[68Ga]PSMA PET/CT Improves Initial Staging and Management Plan of Patients with High-Risk Prostate Cancer
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In this retrospective study, we compared the diagnostic value of 68Gallium prostate-specific membrane antigen positron emission tomography computed tomography ([68Ga]PSMA PET/CT) in primary staging of patients with high-risk prostate cancer (PCa), in comparison to CT, magnetic resonance imaging (MRI), and bone scans, and we explored its overall impact on patients’ management plan.
Patients with pathological confirmation of PCa with high-risk disease were included in this study. Information on patient demographics, clinical and histopathological findings with Gleason score and initial prostate specific antigen PSA levels, and radiological findings for CT, MRI, bone scan, and [68Ga]PSMA PET/CT were retrieved. We stratified the concordance and discordance of each imaging modality on per-patient and per-lesion-site bases.
Twenty-one patients with high-risk disease were included in this study. [68Ga]PSMA PET/CT revealed a significantly higher concordance rate (90 %) compared to the concordance rates of bone scan (75 %), MRI (73 %), and CT (60 %). [68Ga]PSMA PET/CT had a similar accuracy to MRI in detecting prostate lesions but a higher accuracy for suspicious pelvic lymph nodes (95.2 % vs. 80 %). It also superseded CT scan in detecting suspicious pelvic lymph nodes (95.2 % vs. 75 %) and extra-pelvic lymph nodes (100 % vs. 75 %), as well as bone lesions via bone scan (100 % vs. 62.5 %). [68Ga]PSMA PET/CT changed the management in 11 patients (52 %).
[68Ga]PSMA PET/CT is an invaluable imaging modality in the assessment of primary high-risk PCa with great potential for the detection of lymph node spread and bone metastases that would impact the management plan.
Key wordsPSMA PET/CT MRI Bone scan CT scan Theranostics High risk Prostate cancer Primary staging Nuclear medicine
Authors would like to acknowledge and thank the Office of Scientific and Academic Research (OSAR) at KHCC, particularly Mrs. Dalia Al-Rimawi for her work on the statistical analyses of the data.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Statement of Human and Animal Rights
For this type of study, formal consent is not required.
- 2.Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N, European Association of Urology (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent—update 2013. Eur Urol 65:124–137CrossRefGoogle Scholar
- 4.European Association of Urology. Guidelines on prostate cancer. http://uroweb.org/guideline/prostatecancer/
- 6.Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, Eisenhut M, Boxler S, Hadaschik BA, Kratochwil C, Weichert W, Kopka K, Debus J, Haberkorn U (2015) The diagnostic value of PET/CT imaging with the 68Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 42:197–209CrossRefGoogle Scholar
- 7.Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, Graner FP, Kubler H, Haberhorn U, Eisenhut M, Wester HJ, Gschwend JE, Schwaiger M (2015) Evaluation of hybrid 68Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med 56:668–674CrossRefGoogle Scholar
- 8.Ceci F, Uprimny C, Nilica B, Geraldo L, Kendler D, Kroiss A, Bektic J, Horninger W, Lukas P, Decristoforo C, Castellucci P, Fanti S, Virgolini IJ (2015) 68Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate? Eur J Nucl Med Mol Imaging 42:1284–1294CrossRefGoogle Scholar
- 10.von Eyben FE, Picchio M, von Eyben R, Rhee H, Bauman G (2016) 68Ga-labeled prostate-specific membrane antigen ligand positron emission tomography/computed tomography for prostate cancer: a systematic review and meta-analysis. Eur Urol Focus. https://doi.org/10.1016/j.euf.2016.11.002
- 12.D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280:969–974CrossRefGoogle Scholar
- 13.Fanti S, Minozzi S, Morigi JJ, Giesel F, Ceci F, Uprimny C, Hofman MS, Eiber M, Schwarzenbock S, Castellucci P, Bellisario C, Chauvie S, Bergesio F, Emmett L, Haberkorn U, Virgolini I, Schwaiger M, Hicks RJ, Krause BJ, Chiti A (2017) Development of standardized image interpretation for 68Ga-PSMA PET/CT to detect prostate cancer recurrent lesions. Eur J Nucl Med Mol Imaging 44:1622–1635CrossRefGoogle Scholar
- 15.Silver DA, Pelicer I, Fair WR et al (1997) Prostate specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res 3:81–85Google Scholar
- 16.Dewes S, Schiller K, Sauter K, Eiber M, Maurer T, Schwaiger M, Gschwend JE, Combs SE, Habl G (2016) Integration of 68Ga-PSMA-PET imaging in planning of primary definitive radiotherapy in prostate cancer: a retrospective study. Radiat Oncol 11:73. https://doi.org/10.1186/s13014-016-0646-2 CrossRefGoogle Scholar
- 17.Sterzing F, Kratochwil C, Fiedler H, Katayama S, Habl G, Kopka K, Afshar-Oromieh A, Debus J, Haberkorn U, Giesel FL (2016) 68Ga-PSMA-11 PET/CT: a new technique with high potential for the radiotherapeutic management of prostate cancer patients. Eur J Nucl Med Mol Imaging 43:34–41CrossRefGoogle Scholar
- 25.Giesel FL, Hadaschik B, Cardinale J, Radtke J, Vinsensia M, Lehnert W, Kesch C, Tolstov Y, Singer S, Grabe N, Duensing S, Schäfer M, Neels OC, Mier W, Haberkorn U, Kopka K, Kratochwil C (2017) F-18 labelled PSMA-1007: biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. Eur J Nucl Med Mol Imaging 44:678–688CrossRefGoogle Scholar