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Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with 68Ga-PSMA-HBED-CC than with 18F-Fluoroethylcholine PET/CT

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Aim

[68Ga]PSMA-HBED-CC (68Ga-PSMA) is a novel and promising tracer for highly sensitive combined integrated positron emission tomography and X-ray computed tomography (PET/CT) diagnosis of recurrent prostate cancer (PCA). Our aim was to assess the sensitivity, specificity, positive and negative predictive value (PPV/NPV), and accuracy per lesion, as well as the positive predictive value per patient of 68Ga-PSMA PET/CT using post-lymphadenectomy histology as a standard, and to compare these values to those obtained in a patient collective scanned using 18F-Fluoroethylcholine (18FEC) PET/CT.

Methods

Thirty eight patients had 18FEC and 28 patients had 68Ga-PSMA. We performed a pelvic and/or retroperitoneal lymphadenectomy, if necessary supplemented by resection of locally recurrent lesions in accordance with imaging results.

Results

In 30/38 18FEC and 23/28 68Ga-PSMA patients ≥1 focus of PCA was identified in postsurgical histology, leading to a per-patient PPV of 78.9 % for 18FEC and 82.1 % for 68Ga-PSMA. In 18FEC and 68Ga-PSMA patients, a total of 378 and 308 lymph nodes and local lesions were removed, respectively. For 18FEC and 68for Ga-PSMA, the respective sensitivity (95 % confidence interval) was 71.2 % (64.5–79.6 %) and 86.9 % (75.8–94.2 %), specificity was 86.9 % (82.3–90.6 % ) and 93.1 % (89.2–95.9 %), PPV was 67.3 % (57.7–75.9 %) and 75.7 % (64.0–98.5 %), NPV was 88.8 % (84.4–92.3 %) and 96.6 % (93.5–98.5 %), and accuracy was 82.5 % (78.3–86.8 %) and 91.9 % (88.7 %–95.1 %).

Conclusion

In the present series Ga-PSMA PET/CT shows a better performance than FEC PET/CT with a significantly higher NPV and accuracy for the detection of locoregional recurrent and/or metastatic lesions prior to salvage lymphadenectomy.

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    Authors and Affiliations

    1. Department of Urology, RWTH University Hospital Aachen, Aachen, Germany

      David Pfister, Daniel Porres, Axel Heidenreich & Isabel Heidegger

    2. Department of Pathology, RWTH University Hospital Aachen, Aachen, Germany

      Ruth Knuechel & Florian Steib

    3. Department of Nuclear Medicine, RWTH University Hospital Aachen, Aachen, Germany

      Florian F. Behrendt & Frederik A. Verburg

    4. Department of Urology, University Hospital Cologne, Kerpener Strasse 62, 50937, Köln, Cologne, Germany

      David Pfister, Daniel Porres & Axel Heidenreich

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    1. David Pfister
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    Correspondence to David Pfister.

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    Disclosure of potential conflicts of interest

    David Pfister has received consultancy fees and payment for speaker bureaus from Astellas, Ipsen, Sanofi, and Janssen. Axel Heidenreich has received consultancy fees and payment for speaker bureaus from Amgen, Janssen, Ipsen, Sanofi, and Takeda (for whom he is also a board member); research and travel support from Astellas; and a research grant from Sanofi. Florian F. Behrendt has received research support and speaker fees from Bayer. Frederik A. Verburg is a consultant to Bayer and Genzyme. Daniel Porres, Isabell Heidegger, Ruth Knuechel, and Florian Steib have nothing to declare.

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    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. The present study is a retrospective one; for this type of study formal consent is not required.

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    David Pfister and Daniel Porres contributed equally to this work.

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    Pfister, D., Porres, D., Heidenreich, A. et al. Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with 68Ga-PSMA-HBED-CC than with 18F-Fluoroethylcholine PET/CT. Eur J Nucl Med Mol Imaging 43, 1410–1417 (2016). https://doi.org/10.1007/s00259-016-3366-9

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    • DOI: https://doi.org/10.1007/s00259-016-3366-9

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