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68Ga-PSMA-11 PET/CT in newly diagnosed prostate cancer: diagnostic sensitivity and interobserver agreement

  • Mohammad Abd Alkhalik BashaEmail author
  • Maged Abdel Galil Hamed
  • Omar Hussein
  • Tarek El-Diasty
  • Yasser Ibrahim Abdelkhalek
  • Yehia Omar Hussein
  • Ahmed Fathy Alasamer
  • Heba A. E. Mohamed
  • Dalia Salah El Deen
  • Engy Fathy Tantawy
  • Maha Ibrahim Metwally
  • Mohamed M. A. Zaitoun
  • Sameh Abdelaziz Aly
  • Jehan Ibrahim Altohamy
  • Abd El Motaleb Mohamed
  • Amira Hamed Mohamed Afifi
  • Ola Harb
Pelvis
  • 112 Downloads

Abstract

Purpose

To determine the diagnostic sensitivity and interobserver agreement of Gallium 68-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) imaging for diagnosis and staging of patients with newly diagnosed prostate cancer (PC).

Materials and methods

One hundred and seventy-three men (mean age, 68 ± 7.7 years; range 46–84 years) with newly diagnosed, untreated PC were enrolled in this prospective study between January 2017 and August 2018. All patients underwent a 68Ga-PSMA-11 PET/CT examination. For each patient, we determined the disease stage, the Gleason score, and the maximum standardized uptake value (SUVmax) for primary prostatic tumor and extraprostatic metastases. The diagnostic sensitivity and interobserver agreement of 68Ga-PSMA-11 PET/CT for diagnosis and staging of PC were established by histopathology as the reference standard.

Results

68Ga-PSMA-11 PET/CT examinations were interpreted as positive for PC in 166 of 173 patients (101 patients had primary prostatic tumor only, two patients had extraprostatic metastases only and 63 patients had combined lesions). The sensitivity of 68Ga-PSMA-11 PET/CT examination in the diagnosis of PC was 96%. 68Ga-PSMA-11 PET/CT produced a significant change of stage in 28.6% patients with an upstage in 17.9% patients and a downstage in 10.7% patients. The interobserver agreements were almost good to perfect (k = 0.63–0.89) for visual image interpretation, SUVmax measurement, and tumor staging.

Conclusion

68Ga-PSMA-11 PET/CT is a valuable tool with high diagnostic sensitivity (96%) and high reproducibility for diagnosis and staging of patients with newly diagnosed PC.

Keywords

68Ga-PSMA-11 PET/CT Newly diagnosed Prostate cancer Interobserver agreement 

Notes

Acknowledgements

The authors thank all staff members and colleagues in the PET CT Unite - MISR RADIOLOGY center (MRC)-Egypt for their helpful cooperation and all the study participants for their patience and support.

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Conflict of interest

The authors of this manuscript declare no relevant conflicts of interest, and no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ethical approval

Institutional review board approval was obtained.

Informed consent

Written informed consent was obtained from all patients.

