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Comparison of PSMA-ligand PET/CT and multiparametric MRI for the detection of recurrent prostate cancer in the pelvis

  • Ali Afshar-OromiehEmail author
  • Bernd Vollnberg
  • Ian Alberts
  • Alexandrine Bähler
  • Christos Sachpekidis
  • Lotte Dijkstra
  • Fabian Haupt
  • Silvan Boxler
  • Tobias Gross
  • Tim Holland-Letz
  • George Thalmann
  • Johannes Heverhagen
  • Axel Rominger
  • Kirsi Härmä
  • Martin H. Maurer
Original Article
Part of the following topical collections:
  1. Oncology — Genitourinary

Abstract

Purpose

So far, there have been very few studies which provide a direct comparison between MRI and PSMA-ligand PET/CT for the detection of recurrent prostate cancer (rPC). This present study therefore aims to provide further clinical data in order to resolve this urgent clinical question, and thereby strengthen clinical recommendations.

Methods

A retrospective analysis was performed for patients who were scanned at our institution with whole-body PSMA-PET/CT (tracer: 68Ga-PSMA-11) between January 2017 and September 2018 in order to detect rPC. Amongst them, 43 underwent an additional pelvic MRI within 2 months. Both modalities were compared as follows: a consensus read of the PET data was performed by two nuclear physicians. All lesions were recorded with respect to their type and localization. The same process was conducted by two radiologists for pelvic MRI. Thereafter, both modalities were directly compared for every patient and lesion.

Results

Overall, 30/43 patients (69.8%) presented with a pathologic MRI and 38/43 (88.4%) with a pathologic PSMA-PET/CT of the pelvis. MRI detected 53 pelvic rPC lesions (13 of them classified as “uncertain”) and PSMA-PET/CT detected 75 pelvic lesions (three classified as “uncertain”). The superiority of PSMA-PET/CT was statistically significant only if uncertain lesions were classified as false-positive.

Conclusions

PSMA-PET/CT detected more pelvic lesions characteristic for rPC when compared to MRI. In order to detect rPC, a potential future scenario could be conducting first a PSMA-PET/CT. Combining the advantages of both modalities in hybrid PET/MRI scanners would be an ideal future scenario.

Keywords

Prostate cancer PET/CT PSMA Prostate-Specific Membrane Antigen 68Ga-PSMA-11 MRI 

Notes

Compliance with ethical standards

Ethical approval

This evaluation was approved by the ethics committee of the University of Bern (KEK-Nr. 2018–00299). All patients published in this manuscript signed a written informed consent form for the purpose of anonymized evaluation and publication of their data.

