Clinical impact of 68Ga-PSMA-11 PET on patient management and outcome, including all patients referred for an increase in PSA level during the first year after its clinical introduction

Abstract

Purpose

The fast-increasing use of positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) ligand for the imaging of prostate cancer (PCA) biochemical recurrence has led to a rapid change in treatment concepts. Since the superiority of 68Ga-PSMA-11 PET in detecting recurrent PCA is well established, the aim of our study was to assess its effect on management and outcome in all patients imaged during the first year after its introduction into clinical routine.

Methods

Of 327 patients imaged, 223 were referred for recurrent PCA and gave written informed consent for further analysis of their data for this retrospective consecutive cohort analysis. Twenty patients were lost to further follow-up. The rate of detection of recurrence by 68Ga-PSMA-11 PET was based on the clinical reports. Management before the availability of PET diagnostic information was assessed according to guidelines (therapy option without 68Ga-PSMA-11 PET). In the 203 patients with follow-up 6 months after 68Ga-PSMA-11 PET, the therapies effectively implemented as well as follow-up PSA levels were evaluated, with a PSA value of <0.2 ng/ml representing a complete response and a decrease in PSA value of at least 50% from baseline representing a partial response.

Results

68Ga-PSMA-11 PET was positive and identified recurrence in 166 of the 223 patients (74%), with a detection rate of 50% for recurrent disease at low PSA values of <0.5 ng/ml. 68Ga-PSMA-11 PET led to a change in management in 122 of the 203 patients (60%). A substantial increase in the use of metastasis-targeted treatment and a reduction in the use of systemic treatment were observed, with 59 of the 203 patients (29%) undergoing targeted radiotherapy (RTXa) only, and 20 patients (10%) undergoing RTXa with hormonal therapy as the two most frequently selected therapy options. The proportion of patients in whom systemic therapy was selected decreased from 60% (133 of 223 patients) to 34% (70 of 203 patients) on the basis of the information provided by the 68Ga-PSMA-11 PET scan. PSMA PET-directed metastasis-targeted treatment led to a complete response after 6 months in 45% of patients.

Conclusion

The high rate of recurrence detection by PSMA PET was confirmed and PSMA PET led to a change in management in 60% of patients. Focal therapy for PSMA-positive lesions is a promising approach with complete responses in 45% of patients.

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References

  1. 1.

    Afshar-Oromieh A, Holland-Letz T, Giesel FL, Kratochwil C, Mier W, Haufe S, et al. Diagnostic performance of (68)Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging. 2017;44:1258–68. https://doi.org/10.1007/s00259-017-3711-7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Eissa A, El Sherbiny A, Coelho RF, Rassweiler J, Davis JW, Porpiglia F, et al. The role of 68Ga-PSMA PET/CT scan in biochemical recurrence after primary treatment for prostate cancer: a systematic review of literature. Minerva Urol Nefrol. 2018;70:462–78. https://doi.org/10.23736/S0393-2249.18.03081-3.

    Article  PubMed  Google Scholar 

  3. 3.

    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. https://doi.org/10.2967/jnumed.115.160382.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Schwenck J, Rempp H, Reischl G, Kruck S, Stenzl A, Nikolaou K, et al. Comparison of (68)Ga-labelled PSMA-11 and (11)C-choline in the detection of prostate cancer metastases by PET/CT. Eur J Nucl Med Mol Imaging. 2017;44:92–101. https://doi.org/10.1007/s00259-016-3490-6.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Calais J, Czernin J, Cao M, Kishan AU, Hegde JV, Shaverdian N, et al. (68)Ga-PSMA-11 PET/CT mapping of prostate cancer biochemical recurrence after radical prostatectomy in 270 patients with a PSA level of less than 1.0 ng/mL: impact on salvage radiotherapy planning. J Nucl Med. 2018;59:230–7. https://doi.org/10.2967/jnumed.117.201749.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Roach PJ, Francis R, Emmett L, Hsiao E, Kneebone A, Hruby G, et al. The impact of (68)Ga-PSMA PET/CT on management intent in prostate cancer: results of an Australian prospective multicenter study. J Nucl Med. 2018;59:82–8. https://doi.org/10.2967/jnumed.117.197160.

