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Impact of 68Ga-PSMA-11 PET staging on clinical decision-making in patients with intermediate or high-risk prostate cancer

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Abstract

Background

Accurate staging is of major importance to determine the optimal treatment modality for patients with prostate cancer. Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) is a promising technique that outperformed conventional imaging in the detection of nodal and distant metastases in previous studies. However, it is still unclear whether the superior sensitivity and specificity also translate into improved patient management. The aim of this study was to assess the performance of 68Ga-PSMA-11 PET for staging of intermediate and high-risk prostate cancer and its potential impact on disease management.

Methods

In this retrospective analysis, 116 patients who underwent 68Ga-PSMA-11 PET/CT or MRI scans for staging of their intermediate or high-risk prostate cancer between April 2016 and May 2018 were included. The potential impact of 68Ga-PSMA-11 PET staging on patient management was assessed within a simulated multidisciplinary tumour board where hypothetical treatment decisions based on clinical information and conventional imaging alone was determined. This treatment decision was compared with the treatment recommendation based on clinical information and 68Ga-PSMA-11 PET imaging.

Results

The primary tumour was positive on 68Ga-PSMA-11 PET in 113 patients (97%). Nodal metastases were detected in 28 patients (24%) and bone metastases in 14 patients (12%). Compared with clinical staging and conventional imaging, 68Ga-PSMA-11 PET resulted in new information in 42 of 116 patients (36%). In 32 of 116 patients (27%), this information would most likely have changed the management into a different therapy modality (15 patients, 13%) or adjusted treatment details (e.g. modification of radiotherapy field or lymph node dissection template; 17 patients, 14%).

Conclusion

Information from 68Ga-PSMA-11 PET staging has the potential to change the management in more than a fourth of the patients who underwent PET staging for their intermediate to high-risk prostate cancer. Whether these more personalized 68Ga-PSMA-11 PET-based treatment decisions will improve patient outcome needs further investigation.

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Availability of data and material

Patient imaging was done in the scope of the 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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Acknowledgements

The authors acknowledge the technicians Marlena Hofbauer and Josephine Trinckauf and their team for the excellent work on 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

Author notes

  1. Daniela A. Ferraro, Helena I. Garcia Schüler, Thomas Hermanns and Irene A. Burger contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland

    Daniela A. Ferraro, Urs J. Muehlematter, Julian Müller, Philipp A. Kaufmann & Irene A. Burger

  2. Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland

    Helena I. Garcia Schüler

  3. Department of Interventional and Diagnostic Radiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland

    Urs J. Muehlematter

  4. Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland

    Daniel Eberli & Thomas Hermanns

  5. Department of Urology, Spital Limmattal, Schlieren, Switzerland

    Alexander Müller

  6. Uroviva, Zürich, Switzerland

    Roger Gablinger

  7. Department of Radiation Oncology, Stadtspital Triemli, Zürich, Switzerland

    Helmut Kranzbühler

  8. Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, University of Bern, Bern, Switzerland

    Aurelius Omlin

  9. Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland

    Irene A. Burger

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Contributions

DAF and HIGS—data collection, analysis, and manuscript writing

UJM and JM—data collection

DE, PAK—manuscript revision

AM, RG, HK, AO—patient selection and manuscript revision

TH, IAB—study design, manuscript writing

All authors reviewed and agreed to the manuscript content.

Corresponding author

Correspondence to Irene A. Burger.

Ethics declarations

Ethics approval and consent to participate

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

Consent for publication

Not applicable.

Competing interests

IAB has received research grants and speaker honorarium from GE Healthcare, research grants from Swiss Life and speaker honorarium from Bayer Health Care and Astellas Pharma AG. TH holds an advisory function for MSD and Bayer. AO declares an advisory role (compensated, institutional) for Astra Zeneca, Astellas, Bayer, Janssen, Molecular Partners, MSD, Pfizer, Roche, Sanofi Aventis; research support (institutional) from TEVA, Janssen; travel support from Astellas, Bayer, Janssen, Sanofi Aventis and speakers bureau (compensated, institutional) from Bayer, Astellas. Authors DAF, HIGS, UJM, DE, JM, AM, RG, HK, and PAK declare no conflict of interest.

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Ferraro, D.A., Garcia Schüler, H.I., Muehlematter, U.J. et al. Impact of 68Ga-PSMA-11 PET staging on clinical decision-making in patients with intermediate or high-risk prostate cancer. Eur J Nucl Med Mol Imaging 47, 652–664 (2020). https://doi.org/10.1007/s00259-019-04568-1

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