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Digital versus analogue PET in [68Ga]Ga-PSMA-11 PET/CT for recurrent prostate cancer: a matched-pair comparison

  • Ian AlbertsEmail author
  • George Prenosil
  • Christos Sachpekidis
  • Thilo Weitzel
  • Kuangyu Shi
  • Axel Rominger
  • Ali Afshar-Oromieh
Original Article
Part of the following topical collections:
  1. Oncology – Genitourinary

Abstract

Purpose

Digital PET/CT scanners represent a significant step forward in molecular imaging. We report here the clinical impact of digital PET in PSMA-PET/CT.

Methods

In this retrospective study, 88 consecutive patients who underwent [68Ga]Ga-PSMA-11 PET/CT on a digital PET/CT (dPET/CT) scanner for recurrent prostate cancer (PC) were included in a first cohort. In a second step, 88 individuals who underwent an analogue [68Ga]Ga-PSMA-11 PET/CT (aPET/CT) were selected after they were matched to the first cohort for clinical parameters. Following consensus read by two nuclear medicine physicians, the number and type of PC lesions as well as benign, PSMA-positive lesions were recorded. The results were complemented by extensive [68Ga]Ga phantom measurements to determine imaging characteristics of both scanners.

Results

dPET/CT revealed a greater number of PC lesions compared to aPET/CT (326 versus 142) as well as a proportional increase in benign causes of tracer-uptake (144 versus 65). A greater number of scans were noted as pathological for PC on dPET/CT (74/88) compared to aPET/CT (64/88, p < 0.05). The PSMA positivity rate for PC was significantly higher in dPET/CT for the lowest PSA values (PSA < 2.0 ng/ml, p < 0.05).

Conclusion

dPET/CT detected more PC lesions compared to aPET/CT. A significantly higher rate of pathological PET/CTs was noted in the group with the lowest PSA values. A higher number of benign PSMA-positive lesions were also noted in dPET/CT. The differences could be plausibly explained by the measured imaging characteristics of the scanners.

Keywords

Prostate cancer PET/CT Positron emission tomography PSMA Prostate-specific membrane antigen Digital PET 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Supplementary material

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ESM 1 (DOCX 12 kb)
259_2019_4630_MOESM2_ESM.docx (16 kb)
ESM 2 (DOCX 16 kb)

