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68Ga-labelled PSMA ligand HBED-CC PET/CT imaging in patients with recurrent prostate cancer

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Abstract

Background

68Ga-PSMA Positron Emission Tomography/Computerized Tomography (PET/CT) has shown promising results for the detection of recurrent prostate cancer (RPCa). However, the diagnostic value of this method is yet to be validated. The aim of this study was to determine the influence of clinical and biochemical variables on the detection rate of 68Ga-PSMA PET/CT in patients with RPCa.

Methods

This is a prospective study of 121 patients who underwent 68Ga-PSMA-PET/CT and conventional imaging (CI) for RPCa. Detection rates were analyzed and correlated with various clinical and biochemical variables such as Gleason score GS), androgen deprivation therapy (ADT), trigger PSA (tPSA), PSA doubling-time (PSAdt) and PSA velocity (PSAv).

Results

68Ga-PSMA-PET/CT showed at least one focus of pathological 68Ga-PSMA uptake in 92/121 (76%) of patients. Nodal metastases (in 47% of patients) were the most common site of recurrent disease followed by bones (36%) and prostate (32%). Out of 121 patients, 57 (47%) had only positive findings on PSMA scan verified by biopsy or follow-up. The majority of these lesion were located in the lymph nodes (31/57, 54,5%), which were below the detection limit of CT. Univariate analysis showed higher detection rate of PET/CT with increasing tPSA, PSAv and short PSAdt. Best cutoff for tPSA, PSAv and PSAdt was 0.5 ng/ml, 2.25 ng/ml/year and 8.65 months, respectively. The detection rate of PSMA-PET/CT was higher in patients with high grade tumors (GS > 7, 23.7% vs 76.3%) and in patients who were on ADT during of PSMA scan (76.3% vs 96%). In multiple logistic regression analysis, PSAdt and concurrent ADT were identified as predictors of positive 68Ga-PSMA-PET/CT.

Conclusion

68Ga-PSMA-PET/CT is useful for re-staging patients with RPCa and has improved performance compared with CI for disease detection. Detection rates are improved in patients on ADT and with short PSAdt.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Elif Neslihan Akdemir, Murat Tuncel & Meltem Caglar

  2. Department of Radiation Oncology, Medical Faculty, Hacettepe University, Ankara, Turkey

    Fadıl Akyol

  3. Department of Urology, Medical Faculty, Hacettepe University, Ankara, Turkey

    Cenk Yucel Bilen & Haluk Ozen

  4. Department of Pathology, Medical Faculty, Hacettepe University, Ankara, Turkey

    Dilek Ertoy Baydar

  5. Department of Biostatistics, Medical Faculty, Hacettepe University, Ankara, Turkey

    Erdem Karabulut

Authors
  1. Elif Neslihan Akdemir
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  2. Murat Tuncel
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  3. Fadıl Akyol
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  4. Cenk Yucel Bilen
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  5. Dilek Ertoy Baydar
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  6. Erdem Karabulut
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  7. Haluk Ozen
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  8. Meltem Caglar
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Contributions

ENA protocol/project development, data collection, data analysis, manuscript writing/editing. MT protocol/project development, data collection or management, data analysis, manuscript writing. FA data collection, manuscript editing. CYB data collection, manuscript editing. DEB data collection, manuscript editing. EK manuscript editing, statistics. HO data collection, manuscript editing. MC protocol/project development, data management, data analysis, manuscript writing.

Corresponding author

Correspondence to Murat Tuncel.

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The authors declare that they have no conflict of interest.

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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Akdemir, E.N., Tuncel, M., Akyol, F. et al. 68Ga-labelled PSMA ligand HBED-CC PET/CT imaging in patients with recurrent prostate cancer. World J Urol 37, 813–821 (2019). https://doi.org/10.1007/s00345-018-2460-y

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  • DOI: https://doi.org/10.1007/s00345-018-2460-y

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