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68Ga-PSMA I&T PET/CT for primary staging of prostate cancer

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

Abstract

Purpose

The present study is based on a retrospective analysis of Gallium-68 (68Ga)-labelled prostate-specific membrane antigen (68Ga-PSMA I&T) PET/CT performed in newly diagnosed, treatment-naïve prostate cancer (PCa) patients prior to definitive treatment.

Methods

A total of 82 men were included in the study and were imaged with 68Ga-PSMA I&T PET/CT to assess the distribution of PSMA-avid disease for staging purposes (11 with low-risk, 32 with intermediate-risk, and 39 with high-risk PCa). Forty patients (20 with intermediate- and 20 with high-risk disease) underwent subsequent radical prostatectomy with extended pelvic lymph node dissection which allowed for correlation of imaging findings with histopathologic data.

Results

PSMA-positive disease was detected in 83% of patients with 66/82 (80.5%) primary tumours being visualized. PSMA-avid lymph nodes were recorded in 17/82 patients (20.7%, 3 with intermediate-risk and 14 with high-risk PCa); distant disease was found in 14/82 subjects (17.1%, 2 with intermediate-risk and 12 with high-risk PCa). No extraprostatic disease was found in low-risk PCa. SUVmax of primary tumours showed a weak but significant correlation with serum PSA values (r = 0.51, p < 0.001) and Gleason scores (GSC; r = 0.35, p = 0.001), respectively. In correlation with histopathology, calculated per-region sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of lymph node metastases were 35.0%, 98.4%, 63.6%, 95.0%, and 93.0%, respectively.

Conclusions

In patients with initial diagnosis of intermediate- and high-risk prostate cancer, 68Ga-PSMA I&T PET/CT emerges as a relevant staging procedure by identifying nodal and/or distant metastases. Due to the low prevalence of extraprostatic disease, its value seems to be limited in low-risk disease.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Medical University of Gdańsk, Smoluchowskiego Str. 17, 80-952, Gdańsk, Poland

    Wojciech Cytawa & Piotr Lass

  2. Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany

    Wojciech Cytawa, Kazuhito Fukushima, Johannes Tran-Gia, Andreas Schirbel, Andreas K. Buck & Constantin Lapa

  3. Department of Urology, University Hospital Würzburg, Würzburg, Germany

    Anna Katharina Seitz, Markus Krebs & Hubert Kübler

  4. Institute of Pathology, Comprehensive Cancer Center Mainfranken (CCCMF), University of Würzburg, Würzburg, Germany

    Stefan Kircher

  5. Department of Radiology Informatics and Statistics, Medical University of Gdańsk, Gdańsk, Poland

    Tomasz Bandurski

  6. Department of Urology, Medical University of Gdansk, Gdańsk, Poland

    Wojciech Połom & Marcin Matuszewski

  7. Pharmaceutical Radiochemistry, Technische Universität München, Munich, Germany

    Hans-Jürgen Wester

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  1. Wojciech Cytawa
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Correspondence to Constantin Lapa.

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All procedures 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.

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Informed consent was obtained from all individual participants included in the study.

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Hans-Jürgen Wester is founder and shareholder of Scintomics. All other authors declare that they have no conflict of interest.

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This article is part of the Topical Collection on Oncology – Genitourinary

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Cytawa, W., Seitz, A.K., Kircher, S. et al. 68Ga-PSMA I&T PET/CT for primary staging of prostate cancer. Eur J Nucl Med Mol Imaging 47, 168–177 (2020). https://doi.org/10.1007/s00259-019-04524-z

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