References

  1. 1.
    Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA: A Cancer Journal for Clinicians 2011; 61: 69–90.Google Scholar
  2. 2.
    Lindenberg L, Choyke P, Dahut W. Prostate cancer imaging with novel PET tracers. Current urology reports 2016; 17:18.CrossRefGoogle Scholar
  3. 3.
    Rowe SP, Gage KL, Faraj SF, et al. (1) (8) F-DCFBC PET/CT for PSMA-Based Detection and Characterization of Primary Prostate Cancer. J Nucl Med 2015; 56:1003–1010.CrossRefGoogle Scholar
  4. 4.
    Kosuri S, Akhtar NH, Smith M, et al. Review of salvage therapy for biochemically recurrent prostate cancer: the role of imaging and rationale for systemic salvage targeted anti-prostate-specific membrane antigen radioimmunotherapy. Adv Urol 2012; 2012.Google Scholar
  5. 5.
    Yao HH, Hong M, Corcoran NM, et al. Advances in local and ablative treatment of oligometastasis in prostate cancer. Asia Pac J Clin Oncol 2014; 10:308–321.CrossRefGoogle Scholar
  6. 6.
    Heidenreich A, Bastian PJ, Bellmunt J, et al. European Association of Urology. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 2014; 65:467–479.Google Scholar
  7. 7.
    Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur urol 2017; 71:618–629.Google Scholar
  8. 8.
    Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer: Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2014; 65:124–137.CrossRefGoogle Scholar
  9. 9.
    Briganti A, Abdollah F, Nini A, et al. Performance characteristics of computed tomography in detecting lymph node metastases in contemporary patients with prostate cancer treated with extended pelvic lymph node dissection. Eur Urol 2012; 61:1132–1138.CrossRefGoogle Scholar
  10. 10.
    Budiharto T, Joniau S, Lerut E, et al. Prospective evaluation of C-11-choline positron emission tomography/computed tomography and diffusion weighted magnetic resonance imaging for the nodal staging of prostate cancer with high risk lymph node metastases. Eur Urol 2011; 60:125–130.CrossRefGoogle Scholar
  11. 11.
    Ceci F, Fiorentino M, Castellucci P, Fanti S. Molecular Imaging and Precision Medicine in Prostate Cancer. PET Clin 2017; 12:83–92.CrossRefGoogle Scholar
  12. 12.
    Lopci E, Chiti A, Lazzeri M. Re: Laura Evangelista, Alberto Briganti, Stefano Fanti, et al. New Clinical Indications for 18F/11C-choline, New Tracers for Positron Emission Tomography and a Promising Hybrid Device for Prostate Cancer Staging: A Systematic Review of the Literature. Eur Urol 2016; 70: e112–e113.Google Scholar
  13. 13.
    Rhee H, Thomas P, Shepherd B, et al. Prostate Specific Membrane Antigen Positron Emission Tomography May Improve the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Localized Prostate Cancer. J Urol 2016; 196:1261–1267.CrossRefGoogle Scholar
  14. 14.
    Buyyounouski MK, Choyke PL, McKenney JK, et al. Prostate cancer–major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA: a cancer journal for clinicians 2017; 67:245-53.Google Scholar
  15. 15.
    Hamed MA, Basha MA, Ahmed H, Obaya AA, Afifi AH, Abdelbary EH. 68Ga-PSMA PET/CT in Patients with Rising Prostatic-Specific Antigen After Definitive Treatment of Prostate Cancer: Detection Efficacy and Diagnostic accuracy. ​Acad Radiol 2019; 26:450–460.CrossRefGoogle Scholar
  16. 16.
    Kallur KG, Ramachandra PG, Rajkumar K, et al. Clinical utility of gallium-68 PSMA PET/CT scan for prostate cancer. Indian journal of nuclear medicine: IJNM: the official journal of the Society of Nuclear Medicine, India 2017; 32:110–117.Google Scholar
  17. 17.
    Rahbar K, Weckesser M, Huss S, et al. Correlation of intraprostatic tumor extent with 68 Ga-PSMA distribution in patients with prostate cancer. Journal of Nuclear Medicine 2016; 57:563–567.CrossRefGoogle Scholar
  18. 18.
    Kabasakal L, Demirci E, Ocak M, et al. Evaluation of PSMA PET/CT imaging using a 68 Ga-HBED-CC ligand in patients with prostate cancer and the value of early pelvic imaging. Nuclear medicine communications 2015; 36:582–587.CrossRefGoogle Scholar
  19. 19.
    Budäus L, Leyh-Bannurah SR, Salomon G, et al. Initial experience of 68Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Euro urolo 2016; 69:393–396.CrossRefGoogle Scholar
  20. 20.
    McCarthy M, Langton T, Kumar D, Campbell A. Comparison of PSMAHBED and PSMA-I&T as diagnostic agents in prostate cancer. Eur J Nucl Med Mol Imaging 2017; 44:1455–1462.CrossRefGoogle Scholar
  21. 21.