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Calais J, Fendler WP, Eiber M, Gartmann J, Chu FI, Nickols NG, et al. Impact of (68)Ga-PSMA-11 PET/CT on the management of prostate cancer patients with biochemical recurrence. J Nucl Med. 2018;59:434–41. https://doi.org/10.2967/jnumed.117.202945.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Han S, Woo S, Kim YJ, Suh CH. Impact of (68)Ga-PSMA PET on the management of patients with prostate cancer: a systematic review and meta-analysis. Eur Urol. 2018;74:179–90. https://doi.org/10.1016/j.eururo.2018.03.030.

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Mena E, Lindenberg ML, Shih JH, Adler S, Harmon S, Bergvall E, et al. Clinical impact of PSMA-based (18)F-DCFBC PET/CT imaging in patients with biochemically recurrent prostate cancer after primary local therapy. Eur J Nucl Med Mol Imaging. 2018;45:4–11. https://doi.org/10.1007/s00259-017-3818-x.

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Kranzbuhler B, Nagel H, Becker AS, Muller J, Huellner M, Stolzmann P, et al. Clinical performance of (68)Ga-PSMA-11 PET/MRI for the detection of recurrent prostate cancer following radical prostatectomy. Eur J Nucl Med Mol Imaging. 2018;45:20–30. https://doi.org/10.1007/s00259-017-3850-x.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Zschaeck S, Wust P, Beck M, Wlodarczyk W, Kaul D, Rogasch J, et al. Intermediate-term outcome after PSMA-PET guided high-dose radiotherapy of recurrent high-risk prostate cancer patients. Radiat Oncol. 2017;12:140. https://doi.org/10.1186/s13014-017-0877-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Bluemel C, Linke F, Herrmann K, Simunovic I, Eiber M, Kestler C, et al. Impact of (68)Ga-PSMA PET/CT on salvage radiotherapy planning in patients with prostate cancer and persisting PSA values or biochemical relapse after prostatectomy. EJNMMI Res. 2016;6:78. https://doi.org/10.1186/s13550-016-0233-4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Emmett L, van Leeuwen PJ, Nandurkar R, Scheltema MJ, Cusick T, Hruby G, et al. Treatment outcomes from (68)Ga-PSMA PET/CT-informed salvage radiation treatment in men with rising PSA after radical prostatectomy: prognostic value of a negative PSMA PET. J Nucl Med. 2017;58:1972–6. https://doi.org/10.2967/jnumed.117.196683.

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Grubmuller B, Baltzer P, D'Andrea D, Korn S, Haug AR, Hacker M, et al. (68)Ga-PSMA 11 ligand PET imaging in patients with biochemical recurrence after radical prostatectomy - diagnostic performance and impact on therapeutic decision-making. Eur J Nucl Med Mol Imaging. 2018;45:235–42. https://doi.org/10.1007/s00259-017-3858-2.

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Schmidt-Hegemann NS, Fendler WP, Ilhan H, Herlemann A, Buchner A, Stief C, et al. Outcome after PSMA PET/CT based radiotherapy in patients with biochemical persistence or recurrence after radical prostatectomy. Radiat Oncol. 2018;13:37. https://doi.org/10.1186/s13014-018-0983-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Henkenberens C, von Klot CA, Ross TL, Bengel FM, Wester HJ, Katja H, et al. (68)Ga-PSMA ligand PET/CT-based radiotherapy for lymph node relapse of prostate cancer after primary therapy delays initiation of systemic therapy. Anticancer Res. 2017;37:1273–9. https://doi.org/10.21873/anticanres.11444.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Wait S, Han D, Muthu V, Oliver K, Chrostowski S, Florindi F, et al. Towards sustainable cancer care: reducing inefficiencies, improving outcomes – a policy report from the All.Can initiative. J Cancer Policy. 2017;13:47–64.

    Article  Google Scholar 

  18. 18.

    Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117–28. https://doi.org/10.1093/jnci/djq495.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Gillessen S, Attard G, Beer TM, Beltran H, Bossi A, Bristow R, et al. Management of patients with advanced prostate cancer: the report of the Advanced Prostate Cancer Consensus Conference APCCC 2017. Eur Urol. 2018;73:178–211. https://doi.org/10.1016/j.eururo.2017.06.002.

    Article  PubMed  Google Scholar 

  20. 20.

    Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol. 2017;71:630–42. https://doi.org/10.1016/j.eururo.2016.08.002.

    Article  PubMed  Google Scholar 

  21. 21.

    Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71:618–29. https://doi.org/10.1016/j.eururo.2016.08.003.

    Article  PubMed  Google Scholar 

  22. 22.

    Kang J, Reiter R, Steinberg M, King C. Ultra-sensitive PSA following prostatectomy reliably identifies patients requiring postoperative radiation therapy. Int J Radiat Oncol Biol Phys. 2014;90:S130–S1.

    Article  Google Scholar 

  23. 23.

    Chang JH, Park W, Park JS, Pyo H, Huh SJ, Choi HY, et al. Significance of early prostate-specific antigen values after salvage radiotherapy in recurrent prostate cancer patients treated with surgery. Int J Urol. 2015;22:82–7. https://doi.org/10.1111/iju.12604.

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Fendler WP, Rahbar K, Herrmann K, Kratochwil C, Eiber M. (177)Lu-PSMA radioligand therapy for prostate cancer. J Nucl Med. 2017;58:1196–200. https://doi.org/10.2967/jnumed.117.191023.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Fendler WP, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S, et al. Ga-68-PSMA PET/CT: joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2017;44:1014–24. https://doi.org/10.1007/s00259-017-3670-z.

    Article  PubMed  Google Scholar 

  26. 26.

    Hofman MS, Hicks RJ, Maurer T, Eiber M. Prostate-specific membrane antigen PET: clinical utility in prostate cancer, normal patterns, pearls, and pitfalls. Radiographics. 2018;38:200–17. https://doi.org/10.1148/rg.2018170108.

    Article  PubMed  Google Scholar 

  27. 27.

    Fendler WP, Calais J, Allen-Auerbach M, Bluemel C, Eberhardt N, Emmett L, et al. (68)Ga-PSMA-11 PET/CT Interobserver agreement for prostate cancer assessments: an international multicenter prospective study. J Nucl Med. 2017;58:1617–23. https://doi.org/10.2967/jnumed.117.190827.

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Albisinni S, Artigas C, Aoun F, Biaou I, Grosman J, Gil T, et al. Clinical impact of (68)Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer with rising prostate-specific antigen after treatment with curative intent: preliminary analysis of a multidisciplinary approach. BJU Int. 2017;120:197–203. https://doi.org/10.1111/bju.13739.

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid (6)(8)Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015;56:668–74. https://doi.org/10.2967/jnumed.115.154153.

    Article  PubMed  Google Scholar 

  30. 30.

    Afaq A, Alahmed S, Chen SH, Lengana T, Haroon A, Payne H, et al. Impact of (68)Ga-prostate-specific membrane antigen PET/CT on prostate cancer management. J Nucl Med. 2018;59:89–92. https://doi.org/10.2967/jnumed.117.192625.

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    Sterzing F, Kratochwil C, Fiedler H, Katayama S, Habl G, Kopka K, et al. (68)Ga-PSMA-11 PET/CT: a new technique with high potential for the radiotherapeutic management of prostate cancer patients. Eur J Nucl Med Mol Imaging. 2016;43:34–41. https://doi.org/10.1007/s00259-015-3188-1.

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Liu T, Wu LY, Fulton MD, Johnson JM, Berkman CE. Prolonged androgen deprivation leads to downregulation of androgen receptor and prostate-specific membrane antigen in prostate cancer cells. Int J Oncol. 2012;41:2087–92. https://doi.org/10.3892/ijo.2012.1649.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Meller B, Bremmer F, Sahlmann CO, Hijazi S, Bouter C, Trojan L, et al. Alterations in androgen deprivation enhanced prostate-specific membrane antigen (PSMA) expression in prostate cancer cells as a target for diagnostics and therapy. EJNMMI Res. 2015;5:66. https://doi.org/10.1186/s13550-015-0145-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Kranzbuhler B, Salemi S, Umbricht CA, Muller C, Burger IA, Sulser T, et al. Pharmacological upregulation of prostate-specific membrane antigen (PSMA) expression in prostate cancer cells. Prostate. 2018;78:758–65. https://doi.org/10.1002/pros.23522.

