Anna Katharina Seitz1,2, Isabel Rauscher3, Bernhard Haller4, Markus Krönke3, Sophia Luther5, Matthias M Heck5, Thomas Horn5, Jürgen E Gschwend5, Markus Schwaiger3, Matthias Eiber3,6, Tobias Maurer5. 1. Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. seitz_a3@ukw.de. 2. Department of Urology and Paediatric Urology, Julius Maximilians University Medical Centre of Würzburg, Würzburg, Germany. seitz_a3@ukw.de. 3. Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 4. Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 5. Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 6. Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, USA.
Abstract
PURPOSE: To investigate the value of 68Ga-HBED-CC PSMA (68Ga-PSMA) PET/CT for response assessment in metastatic castration-sensitive and castration-resistant prostate cancer (mCSPC and mCRPC) during docetaxel chemotherapy. METHODS: 68Ga-PSMA PET/CT was performed in seven mCSPC patients before and after six cycles of upfront docetaxel chemotherapy and in 16 mCRPC patients before and after three cycles of palliative docetaxel chemotherapy. Radiographic treatment response was evaluated separately on the 68Ga-PSMA PET and CT datasets. Changes in 68Ga-PSMA uptake (SUVmean) were assessed on a per-patient and a per-lesion basis using the PERCIST scoring system with slight modification. Treatment response was defined as absence of any PSMA uptake in all target lesions on posttreatment PET (complete response, CR) or a decrease in summed SUVmean of ≥30% (partial response, PR). The appearance of a new PET-positive lesion or an increase in summed SUVmean of ≥30% (progressive disease, PD) indicated nonresponse. A moderate change in summed SUVmean (between -30% and +30%) without a change in the number of target lesions was defined as stable disease (SD). For treatment response assessment on CT, RECIST1.1 criteria were used. Radiographic responses on 68Ga-PSMA PET [RR(PET)] and on CT [RR(CT)] were compared and correlated with biochemical response (BR). A decrease in serum PSA level of ≥50% was defined as biochemical PR. RESULTS: Biochemical PR was found in six of seven patients with mCSPC (86%, 95% confidence interval 42% to 99.6%). The concordance rate was higher between BR and RR(PET) than between BR and RR(CT) (6/7 vs. 3/6 patients. 68Ga-PSMA PET and CT were concordant in only three patients (50%, 12% to 88%). In mCRPC patients, biochemical PR was found in six of 16 patients (38%, 15% to 65%). Outcome prediction was concordant between BR and RR(PET) in nine of 16 patients (56%), and between BR and RR(CT) in only four of 12 patients (33%) with target lesions on CT. 68Ga-PSMA PET and CT results corresponded in seven of 12 patients (58%, 28% to 85%). CONCLUSION: Our preliminary results suggest that 68Ga-PSMA PET might be a promising method for treatment response assessment in mCSPC and mCRPC. The data indicate that for different metastatic sites, the performance of 68Ga-PSMA PET in response assessment might be superior to that of the conventional CT approach and could help differentiate between progressive disease and treatment response. Because of the limited number of patients, the differences revealed in our study were not statistically significant. Thus larger and prospective studies are clearly needed and warranted to confirm the value of 68Ga-PSMA PET as an imaging biomarker for response assessment.
PURPOSE: To investigate the value of 68Ga-HBED-CC PSMA (68Ga-PSMA) PET/CT for response assessment in metastatic castration-sensitive and castration-resistant prostate cancer (mCSPC and mCRPC) during docetaxel chemotherapy. METHODS: 68Ga-PSMA PET/CT was performed in seven mCSPC patients before and after six cycles of upfront docetaxel chemotherapy and in 16 mCRPC patients before and after three cycles of palliative docetaxel chemotherapy. Radiographic treatment response was evaluated separately on the 68Ga-PSMA PET and CT datasets. Changes in 68Ga-PSMA uptake (SUVmean) were assessed on a per-patient and a per-lesion basis using the PERCIST scoring system with slight modification. Treatment response was defined as absence of any PSMA uptake in all target lesions on posttreatment PET (complete response, CR) or a decrease in summed SUVmean of ≥30% (partial response, PR). The appearance of a new PET-positive lesion or an increase in summed SUVmean of ≥30% (progressive disease, PD) indicated nonresponse. A moderate change in summed SUVmean (between -30% and +30%) without a change in the number of target lesions was defined as stable disease (SD). For treatment response assessment on CT, RECIST1.1 criteria were used. Radiographic responses on 68Ga-PSMA PET [RR(PET)] and on CT [RR(CT)] were compared and correlated with biochemical response (BR). A decrease in serum PSA level of ≥50% was defined as biochemical PR. RESULTS: Biochemical PR was found in six of seven patients with mCSPC (86%, 95% confidence interval 42% to 99.6%). The concordance rate was higher between BR and RR(PET) than between BR and RR(CT) (6/7 vs. 3/6 patients. 68Ga-PSMA PET and CT were concordant in only three patients (50%, 12% to 88%). In mCRPC patients, biochemical PR was found in six of 16 patients (38%, 15% to 65%). Outcome prediction was concordant between BR and RR(PET) in nine of 16 patients (56%), and between BR and RR(CT) in only four of 12 patients (33%) with target lesions on CT. 68Ga-PSMA PET and CT results corresponded in seven of 12 patients (58%, 28% to 85%). CONCLUSION: Our preliminary results suggest that 68Ga-PSMA PET might be a promising method for treatment response assessment in mCSPC and mCRPC. The data indicate that for different metastatic sites, the performance of 68Ga-PSMA PET in response assessment might be superior to that of the conventional CT approach and could help differentiate between progressive disease and treatment response. Because of the limited number of patients, the differences revealed in our study were not statistically significant. Thus larger and prospective studies are clearly needed and warranted to confirm the value of 68Ga-PSMA PET as an imaging biomarker for response assessment.
