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Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement

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Abstract

Purpose

The aim of the study was to elaborate the incidence and type of skeletal involvement in a large cohort of patients with newly diagnosed prostate cancer (PCa) referred for Ga-68 PSMA-11 PET/CT staging in a single center.

Methods

Study cohort included 963 consecutive patients with newly diagnosed PCa referred for Ga-68 PSMA-11 PET/CT study for staging. The incidence of bone involvement, type of bone metastases, and extent of disease were determined and correlated with the ISUP Grade Group (GG) criteria and PSA levels.

Results

Bone metastases were found in 188 (19.5%) of 963 patients. Bone metastases were found in 10.7% of patients with PSA < 10 ng/dL and in 27.4% of patients with PSA > 10 ng/dL and in 6.1% of patients with GG ≤ 2/3 and in 8.9% of patients with GG 4/5. In 7.6% of the patients, skeletal involvement was extensive, while 11.9% of patients had oligometastatic disease. Osteoblastic type metastases were the most common type of bone metastases presented in 133 of the patients with malignant bone involvement (70.7%). More than half of them had only osteoblastic lesions (72 patients (38.3%)), while the other (61 patients (32.5%)) had also intramedullary and/or osteolytic type lesions. Intramedullary metastases were found in 97 patients (51.6%), while 41 (21.8%) of them were only intramedullary lesions. Osteolytic metastases were detected in 36 patients (19.2%), of which 8 were only osteolytic lesions.

Conclusion

Although traditionally bone metastases of PCa are considered osteoblastic, osteolytic and intramedullary metastases are common, as identified on PET with labeled PSMA. Skeletal spread may be present also in patients with GG ≤ 2/3 and PSA < 10 ng/dL.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel

    Mikhail Kesler, Kosta Kerzhner, Jonathan Kuten, Charles Levine & Einat Even-Sapir

  2. Department of Radiology-Musculoskeletal Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel

    Ido Druckmann

  3. Department of Oncology (Uro-Oncology Section), Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, 6423906, Tel Aviv, Israel

    David Sarid & Daniel Keizman

  4. Department of Urology, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel

    Ofer Yossepowitch

  5. Sackler School of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel

    Ofer Yossepowitch & Einat Even-Sapir

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  1. Mikhail Kesler
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Contributions

MK, OY, and EES contributed to the conception of the study, data collection, study design, writing, and revising the manuscript; KK, ID, JK, CL, DS, and DK contributed to the data collection, writing, and revising the manuscript; all authors read and approved the final manuscript.

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Correspondence to Einat Even-Sapir.

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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. This article does not contain any studies with human participants or animals performed by any of the authors. The study protocol was approved by the local institutional ethics committee (reference ID TLV-0327–20). All patients gave written informed consent.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Oncology—Genitourinary.

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Kesler, M., Kerzhner, K., Druckmann, I. et al. Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement. Eur J Nucl Med Mol Imaging 49, 2077–2085 (2022). https://doi.org/10.1007/s00259-021-05655-y

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