Detection Rate of 68Ga-PSMA PET/CT vs. mpMRI Targeted Biopsy for Clinically Significant Prostate Cancer

Background/Aim: To evaluate the diagnostic targeted biopsy (TPBx) in the diagnosis of clinically significant prostate cancer (csPCa: Grade Group >2). Patients and Methods: From January 2021 to January 2022, 45 patients (median age: 67 years) with negative digital rectal examination underwent transperineal prostate biopsy for abnormal PSA values (median 7.3 ng/ml). Before prostate biopsy, all patients underwent mpMRI and 68Ga-PET/CT examinations, which included mpMRI (PI-RADS version 2 >3), and 68Ga-PET/CT index lesions suspicious for cancer (SUVmax >5 g/ml) underwent cognitive targeted cores (mpMRI-TPBx and PSMATPBx: four cores) combined with extended systematic prostate biopsy (eSPBx: median 18 cores). The procedure was performed transperineally using a tru-cut 18-gauge needle under sedation and antibiotic prophylaxis. Results: PCa was found in 29/45 (64.4%) men; in detail, 22/45 (48.9%) were csPCa. 68Gafour (18.1%) vs. seven (31.8%) csPCa, respectively; mpMRITPBx vs. 68Ga-PSMA-TPBx for csPCa showed a diagnostic accuracy of 73.7 vs. 77.5%. Conclusion: 68Ga-PSMA PET/CT TPBx demonstrated good accuracy in the diagnosis of csPCa, which was not inferior to mpMRI-TPBx (77.5 vs. 73.7%), improving the detection rate for cancer in systematic biopsy.