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
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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.
KeywordsPSA 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.
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.
The present study was a retrospective one; for this type of study formal consent is not required.
- 1.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.PubMedCrossRefGoogle Scholar
- 15.Hillier SM, Maresca KP, Femia FJ, Marquis JC, Foss CA, Nguyen N, et al. Preclinical evaluation of novel glutamate-urea-lysine analogues that target prostate-specific membrane antigen as molecular imaging pharmaceuticals for prostate cancer. Cancer Res. 2009;69:6932–40.PubMedPubMedCentralCrossRefGoogle Scholar
- 17.Tagawa ST, Milowsky MI, Morris M, Vallabhajosula S, Christos P, Akhtar NH, et al. Phase II study of lutetium-177-labeled anti-prostate-specific membrane antigen monoclonal antibody J591 for metastatic castration-resistant prostate cancer. Clin Cancer Res. 2013;19:5182–91.PubMedPubMedCentralCrossRefGoogle Scholar
- 18.Osborne JR, Green DA, Spratt DE, Lyashchenko S, Fareedy SB, Robinson BD, et al. A prospective pilot study of (89)Zr-J591/prostate specific membrane antigen positron emission tomography in men with localized prostate cancer undergoing radical prostatectomy. J Urol. 2014;191:1439–45.PubMedPubMedCentralCrossRefGoogle Scholar
- 22.Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th ed. New York: Wiley; 2009.Google Scholar
- 23.Cimitan M, Evangelista L, Hodolic M, Mariani G, Baseric T, Bodanza V, et al. Gleason score at diagnosis predicts the rate of detection of 18F-choline PET/CT performed when biochemical evidence indicates recurrence of prostate cancer: experience with 1,000 patients. J Nucl Med. 2015;56:209–15.PubMedCrossRefGoogle Scholar
- 26.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.PubMedPubMedCentralCrossRefGoogle Scholar