Whole-body low-dose CT can be of value in prostate cancer decision-making: a retrospective study on 601 patients

Abstract

Objectives To evaluate the diagnostic value of whole-body low-dose computed tomography (CT) to detect bone metastasis in prostate cancer (PCa) patients and its possible utility in therapeutic decision-making. Also, to determine the valuable CT features for lesion characterisation. Methods This IRB-approved retrospective study reviewed PCa patients who underwent Ga-68-PSMA PET/CT in our centre from March 2017 to August 2022. Two board-certified radiologists and one nuclear medicine specialist reported all whole-body low-dose CT scans separately, unaware of the Ga-68-PSMA-PET results. The per-lesion and per-patient diagnostic performances were calculated. Also, the significance of CT features was evaluated. Moreover, the inter-observer agreement was analysed. A two-tailed p value < 0.05 was considered significant. Results From 727 reviewed PCa patients, 601 (mean age = 68.7 +/- 8.1) were found to be eligible, including 211 (35.1) referrals for initial staging and 390 (64.9) for evaluating the extent of the disease after biochemical recurrence. Per-patient diagnostic analysis for three reviewers showed 81.0-89.4 sensitivity and 96.6-98.5 specificity in detecting osteo-metastasis. It was able to correctly detect high-burden disease based on both CHAARTED and LATITUDE criteria. Regarding the value of underlying CT features, size > 1 cm, ill-defined borders, presence of soft-tissue component, and cortical destruction were statistically in favour of metastasis. Also, Hu > 900 was in favour of benign entities with 93 specificity. Conclusions Although not as accurate as Ga-68-PSMA PET/CT, whole-body low-dose CT might precisely classify PCa patients considering therapeutic decision-making. Additionally, we proposed diagnostic CT features that could help radiologists with better characterisation of the detected lesions. Critical relevance statement The whole-body low-dose CT can be considered valuable in the clinical decision-making of prostate cancer patients. This modality may obviate performing multiple imaging sessions and high-cost scans in patients diagnosed with the high-burden disease.