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.  https://doi.org/10.3322/caac.21492.CrossRefGoogle Scholar
  2. 2.
    Wong MC, Goggins WB, Wang HH, Fung FD, Leung C, Wong SY, et al. Global incidence and mortality for prostate cancer: analysis of temporal patterns and trends in 36 countries. Eur Urol. 2016;70:862–74.  https://doi.org/10.1016/j.eururo.2016.05.043.CrossRefGoogle Scholar
  3. 3.
    Kessler B, Albertsen P. The natural history of prostate cancer. Urol Clin N Am. 2003;30:219–26.CrossRefGoogle Scholar
  4. 4.
    Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71:618–29.  https://doi.org/10.1016/j.eururo.2016.08.003.CrossRefGoogle Scholar
  5. 5.
    Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, et al. 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. 2015;42:197–209.  https://doi.org/10.1007/s00259-014-2949-6.CrossRefGoogle Scholar
  6. 6.
    Afshar-Oromieh A, Haberkorn U, Eder M, Eisenhut M, Zechmann CM. [68Ga]Gallium-labelled PSMA ligand as superior PET tracer for the diagnosis of prostate cancer: comparison with 18F-FECH. Eur J Nucl Med Mol Imaging. 2012;39:1085–6.  https://doi.org/10.1007/s00259-012-2069-0.CrossRefGoogle Scholar
  7. 7.
    Afshar-Oromieh A, Holland-Letz T, Giesel FL, Kratochwil C, Mier W, Haufe S, et al. 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. 2017;44:1258–68.  https://doi.org/10.1007/s00259-017-3711-7.CrossRefGoogle Scholar
  8. 8.
    Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA, et al. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013;40:486–95.  https://doi.org/10.1007/s00259-012-2298-2.CrossRefGoogle Scholar
  9. 9.
    Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG, et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2014;41:11–20.  https://doi.org/10.1007/s00259-013-2525-5.CrossRefGoogle Scholar
  10. 10.
    Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid 68Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015;56:668–74.  https://doi.org/10.2967/jnumed.115.154153.CrossRefGoogle Scholar
  11. 11.
    Rauscher I, Duwel C, Haller B, Rischpler C, Heck MM, Gschwend JE, et al. 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. 2018;73:656–61.  https://doi.org/10.1016/j.eururo.2018.01.006.CrossRefGoogle Scholar
  12. 12.
    Afshar-Oromieh A, Babich JW, Kratochwil C, Giesel FL, Eisenhut M, Kopka K, et al. The rise of PSMA ligands for diagnosis and therapy of prostate cancer. J Nucl Med. 2016;57:79S–89S.  https://doi.org/10.2967/jnumed.115.170720.CrossRefGoogle Scholar
  13. 13.
    Rahbar K, Afshar-Oromieh A, Jadvar H, Ahmadzadehfar H. PSMA theranostics: current status and future directions. Mol Imaging. 2018;17:1536012118776068.  https://doi.org/10.1177/1536012118776068.CrossRefGoogle Scholar
  14. 14.
    Eiber M, Fendler WP, Rowe SP, Calais J, Hofman MS, Maurer T, et al. Prostate-specific membrane antigen ligands for imaging and therapy. J Nucl Med. 2017;58:67S–76S.  https://doi.org/10.2967/jnumed.116.186767.CrossRefGoogle Scholar
  15. 15.
    Sahlmann CO, Meller B, Bouter C, Ritter CO, Strobel P, Lotz J, et al. Biphasic (6)(8)Ga-PSMA-HBED-CC-PET/CT in patients with recurrent and high-risk prostate carcinoma. Eur J Nucl Med Mol Imaging. 2016;43:898–905.  https://doi.org/10.1007/s00259-015-3251-y.CrossRefGoogle Scholar
  16. 16.
    Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C, et al. (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. 2016;70:553–7.  https://doi.org/10.1016/j.eururo.2015.12.051.CrossRefGoogle Scholar
  17. 17.
    Maurer T, Weirich G, Schottelius M, Weineisen M, Frisch B, Okur A, et al. Prostate-specific membrane antigen-radioguided surgery for metastatic lymph nodes in prostate cancer. Eur Urol. 2015;68:530–4.  https://doi.org/10.1016/j.eururo.2015.04.034.CrossRefGoogle Scholar
  18. 18.
    Pfister D, Porres D, Heidenreich A, Heidegger I, Knuechel R, Steib F, et al. Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with (68)Ga-PSMA-HBED-CC than with (18)F-Fluoroethylcholine PET/CT. Eur J Nucl Med Mol Imaging. 2016;43:1410–7.  https://doi.org/10.1007/s00259-016-3366-9.CrossRefGoogle Scholar
  19. 19.