    Sachpekidis C, Kopka K, Eder M, et al. 68Ga-PSMA-11 dynamic PET/CT imaging in primary prostate cancer. Clin Nucl Med 2016; 41:e473–479.CrossRefGoogle Scholar
  22. 22.
    Berger I, Annabattula C, Lewis J, et al. 68 Ga-PSMA PET/CT vs. mpMRI for locoregional prostate cancer staging: correlation with final histopathology. Prostate cancer and prostatic diseases 2018; 21:204–211.Google Scholar
  23. 23.
    Perera M, Papa N, Christidis D, et al. Sensitivity, specificity, and predictors of positive 68Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol 2016; 70:926–937CrossRefGoogle Scholar
  24. 24.
    Wong HS, Leung J, Bartholomeusz D, et al. Comparative study between 68Ga‐prostate‐specific membrane antigen positron emission tomography and conventional imaging in the initial staging of prostate cancer. Journal of medical imaging and radiation oncology 2018; 62:816-822.CrossRefGoogle Scholar
  25. 25.
    Dewes S, Schiller K, Sauter K et al. Integration of (68) Ga-PSMA-PET imaging in planning of primary definitive radiotherapy in prostate cancer: a retrospective study. Radiat Oncol 2016; 11:73.CrossRefGoogle Scholar
  26. 26.
    Hruby G, Eade T, Emmett L, et al. 68Ga-PSMA-PET/CT staging prior to definitive radiation treatment for prostate cancer. Asia-Pacific J of Clin Oncol 2018; 14: 343–346.CrossRefGoogle Scholar
  27. 27.
    Han S, Woo S, Kim YJ, Suh CH. Impact of 68Ga-PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta-analysis. European urology 2018; 47:179–190.CrossRefGoogle Scholar
  28. 28.
    Schreiter V, Gericke M, Beck M, Ghadjar P, Boening G, Schreiter NF. Usefulness of Ga-68 HBED-CC PSMA PET/CT for Tumor Staging in the Initial Diagnostic Assessment of Prostate Cancer. J Nucl Med Radiat Ther 2016; 7: 291.Google Scholar
  29. 29.
    Meyrick DP, Asokendaran M, Skelly LA, Lenzo NP, Henderson A. The role of 68 Ga-PSMA-I&T PET/CT in the pretreatment staging of primary prostate cancer. Nuclear medicine communications 2017; 38:956–963.CrossRefGoogle Scholar
  30. 30.
    Fendler WP, Calais J, Allen-Auerbach M, et al. 68Ga-PSMA-11 PET/CT interobserver agreement for prostate cancer assessments: an international multicenter prospective study. Journal of Nuclear Medicine 2017; 58:1617–1623.CrossRefGoogle Scholar
  31. 31.
    Maurer T, Gschwend JE, Rauscher I, et al. Diagnostic Efficacy of (68)Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer. J Urol 2016; 195:1436–1443.CrossRefGoogle Scholar
  32. 32.
    Uprimny C, Kroiss AS, Decristoforo C, et al. 68Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Med Mol Imaging 2017; 44:941–949.CrossRefGoogle Scholar
  33. 33.
    Kranzbühler B, Nagel H, Becker AS, et al. Clinical performance of 68Ga-PSMA-11 PET/MRI for the detection of recurrent prostate cancer following radical prostatectomy. Eur J Nucl Med Mol Imaging 2018; 45:20–30.CrossRefGoogle Scholar
  34. 34.
    Sathekge M, Lengana T, Maes A, et al. 68Ga-PSMA-11 PET/CT in primary staging of prostate carcinoma: preliminary results on differences between black and white South-Africans. Eur J Nucl Med Mol Imaging 2018; 45:226–234.‏CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mohammad Abd Alkhalik Basha
    • 1
    Email author
  • Maged Abdel Galil Hamed
    • 1
  • Omar Hussein
    • 2
  • Tarek El-Diasty
    • 3
  • Yasser Ibrahim Abdelkhalek
    • 2
  • Yehia Omar Hussein
    • 2
  • Ahmed Fathy Alasamer
    • 2
  • Heba A. E. Mohamed
    • 1
  • Dalia Salah El Deen
    • 1
  • Engy Fathy Tantawy
    • 1
  • Maha Ibrahim Metwally
    • 1
  • Mohamed M. A. Zaitoun
    • 1
  • Sameh Abdelaziz Aly
    • 4
  • Jehan Ibrahim Altohamy
    • 5
  • Abd El Motaleb Mohamed
    • 6
  • Amira Hamed Mohamed Afifi
    • 7
  • Ola Harb
    • 8
  1. 1.Department of Radio-diagnosis, Nuclear Medicine UnitZagazig UniversityZagazigEgypt
  2. 2.Department of Radio-diagnosis, Nuclear Medicine UnitAin Shams UniversityCairoEgypt
  3. 3.Department of Radio-diagnosis, Urology and Nephrology CentreMansoura UniversityMansouraEgypt
  4. 4.Department of Radio-diagnosisBenha UniversityBenhaEgypt
  5. 5.Department of Radio-diagnosisNational Institute of Urology and NephrologyCairoEgypt
  6. 6.Department of Clinical OncologyZagazig UniversityZagazigEgypt
  7. 7.Department of Clinical PathologyZagazig UniversityZagazigEgypt
  8. 8.Department of PathologyZagazig UniversityZagazigEgypt

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