Advertisement

World Journal of Urology

, Volume 36, Issue 4, pp 519–527 | Cite as

68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) for primary staging of high-risk prostate cancer: a systematic review

  • Julia Corfield
  • Marlon Perera
  • Damien Bolton
  • Nathan Lawrentschuk
Topic Paper

Abstract

Purpose

To systematically review currently available data on 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) used for the primary staging of high-risk prostate cancer.

Methods

We performed critical reviews of EMBASE, Web of Science (including MEDLINE) and Cochrane databases in October 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We included studies that utilized 68Ga-PSMA PET for primary staging of prostate cancer. Quality was assessed using the Critical Appraisal Skills Programme checklist for diagnostic test studies.

Results

Following our systematic search strategy, 12 studies were included for assessment. These studies comprised a total of 322 patients who underwent 68Ga-PSMA PET scanning for the purpose of primary staging. Only 5 of these studies included histopathologic correlation data. High variation in methodology and outcomes such as sensitivity (range 33–99%) and specificity (> 90%) was seen across all studies. The ability of 68Ga-PSMA PET to detect malignant lesions was evident across studies, with most studies demonstrating increased detection rates with respect to conventional imaging modalities.

Conclusions

In the primary staging of prostate cancer 68Ga-PSMA PET appears to outperform traditional imaging modalities. Overall, there are few high-quality studies investigating 68Ga-PSMA PET in this sub-group highlighting the need for formal assessment of PSMA PET in the form of large-volume, prospective studies.

Keywords

Prostate cancer Imaging Positron emission tomography Prostate-specific membrane antigen PSMA 

Notes

Acknowledgements

We would like to acknowledge the support of the Young urology researchers organisation (YURO) community of Australia and New Zealand for enabling this manuscript to progress to completion.

