Extent of disease in recurrent prostate cancer determined by [68Ga]PSMA-HBED-CC PET/CT in relation to PSA levels, PSA doubling time and Gleason score

  • Frederik A. Verburg
  • David Pfister
  • Axel Heidenreich
  • Andreas Vogg
  • Natascha I. Drude
  • Stefan Vöö
  • Felix M. Mottaghy
  • Florian F. Behrendt
Original Article



To examine the relationship between the extent of disease determined by [68Ga]PSMA-HBED-CC-PET/CT and the important clinical measures prostate-specific antigen (PSA), PSA doubling time (PSAdt) and Gleason score.


We retrospectively studied the first 155 patients with recurrent prostate cancer (PCA) referred to our university hospital for [68Ga]PSMA-HBED-CC PET/CT.


PET/CT was positive in 44 %, 79 % and 89 % of patients with PSA levels of ≤1, 1 – 2 and ≥2 ng/ml, respectively. Patients with high PSA levels showed higher rates of local prostate tumours (p < 0.001), and extrapelvic lymph node (p = 0.037) and bone metastases (p = 0.013). A shorter PSAdt was significantly associated with pelvic lymph node (p = 0.026), extrapelvic lymph node (p = 0.001), bone (p < 0.001) and visceral (p = 0.041) metastases. A high Gleason score was associated with more frequent pelvic lymph node metastases (p = 0.039). In multivariate analysis, both PSA and PSAdt were independent determinants of scan positivity and of extrapelvic lymph node metastases. PSAdt was the only independent marker of bone metastases (p = 0.001). Of 20 patients with a PSAdt <6 months and a PSA ≥2 ng/ml, 19 (95 %) had a positive scan and 12 (60 %) had M1a disease. Of 14 patients with PSA <1 ng/ml and PSAdt >6 months, only 5 (36 %) had a positive scan and 1 (7 %) had M1a disease.


[68Ga]PSMA-HBED-CC PET/CT will identify PCA lesions even in patients with very low PSA levels. Higher PSA levels and shorter PSAdt are independently associated with scan positivity and extrapelvic metastases, and can be used for patient selection for [68Ga]PSMA-HBED-CC PET/CT.


PSA PSA doubling time Gleason score Prostate cancer [68Ga]PSMA-HBED-CC PET/CT 


Compliance with ethical standards

Conflicts of interest

Frederik A. Verburg has in the past accepted consultancy fees from Roche and is a consultant to Bayer. Axel Heidenreich has received consultancy fees and payment for speaker bureaux from Amgen, Janssen, Ipsen, Sanofi and Takeda (and also serves on the board of Takeda); research and travel support from Astellas; and a research grant from Sanofi. Felix M. Mottaghy has received research support and speaker fees from Bayer. Florian F. Behrendt has received research support and speaker fees from Bayer. David Pfister has received consultancy fees and payment for speaker bureaux from Astellas, Ipsen, Sanofi, Janssen. Andreas Vogg, Natascha Drude and Stefan Vöö have no conflicts to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

The present study was a retrospective one; for this type of study formal consent is not required.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Frederik A. Verburg
    • 1
    • 2
  • David Pfister
    • 3
  • Axel Heidenreich
    • 3
  • Andreas Vogg
    • 1
  • Natascha I. Drude
    • 1
  • Stefan Vöö
    • 2
  • Felix M. Mottaghy
    • 1
    • 2
  • Florian F. Behrendt
    • 1
  1. 1.Department of Nuclear MedicineRWTH University Hospital AachenAachenGermany
  2. 2.Department of Nuclear MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
  3. 3.Department of UrologyRWTH University Hospital AachenAachenGermany

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