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7–30.  https://doi.org/10.3322/caac.21387.CrossRefPubMedGoogle Scholar
  2. 2.
    Fossati N, Karnes RJ, Colicchia M, Boorjian SA, Bossi A, Seisen T, et al. Impact of early salvage radiation therapy in patients with persistently elevated or rising prostate-specific antigen after radical prostatectomy. Eur Urol. 2017.  https://doi.org/10.1016/j.eururo.2017.07.026.CrossRefGoogle Scholar
  3. 3.
    Afshar-Oromieh A, Holland-Letz T, Giesel FL, Kratochwil C, Mier W, Haufe S, et al. Diagnostic performance of 68Ga-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.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Israeli RS, Powell CT, Corr JG, Fair WR, Heston WDW. Expression of the prostate-specific membrane antigen. Cancer Res. 1994;54:1807.PubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid (6)(8)Ga-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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    Virgolini I, Decristoforo C, Haug A, Fanti S, Uprimny C. Current status of theranostics in prostate cancer. Eur J Nucl Med Mol Imaging. 2018;45:471–95.  https://doi.org/10.1007/s00259-017-3882-2.CrossRefPubMedGoogle Scholar
  9. 9.
    Beyer T, Townsend DW, Brun T, Kinahan PE, Charron M, Roddy R, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med. 2000;41:1369–79.PubMedGoogle Scholar
  10. 10.
    Rausch I, Ruiz A, Valverde-Pascual I, Cal-Gonzalez J, Beyer T, Carrio I. Performance evaluation of the Vereos PET/CT system according to the NEMA NU2-2012 standard. J Nucl Med. 2019;60:561–7.  https://doi.org/10.2967/jnumed.118.215541.CrossRefPubMedGoogle Scholar
  11. 11.
    van Sluis JJ, de Jong J, Schaar J, Noordzij W, van Snick P, Dierckx R, et al. Performance characteristics of the digital Biograph Vision PET/CT system. J Nucl Med. 2019.  https://doi.org/10.2967/jnumed.118.215418.CrossRefGoogle Scholar
  12. 12.
    Nguyen NC, Vercher-Conejero JL, Sattar A, Miller MA, Maniawski PJ, Jordan DW, et al. Image quality and diagnostic performance of a digital PET prototype in patients with oncologic diseases: initial experience and comparison with analog PET. J Nucl Med. 2015;56:1378–85.  https://doi.org/10.2967/jnumed.114.148338.CrossRefPubMedGoogle Scholar
  13. 13.
    van Sluis J, Boellaard R, Dierckx RA, Stormezand G, Glaudemans A, Noordzij W. Image quality and activity optimization in oncological (18)F-FDG PET using the digital Biograph Vision PET/CT. J Nucl Med. 2019.  https://doi.org/10.2967/jnumed.119.234351.
  14. 14.
    Lopez-Mora DA, Flotats A, Fuentes-Ocampo F, Camacho V, Fernandez A, Ruiz A, et al. Comparison of image quality and lesion detection between digital and analog PET/CT. Eur J Nucl Med Mol Imaging. 2019;46:1383–90.  https://doi.org/10.1007/s00259-019-4260-z.CrossRefPubMedGoogle Scholar
  15. 15.
    Afshar-Oromieh A, Debus N, Uhrig M, Hope TA, Evans MJ, Holland-Letz T, et al. Impact of long-term androgen deprivation therapy on PSMA ligand PET/CT in patients with castration-sensitive prostate cancer. Eur J Nucl Med Mol Imaging. 2018;45:2045–54.  https://doi.org/10.1007/s00259-018-4079-z.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    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 (Basel). 7:779–96.  https://doi.org/10.3390/ph7070779.CrossRefGoogle Scholar
  17. 17.
    Fendler WP, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S, et al. (68)Ga-PSMA PET/CT: joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2017;44:1014–24.  https://doi.org/10.1007/s00259-017-3670-z.CrossRefPubMedGoogle Scholar
  18. 18.
    Rischpler C, Beck TI, Okamoto S, Schlitter AM, Knorr K, Schwaiger M, et al. (68)Ga-PSMA-HBED-CC uptake in cervical, coeliac and sacral ganglia as an important pitfall in prostate cancer PET imaging. J Nucl Med. 2018.  https://doi.org/10.2967/jnumed.117.204677.CrossRefGoogle Scholar
  19. 19.
    Afshar-Oromieh A, Sattler LP, Steiger K, Holland-Letz T, da Cunha ML, Mier W, et al. Tracer uptake in mediastinal and paraaortal thoracic lymph nodes as a potential pitfall in image interpretation of PSMA ligand PET/CT. Eur J Nucl Med Mol Imaging. 2018;45:1179–87.  https://doi.org/10.1007/s00259-018-3965-8.CrossRefPubMedGoogle Scholar
  20. 20.
