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Application of [68Ga]PSMA PET/CT in Diagnosis and Management of Prostate Cancer Patients

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Abstract

Purpose

The early and accurate diagnosis of locoregional recurrence or metastasis in prostate cancer (PC) has a significant impact on treatment options. Prostatic-specific membrane antigen (PSMA) positron emission tomography (PET)/x-ray computed tomograph (CT) imaging has recently been introduced as a novel procedure in managing PC. The aim of this study was to evaluate the efficacy of [68Ga]PSMA PET/CT in managing PC patients and to compare the detection rate of PET/CT and bone scans (BSs) in detecting bone metastasis.

Procedures

We evaluated 415 patients with PC who underwent [68Ga]PSMA PET/CT between March 2015 and September 2018. The patients were classified into three groups: staging, biomedical recurrence (BCR), and follow-up or monitoring, based on the intent to perform PET/CT.

Results

We evaluated 415 patients aged 41–99 (68.25 ± 9.59). Of these patients, 344 (82.9 %) had at least one localized lesion. The detection rates were 48.3 %, 52.6 %, 74.4 %, 79.6 %, and 93.9 % for a PSA value of < 0.2 ng/ml, ≥ 0.2–< 0.5 ng/ml, ≥ 0.5–< 1 ng/ml, ≥ 1–< 2 ng/ml, and ≥ 2 ng/ml, respectively (p < 0.05). The detection rates increased significantly with higher GSs; the rates were 68.3 % (28/41), 74.5 % (73/98), 93.9 % (46/49), and 91 % (61/67) for a GS of < 7, 7, 8, and > 8, respectively (p < 0.05). An ideal cut-off value of > 1.16 ng/ml was obtained for PSA value, which equates to specificity of 75 % and sensitivity of 77 %. In comparing BSs and PET/CT, a region-based analysis showed the superiority of PET/CT over BSs for all regions expect the skull (p < 0.05). PET/CT detected 258 suspicious regions, 255 of which were metastatic and three of which were equivocal. BSs detected only 223 suspicious regions, 203 of which were metastatic and 20 of which were equivocal.

Conclusions

[68Ga]PSMA PET/CT showed a high detection rate for lesions in PC patients. PSA level, GS, and a PSA doubling time of less than 6 months were shown to be the affective variables. In addition, 68Ga-PSMA PET/CT showed better performance in detecting bone lesions than BSs.

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Funding

This work was supported in part by Imam Reza International University and Bushehr University of Medical Sciences.

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Authors and Affiliations

  1. Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran

    Habibollah Dadgar, Farshad Emami & Nasim Norouzbeigi

  2. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

    Manouchehr Seyedi Vafaee

  3. Translational Neuroscience, BRIDGE, University of Southern Denmark, Odense, Denmark

    Manouchehr Seyedi Vafaee

  4. Neuroscience Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

    Manouchehr Seyedi Vafaee

  5. Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran

    Esmail Jafari & Majid Assadi

  6. Department of Diagnostic Radiology, Keck School of Medicine, University of Southern California (USC), 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA

    Ali Gholamrezanezhad

  7. Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Hojjat Ahmadzadehfar

Authors
  1. Habibollah Dadgar
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  2. Farshad Emami
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  3. Nasim Norouzbeigi
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  4. Manouchehr Seyedi Vafaee
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  5. Esmail Jafari
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  6. Ali Gholamrezanezhad
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  7. Majid Assadi
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  8. Hojjat Ahmadzadehfar
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Contributions

H Dadgar: Data collection, project development, manuscript writing; F Emami: data collection, project development; N Norouzbeigi: data collection; M Seyedi Vafaee: manuscript writing, data analysis; E Jafari: manuscript writing, data analysis; A Gholamrezanezhad: project development, manuscript writing; M Assadi: manuscript writing, data analysis, project development; H Ahmadzadehfar: manuscript writing, data analysis.

Corresponding author

Correspondence to Majid Assadi.

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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.

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Dadgar, H., Emami, F., Norouzbeigi, N. et al. Application of [68Ga]PSMA PET/CT in Diagnosis and Management of Prostate Cancer Patients. Mol Imaging Biol 22, 1062–1069 (2020). https://doi.org/10.1007/s11307-019-01445-z

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