Abstract
P1507
Introduction: Prostate cancer (PCa) is the second most common malignancy to occur in men worldwide, according to the International Agency for Research on Cancer (IARC). There were an estimated 1.4 million new cases and 375,000 deaths due to PCa in 2020. The risk of PCa increases with increasing age. PCa is typically a slowly progressing disease and survival rates are excellent in early-diagnosed cases.
Few studies have recently investigated the viability of CT scans in detecting PCa. Jia et. al. and Huang et al. investigated the use of contrast-enhanced CT (CECT) in detecting peripheral zone PCa and found that a focal area of abnormally increased enhancement in the periphery of the prostate may represent a clinically significant cancer and deserves further investigation with prostate-specific antigen measurement and correlation with other clinical risk-factors for PCa. It is being reported that if a focal lesion in the peripheral zone showed attenuation over 25 HU on either non-contrast or contrast-enhanced CT, it raised strong suspicion for PCa
In the past few years, Ga-68 PSMA PET/CT has emerged as a strong complementary imaging modality to mpMRI for primary prostate cancer detection with comparable, if not better, diagnostic accuracy.
Although PSMA PET/CT scan is commonly performed for prostate cancer these days, the CT component is largely under-utilized in the evaluation of prostate cancer. The purpose of this study was to identify the sensitivity of the non-contrast CT component of PSMA PET/CT based on its attenuation as measured by HU level in the detection of prostate cancer, taking PSMA PET as gold standard.
Methods: A retrospective analysis included 50 biopsy-proven prostate cancer patients between April 2018 and March 2022 who underwent staging whole body PSMA/CT prior to treatment. The control subjects were 50 randomly selected adult male patients who underwent PET/CT for non-prostate malignancy during the same time period.
Two readers independently calculated the Hounsfield unit (HU) of the normal peripheral zone, central zone, and corresponding PSMA avid focus in cases.
Results: There was no significant difference between the normal peripheral zone HU of the two groups. A significant difference in the mean HU was seen between the PSMA avid focus and the normal peripheral zone of cases and controls. ROC curve analysis revealed a mean HU cut-off of >34.9 for detecting PCa with a sensitivity and specificity of 86% and 90% respectively between cases and controls (AUC 0.88)
Conclusions: Our study adds to the evidence that detection of clinically significant PCa is possible on routinely performed non-contrast CT scans. Radiologists should routinely look for and convey these findings to facilitate further work-up and early detection of PCa.
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