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68Ga-PSMA PET/CT in patients with recurrent prostate cancer after radical treatment: prospective results in 314 patients

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Abstract

Purpose

We studied the usefulness of 68Ga-prostate-specific membrane antigen (PSMA) PET/CT for detecting relapse in a prospective series of patients with biochemical recurrence (BCR) of prostate cancer (PCa) after radical treatment.

Methods

Patients with BCR of PCa after radical surgery and/or radiotherapy with or without androgen-deprivation therapy were included in the study. 68Ga-PSMA PET/CT scans performed from the top of the head to the mid-thigh 60 min after intravenous injection of 150 ± 50 MBq of 68Ga-PSMA were interpreted by two nuclear medicine physicians. The results were correlated with prostate-specific antigen (PSA) levels at the time of the scan (PSApet), PSA doubling time, Gleason score, tumour stage, postsurgery tumour residue, time from primary therapy to BCR, and patient age. When available, 68Ga-PSMA PET/CT scans were compared with negative 18F-choline PET/CT scans routinely performed up to 1 month previously.

Results

From November 2015 to October 2017, 314 PCa patients with BCR were evaluated. Their median age was 70 years (range 44–92 years) and their median PSApet was 0.83 ng/ml (range 0.003–80.0 ng/ml). 68Ga-PSMA PET/CT was positive (one or more suspected PCa lesions detected) in 197 patients (62.7%). Lesions limited to the pelvis, i.e. the prostate/prostate bed and/or pelvic lymph nodes (LNs), were detected in 117 patients (59.4%). At least one distant lesion (LNs, bone, other organs, separately or combined with local lesions) was detected in 80 patients (40.6%). PSApet was higher in PET-positive than in PET-negative patients (P < 0.0001). Of 88 patients negative on choline PET/CT scans, 59 (67%) were positive on 68Ga-PSMA PET/CT.

Conclusion

We confirmed the value of 68Ga-PSMA PET/CT in restaging PCa patients with BCR, highlighting its superior performance and safety compared with choline PET/CT. Higher PSApet was associated with a higher relapse detection rate.

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Acknowledgments

The authors thank Gráinne Tierney and Cristiano Verna for editorial assistance.

Funding

This study was partially supported by the Italian Ministry of Health, grant RF-2016-02364230, and by the Italian Association for Cancer Research (AIRC), grant IG 20476.

Author information

Author notes

  1. Paola Caroli and Israel Sandler contributed equally to this work.

Authors and Affiliations

  1. Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy

    Paola Caroli, Israel Sandler, Federica Matteucci, Monica Celli & Giovanni Paganelli

  2. Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Ugo De Giorgi

  3. Morphology, Surgery and Experimental Medicine Department, University of Ferrara, Ferrara, Italy

    Licia Uccelli

  4. Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Flavia Foca

  5. Radiology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Domenico Barone

  6. Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Antonino Romeo

  7. Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Anna Sarnelli

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  1. Paola Caroli
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  2. Israel Sandler
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  3. Federica Matteucci
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  11. Giovanni Paganelli
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Contributions

Conception and design: G.P., I.S., U.De G. and P.C.

Collection and assembly of data: P.C., F.M. and I.S.

Data analysis and interpretation: F.F., I.S. and P.C.

Manuscript writing: All authors.

Final approval of manuscipt: All authors.

Accountable for all aspects of the work: All authors.

Corresponding author

Correspondence to Giovanni Paganelli.

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Conflicts of interest

None.

Ethical approval

The protocol was approved by the Ethics Committee of Area Vasta Romagna and by the competent Italian regulatory authorities. The study was performed in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice.

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All patients gave their written informed consent.

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Caroli, P., Sandler, I., Matteucci, F. et al. 68Ga-PSMA PET/CT in patients with recurrent prostate cancer after radical treatment: prospective results in 314 patients. Eur J Nucl Med Mol Imaging 45, 2035–2044 (2018). https://doi.org/10.1007/s00259-018-4067-3

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  • DOI: https://doi.org/10.1007/s00259-018-4067-3

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