68Ga prostate-specific membrane antigen PET/computed tomography in benign and malignant prostatic lesions: a study of maximum standardized uptake value and uptake patterns with clinicopathological correlation

AIM: Assessment of maximum standardized uptake value (SUVmax) values and patterns of uptake on 68Ga prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) in benign and malignant prostatic lesions. METHODS: Retrospective observational study of prostate cancer patients referred for 68Ga-PSMA PET/CT for initial staging. SUVmax of the prostatic lesion was correlated with risk category, International Society of Urological Pathology (ISUP) grade groups, prostate-specific antigen (PSA), and Gleason score. Uptake patterns across risk categories were also evaluated. RESULTS: A total of 325 subjects were included (14 benign and 311 malignant). Median SUVmax of benign lesions was 8.29. Grade groups 4 and 5 showed significantly higher median SUVmax values (26.42 and 26.55) than other grade groups. SUVmax correlated positively with ISUP grade group, Gleason score, and serum PSA (all P < 0.001). SUVmax differed significantly among benign/low-, intermediate-, and high-risk groups. Receiver operating characteristic analysis identified an SUVmax cut-off of 10.91 for diagnosing prostate cancer, with 80% sensitivity, 79% specificity, 98.8% positive predictive value, and 80% diagnostic accuracy. Uptake pattern within the prostate did not differ significantly across risk categories. CONCLUSION: SUVmax differentiates high-risk from low- and intermediate-risk prostate cancer and may serve as a noninvasive independent prognostic marker. Intraprostatic uptake pattern has no significant role in lesion categorization.