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Stellenwert der PSMA-Liganden-Bildgebung beim Prostatakarzinom

Significance of PSMA imaging in prostate cancer

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Zusammenfassung

Hintergrund

Das Prostatakarzinom (PCa) ist die häufigste Krebserkrankung bei Männern in Industrieländern. Zu Verbesserung der PCa-Diagnostik wurde in den letzten Jahren 68Ga-PSMA-11 als neuer PET-Tracer (Positronen-Emissions-Tomographie) entwickelt. 68Ga-PSMA-11 bindet hochspezifisch an das prostataspezifische Membranantigen (PSMA), welches bei dem überwiegenden Teil der Patienten auf der Oberfläche der PCa-Zellen hochreguliert ist.

Fragestellung

Die aktuellen Wertigkeit der 68Ga-PSMA-11-PET-Bildgebung beim PCa wird in Bezug auf Staging bei Erstdiagnose, in der Rezidivsituation und im metastasierten Stadium analysiert.

Material und Methoden

Es wird eine retrospektive Analyse der aktuellen Literatur (Pubmed-Recherche) bezüglich der 68Ga-PSMA-11-PET-Diagnostik im Primärstaging, im biochemischen Rezidiv und der metastasierten Situation durchgeführt.

Ergebnisse

Verglichen mit der konventionellen Bildgebung erzielt die 68Ga-PSMA-11-PET/CT sowohl beim Primär- als auch beim Rezidivstaging höhere Sensitivitäten mit hervorragenden Spezifitäten. Im Vergleich zur Cholin-PET/CT weist die 68Ga-PSMA-11-PET/CT deutlich höhere Detektionsraten in der Rezidivsituation auf, insbesondere bei Patienten mit niedrigen PSA-Werten. Im Rezidivstaging führt die Anwendung der 68Ga-PSMA-11-PET/CT in einem guten Viertel der Fälle zur Veränderung des Therapiekonzepts. Der Stellenwert der 68Ga-PSMA-11-PET/CT im Routinestaging des polytop metastasierten PCa bleibt unklar.

Schlussfolgerungen

Aufgrund der guten Resultate der 68Ga-PSMA-11-PET/CT, gerade auch bei gering erhöhtem prostataspezifischem Antigen, wird diese auch zukünftig eine große Rolle in der PCa-Diagnostik einnehmen und nach Aktualisierung der Leitlinie zunehmend Anwendung finden.

Abstract

Background

Prostate cancer (PCa) is one of the most common malignancies of men in developed countries. To improve clinical diagnostics of PCa, 68Ga-PSMA-11 was recently introduced as a new PET tracer. 68Ga-PSMA-11 is able to specifically bind to the prostate-specific membrane antigen (PSMA), which is upregulated on the surface of prostate cancer cells in most patients.

Objectives

To analyse the current significance of 68Ga-PSMA-11 PET imaging in prostate cancer in relation to staging of men with initial diagnosis, biochemical recurrence and metastatic disease.

Materials and methods

Retrospective analysis of current literature (PubMed search) regarding 68Ga-PSMA-11 PET diagnostics in primary staging, in biochemical recurrence and in metastasized disease.

Results

Compared to conventional imaging, 68Ga-PSMA-11 PET/CT reaches a higher sensitivity with an excellent specificity in the clinical diagnosis of primary staging as well as staging for recurrence and advanced, metastasized disease. In biochemical recurrence, 68Ga-PSMA-11 PET/CT shows significantly higher detection rates in comparison to choline PET/CT, especially in patients with low PSA values. In the clinical diagnosis of recurrent disease, therapy concepts were changed in more than a quarter of the patients due to the use of 68Ga-PSMA-11 PET/CT. The significance of staging with 68Ga-PSMA-11 PET/CT in advanced metastasized patients remains uncertain.

Conclusions

Due to the excellent results of 68Ga-PSMA-11 PET imaging, even in patients with slightly elevated PSA levels, it will continue to play an important role in clinical diagnostics of prostate cancer and, thus, its clinical utilization will become more widely spread.

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Abbreviations

BCR:

Biochemisches Rezidiv

CT:

Computertomographie

MIP:

„Maximum intensity projection“

MRT:

Magnetresonanztomographie

PET:

Positronen-Emissions-Tomographie

PSA:

Prostataspezifisches Antigen

PSMA:

Prostataspezifisches Membranantigen

PCa:

Prostatakarzinom

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Authors and Affiliations

  1. Urologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    C. Gasch & B. Hadaschik

  2. Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    C. Düwel & T. Maurer

  3. Abteilung Radiopharmazeutische Chemie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland

    K. Kopka

  4. Abteilung Nuklearmedizin, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    C. Kratochwil, M. Vinsensia, U. Haberkorn &  F. L. Giesel

  5. Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    M. Eiber

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  1. C. Gasch
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  2. C. Düwel
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  7. T. Maurer
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  8. U. Haberkorn
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Correspondence to F. L. Giesel.

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Interessenkonflikt

C. Gasch, C. Düwel, C. Kratochwil, M. Vinsensia, M. Eiber, T. Maurer und B. Hadaschik geben an, dass kein Interessenkonflikt besteht. Patentteilhaber für PSMA-617: U. Haberkorn, K. Kopka; Patentanmeldung für PSMA-1007: U. Haberkorn, K. Kopka, F. Giesel

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Gasch, C., Düwel, C., Kopka, K. et al. Stellenwert der PSMA-Liganden-Bildgebung beim Prostatakarzinom. Urologe 56, 3–12 (2017). https://doi.org/10.1007/s00120-016-0293-0

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