Local recurrence of prostate cancer after radical prostatectomy is at risk to be missed in 68Ga-PSMA-11-PET of PET/CT and PET/MRI: comparison with mpMRI integrated in simultaneous PET/MRI

  • Martin T. Freitag
  • Jan P. Radtke
  • Ali Afshar-Oromieh
  • Matthias C. Roethke
  • Boris A. Hadaschik
  • Martin Gleave
  • David Bonekamp
  • Klaus Kopka
  • Matthias Eder
  • Thorsten Heusser
  • Marc Kachelriess
  • Kathrin Wieczorek
  • Christos Sachpekidis
  • Paul Flechsig
  • Frederik Giesel
  • Markus Hohenfellner
  • Uwe Haberkorn
  • Heinz-Peter Schlemmer
  • A. Dimitrakopoulou-Strauss
Original Article



The positron emission tomography (PET) tracer 68Ga-PSMA-11, targeting the prostate-specific membrane antigen (PSMA), is rapidly excreted into the urinary tract. This leads to significant radioactivity in the bladder, which may limit the PET-detection of local recurrence (LR) of prostate cancer (PC) after radical prostatectomy (RP), developing in close proximity to the bladder. Here, we analyze if there is additional value of multi-parametric magnetic resonance imaging (mpMRI) compared to the 68Ga-PSMA-11-PET-component of PET/CT or PET/MRI to detect LR.


One hundred and nineteen patients with biochemical recurrence after prior RP underwent both hybrid 68Ga-PSMA-11-PET/CTlow-dose (1 h p.i.) and -PET/MRI (2-3 h p.i.) including a mpMRI protocol of the prostatic bed. The comparison of both methods was restricted to the abdomen with focus on LR (McNemar). Bladder-LR distance and recurrence size were measured in axial T2w-TSE. A logistic regression was performed to determine the influence of these variables on detectability in 68Ga-PSMA-11-PET. Standardized-uptake-value (SUVmean) quantification of LR was performed.


There were 93/119 patients that had at least one pathologic finding. In addition, 18/119 Patients (15.1%) were diagnosed with a LR in mpMRI of PET/MRI but only nine were PET-positive in PET/CT and PET/MRI. This mismatch was statistically significant (p = 0.004). Detection of LR using the PET-component was significantly influenced by proximity to the bladder (p = 0.028). The PET-pattern of LR-uptake was classified into three types (1): separated from bladder; (2): fuses with bladder, and (3): obliterated by bladder). The size of LRs did not affect PET-detectability (p = 0.84), mean size was 1.7 ± 0.69 cm long axis, 1.2 ± 0.46 cm short-axis. SUVmean in nine men was 8.7 ± 3.7 (PET/CT) and 7.0 ± 4.2 (PET/MRI) but could not be quantified in the remaining nine cases (obliterated by bladder).


The present study demonstrates additional value of hybrid 68Ga-PSMA-11-PET/MRI by gaining complementary diagnostic information compared to the 68Ga-PSMA-11-PET/CTlow-dose for patients with LR of PC.


68Ga-PSMA-11 Local relapse Local recurrence PET/MRI PET/CT Prostate specific membrane antigen 



Androgen deprivation therapy


Biochemical recurrence


Computed tomography


Dynamic contrast-enhanced imaging


Diffusion-weighted imaging


Gleason score


Local recurrence


Magnetic resonance imaging


Multiparametric MRI


Prostate cancer


Positron emission tomography


Radical prostatectomy




Standard uptake value




Prostate-specific membrane antigen




2 − 18F-fluoro-2-deoxy-D-glucose



We would like to express our gratitude to Dr. Stefan Kegel and the support of our technicians Regula Gnirs, Heike Streib-Retzbach, Julia Schliebus, Cora Weyrich, and Rene Hertel for their excellent support.

Compliance with ethical standards


There was no funding for this study.

Conflicts of interest

Heinz-Peter Schlemmer, Ali Afshar-Oromieh and Matthias C. Roethke have received honoraria from Siemens Healthcare for educational sessions. The other authors report no conflict of interest.

Informed consent

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


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Martin T. Freitag
    • 1
    • 2
  • Jan P. Radtke
    • 1
    • 3
  • Ali Afshar-Oromieh
    • 4
  • Matthias C. Roethke
    • 1
  • Boris A. Hadaschik
    • 3
  • Martin Gleave
    • 5
  • David Bonekamp
    • 1
  • Klaus Kopka
    • 6
  • Matthias Eder
    • 6
  • Thorsten Heusser
    • 7
  • Marc Kachelriess
    • 7
  • Kathrin Wieczorek
    • 8
  • Christos Sachpekidis
    • 2
  • Paul Flechsig
    • 4
  • Frederik Giesel
    • 4
  • Markus Hohenfellner
    • 3
  • Uwe Haberkorn
    • 4
  • Heinz-Peter Schlemmer
    • 1
  • A. Dimitrakopoulou-Strauss
    • 2
  1. 1.Department of Radiology, German Cancer Research CenterHeidelbergGermany
  2. 2.Clinical Cooperation Unit Nuclear Medicine, German Cancer Research CenterHeidelbergGermany
  3. 3.Department of UrologyUniversity Hospital HeidelbergHeidelbergGermany
  4. 4.Department of Nuclear MedicineUniversity Hospital HeidelbergHeidelbergGermany
  5. 5.The Vancouver Prostate CentreUniversity of British ColumbiaVancouverCanada
  6. 6.Division of Radiopharmaceutical Chemistry, German Cancer Research CenterHeidelbergGermany
  7. 7.Department of Medical Physics in Radiology, German Cancer Research CenterHeidelbergGermany
  8. 8.Institute of PathologyUniversity Hospital HeidelbergHeidelbergGermany

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