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Prediction nomogram for 68Ga-PSMA-11 PET/CT in different clinical settings of PSA failure after radical treatment for prostate cancer

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

Abstract

Objective

The objective of this study was to develop a clinical nomogram to predict gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11-PET/CT) positivity in different clinical settings of PSA failure.

Materials and methods

Seven hundred three (n = 703) prostate cancer (PCa) patients with confirmed PSA failure after radical therapy were enrolled. Patients were stratified according to different clinical settings (first-time biochemical recurrence [BCR]: group 1; BCR after salvage therapy: group 2; biochemical persistence after radical prostatectomy [BCP]: group 3; advanced-stage PCa before second-line systemic therapies: group 4).

First, we assessed 68Ga-PSMA-11-PET/CT positivity rate. Second, multivariable logistic regression analyses were used to determine predictors of positive scan. Third, regression-based coefficients were used to develop a nomogram predicting positive 68Ga-PSMA-11-PET/CT result and 200 bootstrap resamples were used for internal validation. Fourth, receiver operating characteristic (ROC) analysis was used to identify the most informative nomogram’s derived cutoff. Decision curve analysis (DCA) was implemented to quantify nomogram’s clinical benefit.

Results

68Ga-PSMA-11-PET/CT overall positivity rate was 51.2%, while it was 40.3% in group 1, 54% in group 2, 60.5% in group 3, and 86.9% in group 4 (p < 0.001). At multivariable analyses, ISUP grade, PSA, PSA doubling time, and clinical setting were independent predictors of a positive scan (all p ≤ 0.04). A nomogram based on covariates included in the multivariate model demonstrated a bootstrap-corrected accuracy of 82%. The nomogram-derived best cutoff value was 40%. In DCA, the nomogram revealed clinical net benefit of > 10%.

Conclusions

This novel nomogram proved its good accuracy in predicting a positive scan, with values ≥ 40% providing the most informative cutoff in counselling patients to 68Ga-PSMA-11-PET/CT. This tool might be important as a guide to clinicians in the best use of PSMA-based PET imaging.

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Acknowledgments

Authors would thank Alessandro Lambertini MD (Nuclear Medicine, S.Orsola-Malpighi University of Bologna) for his contribution in final linguistic review.

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Author notes

  1. Francesco Ceci and Lorenzo Bianchi contributed equally to this work.

Authors and Affiliations

  1. Metropolitan Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Francesco Ceci, Giulia Polverari, Andrea Farolfi, Paolo Castellucci & Stefano Fanti

  2. Nuclear Medicine, AOU Città della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, Corso AM Dogliotti, 14, 10129, Turin, Italy

    Francesco Ceci

  3. Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy

    Francesco Ceci, Lorenzo Bianchi, Marco Borghesi, Riccardo Schiavina & Eugenio Brunocilla

  4. Department of Urology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Lorenzo Bianchi, Marco Borghesi, Riccardo Schiavina & Eugenio Brunocilla

  5. Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy

    Alberto Briganti

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  1. Francesco Ceci
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Correspondence to Francesco Ceci.

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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 principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Supplementary Figure 1

Receiver-operator characteristic (ROC) and area under curve (AUC) of the nomogram in overall population to predict positive 68Ga-PSMA-11-PET/CT results (AUC=0.82; 95%CI=0.79-0.85). (JPEG 60 kb)

Supplementary Figure 2

Receiver-operator characteristic (ROC) and area under curve (AUC) of each nomogram derived cut-off to predict positive 68Ga-PSMA-11-PET/CT results. The best nomogram’s cut-off to predict positive scan was 40% (AUC=0.76; 95%CI=0.72-0.79). (JPEG 147 kb)

Supplementary Table 1

Univariate and multivariate logistic regression to predict positive findings at 68Ga-PSMA-11-PET/CT in Group-1 (n=325) (DOCX 17 kb)

Supplementary Table 2

Univariate and multivariate logistic regression to predict positive findings at 68Ga-PSMA-11-PET/CT in Group-2 (n=241) (DOCX 17 kb)

Supplementary Table 3

Univariate and multivariate logistic regression to predict positive findings at 68Ga-PSMA-11-PET/CT in Group-3 (n=76) (DOCX 16 kb)

Supplementary Table 4

Univariate and multivariate logistic regression to predict positive findings at 68Ga-PSMA-11-PET/CT in Group-4 (n=61) (DOCX 16 kb)

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Ceci, F., Bianchi, L., Borghesi, M. et al. Prediction nomogram for 68Ga-PSMA-11 PET/CT in different clinical settings of PSA failure after radical treatment for prostate cancer. Eur J Nucl Med Mol Imaging 47, 136–146 (2020). https://doi.org/10.1007/s00259-019-04505-2

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  • DOI: https://doi.org/10.1007/s00259-019-04505-2

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