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Diagnosis of recurrent prostate cancer with PET/CT imaging using the gastrin-releasing peptide receptor antagonist 68Ga-RM2: Preliminary results in patients with negative or inconclusive [18F]Fluoroethylcholine-PET/CT

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose/background

[18F]fluoroethylcholine (18FECH) has been shown to be a valuable PET-tracer in recurrent prostate cancer (PCa), but still has limited accuracy. RM2 is a gastrin-releasing peptide receptor (GRPr) antagonist that binds to GRPr on PCa cells. Recent studies suggest that GRPr imaging with PET/CT is a promising technique for staging and restaging of PCa. We explore the value of GRPr-PET using the 68Ga-labeled GRPr antagonist RM2 in a selected population of patients with biochemically recurrent PCa and a negative/inconclusive 18FECH-PET/CT.

Material and methods

In this retrospective study 16 men with biochemical PCa relapse and negative (n = 14) or inconclusive (n = 2) 18FECH-PET/CT underwent whole-body 68Ga-RM2-PET/CT. Mean time from 18FECH-PET/CT to 68Ga-RM2-PET/CT was 6.1 ± 6.8 months. Primary therapies in these patients were radical prostatectomy (n = 13; 81.3%) or radiotherapy (n = 3; 18.7%). 14/16 patients (87.5%) had already undergone salvage therapies because of biochemical relapse prior to 68Ga-RM2-PET/CT imaging. Mean ± SD PSA at 68Ga-RM2-PET/CT was 19.4 ± 53.5 ng/ml (range 1.06–226.4 ng/ml).

Results

68Ga-RM2-PET/CT showed at least one region with focal pathological uptake in 10/16 patients (62.5%), being suggestive of local relapse (n = 4), lymph node metastases (LNM; n = 4), bone metastases (n = 1) and lung metastasis with hilar LNM (n = 1). Seven of ten positive 68Ga-RM2 scans were positively confirmed by surgical resection and histology of the lesions (n = 2), by response to site-directed therapies (n = 2) or by further imaging (n = 3). Patients with a positive 68Ga-RM2-scan showed a significantly higher median PSA (6.8 ng/ml, IQR 10.2 ng/ml) value than those with a negative scan (1.5 ng/ml, IQR 3.1 ng/ml; p = 0.016). Gleason scores or concomitant antihormonal therapy had no apparent impact on the detection of recurrent disease.

Conclusion

Even in this highly selected population of patients with known biochemical recurrence but negative or inconclusive 18FECH-PET/CT, a 68Ga-RM2-PET/CT was helpful to localize PCa recurrence in the majority of the cases. Thus, 68Ga-RM2-PET/CT deserves further investigation as a promising imaging modality for imaging PCa recurrence.

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Acknowledgements

We thank Piramal Imaging for providing the precursor to support this study.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Medical Center –Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Gesche Wieser, H. Christian Rischke, Mark Bartholomä & Philipp T. Meyer

  2. Department of Radiation Oncology, Medical Center – Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Ilinca Popp, H. Christian Rischke & Anca-Ligia Grosu

  3. Institute for Pathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Vanessa Drendel

  4. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Wolfgang A. Weber

  5. Division of Radiological Chemistry, University Hospital Basel, Basel, Switzerland

    Rosalba Mansi

  6. Department of Urology, Medical Center –Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79102, Freiburg, Germany

    Ulrich Wetterauer, Wolfgang Schultze-Seemann & Cordula Annette Jilg

  7. German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany

    Philipp T. Meyer

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  1. Gesche Wieser
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Corresponding author

Correspondence to Cordula Annette Jilg.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was reviewed and approved by the local Ethics Committee (N° 562/15). Informed consent was obtained from all individual participants included in the study.

Disclosure / conflict of interest

CAJ, GW, IP, HCR, VD, UW, WSS, MB, ALG and RM declared that no competing interests or financial disclosures exist. PTM received financial support for ongoing research by GE and Piramal Imaging WAW received study support for ongoing research by Piramal Imaging, Endocyte and Ipsen Pharmaceuticals.

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Wieser, G., Popp, I., Christian Rischke, H. et al. Diagnosis of recurrent prostate cancer with PET/CT imaging using the gastrin-releasing peptide receptor antagonist 68Ga-RM2: Preliminary results in patients with negative or inconclusive [18F]Fluoroethylcholine-PET/CT. Eur J Nucl Med Mol Imaging 44, 1463–1472 (2017). https://doi.org/10.1007/s00259-017-3702-8

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