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Strahlentherapie und Onkologie

, Volume 194, Issue 4, pp 303–310 | Cite as

Patterns of relapse as determined by 68Ga-PSMA ligand PET/CT after radical prostatectomy

Importance for tailoring and individualizing treatment
  • Christoph Henkenberens
  • Thorsten Derlin
  • Frank M. Bengel
  • Tobias L. Ross
  • Hans-Jürgen Wester
  • Katja Hueper
  • Markus A. Kuczyk
  • Hans Christiansen
  • Christoph A. von Klot
Original Article

Abstract

Purpose

To evaluate the patterns of relapse and impact on the intended treatment when using 68Ga-prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) imaging for restaging of disease in patients with biochemical relapse after radical prostatectomy (RP) before salvage radiotherapy (sRT).

Methods

In all, 39 patients with biochemical recurrence after RP who had no primary indication for adjuvant RT due to the absence of biologically unfavorable disease (e.g., extracapsular extension, seminal vesicle invasion, positive margins, or lymph node involvement) underwent a 68Ga-PSMA ligand PET/CT for planning of sRT.

Results

PET/CT was positive in 84.6% (33/39) of patients. A total of 61 lesions were observed in these patients (on average 1.8 lesions per patient); 30.3% (10/33) of patients had locally recurrent disease in the prostatic bed. The clinical TNM stage (TNM: tumour-lymph nodes-metastasis-classification) was altered in 69.7% (23/33) of patients following PET, resulting in individualized treatment concepts. A prostate-specific antigen (PSA) >1.0 ng/mL was significantly associated with an increased risk of extrapelvic metastatic disease (p = 0.048). The PSA level at the time of PSMA ligand PET/CT correlated with the peak standardized uptake value (SUVpeak; p = 0.002). According to current clinical guidelines, the remaining 15.4% (6/39) of patients without evidence of disease on PET received sRT with a dose of 66.0 Gy.

Conclusion

Our results suggest that in patients with biochemical recurrence who did not receive early sRT, a 68Ga-PSMA ligand PET/CT for restaging of disease allows for tailoring and individualizing treatment. Particularly in patients with PSA levels above 1.0 ng/mL, a 68Ga-PSMA ligand PET/CT should be performed for therapy planning, since patients often have metastases not confined to the pelvis.

Keywords

Prostate cancer Prostate-specific membrane antigen ligand Positron emission tomography Individualized treatment Computed tomography 

Rezidivmuster in der 68Ga-PSMA-Liganden-PET/CT nach radikaler Prostatektomie

Bedeutung einer zugeschnittenen und individualisierten Therapie

Zusammenfassung

Zielsetzung

Evaluation des Rezidivmusters und Einfluss auf das Behandlungskonzept unter Verwendung der 68Ga-prostataspezifischen Membranantigen-(PSMA-)Liganden-Positronenemissionstomographie/Computertomographie (PET/CT) für das Staging bei Patienten mit biochemischem Rezidiv nach radikaler Prostatektomie (RP) vor geplanter Salvage-Radiotherapie (sRT).

Methoden

Vor geplanter sRT erhielten 39 Patienten mit biochemischem Rezidiv nach RP, die aufgrund fehlender histopathologisch ungünstiger Merkmale (extrakapsulärer Befall, Samenblaseninvasion, positive Schnittränder, Lymphknotenbefall) keine Indikation zur postoperativen adjuvanten RT hatten, eine 68Ga-PSMA-Liganden-PET/CT.

Ergebnisse

Die PET/CT war bei 84,6 % (33/39) der Patienten positiv. Bei diesen 33 Patienten zeigten sich insgesamt 61 Läsionen (durchschnittlich 1,8 Läsionen pro Patient). Ein Lokalrezidiv in der ehemaligen Prostataloge hatten 30,3 % (10/33), so dass sich bei 69,7 % (23/33) eine Änderung des klinischen TNM-Status (TNM: „tumour-lymph nodes-metastasis-classification“) mit daraus resultierender Individualisierung des Behandlungskonzepts ergab. Ein PSA (prostataspezifisches Antigen) >1,0 ng/ml ging mit einem signifikant erhöhten Risiko einer extrapelvinen Metastasierung einher (p = 0,048). Der PSA-Wert zum Zeitpunkt des PSMA-Liganden-PET/CT korrelierte signifikant mit dem „peak standardized uptake value“ (SUVpeak; p = 0,002). Entsprechend den aktuellen klinischen Leitlinien erhielten die Patienten ohne Metastasennachweis (15,4 %; 6/39) eine sRT mit einer Dosis von 66,0 Gy.

Schlussfolgerung

Unsere Ergebnisse zeigen, dass bei Patienten, die keine frühe sRT erhielten, eine 68Ga-PSMA-Liganden-PET/CT erlaubte, das Behandlungskonzept zu individualisieren. Insbesondere bei Patienten mit einem PSA-Wert größer 1,0 ng/ml, die ein signifikant höheres Risiko für Metastasen außerhalb des Beckens aufwiesen, sollte eine Therapieplanung mittels 68Ga-PSMA-Liganden-PET/CT erfolgen.

Schlüsselwörter

Prostatakrebs Prostataspezifischer Membranantigenligand Positronenemissionstomographie Individualisierte Behandlung Computertomographie 

Notes

Compliance with ethical guidelines

Conflict of interest

C. Henkenberens, T. Derlin, F.M. Bengel, T.L. Ross, K. Hueper, M.A. Kuczyk, H. Christiansen and and C.A. von Klot declare that they have no competing interests. H.-J. Wester is a shareholder of Scintomics.

Ethical standards

All patients gave written informed consent prior to 68Ga-PSMA ligand PET/CT. This retrospective study complied with the regulations of the local institutional review board and the principles of the Declaration of Helsinki.

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Copyright information

© Springer-Verlag GmbH Deutschland 2017

Authors and Affiliations

  • Christoph Henkenberens
    • 1
  • Thorsten Derlin
    • 3
  • Frank M. Bengel
    • 3
  • Tobias L. Ross
    • 3
  • Hans-Jürgen Wester
    • 4
  • Katja Hueper
    • 5
  • Markus A. Kuczyk
    • 2
  • Hans Christiansen
    • 1
  • Christoph A. von Klot
    • 2
  1. 1.Department of Radiotherapy and Special OncologyHannover Medical SchoolHannoverGermany
  2. 2.Department of Urology and Urologic OncologyHannover Medical SchoolHannoverGermany
  3. 3.Department of Nuclear MedicineHannover Medical SchoolHannoverGermany
  4. 4.Pharmaceutical RadiochemistryTechnical University MunichGarchingGermany
  5. 5.Department of RadiologyHannover Medical SchoolHannoverGermany

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