &gt; 7, PSA doubling time &lt; 10 mo, or PSA &gt; 1.0 ng/mL) with negative or equivocal conventional imaging results. PET was interpreted with mpMR and wbMR in consensus by 2 radiologists and compared with prospective interpretation of PET or MRI alone. Performance measures of each modality (PET, MRI, and PET/mpMR–wbMR) were compared for each radiotracer and each individual patient (for ¹⁸F-FCH, or ⁶⁸Ga-PSMA for patients who had ⁶⁸Ga-PSMA PET) and to a composite reference standard. <b>Results:</b> There were 86 patients with PET (¹⁸F-FCH [<i>n</i> = 76] and/or ⁶⁸Ga-PSMA [<i>n</i> = 26]) who had mpMR and wbMR. Local tumor recurrence was detected in 20 of 76 (26.3%) on ¹⁸F-FCH PET/mpMR, versus 11 of 76 (14.5%) on ¹⁸F-FCH PET (<i>P</i> = 0.039), and in 11 of 26 (42.3%) on ⁶⁸Ga-PSMA PET/mpMR, versus 6 of 26 (23.1%) on ⁶⁸Ga-PSMA PET (<i>P</i> = 0.074). Per patient, PET/mpMR was more often positive for local tumor recurrence than PET (<i>P</i> = 0.039) or mpMR (<i>P</i> = 0.019). There were 20 of 86 patients (23.3%) with regional nodal metastases on both PET/wbMR and PET (<i>P</i> = 1.0) but only 12 of 86 (14%) on wbMR (<i>P</i> = 0.061). Similarly, there were more nonregional metastases detected on PET/wbMR than on PET (<i>P</i> = 0.683) or wbMR (<i>P</i> = 0.074), but these differences did not reach significance. Compared with the composite reference standard for the detection of disease beyond the prostatic fossa, PET/wbMR, PET, and wbMR had sensitivity of 50%, 50%, and 8.3%, respectively, and specificity of 97.1%, 97.1%, and 94.1%, respectively. <b>Conclusion:</b> Interpretation of PET/mpMR resulted in a higher detection rate for local tumor recurrence in the prostatic bed in men with biochemical failure after radical prostatectomy. However, the addition of wbMR to ¹⁸F-FCH or ⁶⁸Ga-PSMA PET did not improve detection of regional or distant metastases.

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