    Krohn T, Verburg FA, Pufe T, Neuhuber W, Vogg A, Heinzel A, et al. [(68)Ga]PSMA-HBED uptake mimicking lymph node metastasis in coeliac ganglia: an important pitfall in clinical practice. Eur J Nucl Med Mol Imaging. 2015;42:210–4.  https://doi.org/10.1007/s00259-014-2915-3.CrossRefPubMedGoogle Scholar
  21. 21.
    Afshar-Oromieh A, Vollnberg B, Alberts I, Bahler A, Sachpekidis C, Dijkstra L, et al. Comparison of PSMA-ligand PET/CT and multiparametric MRI for the detection of recurrent prostate cancer in the pelvis. Eur J Nucl Med Mol Imaging. 2019.  https://doi.org/10.1007/s00259-019-04438-w.CrossRefGoogle Scholar
  22. 22.
    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;46:1542–50.  https://doi.org/10.1007/s00259-019-04308-5.CrossRefPubMedGoogle Scholar
  23. 23.
    Calais J, Czernin J, Fendler WP, Elashoff D, Nickols NG. Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]. BMC Cancer. 2019;19:18.  https://doi.org/10.1186/s12885-018-5200-1.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Schillaci O, Urbano N. Digital PET/CT: a new intriguing chance for clinical nuclear medicine and personalized molecular imaging. Eur J Nucl Med Mol Imaging. 2019.  https://doi.org/10.1007/s00259-019-04300-z.CrossRefGoogle Scholar
  25. 25.
    Fuentes-Ocampo F, Lopez-Mora DA, Flotats A, Paillahueque G, Camacho V, Duch J, et al. Digital vs analog PET/CT: intra-subject comparison of the SUVmax in target lesions and reference regions European journal of nuclear medicine and molecular imaging 2019. doi: https://doi.org/10.1007/s00259-018-4256-0.CrossRefGoogle Scholar
  26. 26.
    Sachpekidis C, Kopka K, Eder M, Hadaschik BA, Freitag MT, Pan L, et al. 68Ga-PSMA-11 Dynamic PET/CT Imaging in Primary Prostate Cancer. Clin Nucl Med. 2016;41:e473–e9.  https://doi.org/10.1097/RLU.0000000000001349.CrossRefPubMedGoogle Scholar
  27. 27.
    Afshar-Oromieh A, Hetzheim H, Kubler W, Kratochwil C, Giesel FL, Hope TA, et al. Radiation dosimetry of (68)Ga-PSMA-11 (HBED-CC) and preliminary evaluation of optimal imaging timing. Eur J Nucl Med Mol Imaging. 2016;43:1611–20.  https://doi.org/10.1007/s00259-016-3419-0.CrossRefPubMedGoogle Scholar
  28. 28.
    Rauscher I, Kronke M, Konig M, Gafita A, Maurer T, Horn T, et al. Matched-pair comparison of (68)Ga-PSMA-11 and (18)F-PSMA-1007 PET/CT: frequency of pitfalls and detection efficacy in biochemical recurrence after radical prostatectomy. J Nucl Med. 2019.  https://doi.org/10.2967/jnumed.119.229187.
  29. 29.
    Paschalis A, Sheehan B, Riisnaes R, Rodrigues DN, Gurel B, Bertan C, et al. Prostate-specific membrane antigen heterogeneity and DNA repair defects in prostate cancer. Eur Urol. 2019;76:469–78.  https://doi.org/10.1016/j.eururo.2019.06.030.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Hubble D, Robins P. RE: Uptake in sympathetic ganglia on 68Ga-PSMA-HBED PET/CT: A potential pitfall in scan interpretation. J Med Imaging Radiat Oncol. 2018;62:377–8.  https://doi.org/10.1111/1754-9485.12739.CrossRefPubMedGoogle Scholar
  31. 31.
    Kanthan GL, Hsiao E, Vu D, Schembri GP. Uptake in sympathetic ganglia on 68Ga-PSMA-HBED PET/CT: a potential pitfall in scan interpretation. J Med Imaging Radiat Oncol. 2017;61:732–8.  https://doi.org/10.1111/1754-9485.12622.CrossRefPubMedGoogle Scholar
  32. 32.
    Rahbar K, Afshar-Oromieh A, Bogemann M, Wagner S, Schafers M, Stegger L, et al. (18)F-PSMA-1007 PET/CT at 60 and 120 minutes in patients with prostate cancer: biodistribution, tumour detection and activity kinetics. Eur J Nucl Med Mol Imaging. 2018;45:1329–34.  https://doi.org/10.1007/s00259-018-3989-0.CrossRefPubMedGoogle Scholar
  33. 33.
    van der Vos CS, Koopman D, Rijnsdorp S, Arends AJ, Boellaard R, van Dalen JA, et al. Quantification, improvement, and harmonization of small lesion detection with state-of-the-art PET. Eur J Nucl Med Mol Imaging. 2017;44:4–16.  https://doi.org/10.1007/s00259-017-3727-z.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Koopman D, Jager PL, van Dalen JA. Small-voxel reconstructions significantly influence SUVs in PET imaging. Eur J Nucl Med Mol Imaging. 2019;46:1751–2.  https://doi.org/10.1007/s00259-019-04301-y.CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Nuclear MedicineInselspitalBernSwitzerland

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