{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:22:39Z","timestamp":1789842159759,"version":"4.0.1"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Prostate-specific membrane antigen (PSMA) is markedly overexpressed in prostate cancer (PCa), and there is growing evidence to support its usefulness in initial diagnostic assessments. This study compares the diagnostic performance of PSMA positron emission tomography\/computed tomography (PET\/CT) and magnetic resonance imaging (mpMRI) in evaluating seminal vesicle invasion (SVI), extraprostatic extension (EPE), and pelvic lymph node involvement before radical prostatectomy. Methods: A retrospective, single-institution analysis was performed. From a cohort of 325 patients who underwent radical prostatectomy between June 2022 to November 2024, 85 had undergone preoperative PSMA PET\/CT for intermediate- and high-risk disease at biopsy, forming our study group. Two blinded specialists, one in radiology and one in nuclear medicine, independently interpreted the scans, using histopathological results as the reference standard. The primary outcome was diagnostic accuracy for T- and N-stage classification, while the secondary outcomes included the correct identification of the index lesion and comparative performance for each modality. Results: The study cohort comprised patients with intermediate-to-high-risk prostate cancer (median age: 66 years; median PSA level: 11.6 ng\/mL; median PSA density: 0.3 ng\/mL\/cm3). Forty-eight patients presented with an ISUP grade of 3 or higher on biopsy. PSMA PET\/CT was more sensitive than MRI for detecting EPE (72.2% vs. 46.9%) and nodal metastases (91.7% vs. 8.3%). Furthermore, PSMA PET\/CT demonstrated significantly higher concordance with histopathological findings in index tumor localization (76.5% vs. 67.9%, p &lt; 0.001). An exploratory analysis revealed a potential age-dependent pattern, but this requires confirmation in larger studies. Conclusions: In this select cohort, PSMA PET\/CT demonstrated greater accuracy than MRI for locoregional staging in patients with intermediate-to-high-risk prostate cancer (PCa). However, the generalizability of these findings is limited by the retrospective design and potential selection bias. These results suggest that PSMA PET\/CT may have a valuable role in the initial staging workflow, but this needs to be confirmed in larger, prospective studies. An exploratory analysis suggested a potential age-dependent pattern, but this requires confirmation in larger studies.<\/jats:p>","DOI":"10.3390\/medsci14010064","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T16:12:37Z","timestamp":1770048757000},"page":"64","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diagnostic Accuracy of PSMA-PET\/CT vs. mpMRI in Primary Staging of Intermediate- and High-Risk Prostate Cancer"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2425-9795","authenticated-orcid":false,"given":"Vanessa","family":"Talavera Cobo","sequence":"first","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Andres","family":"Y\u00e1nez Ruiz","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Daniel","family":"Tapia Tapia","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2503-9368","authenticated-orcid":false,"given":"Andres","family":"Calva Lopez","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1175-5706","authenticated-orcid":false,"given":"Carmina Alejandra","family":"Mu\u00f1oz Bastidas","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Javer","family":"Ancizu Marckert","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Torres Roca","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3882-4203","authenticated-orcid":false,"given":"Luis Labairu","family":"Huerta","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1803-580X","authenticated-orcid":false,"given":"Daniel","family":"Sanchez Zalabardo","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Jose","family":"Diez-Caballero Alonso","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9749-8076","authenticated-orcid":false,"given":"Francisco","family":"Guillen-Grima","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"},{"name":"Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain"},{"name":"Group of Clinical Epidemiology, Area of Epidemiology and Public Health, Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain"},{"name":"CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5698-641X","authenticated-orcid":false,"given":"Jose E.","family":"Robles Garc\u00eda","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7745-5650","authenticated-orcid":false,"given":"Bernardino","family":"Mi\u00f1ana-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Urology Department, Cl\u00ednica Universidad de Navarra, 28027 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s11307-021-01650-9","article-title":"Incremental Impact of [68Ga]Ga-PSMA-11 PET\/CT in Primary N and M Staging of Prostate Cancer Prior to Curative-Intent Surgery: A Prospective Clinical Trial in Comparison with mpMRI","volume":"24","author":"Szigeti","year":"2022","journal-title":"Mol. Imaging Biol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Liu, X., Jiang, T., Gao, C.L., Liu, H.T., Sun, Y., Zou, Q., Tang, R., and Zeng, W.B. (2022). Detection rate of fluorine-18 prostate-specific membrane antigen-1007 PET\/CT for prostate cancer in primary staging and biochemical recurrence with different serum PSA levels: A systematic review and meta-analysis. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.911146"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/pros.24799","article-title":"Head-to-head comparison of GA-68 PSMA PET\/CT and multiparametric MRI findings with postoperative results in preoperative locoregional staging and localization of prostate cancer","volume":"85","author":"Dinckal","year":"2025","journal-title":"Prostate"},{"key":"ref_4","unstructured":"Cornford, P., Tilki, D., van den Bergh, R.C.N., Eberli, D., De Meerleer, G., De Santis, M., Farolfi, A., Gandaglia, G., Gillessen, S., and Grivas, N. (2025). EAU\u2013EANM\u2013ESTRO\u2013ESUR\u2013ISUP\u2013SIOG Guidelines on Prostate Cancer. EAU Guidelines, EAU Guidelines Office."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13550-022-00881-3","article-title":"Comparison of 68Ga-PSMA PET\/CT and multiparametric MRI for the detection of low- and intermediate-risk prostate cancer","volume":"12","author":"Zhou","year":"2022","journal-title":"EJNMMI Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"469","DOI":"10.2967\/jnumed.117.198119","article-title":"Prostate cancer molecular imaging standardized evaluation (PROMISE): Proposed miTNM classification for the interpretation of PSMA-ligand PET\/CT","volume":"59","author":"Eiber","year":"2018","journal-title":"J. Nucl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4590","DOI":"10.36922\/arnm.4590","article-title":"68Ga-PSMA PET CT\/MRI in the initial diagnosis and staging of prostate cancer: A review","volume":"2","author":"Akinmuleya","year":"2024","journal-title":"Adv. Radiother. Nucl. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1055\/s-0044-1787733","article-title":"Baseline Ga-68 PSMA PET-Derived Primary Tumor Parameters in Patients with Prostate Cancer and Their Association with Clinical Risk Stratification and Clinicopathologic Features","volume":"23","author":"Aksu","year":"2024","journal-title":"World J. Nucl. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1007\/s12149-025-02033-8","article-title":"Superiority of 68Ga-PSMA-11 PET\/CT over mpMRI for lateralization accuracy of diagnosing intra-glandular prostate cancer lesions: Avoiding fluke targeting","volume":"39","author":"Wang","year":"2025","journal-title":"Ann. Nucl. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/s00259-023-06464-1","article-title":"A single-center, multi-factor, retrospective study to improve the diagnostic accuracy of primary prostate cancer using [68Ga]Ga-PSMA-11 total-body PET\/CT imaging","volume":"51","author":"Lv","year":"2024","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Awenat, S., Piccardo, A., Carvoeiras, P., Signore, G., Giovanella, L., Prior, J.O., and Treglia, G. (2021). Diagnostic role of 18F-PSMA-1007 PET\/CT in prostate cancer staging: A systematic review. Diagnostics, 11.","DOI":"10.3390\/diagnostics11030552"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s41824-020-00085-9","article-title":"Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of prostate cancer: A systematic review and meta-analysis","volume":"4","author":"Woo","year":"2020","journal-title":"Eur. J. Hybrid Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wang, Y., Jing, R., Wang, H., and Zhao, Q. (2024). 68Ga-PSMA-11 PET and mpMRI in the diagnosis of initial lymph node staging of prostate cancer: A head-to-head comparative meta-analysis. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1425134"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"847","DOI":"10.2967\/jnumed.121.262398","article-title":"Head-to-head comparison of 68Ga-PSMA-11 PET\/CT and mpMRI with histopathology gold-standard in the detection, intra-prostatic localization and local extension of primary prostate cancer: Results from a prospective single-center imaging trial","volume":"63","author":"Sonni","year":"2022","journal-title":"J. Nucl. Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Cereser, L., Evangelista, L., Giannarini, G., and Girometti, R. (2023). Prostate MRI and PSMA-PET in the Primary Diagnosis of Prostate Cancer. Diagnostics, 13.","DOI":"10.3390\/diagnostics13162697"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Vescovo, M., Raspollini, M.R., Nibid, L., Castiglione, F., Nardi, E., de Biase, D., Massari, F., Giunchi, F., Pepe, F., and Troncone, G. (2025). Storage Time and DNA Quality Determine BRCA1\/2 Sequencing Success in Prostate Cancer: A Multicentre Analysis with Therapeutic Implications. Cancers, 17.","DOI":"10.3390\/cancers17101705"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/S0140-6736(20)30314-7","article-title":"Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): A prospective, randomised, multicentre study","volume":"395","author":"Hofman","year":"2020","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.eururo.2021.08.002","article-title":"The Additive Diagnostic Value of Prostate-specific Membrane Antigen Positron Emission Tomography Computed Tomography to Multiparametric Magnetic Resonance Imaging Triage in the Diagnosis of Prostate Cancer (PRIMARY): A Prospective Multicentre Study","volume":"80","author":"Emmett","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1001\/jamaoncol.2021.3771","article-title":"Diagnostic Accuracy of 68Ga-PSMA-11 PET for Pelvic Nodal Metastasis Detection Prior to Radical Prostatectomy and Pelvic Lymph Node Dissection: A Multicenter Prospective Phase 3 Imaging Trial","volume":"7","author":"Hope","year":"2021","journal-title":"JAMA Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40644-020-0290-9","article-title":"PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: An expedited systematic review","volume":"20","author":"Petersen","year":"2020","journal-title":"Cancer Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.eururo.2015.06.010","article-title":"Initial Experience of 68Ga-PSMA PET\/CT Imaging in High-risk Prostate Cancer Patients Prior to Radical Prostatectomy","volume":"69","author":"Salomon","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wang, X., Wen, Q., Zhang, H., and Ji, B. (2021). Head-to-Head Comparison of 68Ga-PSMA-11 PET\/CT and Multiparametric MRI for Pelvic Lymph Node Staging Prior to Radical Prostatectomy in Patients with Intermediate to High-Risk Prostate Cancer: A Meta-Analysis. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.737989"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Von Stauffenberg, F., Poyet, C., Beintner-Skawran, S., Maurer, A., and Schmid, F.A. (2024). Current Clinical Applications of PSMA-PET for Prostate Cancer Diagnosis, Staging, and Treatment. Cancers, 16.","DOI":"10.3390\/cancers16244263"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.euros.2023.01.010","article-title":"A Systematic Review of the Variability in Performing and Reporting Intraprostatic Prostate-specific Membrane Antigen Positron Emission Tomography in Primary Staging Studies","volume":"50","author":"Ptasznik","year":"2023","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s00259-024-06857-w","article-title":"Standardized template for clinical reporting of PSMA PET\/CT scans","volume":"52","author":"Esfahani","year":"2024","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1053\/j.semnuclmed.2023.07.005","article-title":"Standardized PSMA-PET Imaging of Advanced Prostate Cancer","volume":"54","author":"Seifert","year":"2024","journal-title":"Semin. Nucl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.eururo.2023.02.002","article-title":"Second Version of the Prostate Cancer Molecular Imaging Standardized Evaluation Framework Including Response Evaluation for Clinical Trials (PROMISE V2)","volume":"83","author":"Seifert","year":"2023","journal-title":"Eur. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/RLU.0000000000004951","article-title":"The PRIMARY Score Diagnostic Performance and Added Value Compared with MRI in Detecting Clinically Significant Prostate Cancer","volume":"49","author":"Guo","year":"2024","journal-title":"Clin. Nucl. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s00259-020-05025-0","article-title":"PET\/MRI in prostate cancer: A systematic review and meta-analysis","volume":"48","author":"Evangelista","year":"2021","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"469","DOI":"10.6004\/jnccn.2025.0052","article-title":"Prostate Cancer, Version 3.2026, NCCN Clinical Practice Guidelines in Oncology","volume":"23","author":"Spratt","year":"2025","journal-title":"J. Natl. Compr. Cancer Netw."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/1\/64\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T16:26:34Z","timestamp":1770049594000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/1\/64"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,31]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medsci14010064"],"URL":"https:\/\/doi.org\/10.3390\/medsci14010064","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,31]]}}}