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Preliminary results on response assessment using 68Ga-HBED-CC-PSMA PET/CT in patients with metastatic prostate cancer undergoing docetaxel chemotherapy

  • Anna Katharina Seitz
  • Isabel Rauscher
  • Bernhard Haller
  • Markus Krönke
  • Sophia Luther
  • Matthias M. Heck
  • Thomas Horn
  • Jürgen E. Gschwend
  • Markus Schwaiger
  • Matthias Eiber
  • Tobias Maurer
Original Article

Abstract

Purpose

To investigate the value of 68Ga-HBED-CC PSMA (68Ga-PSMA) PET/CT for response assessment in metastatic castration-sensitive and castration-resistant prostate cancer (mCSPC and mCRPC) during docetaxel chemotherapy.

Methods

68Ga-PSMA PET/CT was performed in seven mCSPC patients before and after six cycles of upfront docetaxel chemotherapy and in 16 mCRPC patients before and after three cycles of palliative docetaxel chemotherapy. Radiographic treatment response was evaluated separately on the 68Ga-PSMA PET and CT datasets. Changes in 68Ga-PSMA uptake (SUVmean) were assessed on a per-patient and a per-lesion basis using the PERCIST scoring system with slight modification. Treatment response was defined as absence of any PSMA uptake in all target lesions on posttreatment PET (complete response, CR) or a decrease in summed SUVmean of ≥30% (partial response, PR). The appearance of a new PET-positive lesion or an increase in summed SUVmean of ≥30% (progressive disease, PD) indicated nonresponse. A moderate change in summed SUVmean (between −30% and +30%) without a change in the number of target lesions was defined as stable disease (SD). For treatment response assessment on CT, RECIST1.1 criteria were used. Radiographic responses on 68Ga-PSMA PET [RR(PET)] and on CT [RR(CT)] were compared and correlated with biochemical response (BR). A decrease in serum PSA level of ≥50% was defined as biochemical PR.

Results

Biochemical PR was found in six of seven patients with mCSPC (86%, 95% confidence interval 42% to 99.6%). The concordance rate was higher between BR and RR(PET) than between BR and RR(CT) (6/7 vs. 3/6 patients. 68Ga-PSMA PET and CT were concordant in only three patients (50%, 12% to 88%). In mCRPC patients, biochemical PR was found in six of 16 patients (38%, 15% to 65%). Outcome prediction was concordant between BR and RR(PET) in nine of 16 patients (56%), and between BR and RR(CT) in only four of 12 patients (33%) with target lesions on CT. 68Ga-PSMA PET and CT results corresponded in seven of 12 patients (58%, 28% to 85%).

Conclusion

Our preliminary results suggest that 68Ga-PSMA PET might be a promising method for treatment response assessment in mCSPC and mCRPC. The data indicate that for different metastatic sites, the performance of 68Ga-PSMA PET in response assessment might be superior to that of the conventional CT approach and could help differentiate between progressive disease and treatment response. Because of the limited number of patients, the differences revealed in our study were not statistically significant. Thus larger and prospective studies are clearly needed and warranted to confirm the value of 68Ga-PSMA PET as an imaging biomarker for response assessment.

Keywords

Therapy response Castration-sensitive prostate cancer Castration-resistant prostate cancer Prostate-specific membrane antigen 68Ga-PSMA-HBED-CC 

Notes

Funding

This study was funded by Deutsche Forschungsgemeinschaft (DFG) under grant agreement no. SFB 824.

Compliance with ethical standards

Conflicts of interest

None.

Ethical approval

All reported investigations were conducted in accordance with the principles of the Declaration of Helsinki and with national regulations. The study was approved by the Ethics Committee of the Technical University Munich (permit 5665/13).

Informed consent

Written informed consent for evaluation and publication of their anonymized data was obtained from all patients

Supplementary material

259_2017_3887_MOESM1_ESM.docx (78 kb)
ESM 1 (DOCX 78 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Anna Katharina Seitz
    • 1
    • 2
  • Isabel Rauscher
    • 3
  • Bernhard Haller
    • 4
  • Markus Krönke
    • 3
  • Sophia Luther
    • 1
  • Matthias M. Heck
    • 1
  • Thomas Horn
    • 1
  • Jürgen E. Gschwend
    • 1
  • Markus Schwaiger
    • 3
  • Matthias Eiber
    • 3
    • 5
  • Tobias Maurer
    • 1
  1. 1.Department of Urology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
  2. 2.Department of Urology and Paediatric UrologyJulius Maximilians University Medical Centre of WürzburgWürzburgGermany
  3. 3.Department of Nuclear Medicine, Klinikum rechts der IsarTechnical University of MunichMunichGermany
  4. 4.Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
  5. 5.Department of Molecular and Medical PharmacologyDavid Geffen School of Medicine at UCLALos AngelesUSA

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