Role of ¹⁸ F-PSMA PET/MRI in Prostate Cancer Recurrence After Prostatectomy

¹⁸F-PSMA PET/CT and pelvic MRI are useful for assessing biochemical recurrence of prostate cancer after prostatectomy. We evaluated the role of ¹⁸F-PSMA PET/MRI in a 1-stop-shop protocol combining a single injection of ¹⁸F-PSMA, followed by pelvic PET/multiparametric MRI (mpMRI) and whole-body PET/CT acquisitions for the detection of recurrent disease. Methods: We evaluated 106 consecutive patients referred to our institute for biochemical recurrence after prostatectomy using a 1-stop-shop protocol comprising whole-body ¹⁸F-PSMA PET/CT and pelvic ¹⁸F-PSMA PET/mpMRI. Each imaging modality was reviewed in a blinded manner by 2 independent, experienced readers. ¹⁸F-PSMA PET/MRI, with positivity on either MRI or PSMA PET, served as the reference standard. Results:¹⁸F-PSMA PET/MRI detected more local recurrences (n = 52, 49.06%) compared with ¹⁸F-PSMA PET/CT (n = 42, 39.62%) and mpMRI (n = 46, 43.00%). Discordant cases accounted for 18 patients (17%): 10% were positive only on MRI and 7% only on PSMA PET. Compared with ¹⁸F-PSMA PET/MRI, both mpMRI and ¹⁸F-PSMA PET demonstrated similar performance, with sensitivities of 88.5% and 78.8% and specificities of 100% and 98.1%, respectively. Conclusion:¹⁸F-PSMA PET/MRI outperformed PET/CT and mpMRI in the detection of local recurrences of prostate cancer.