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Afshar-Oromieh A, Debus N, Uhrig M, Hope TA, Evans MJ, Holland-Letz T, et al. Impact of long-term androgen deprivation therapy on PSMA ligand PET/CT in patients with castration-sensitive prostate cancer. Eur J Nucl Med Mol Imaging. 2018;45:2045–54.. https://doi.org/10.1007/s00259-018-4079-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Hope TA, Aggarwal R, Chee B, Tao D, Greene KL, Cooperberg MR, et al. Impact of (68)Ga-PSMA-11 PET on management in patients with biochemically recurrent prostate cancer. J Nucl Med. 2017;58:1956–61. https://doi.org/10.2967/jnumed.117.192476.

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    van Leeuwen PJ, Stricker P, Hruby G, Kneebone A, Ting F, Thompson B, et al. (68)Ga-PSMA has a high detection rate of prostate cancer recurrence outside the prostatic fossa in patients being considered for salvage radiation treatment. BJU Int. 2016;117:732–9. https://doi.org/10.1111/bju.13397.

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    Schmidt-Hegemann NS, Fendler WP, Buchner A, Stief C, Rogowski P, Niyazi M, et al. Detection level and pattern of positive lesions using PSMA PET/CT for staging prior to radiation therapy. Radiat Oncol. 2017;12:176. https://doi.org/10.1186/s13014-017-0902-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. 39.

    King CR. Adjuvant versus salvage radiotherapy for high-risk prostate cancer patients. Semin Radiat Oncol. 2013;23:215–21. https://doi.org/10.1016/j.semradonc.2013.01.009.

    Article  PubMed  Google Scholar 

  40. 40.

    Tendulkar RD, Agrawal S, Gao T, Efstathiou JA, Pisansky TM, Michalski JM, et al. Contemporary update of a multi-institutional predictive nomogram for salvage radiotherapy after radical prostatectomy. J Clin Oncol. 2016;34:3648–54. https://doi.org/10.1200/JCO.2016.67.9647.

    Article  PubMed  Google Scholar 

  41. 41.

    Stephenson AJ, Shariat SF, Zelefsky MJ, Kattan MW, Butler EB, The BS, et al. Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA. 2004;291:1325–32. https://doi.org/10.1001/jama.291.11.1325.

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Song DY, Thompson TL, Ramakrishnan V, Harrison R, Bhavsar N, Onaodowan O, et al. Salvage radiotherapy for rising or persistent PSA after radical prostatectomy. Urology. 2002;60:281–7.

    Article  PubMed  Google Scholar 

  43. 43.

    Goenka A, Magsanoc JM, Pei X, Schechter M, Kollmeier M, Cox B, et al. Long-term outcomes after high-dose postprostatectomy salvage radiation treatment. Int J Radiat Oncol Biol Phys. 2012;84:112–8. https://doi.org/10.1016/j.ijrobp.2011.10.077.

    Article  PubMed  Google Scholar 

  44. 44.

    Pacholke HD, Wajsman Z, Algood CB, Neulander EZ, Morris CG, Zlotecki RA. Postoperative adjuvant and salvage radiotherapy for prostate cancer: impact on freedom from biochemical relapse and survival. Urology. 2004;64:982–6. https://doi.org/10.1016/j.urology.2004.06.020.

    Article  PubMed  Google Scholar 

  45. 45.

    Liauw SL, Webster WS, Pistenmaa DA, Roehrborn CG. Salvage radiotherapy for biochemical failure of radical prostatectomy: a single-institution experience. Urology. 2003;61:1204–10.

    Article  PubMed  Google Scholar 

  46. 46.

    Stephenson AJ, Scardino PT, Kattan MW, Pisansky TM, Slawin KM, Klein EA, et al. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol. 2007;25:2035–41. https://doi.org/10.1200/JCO.2006.08.9607.

    Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Carrie C, Hasbini A, de Laroche G, Richaud P, Guerif S, Latorzeff I, et al. Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol. 2016;17:747–56. https://doi.org/10.1016/S1470-2045(16)00111-X.

    Article  CAS  PubMed  Google Scholar 

  48. 48.

    Bartkowiak D, Bottke D, Thamm R, Siegmann A, Hinkelbein W, Wiegel T. The PSA-response to salvage radiotherapy after radical prostatectomy correlates with freedom from progression and overall survival. Radiother Oncol. 2016;118:131–5. https://doi.org/10.1016/j.radonc.2015.10.028.

