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Comparison of standard and delayed imaging to improve the detection rate of [68Ga]PSMA I&T PET/CT in patients with biochemical recurrence or prostate-specific antigen persistence after primary therapy for prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging volume 44, pages 960–968 (2017)Cite this article

Abstract

Purpose

The aim of this study was to assess the value of dual-time point imaging in PET/CT for detection of biochemically recurrent or persistent prostate cancer, using the prostate-specific membrane antigen (PSMA) ligand [68Ga]PSMA I&T.

Methods

240 patients who underwent a [68Ga]PSMA I&T PET/CT in the context of biochemical relapse of prostate cancer were included in this retrospective analysis. Imaging consisted of a standard whole-body PET/CT (1 h p.i.), followed by delayed (3 h p.i.) imaging of the abdomen. PSA-stratified proportions of positive PET/CT results, standardized uptake values and target-to-background ratios were analyzed, and compared between standard and delayed imaging.

Results

The overall detection rates of [68Ga]PSMA I&T PET/CT were 94.2, 71.8, 58.6, 55.9 and 38.9% for PSA levels of ≥2, 1 to <2, 0.5 to <1, >0.2 to <0.5, and 0.01 to 0.2 ng/mL, respectively. Although the target-to-background ratio improved significantly over time (P < 0.0001), the majority (96.6%) of all lesions suggestive of recurrent disease could already be detected in standard imaging. Delayed imaging at 3 h p.i. exclusively identified pathologic findings in 5.4% (10/184) of abnormal [68Ga]PSMA I&T PET/CT scans, and exclusively detected 3.4% (38/1134) of all lesions suggestive of recurrent disease.

Conclusions

[68Ga]PSMA I&T PET/CT shows high detection rates in patients with prostate-specific antigen persistence or biochemical recurrence of prostate cancer. Delayed imaging can detect lesions with improved contrast compared to standard imaging. However, the impact on detection rates was limited in this study.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany

    Sebastian Schmuck, Stefan Nordlohne, Jan M. Sohns, Tobias L. Ross, Frank M. Bengel & Thorsten Derlin

  2. Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany

    Christoph-A. von Klot

  3. Department of Radiation Oncology, Hannover Medical School, Hannover, Germany

    Christoph Henkenberens & Hans Christiansen

  4. Pharmaceutical Radiochemistry, Technische Universität München|, Garching, Germany

    Hans-Jürgen Wester

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  1. Sebastian Schmuck
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Correspondence to Thorsten Derlin.

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Conflict of interest

Prof. Dr. Hans-Jürgen Wester is a shareholder of Scintomics. All other authors have nothing to disclose.

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 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Schmuck, S., Nordlohne, S., von Klot, CA. et al. Comparison of standard and delayed imaging to improve the detection rate of [68Ga]PSMA I&T PET/CT in patients with biochemical recurrence or prostate-specific antigen persistence after primary therapy for prostate cancer. Eur J Nucl Med Mol Imaging 44, 960–968 (2017). https://doi.org/10.1007/s00259-017-3669-5

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  • DOI: https://doi.org/10.1007/s00259-017-3669-5

Keywords

  • Prostate cancer
  • Detection rate
  • Delayed imaging
  • Dual-phase imaging
  • PSMA
  • PET/CT