    Hijazi S, Meller B, Leitsmann C, Strauss A, Meller J, Ritter CO, et al. Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68Ga-PSMA-positron emission tomography/computerized tomography. Prostate. 2015;75:1934–40.  https://doi.org/10.1002/pros.23091.CrossRefGoogle Scholar
  20. 20.
    Eder M, Neels O, Muller M, Bauder-Wust U, Remde Y, Schafer M, et al. Novel preclinical and radiopharmaceutical aspects of [68Ga]Ga-PSMA-HBED-CC: a new pet tracer for imaging of prostate cancer. Pharmaceuticals. 2014;7:779–96.  https://doi.org/10.3390/ph7070779.CrossRefGoogle Scholar
  21. 21.
    Bashir U, Tree A, Mayer E, Levine D, Parker C, Dearnaley D, et al. Impact of Ga-68-PSMA PET/CT on management in prostate cancer patients with very early biochemical recurrence after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2019;46(4):901–7.  https://doi.org/10.1007/s00259-018-4249-z.
  22. 22.
    Afshar-Oromieh A, Haberkorn U, Schlemmer HP, Fenchel M, Eder M, Eisenhut M, et al. Comparison of PET/CT and PET/MRI hybrid systems using a 68Ga-labelled PSMA ligand for the diagnosis of recurrent prostate cancer: initial experience. Eur J Nucl Med Mol Imaging. 2014;41:887–97.  https://doi.org/10.1007/s00259-013-2660-z.CrossRefGoogle Scholar
  23. 23.
    Maurer MH, Harma KH, Thoeny H. Diffusion-weighted genitourinary imaging. Urol Clin North Am. 2018;45:407–25.  https://doi.org/10.1016/j.ucl.2018.03.003.CrossRefGoogle Scholar
  24. 24.
    Sawicki LM, Kirchner J, Buddensieck C, Antke C, Ullrich T, Schimmoller L, et al. Prospective comparison of whole-body MRI and (68)Ga-PSMA PET/CT for the detection of biochemical recurrence of prostate cancer after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2019;46(7):1542–50.  https://doi.org/10.1007/s00259-019-04308-5.
  25. 25.
    Zacho HD, Nielsen JB, Afshar-Oromieh A, Haberkorn U, deSouza N, De Paepe K, et al. Prospective comparison of (68)Ga-PSMA PET/CT, (18)F-sodium fluoride PET/CT and diffusion weighted-MRI at for the detection of bone metastases in biochemically recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2018;45:1884–97.  https://doi.org/10.1007/s00259-018-4058-4.CrossRefGoogle Scholar
  26. 26.
    Rauscher I, Maurer T, Beer AJ, Graner FP, Haller B, Weirich G, et al. 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. 2016;57:1713–9.  https://doi.org/10.2967/jnumed.116.173492.CrossRefGoogle Scholar
  27. 27.
    Emmett L, Metser U, Bauman G, Hicks RJ, Weickhardt A, Davis ID, et al. A prospective, multi-site, international comparison of F-18 fluoro-methyl-choline, multi-parametric magnetic resonance and Ga-68 HBED-CC (PSMA-11) in men with high-risk features and biochemical failure after radical prostatectomy: clinical performance and patient outcomes. J Nucl Med. 2018;60(6):794–800.  https://doi.org/10.2967/jnumed.118.220103.
  28. 28.
    Moghanaki D, Turkbey B, Vapiwala N, Ehdaie B, Frank SJ, McLaughlin PW, et al. Advances in prostate cancer magnetic resonance imaging and positron emission tomography-computed tomography for staging and radiotherapy treatment planning. Semin Radiat Oncol. 2017;27:21–33.  https://doi.org/10.1016/j.semradonc.2016.08.008.CrossRefGoogle Scholar
  29. 29.
    Hope TA, Afshar-Oromieh A, Eiber M, Emmett L, Fendler WP, Lawhn-Heath C, et al. Imaging prostate cancer with prostate-specific membrane antigen PET/CT and PET/MRI: current and future applications. AJR Am J Roentgenol. 2018;211:286–94.  https://doi.org/10.2214/AJR.18.19957.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ali Afshar-Oromieh
    • 1
    • 2
    Email author
  • Bernd Vollnberg
    • 1
  • Ian Alberts
    • 1
  • Alexandrine Bähler
    • 3
  • Christos Sachpekidis
    • 1
  • Lotte Dijkstra
    • 1
  • Fabian Haupt
    • 3
  • Silvan Boxler
    • 4
  • Tobias Gross
    • 4
  • Tim Holland-Letz
    • 5
  • George Thalmann
    • 4
  • Johannes Heverhagen
    • 3
  • Axel Rominger
    • 1
  • Kirsi Härmä
    • 3
  • Martin H. Maurer
    • 3
  1. 1.Department of Nuclear Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
  2. 2.Department of Nuclear MedicineHeidelbergGermany
  3. 3.Department of Radiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
  4. 4.Department of Urology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
  5. 5.Department of BiostatisticsGerman Cancer Research CenterHeidelbergGermany

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