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PSA-stratified detection rates for [68Ga]THP-PSMA, a novel probe for rapid kit-based 68Ga-labeling and PET imaging, in patients with biochemical recurrence after primary therapy for prostate cancer

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

Abstract

Purpose

[68Ga]Tris(hydroxypyridinone)(THP)-PSMA is a novel radiopharmaceutical for one-step kit-based radiolabelling, based on direct chelation of 68Ga3+ at low concentration, room temperature and over a wide pH range, using direct elution from a 68Ge/68Ga-generator. We evaluated the clinical detection rates of [68Ga]THP-PSMA PET/CT in patients with biochemically recurrent prostate cancer after prostatectomy.

Methods

Consecutive patients (n=99) referred for evaluation of biochemical relapse of prostate cancer by [68Ga]THP-PSMA PET/CT were analyzed retrospectively. Patients underwent a standard whole-body PET/CT (1 h p.i.), followed by delayed (3 h p.i.) imaging of the abdomen. PSA-stratified cohorts of positive PET/CT results, standardized uptake values (SUVs) and target-to-background ratios (TBRs) were analyzed, and compared between standard and delayed imaging.

Results

At least one lesion suggestive of recurrent or metastatic prostate cancer was identified on PET images in 52 patients (52.5%). Detection rates of [68Ga]THP-PSMA PET/CT increased with increasing PSA level: 94.1% for a PSA value of ≥10 ng/mL, 77.3% for a PSA value of 2 to <10 ng/mL, 54.5% for a PSA value of 1 to <2 ng/mL, 14.3% for a PSA value of 0.5 to <1 ng/mL, 20.0% for a PSA value of >0.2 to <0.5, and 22.2% for a PSA value of 0.01 to 0.2 ng/mL. [68Ga]THP-PSMA uptake (SUVs) in metastases decreased over time, whereas TBRs improved. Delayed imaging at 3 h p.i. exclusively identified pathologic findings in 2% of [68Ga]THP-PSMA PET/CT scans. Detection rate was higher in patients with a Gleason score ≥8 (P=0.02) and in patients receiving androgen deprivation therapy (P=0.003).

Conclusions

In this study, [68Ga]THP-PSMA PET/CT showed suitable detection rates in patients with biochemical recurrence of prostate cancer and PSA levels ≥ 2 ng /mL. Detections rates were lower than in previous studies evaluating other PSMA ligands, though prospective direct radiotracer comparison studies are mandatory particularly in patients with low PSA levels to evaluate the relative performance of different PSMA ligands.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany

    Thorsten Derlin, Sebastian Schmuck, Sophie M. Schneefeld, Almut C. A. Walte, James T. Thackeray, Tobias L. Ross & Frank M. Bengel

  2. ROTOP Pharmaka GmbH, Dresden, Germany

    Cathleen Juhl & Johanna Zörgiebel

  3. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany

    Katja Hueper

  4. Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany

    Christoph A. von Klot

  5. Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany

    Christoph Henkenberens & Hans Christiansen

Authors
  1. Thorsten Derlin
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  2. Sebastian Schmuck
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  3. Cathleen Juhl
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  13. Frank M. Bengel
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Corresponding author

Correspondence to Thorsten Derlin.

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Conflict of interest

[68Ga]THP-PSMA was provided by ROTOP Pharmaka GmbH under an evaluation agreement. Cathleen Juhl and Johanna Zörgiebel are employees of ROTOP Pharmaka GmbH. Thorsten Derlin and Tobias L. Ross received travel expenses from ROTOP Pharmaka GmbH. All other authors have nothing to disclose.

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Derlin, T., Schmuck, S., Juhl, C. et al. PSA-stratified detection rates for [68Ga]THP-PSMA, a novel probe for rapid kit-based 68Ga-labeling and PET imaging, in patients with biochemical recurrence after primary therapy for prostate cancer. Eur J Nucl Med Mol Imaging 45, 913–922 (2018). https://doi.org/10.1007/s00259-017-3924-9

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  • DOI: https://doi.org/10.1007/s00259-017-3924-9

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