Skip to main content
SpringerLink
Log in

Hybridbildgebung beim Prostatakarzinom

Status quo und zukünftige Entwicklungen

Hybrid imaging in prostate cancer

Status quo and future applications

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

In den letzten Jahren hat die PSMA-Liganden-PET (PSMA: prostataspezifisches Membranantigen, PET: Positronen-Emissions-Tomographie) mit Tracern wie dem 68Ga-PSMA-11 vielversprechende Ergebnisse gezeigt und so zur Verbesserung der Versorgung von Prostatakarzinompatienten beigetragen.

Ziel

Im Folgenden wird die aktuelle Datenlage zur PSMA-Liganden-PET zusammengefasst, insbesondere auch im Hinblick auf den zunehmenden Ersatz von 68Ga-PSMA-Liganden durch 18F-markierte PSMA-Liganden.

Ergebnisse

Den häufigsten Einsatz findet die PSMA-Liganden-PET beim biochemischen Rezidiv. Hier zeigt die 68Ga-PSMA-11-PET/CT selbst bei niedrigen PSA-Werten im Vergleich zu konventionellen Bildgebungsmodalitäten hervorragende Detektionsraten, insbesondere auch bei kleinen, morphologisch unauffälligen Läsionen. Auch im primären Staging von Hochrisikopatienten, vor allem in Kombination mit der multiparametrischen MRT, gewinnt die 68Ga-PSMA PET zunehmend an Bedeutung. Insbesondere aufgrund logistischer Vorteile werden aktuell 68Ga-markierte PSMA-Liganden zunehmend durch 18F-markierte PSMA-Liganden, wie z. B. 18F-DCFPyL und 18F-PSMA-1007, ersetzt.

Schlussfolgerung

Der Einsatz der PSMA-Liganden-PET hat die PC-Bildgebung revolutioniert. Somit wird dieses Verfahren voraussichtlich in Zukunft eine noch größere Rolle in der Diagnostik des PC einnehmen, insbesondere, da nun 18F-markierte PSMA-Liganden zur Verfügung stehen. Allerdings ist eine simultane Bildanalyse von PET und CT sowie eine differenzierte Bildauswertung (klinischer Kontext, Kenntnis der gängigen Pitfalls) zwingend notwendig.

Abstract

Background

Recently, the use of prostate-specific membrane antigen (PSMA) tracers like 68Ga-PSMA-11 in positron emission tomography (PET) have shown promising results and are helping to improve care for patients with prostate cancer (PC).

Purpose

In the following we review the current literature on PSMA-ligand PET, in particular with regard to the currently increasing replacement of 68Ga-PSMA ligands by 18F-labeled PSMA ligands.

Results

PSMA-ligand PET is most frequently used for biochemical recurrence. Here, 68Ga-PSMA-11 PET/CT shows superior detection rates compared to conventional imaging modalities, especially in small, morphologically unsuspicious lesions, even at low PSA values. Furthermore, 68Ga-PSMA PET imaging seems to be an encouraging alternative for staging of high-risk patients, particularly in combination with multiparametric MRI.

Conclusion

The use of PSMA-ligand PET has revolutionized PC imaging. Thus, PSMA-ligand PET is expected to play an even greater role in PC diagnostics in the future, especially as 18F-labeled PSMA ligands are now increasingly used. However, simultaneous image analysis of PET and CT as well as a differentiated image evaluation (clinical context, knowledge of common pitfalls) is mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Torre LA et al (2016) Global cancer incidence and mortality rates and trends—an update. Cancer Epidemiol Biomark Prev 25(1):16–27

    Google Scholar 

  2. Hovels AM et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63(4):387–395

    CAS  PubMed  Google Scholar 

  3. Evangelista L et al (2013) Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: a systematic literature review and meta-analysis. Eur Urol 63(6):1040–1048

    PubMed  Google Scholar 

  4. Evangelista L et al (2013) Choline PET or PET/CT and biochemical relapse of prostate cancer: a systematic review and meta-analysis. Clin Nucl Med 38(5):305–314

    PubMed  Google Scholar 

  5. Oto A et al (2011) Diffusion-weighted and dynamic contrast-enhanced MRI of prostate cancer: correlation of quantitative MR parameters with Gleason score and tumor angiogenesis. Am J Roentgenol 197(6):1382–1390

    Google Scholar 

  6. Al-Bayati M et al (2018) Integrated 68gallium labelled prostate-specific membrane antigen-11 positron emission tomography/magnetic resonance imaging enhances discriminatory power of multi-parametric prostate magnetic resonance imaging. Urol Int 100(2):164–171

    CAS  PubMed  Google Scholar 

  7. Eiber M et al (2016) Simultaneous (68)Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol 70(5):829–836

    CAS  PubMed  Google Scholar 

  8. Eiber M et al (2015) (68)Ga-PSMA PET/MR with multimodality image analysis for primary prostate cancer. Abdom Imaging 40(6):1769–1771

    PubMed  Google Scholar 

  9. Bates A, Miles K (2017) Prostate-specific membrane antigen PET/MRI validation of MR textural analysis for detection of transition zone prostate cancer. Eur Radiol 27(12):5290–5298

    PubMed  Google Scholar 

  10. Uprimny C et al (2017) (68)Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Med Mol Imaging 44(6):941–949

    CAS  PubMed  Google Scholar 

  11. Hicks RM et al (2018) Diagnostic accuracy of (68)Ga-PSMA-11 PET/MRI compared with multiparametric MRI in the detection of prostate cancer. Radiology 289(3):730–737

    PubMed  PubMed Central  Google Scholar 

  12. Muehlematter UJ et al (2019) Diagnostic accuracy of multiparametric MRI versus (68)Ga-PSMA-11 PET/MRI for extracapsular extension and seminal vesicle invasion in patients with prostate cancer. Radiology 293(2):350–358

