Comparison of 68Ga-labelled PSMA-11 and 11C-choline in the detection of prostate cancer metastases by PET/CT
- 3.3k Downloads
Prostate-specific membrane antigen (PSMA) is expressed ubiquitously on the membrane of most prostate tumors and its metastasis. While PET/CT using 11C-choline was considered as the gold standard in the staging of prostate cancer, PET with radiolabelled PSMA ligands was introduced into the clinic in recent years. Our aim was to compare the PSMA ligand 68Ga-PSMA-11 with 11C-choline in patients with primary and recurrent prostate cancer.
123 patients underwent a whole-body PET/CT examination using 68Ga-PSMA-11 and 11C-choline. Suspicious lesions were evaluated visually and semiquantitatively (SUVavg). Out of these, 103 suffered from a confirmed biochemical relapse after prostatectomy and/or radiotherapy (mean PSA level of 4.5 ng/ml), while 20 patients underwent primary staging.
In 67 patients with biochemical relapse, we detected 458 lymph nodes suspicious for metastasis. PET using 68Ga-PSMA-11 showed a significantly higher uptake and detection rate than 11C-choline PET. Also 68Ga-PSMA-11 PET identified significantly more patients with suspicious lymph nodes as well as affected lymph nodes regions especially at low PSA levels. Bone lesions suspicious for prostate cancer metastasis were revealed in 36 patients’ biochemical relapse. Significantly more bone lesions were detected by 68Ga-PSMA-11, but only 3 patients had only PSMA-positive bone lesions. Nevertheless, we detected also 29 suspicious lymph nodes and 8 bone lesions, which were only positive as per 11C-choline PET. These findings led to crucial differences in the TNM classification and the identification of oligometastatic patients. In the patients who underwent initial staging, all primary tumors showed uptake of both tracers. Although significantly more suspicious lymph nodes and bone lesions were identified, only 2 patients presented with bone lesions only detected by 68Ga-PSMA-11 PET.
Thus, PET using 68Ga-PSMA-11 showed a higher detection rate than 11C-choline PET for lymph nodes as well as bone lesions. However, we found lymph nodes and bone lesions which were not concordant applying both tracers.
KeywordsProstate cancer PET/CT PSMA Choline
Compliance with ethical standards
All patients gave written informed consent for the purpose of anonymized evaluation and publication of their data. All reported investigations were conducted in accordance with the Helsinki Declaration and with national regulations. The data analysis was approved by the ethics committee of the University of Tübingen (416/2015R).
Nothing to declare.
Conception and design: JS, ClF, HR; Analysis and interpretation of data: JS, HR CP, ClF; Drafting manuscript and critical revision JS, ClF, HR, CP, SK, AS, GR and KN. All authors read and approved the final manuscript.
- 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. doi: 10.1007/s00259-012-2298-2.CrossRefPubMedGoogle Scholar
- 2.Zechmann CM, Afshar-Oromieh A, Armor T, Stubbs JB, Mier W, Hadaschik B, et al. Radiation dosimetry and first therapy results with a (124)I/ (131)I-labeled small molecule (MIP-1095) targeting PSMA for prostate cancer therapy. Eur J Nucl Med Mol Imaging. 2014;41:1280–92. doi: 10.1007/s00259-014-2713-y.CrossRefPubMedPubMedCentralGoogle Scholar
- 3.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. doi: 10.1007/s00259-013-2525-5.CrossRefPubMedGoogle Scholar
- 4.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. doi: 10.1007/s00259-014-2949-6.CrossRefPubMedGoogle Scholar
- 7.Yao V, Berkman CE, Choi JK, O’Keefe DS, Bacich DJ. Expression of prostate-specific membrane antigen (PSMA), increases cell folate uptake and proliferation and suggests a novel role for PSMA in the uptake of the Non-Polyglutamated folate. Folic Acid Prostate. 2010;70:305–16. doi: 10.1002/Pros.21065.PubMedGoogle Scholar
- 10.Morigi JJ, Stricker PD, van Leeuwen PJ, Tang R, Ho B, Nguyen Q, et al. Prospective comparison of 18F-fluoromethylcholine versus 68Ga-PSMA PET/CT in prostate cancer patients Who have rising PSA after curative treatment and are being considered for targeted therapy. J Nucl Med. 2015;56:1185–90. doi: 10.2967/jnumed.115.160382.CrossRefPubMedGoogle Scholar
- 16.Brendle C, Kupferschlager J, Nikolaou K, la Fougere C, Gatidis S, Pfannenberg C. Is the standard uptake value (SUV) appropriate for quantification in clinical PET imaging? - Variability induced by different SUV measurements and varying reconstruction methods. Eur J Radiol. 2015;84:158–62. doi: 10.1016/j.ejrad.2014.10.018.CrossRefPubMedGoogle Scholar
- 22.Evangelista L, Guttilla A, Zattoni F, Muzzio PC. Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: a systematic literature review and meta-analysis. Eur Urol. 2013;63:1040–8. doi: 10.1016/j.eururo.2012.09.039.CrossRefPubMedGoogle Scholar
- 24.Cimitan M, Bortolus R, Morassut S, Canzonieri V, Garbeglio A, Baresic T, et al. [18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients. Eur J Nucl Med Mol Imaging. 2006;33:1387–98. doi: 10.1007/s00259-006-0150-2.CrossRefPubMedGoogle Scholar
- 27.Krause BJ, Souvatzoglou M, Tuncel M, Herrmann K, Buck AK, Praus C, et al. The detection rate of [11C]choline-PET/CT depends on the serum PSA-value in patients with biochemical recurrence of prostate cancer. Eur J Nucl Med Mol Imaging. 2008;35:18–23. doi: 10.1007/s00259-007-0581-4.CrossRefPubMedGoogle Scholar
- 28.Castellucci P, Fuccio C, Rubello D, Schiavina R, Santi I, Nanni C, et al. Is there a role for C-11-choline PET/CT in the early detection of metastatic disease in surgically treated prostate cancer patients with a mild PSA increase < 1.5 ng/ml? Eur J Nucl Med Mol Imaging. 2011;38:55–63. doi: 10.1007/s00259-010-1604-0.CrossRefPubMedGoogle Scholar
- 29.Hijazi S, Meller B, Leitsmann C, Strauss A, Meller J, Ritter CO, et al. Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by (68) Ga-PSMA-positron emission tomography/computerized tomography. Prostate. 2015;75:1934–40. doi: 10.1002/pros.23091.CrossRefPubMedGoogle Scholar
- 30.Herlemann A, Wenter V, Kretschmer A, Thierfelder K, Bartenstein P, Faber C, et al. 68Ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer. Eur Urol. 2016.Google Scholar
- 37.Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C, et al. 68Ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer. Eur Urol. 2016. doi: 10.1016/j.eururo.2015.12.051.PubMedGoogle Scholar