    Article  PubMed  Google Scholar 

  49. 49.

    Ray ME, Thames HD, Levy LB, Horwitz EM, Kupelian PA, Martinez AA, et al. PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis. Int J Radiat Oncol Biol Phys. 2006;64:1140–50. https://doi.org/10.1016/j.ijrobp.2005.07.006.

    Article  PubMed  Google Scholar 

  50. 50.

    Hussain M, Tangen CM, Higano C, Schelhammer PF, Faulkner J, Crawford ED, et al. Absolute prostate-specific antigen value after androgen deprivation is a strong independent predictor of survival in new metastatic prostate cancer: data from Southwest Oncology Group Trial 9346 (INT-0162). J Clin Oncol. 2006;24:3984–90. https://doi.org/10.1200/Jco.2006.06.4246.

    Article  PubMed  Google Scholar 

  51. 51.

    Winter A, Henke RP, Wawroschek F. Targeted salvage lymphadenectomy in patients treated with radical prostatectomy with biochemical recurrence: complete biochemical response without adjuvant therapy in patients with low volume lymph node recurrence over a long-term follow-up. BMC Urol. 2015;15:10. https://doi.org/10.1186/s12894-015-0004-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Shipley WU, Seiferheld W, Lukka HR, Major PP, Heney NM, Grignon DJ, et al. Radiation with or without antiandrogen therapy in recurrent prostate cancer. N Engl J Med. 2017;376:417–28. https://doi.org/10.1056/NEJMoa1607529.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors acknowledge the technicians Josephine Trinckauf and Marlena Hofbauer and their team for the excellent work in producing high-quality PET images.

Funding

The Department of Nuclear Medicine holds an institutional Research Contract with GE Healthcare. The authors thank the Sick legat and the Iten-Kohaut Foundation for their financial support.

Author information

Affiliations

Authors

Contributions

Julian Müller – data collection, manuscript editing.

Daniela A. Ferraro – data collection, manuscript editing.

Urs J. Muehlematter – statistics, data analysis.

Helena I. Garcia Schüler – data analysis, manuscript editing.

Sarah Kedzia - data collection, data analysis, manuscript editing.

Daniel Eberli, Matthias Guckenberger, Stephanie G. C. Kroeze, Tullio Sulser, Daniel M. Schmid, Aurelius Omlin, Alexander Müller, Thomas Zilli, Hubert John, Helmut Kranzbuehler – patient assessment, data analysis.

Philipp A. Kaufmann, Gustav K. von Schulthess, Irene A. Burger – study design and manuscript editing.

All authors reviewed and agreed to the manuscript content.

Corresponding author

Correspondence to Irene A. Burger.

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Conflicts of interest

I.A.B., G.K.v.S. and P.A.K. received research grants and speaker honoraria from GE Healthcare. I.A.B. received research grants from Swiss Life and speaker honoraria from Bayer Health Care and Astellas Pharma AG. M.G. received research grants from Varian. A.O. has an advisory role (compensated, institutional): Astellas, Bayer, Sanofi, Roche, Janssen, MSD, Molecular Partners. Research support (institutional): Teva, Janssen. Travel support: Astellas, Bayer, Sanofi, Janssen. Speaker Bureau (compensated, institutional): Astellas, Janssen, Bayer. All other authors declare no conflicts of interest.

Ethical approval and consent to participate

The local ethics committee approved the study protocol and all patients gave general written informed consent for retrospective use of their data (BASEC Nr. 2018–01284).

Consent for publication

Not applicable.

Availability of data and material

Patient imaging was done in the scope of routine clinical diagnostic studies, and the raw data are stored in the hospital archiving system at the Zurich University Hospital, Zurich, Switzerland.

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Müller, J., Ferraro, D.A., Muehlematter, U.J. et al. Clinical impact of 68Ga-PSMA-11 PET on patient management and outcome, including all patients referred for an increase in PSA level during the first year after its clinical introduction. Eur J Nucl Med Mol Imaging 46, 889–900 (2019). https://doi.org/10.1007/s00259-018-4203-0

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Keywords

  • PSMA
  • Detection rate
  • Prostate cancer
  • Biochemical recurrence
  • Change in management
  • Targeted