    PubMed  Google Scholar 

  13. Maurer T et al (2016) Diagnostic efficacy of (68)gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol 195(5):1436–1443

    PubMed  Google Scholar 

  14. Budaus L et al (2016) Initial experience of (68)Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol 69(3):393–396

    PubMed  Google Scholar 

  15. Herlemann A et al (2016) (68)Ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer. Eur Urol 70(4):553–557

    CAS  PubMed  Google Scholar 

  16. Hope TA et al (2019) Metaanalysis of (68)Ga-PSMA-11 PET accuracy for the detection of prostate cancer validated by histopathology. J Nucl Med 60(6):786–793

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Calais J, Cao M, Nickols NG (2018) The utility of PET/CT in the planning of external radiation therapy for prostate cancer. J Nucl Med 59(4):557–567

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Schmidt-Hegemann NS et al (2019) Impact of (68)Ga-PSMA PET/CT on the radiotherapeutic approach to prostate cancer in comparison to CT: a retrospective analysis. J Nucl Med 60(7):963–970

    PubMed  PubMed Central  Google Scholar 

  19. Tombal B, Lecouvet F (2012) Modern detection of prostate cancer’s bone metastasis: is the bone scan era over? Adv Urol 2012:893193

    PubMed  Google Scholar 

  20. Roach PJ et al (2018) The impact of (68)Ga-PSMA PET/CT on management intent in prostate cancer: results of an Australian prospective multicenter study. J Nucl Med 59(1):82–88

    CAS  PubMed  Google Scholar 

  21. Eiber M et al (2015) Evaluation of hybrid (6)(8)Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med 56(5):668–674

    PubMed  Google Scholar 

  22. Afshar-Oromieh A et al (2015) The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 42(2):197–209

    CAS  PubMed  Google Scholar 

  23. Afshar-Oromieh A et al (2017) Diagnostic performance of (68)Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging 44(8):1258–1268

    PubMed  PubMed Central  Google Scholar 

  24. Perera M et al (2016) Sensitivity, specificity, and predictors of positive (68)Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol 70(6):926–937

    PubMed  Google Scholar 

  25. Rauscher I et al (2018) Efficacy, predictive factors, and prediction nomograms for (68)Ga-labeled prostate-specific membrane antigen-ligand positron-emission tomography/computed tomography in early biochemical recurrent prostate cancer after radical prostatectomy. Eur Urol 73(5):656–661

    PubMed  Google Scholar 

  26. Rauscher I et al (2016) Value of 68Ga-PSMA HBED-CC PET for the assessment of lymph node metastases in prostate cancer patients with biochemical recurrence: comparison with histopathology after salvage lymphadenectomy. J Nucl Med 57(11):1713–1719

    CAS  PubMed  Google Scholar 

  27. Jilg CA et al (2017) Diagnostic accuracy of Ga-68-HBED-CC-PSMA-Ligand-PET/CT before salvage lymph node dissection for recurrent prostate cancer. Theranostics 7(6):1770–1780

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Maurer T et al (2015) Prostate-specific membrane antigen-radioguided surgery for metastatic lymph nodes in prostate cancer. Eur Urol 68(3):530–534

    PubMed  Google Scholar 

  29. Rahbar K et al (2018) Advantage of (18)F-PSMA-1007 over (68)Ga-PSMA-11 PET imaging for differentiation of local recurrence vs. urinary tracer excretion. Eur J Nucl Med Mol Imaging 45(6):1076–1077

    CAS  PubMed  Google Scholar 

  30. Dietlein M et al (2015) Comparison of [(18)F]DCFPyL and [(68)Ga]Ga-PSMA-HBED-CC for PSMA-PET imaging in patients with relapsed prostate cancer. Mol Imaging Biol 17(4):575–584

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Giesel FL et al (2018) Detection efficacy of [(18)F]PSMA-1007 PET/CT in 251 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. https://doi.org/10.2967/jnumed.118.212233

    Article  PubMed  PubMed Central  Google Scholar 

  32. Rauscher I et al (2019) Matched-pair comparison of (68)Ga-PSMA-11 and (18)F-PSMA-1007 PET/CT: frequency of pitfalls and detection efficacy in biochemical recurrence after radical prostatectomy. J Nucl Med. https://doi.org/10.2967/jnumed.119.229187

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Radiologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland

    Michal-Kamil Chodyla & Axel Wetter

  2. Klinik und Poliklinik für Nuklearmedizin, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    Matthias Eiber &  Isabel Rauscher

Authors
  1. Michal-Kamil Chodyla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthias Eiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Axel Wetter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isabel Rauscher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Isabel Rauscher.

Ethics declarations

Interessenkonflikt

M.-K. Chodyla, M. Eiber, A. Wetter und I. Rauscher geben an: Mit der Veröffentlichung des Artikels ist kein direkter oder indirekter wirtschaftlicher finanzieller Anreiz verbunden, und es wurde keine außerinstitutionelle Finanzierung erreicht. Alle Autoren versichern, dass keine Finanzierungsvereinbarung ihre Fähigkeit einschränkt, ihre Forschung/Studie angemessen zu vervollständigen und zu veröffentlichen, und dass sie die volle Kontrolle über Primärdaten hatten. Die Abbildungen wurden nicht anderweitig publiziert.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chodyla, MK., Eiber, M., Wetter, A. et al. Hybridbildgebung beim Prostatakarzinom. Radiologe 60, 386–393 (2020). https://doi.org/10.1007/s00117-020-00642-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-020-00642-0

Schlüsselwörter

Keywords

Search

Navigation