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Clinicopathological predictors of positive 68Ga-PSMA-11 PET/CT in PSA-only recurrence of localized prostate cancer following definitive therapy

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Abstract

Objective

To demonstrate the effect of clinicopathological factors on 68Ga-PSMA-11 PET/CT positivity at the time of biochemical recurrence (BCR) of localized prostate cancer (PCa) following definitive therapy.

Methods

We retrospectively reviewed our institutional database for PCa patients who had BCR and subsequently underwent 68Ga-PSMA-11 PET/CT between April 2014 and February 2018. A total of 51 patients who were metastasis-free before PSMA imaging and previously treated with definitive therapy (radical prostatectomy or external beam radiotherapy) for localized disease (pT1c—T3b pN0-1 cM0) were included.

Results

37 out of 51 patients (72.5%) had positive 68Ga-PSMA-11 PET/CT scans. Age at diagnosis, Gleason score (GS), D’Amico risk status of PCa, initial PSA level before treatment and PSA doubling time were not associated with PSMA positivity. Pre-scan PSA levels of > 0.2 ng/ml and PSA velocity of ≥ 1 ng/ml/year were significantly associated with increased PSMA positivity, whereas history of androgen deprivation therapy showed a trend towards significance. The optimal cutoffs for distinguishing between positive and negative scans were ≥ 0.71 ng/ml for pre-scan PSA and ≥ 1.22 ng/ml/yr for PSA velocity. In multivariable analysis, log pre-scan PSA and pre-scan PSA level > 0.2 ng/ml remained significant predictors for PSMA positivity, whereas the association of PSA velocity and of ADT was lost.

Conclusions

In BCR of localized PCa following definitive therapy, pre-scan PSA was strongly associated with positive 68Ga-PSMA-11 scan, even at PSA levels ranging from 0.2 to 1.0 ng/ml. Therefore, clinical and pathological predictors of positive 68Ga-PSMA-11 PET/CT in PSA-only recurrence of localized prostate cancer need to be further elucidated.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Urology, School of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey

    Ahmet Murat Aydin, Bahadir Haberal, Meylis Artykov, Cenk Yucel Bilen & Sertac Yazici

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  1. Ahmet Murat Aydin
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  2. Bahadir Haberal
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  3. Meylis Artykov
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  4. Cenk Yucel Bilen
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  5. Sertac Yazici
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Correspondence to Sertac Yazici.

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Ethical approval

This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and all subsequent revisions. Institutional review board approval was obtained for this retrospective study (Approval Number: GO 18/384-44).

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Aydin, A.M., Haberal, B., Artykov, M. et al. Clinicopathological predictors of positive 68Ga-PSMA-11 PET/CT in PSA-only recurrence of localized prostate cancer following definitive therapy. Ann Nucl Med 33, 326–332 (2019). https://doi.org/10.1007/s12149-019-01340-1

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  • DOI: https://doi.org/10.1007/s12149-019-01340-1

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