{
  "abstract": "BackgroundThe incremental value of PSMA PET/CT over multiparametric MRI (mpMRI) for selecting patients for prostate cancer focal therapy is undefined. Unlike lesion-detection studies, we evaluated whether PSMA PET/CT, mpMRI, and their combination correctly determine focal therapy eligibility when validated against whole-mount histopathology (WMHP).\n\nMethodsWe retrospectively analyzed patients undergoing radical prostatectomy (RP) at UCLA (2017-2024) with preoperative PSMA PET/CT and mpMRI, biopsy grade group (GG) [≤]3, unilateral disease, and prostate-specific antigen <20 ng/mL. Two blinded readers per modality assessed extraprostatic extension (EPE), seminal vesicle invasion (SVI), bilateral disease, and multifocality; a third adjudicated discordances. Eligibility required absence of all four. On WMHP, ineligibility was EPE, SVI, multifocal or bilateral disease with a contralateral or secondary GG[≥]2 nodule, or any GG>3 focus at RP. Modalities were compared by McNemar tests.\n\nResultsOf 112 patients, 77 (69%) were ineligible on WMHP, including 19 (17%) with a GG>3 focus at RP. Sensitivity and specificity were 53% and 54% for PET and 70% and 49% for mpMRI. Combined imaging improved sensitivity to 83% (P<0.001 vs PET; P=0.002 vs MRI) but reduced specificity to 26%. Per 100 patients at this prevalence, this would correctly identify approximately 9 additional ineligible patients while falsely excluding approximately 7 true candidates. mpMRI was more sensitive than PET for EPE (77% vs 32%, P<0.001), whereas PET was more specific (90% vs 58%, P<0.001). Combined imaging improved detection of multifocal (44% vs 23%, P=0.001) and bilateral disease (45% vs 23%, P=0.002) versus MRI alone.\n\nConclusionsAdding PSMA PET/CT to mpMRI significantly improves sensitivity for exclusionary features, reflecting complementary molecular and anatomic information. However, combined imaging still misses a substantial proportion of adverse pathology, so imaging alone should not determine eligibility.\n\nO_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=98 SRC=\"FIGDIR/small/26362553v1_ufig1.gif\" ALT=\"Figure 1\"> View larger version (46K): org.highwire.dtl.DTLVardef@e312org.highwire.dtl.DTLVardef@3bce70org.highwire.dtl.DTLVardef@6e56aeorg.highwire.dtl.DTLVardef@1fcbac1_HPS_FORMAT_FIGEXP M_FIG Graphical Abstract\n\nC_FIG",
  "abstract_shown": true,
  "affiliations": [
    "Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Urology, David Geffen School of Medicine, University of Californ"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 19,
  "authors": [
    {
      "name": "I. Sonni"
    },
    {
      "name": "Z. Mohammadigoldar"
    },
    {
      "name": "G. Furey"
    },
    {
      "name": "K. Kimura"
    },
    {
      "name": "P. C. Movva"
    },
    {
      "name": "A. Holzgreve"
    },
    {
      "name": "S. Bahri"
    },
    {
      "name": "T. Sevco"
    },
    {
      "name": "A. Chung"
    },
    {
      "name": "A. Sisk"
    },
    {
      "name": "T. Grogan"
    },
    {
      "name": "J. Czernin"
    },
    {
      "name": "K. Sung"
    },
    {
      "name": "J. Calais"
    },
    {
      "name": "S. E. Eggener"
    },
    {
      "name": "W. Brisbane"
    },
    {
      "name": "R. E. Reiter"
    },
    {
      "name": "S. Raman"
    },
    {
      "affs": [
        0
      ],
      "name": "A. B. Weiner"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/eq8kgq8g6sjpj.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.09.26362553",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.09.26362553v1.full",
  "id": "eq8kgq8g6sjpj",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.09.26362553v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "radiology and imaging"
    ],
    [
      "openalex",
      "2740|Prostate Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7212373738",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.09.26362553v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-09",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/eq8kgq8g6sjpj.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:23Z",
      "native_id": "10.64898/2026.09.09.26362553",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.09.26362553v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:radiology and imaging",
      "subfield": "imaging"
    }
  ],
  "title": "Prostate-Specific Membrane Antigen PET/CT Complements MRI for Focal Therapy Selection in Prostate Cancer: A Whole-Mount Histopathologic Study",
  "title_text": "Prostate-Specific Membrane Antigen PET/CT Complements MRI for Focal Therapy Selection in Prostate Cancer: A Whole-Mount Histopathologic Study",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:23Z",
  "url": "https://research.draconitic.com/paper/eq8kgq8g6sjpj",
  "venue": "medRxiv",
  "versions": []
}