Diagnostic Performance of 18F-PSMA-1007 PET/CT for Seminal Vesicle Invasion in Prostate Cancer

Introduction: To determine the PCa patients with ¹⁸F-PSMA-1007 PET/CT seminal vesicle invasion (SVI) findings represent a higher-risk clinical outcome.

Methods: Retrospective analysis of consecutive 392 biopsy-proven PCa patients between September 2020 and November 2021 compared the prostate-specific antigen (PSA), Gleason score and international urology Society of Pathology (ISUP), and prostate gland Maximum Standardized Uptake Value (SUVmax) between ¹⁸F-PSMA-1007 PET/CT SVI positive and negative. Receiver operating characteristics was calculated for clinicopathologic characteristics and SUVmax. Finally, the consistency between PET/CT SVI results and 49 follow-up patients and 88 independent cohort pathologically confirmed SVI patients were analysed.

Results: There were significant differences in clinicopathologic characteristics and SUVmax between patients with positive (203/392) and negative (189/392) PET/CT SVI. The prostate gland SUVmax threshold was 14.55 and the area under the curve was 0.761 (P < .001), with 80.79% sensitivity and 60.85% specificity, which were statistically different compared with PSA, Gleason score and ISUP (P = .002; P = .002 and P = .026, respectively). During follow-up,14 patients had disease progression, of which 10/14 (71.43%) had SUVmax > 14.55 and positive PET/CT SVI. Thirty-five patients remained stable or improved, of which 14/35 patients (40.00%) had SUVmax > 14.55 and positive PET/CT SVI. Among 88 independent cohort patients, 15/16 (93.75%) of true-positive and false-negative 10/12 (83.33%) had SUVmax >14.55.

Conclusions: ¹⁸F-PSMA PET/CT SVI represents a higher-risk clinical outcome. The prostate gland SUVmax >14.55 may indicate a worse prognosis for PCa patients and potential evidence of pathology seminal vesicle invasion on negative PET/CT.

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