DOI: 10.1007/s00259-017-3858-2Pages: 1-8

68Ga-PSMA 11 ligand PET imaging in patients with biochemical recurrence after radical prostatectomy – diagnostic performance and impact on therapeutic decision-making

1. Medical University of Vienna, Department of Urology

2. Medical University of Vienna, Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy

3. Medical University of Vienna, Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy

4. University Hospital Krems, Karl Landsteiner University of Health Sciences, Department of Urology and Andrology

5. Medical University of Vienna, Department of Radiation Oncology

6. Center for Biomarker Research in Medicine, CBmed GmbH

7. Weill Medical College of Cornell University, Division of Radiopharmaceutical Sciences, Department of Radiology

8. Medical University of Vienna, Clinical Institute of Pathology

9. University of Texas Southwestern, Department of Urology

10. Weill Medical College of Cornell University, Department of Urology and Division of Medical Oncology

Correspondence to:
Markus Hartenbach
Tel: 0043 1 40400 45330
Email: markus.hartenbach@meduniwien.ac.at

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Abstract

Objective

To evaluate the diagnostic performance of [68Ga]Ga-PSMAHBED-CC conjugate 11 positron emission tomography (PSMA-PET) in the early detection of metastases in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) for clinically non-metastatic prostate cancer, to compare it to CT/MRI alone and to assess its impact on further therapeutic decisions.

Material and methods

We retrospectively assessed 117 consecutive hormone-naïve BCR patients who had 68Ga-PSMA 11 PET/CT (n = 46) or PET/MRI (n = 71) between May 2014 and January 2017. BCR was defined as two PSA rises above 0.2 ng/ml. Two dedicated uro-oncological imaging experts (radiology/nuclear medicine) reviewed separately all images. All results were presented in a blinded sequential fashion to a multidisciplinary tumorboard in order to assess the influence of PSMA-PET imaging on decision-making.

Results

The median time from RP to BCR was 36 months (IQR 16–72). Overall, 69 (59%) patients received postoperative radiotherapy. Median PSA level at the time of imaging was 1.04 ng/ml (IQR 0.58–1.87). PSMA-positive lesions were detected in 100 (85.5%) patients. Detection rates were 65% for a PSA value of 0.2 to <0.5 ng/ml, 85.7% for 0.5 to <1, 85.7% for 1 to <2 and 100% for ≥2. PSMA-positive lesions could be confirmed by either histology (16%), PSA decrease in metastasis-directed radiotherapy (45%) or additional information in diffusion-weighted imaging when PET/MRI was performed (18%) in 79% of patients. PSMA-PET detected lesions in 67 patients (57.3%) who had no suspicious correlates according to the RECIST 1.1 criteria on MRI or CT. PSMA-PET changed therapeutic decisions in 74.6% of these 67 patients (p < 0.001), with 86% of them being considered for metastases-directed therapies.

Conclusions

We confirm the high performance of PSMA-PET imaging for the detection of disease recurrence sites in patients with BCR after RP, even at relatively low PSA levels. Moreover, it adds significant information to standard CT/MRI, changing treatment strategies in a significant number of patients.

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  • Accepted: Oct 10, 2017
  • Online: Oct 26, 2017

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