Matthias Eiber1, Tobias Maurer2, Michael Souvatzoglou3, Ambros J Beer4, Alexander Ruffani3, Bernhard Haller5, Frank-Philipp Graner3, Hubert Kübler2, Uwe Haberkorn6, Michael Eisenhut6, Hans-Jürgen Wester7, Jürgen E Gschwend2, Markus Schwaiger3. 1. Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany matthias.eiber@tum.de. 2. Department of Urology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany. 3. Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany. 4. Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany. 5. Klinikum Rechts der Isar, Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany. 6. Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany; and. 7. Technische Universität München, Pharmaceutical Radiochemistry, Garching, Germany.
Abstract
UNLABELLED: The expression of prostate-specific membrane antigen (PSMA) is increased in prostate cancer. Recently, (68)Ga-PSMA (Glu-NH-CO-NH-Lys-(Ahx)-[(68)Ga(HBED-CC)]) was developed as a PSMA ligand. The aim of this study was to investigate the detection rate of (68)Ga-PSMA PET/CT in patients with biochemical recurrence after radical prostatectomy. METHODS: Two hundred forty-eight of 393 patients were evaluable for a retrospective analysis. Median prostate-specific antigen (PSA) level was 1.99 ng/mL (range, 0.2-59.4 ng/mL). All patients underwent contrast-enhanced PET/CT after injection of 155 ± 27 MBq of (68)Ga-PSMA ligand. The detection rates were correlated with PSA level and PSA kinetics. The influence of antihormonal treatment, primary Gleason score, and contribution of PET and morphologic imaging to the final diagnosis were assessed. RESULTS: Two hundred twenty-two (89.5%) patients showed pathologic findings in (68)Ga-PSMA ligand PET/CT. The detection rates were 96.8%, 93.0%, 72.7%, and 57.9% for PSA levels of ≥2, 1 to <2, 0.5 to <1, and 0.2 to <0.5 ng/mL, respectively. Whereas detection rates increased with a higher PSA velocity (81.8%, 82.4%, 92.1%, and 100% in <1, 1 to <2, 2 to <5, and ≥5 ng/mL/y, respectively), no significant association could be found for PSA doubling time (82.7%, 96.2%, and 90.7% in >6, 4-6, and <4 mo, respectively). (68)Ga-PSMA ligand PET (as compared with CT) exclusively provided pathologic findings in 81 (32.7%) patients. In 61 (24.6%) patients, it exclusively identified additional involved regions. In higher Gleason score (≤7 vs. ≥8), detection efficacy was significantly increased (P = 0.0190). No significant difference in detection efficacy was present regarding antiandrogen therapy (P = 0.0783). CONCLUSION: Hybrid (68)Ga-PSMA ligand PET/CT shows substantially higher detection rates than reported for other imaging modalities. Most importantly, it reveals a high number of positive findings in the clinically important range of low PSA values (<0.5 ng/mL), which in many cases can substantially influence the further clinical management.
UNLABELLED: The expression of prostate-specific membrane antigen (PSMA) is increased in prostate cancer. Recently, (68)Ga-PSMA (Glu-NH-CO-NH-Lys-(Ahx)-[(68)Ga(HBED-CC)]) was developed as a PSMA ligand. The aim of this study was to investigate the detection rate of (68)Ga-PSMA PET/CT in patients with biochemical recurrence after radical prostatectomy. METHODS: Two hundred forty-eight of 393 patients were evaluable for a retrospective analysis. Median prostate-specific antigen (PSA) level was 1.99 ng/mL (range, 0.2-59.4 ng/mL). All patients underwent contrast-enhanced PET/CT after injection of 155 ± 27 MBq of (68)Ga-PSMA ligand. The detection rates were correlated with PSA level and PSA kinetics. The influence of antihormonal treatment, primary Gleason score, and contribution of PET and morphologic imaging to the final diagnosis were assessed. RESULTS: Two hundred twenty-two (89.5%) patients showed pathologic findings in (68)Ga-PSMA ligand PET/CT. The detection rates were 96.8%, 93.0%, 72.7%, and 57.9% for PSA levels of ≥2, 1 to <2, 0.5 to <1, and 0.2 to <0.5 ng/mL, respectively. Whereas detection rates increased with a higher PSA velocity (81.8%, 82.4%, 92.1%, and 100% in <1, 1 to <2, 2 to <5, and ≥5 ng/mL/y, respectively), no significant association could be found for PSA doubling time (82.7%, 96.2%, and 90.7% in >6, 4-6, and <4 mo, respectively). (68)Ga-PSMA ligand PET (as compared with CT) exclusively provided pathologic findings in 81 (32.7%) patients. In 61 (24.6%) patients, it exclusively identified additional involved regions. In higher Gleason score (≤7 vs. ≥8), detection efficacy was significantly increased (P = 0.0190). No significant difference in detection efficacy was present regarding antiandrogen therapy (P = 0.0783). CONCLUSION: Hybrid (68)Ga-PSMA ligand PET/CT shows substantially higher detection rates than reported for other imaging modalities. Most importantly, it reveals a high number of positive findings in the clinically important range of low PSA values (<0.5 ng/mL), which in many cases can substantially influence the further clinical management.
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Authors: Julian Müller; Daniela A Ferraro; Urs J Muehlematter; Helena I Garcia Schüler; Sarah Kedzia; Daniel Eberli; Matthias Guckenberger; Stephanie G C Kroeze; Tullio Sulser; Daniel M Schmid; Aurelius Omlin; Alexander Müller; Thomas Zilli; Hubert John; Helmut Kranzbuehler; Philipp A Kaufmann; Gustav K von Schulthess; Irene A Burger Journal: Eur J Nucl Med Mol Imaging Date: 2018-11-28 Impact factor: 9.236