Author contributions

All authors in the submitted article have made a substantial contribution to the information submitted for publication. JC: protocol/project development, data collection or management, data analysis, manuscript writing/editing. MP: protocol/project development, data collection or management, data analysis, manuscript writing/editing. DB: protocol/project development. NL: protocol/project development, Manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108CrossRefPubMedGoogle Scholar
  2. 2.
    Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol 71(4):630–642CrossRefPubMedGoogle Scholar
  3. 3.
    Mottet NBJ, Briers E, Bolla M, Cornford P, De Santis M, Henry A, Joniau A, Lam T, Mason MD, Matveev V, van der Kwast TH, van der Poel H, Rouvière O, Wiegel T; members of the EAU–ESTRO–SIOG prostate cancer guidelines Panel., EAU–ESTRO–SIOG guidelines on prostate cancer. Edn. Presented at the EAU Annual Congress MI—PEGO. https://uroweb.org/guideline/prostate-cancer/. Accessed 26 Mar 2017
  4. 4.
    Hovels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63(4):387–395CrossRefPubMedGoogle Scholar
  5. 5.
    Chang SS (2004) Overview of prostate-specific membrane antigen. Rev Urol 6(Suppl 10):S13–S18PubMedPubMedCentralGoogle Scholar
  6. 6.
    Huang E, Teh BS, Mody DR, Carpenter LS, Butler EB (2003) Prostate adenocarcinoma presenting with inguinal lymphadenopathy. Urology 61(2):463CrossRefPubMedGoogle Scholar
  7. 7.
    Wu LM, Xu JR, Ye YQ, Lu Q, Hu JN (2012) The clinical value of diffusion-weighted imaging in combination with T2-weighted imaging in diagnosing prostate carcinoma: a systematic review and meta-analysis. AJR Am J Roentgenol 199(1):103–110CrossRefPubMedGoogle Scholar
  8. 8.
    Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C (1997) Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res 3(1):81–85PubMedGoogle Scholar
  9. 9.
    Sweat SD, Pacelli A, Murphy GP, Bostwick DG (1998) Prostate-specific membrane antigen expression is greatest in prostate adenocarcinoma and lymph node metastases. Urology 52(4):637–640CrossRefPubMedGoogle Scholar
  10. 10.
    Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M et al (2015) 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 42(2):197–209CrossRefPubMedGoogle Scholar
  11. 11.
    Eder M, Schafer M, Bauder-Wust U, Hull WE, Wangler C, Mier W et al (2012) 68 Ga-complex lipophilicity and the targeting property of a urea-based PSMA inhibitor for PET imaging. Bioconjug Chem 23(4):688–697CrossRefPubMedGoogle Scholar
  12. 12.
    Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA et al (2013) PET imaging with a [68 Ga]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 40(4):486–495CrossRefPubMedGoogle Scholar
  13. 13.
    Perera M, Papa N, Christidis D, Wetherell D, Hofman MS, Murphy DG et al (2016) Sensitivity, specificity, and predictors of positive 68 Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol 70(6):926–937CrossRefPubMedGoogle Scholar
  14. 14.
    Critical Appraisal Skills Programme. CASP (Diagnostic Test Study) Checklist 2017 [cited 2017 October 28]. http://www.casp-uk.net/casp-tools-checklists
  15. 15.
    Budaus L, Leyh-Bannurah SR, Salomon G, Michl U, Heinzer H, Huland H et al (2016) Initial experience of (68)Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol 69(3):393–396CrossRefPubMedGoogle Scholar
  16. 16.
    Demirkol MO, Acar O, Ucar B, Ramazanoglu SR, Saglican Y, Esen T (2015) Prostate-specific membrane antigen-based imaging in prostate cancer: impact on clinical decision making process. Prostate 75(7):748–757CrossRefPubMedGoogle Scholar
  17. 17.
    Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C et al (2016) 68 Ga-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 70(4):553–557CrossRefPubMedGoogle Scholar
  18. 18.
    Hijazi S, Meller B, Leitsmann C, Strauss A, Meller J, Ritter CO et al (2015) Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68 Ga-PSMA-positron emission tomography/computerized tomography. Prostate 75(16):1934–1940CrossRefPubMedGoogle Scholar
  19. 19.
    Kabasakal L, Demirci E, Ocak M, Akyel R, Nematyazar J, Aygun A et al (2015) Evaluation of PSMA PET/CT imaging using a 68 Ga-HBED-CC ligand in patients with prostate cancer and the value of early pelvic imaging. Nucl Med Commun 36(6):582–587CrossRefPubMedGoogle Scholar
  20. 20.
    Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G et al (2016) Diagnostic efficacy of (68)Gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol 195(5):1436–1443CrossRefPubMedGoogle Scholar
  21. 21.
    Rahbar K, Weckesser M, Huss S, Semjonow A, Breyholz HJ, Schrader AJ et al (2016) Correlation of intraprostatic tumor extent with (6)(8)Ga-PSMA distribution in patients with prostate cancer. J Nucl Med 57(4):563–567CrossRefPubMedGoogle Scholar
  22. 22.
    Sachpekidis C, Kopka K, Eder M, Hadaschik BA, Freitag MT, Pan L et al (2016) 68 Ga-PSMA-11 dynamic PET/CT imaging in primary prostate cancer. Clin Nucl Med 41(11):e473–e479CrossRefPubMedGoogle Scholar
  23. 23.
    Schwenck J, Rempp H, Reischl G, Kruck S, Stenzl A, Nikolaou K et al (2017) Comparison of 68 Ga-labelled PSMA-11 and 11C-choline in the detection of prostate cancer metastases by PET/CT. Eur J Nucl Med Mol Imaging 44(1):92–101CrossRefPubMedGoogle Scholar
  24. 24.
    Sterzing F, Kratochwil C, Fiedler H, Katayama S, Habl G, Kopka K et al (2016) (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 43(1):34–41CrossRefPubMedGoogle Scholar
  25. 25.
    Uprimny C, Kroiss AS, Decristoforo C, Fritz J, von Guggenberg E, Kendler D et al (2017) 68 Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Med Mol Imaging 44:941–946CrossRefPubMedGoogle Scholar
  26. 26.
    van Leeuwen PJ, Emmett L, Ho B, Delprado W, Ting F, Nguyen Q et al (2017) Prospective evaluation of 68 gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU Int 119(2):209–215CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The University of MelbourneMelbourneAustralia
  2. 2.Department of SurgeryAustin HospitalMelbourneAustralia
  3. 3.Department of Surgical OncologyPeter MacCallum Cancer CentreMelbourneAustralia
  4. 4.School of MedicineUniversity of QueenslandBrisbaneAustralia

Personalised recommendations