Authors: Srikala S Sridhar; Stephen J Freedland; Martin E Gleave; Celestia Higano; Peter Mulders; Chris Parker; Oliver Sartor; Fred Saad Journal: Eur Urol Date: 2013-08-11 Impact factor: 20.096
Authors: Bruce D Cheson; Richard I Fisher; Sally F Barrington; Franco Cavalli; Lawrence H Schwartz; Emanuele Zucca; T Andrew Lister Journal: J Clin Oncol Date: 2014-09-20 Impact factor: 44.544
Authors: Lars Budäus; Sami-Ramzi Leyh-Bannurah; Georg Salomon; Uwe Michl; Hans Heinzer; Hartwig Huland; Markus Graefen; Thomas Steuber; Clemens Rosenbaum Journal: Eur Urol Date: 2015-06-25 Impact factor: 20.096
Authors: Susan Halabi; William Kevin Kelly; Hua Ma; Haojin Zhou; Nicole C Solomon; Karim Fizazi; Catherine M Tangen; Mark Rosenthal; Daniel P Petrylak; Maha Hussain; Nicholas J Vogelzang; Ian M Thompson; Kim N Chi; Johann de Bono; Andrew J Armstrong; Mario A Eisenberger; Abderrahim Fandi; Shaoyi Li; John C Araujo; Christopher J Logothetis; David I Quinn; Michael J Morris; Celestia S Higano; Ian F Tannock; Eric J Small Journal: J Clin Oncol Date: 2016-03-07 Impact factor: 44.544
Authors: Ian F Tannock; Ronald de Wit; William R Berry; Jozsef Horti; Anna Pluzanska; Kim N Chi; Stephane Oudard; Christine Théodore; Nicholas D James; Ingela Turesson; Mark A Rosenthal; Mario A Eisenberger Journal: N Engl J Med Date: 2004-10-07 Impact factor: 91.245
Authors: Sarah M Schwarzenböck; Matthias Eiber; Günther Kundt; Margitta Retz; Monique Sakretz; Jens Kurth; Uwe Treiber; Roman Nawroth; Ernst J Rummeny; Jürgen E Gschwend; Markus Schwaiger; Mark Thalgott; Bernd J Krause Journal: Eur J Nucl Med Mol Imaging Date: 2016-06-17 Impact factor: 9.236
Authors: Channing J Paller; Danilo Piana; James R Eshleman; Stacy Riel; Samuel R Denmeade; Pedro Isaacsson Velho; Steven P Rowe; Martin G Pomper; Emmanuel S Antonarakis; Jun Luo; Mario A Eisenberger Journal: Prostate Date: 2019-07-30 Impact factor: 4.104
Authors: Bernard H E Jansen; Matthijs C F Cysouw; André N Vis; Reindert J A van Moorselaar; Jens Voortman; Yves J L Bodar; Patrick R Schober; N Harry Hendrikse; Otto S Hoekstra; Ronald Boellaard; D E Oprea-Lager Journal: J Nucl Med Date: 2020-01-10 Impact factor: 10.057
Authors: Christian Schmidkonz; Michael Cordes; Daniela Schmidt; Tobias Bäuerle; Theresa Ida Goetz; Michael Beck; Olaf Prante; Alexander Cavallaro; Michael Uder; Bernd Wullich; Peter Goebell; Torsten Kuwert; Philipp Ritt Journal: Eur J Nucl Med Mol Imaging Date: 2018-05-03 Impact factor: 9.236
Authors: Christian Daniel Fankhauser; Cédric Poyet; Stephanie G C Kroeze; Benedikt Kranzbühler; Helena I Garcia Schüler; Matthias Guckenberger; Philipp A Kaufmann; Thomas Hermanns; Irene A Burger Journal: World J Urol Date: 2018-07-20 Impact factor: 4.226
Authors: Isabel Rauscher; Wolfgang P Fendler; Thomas A Hope; Andrew Quon; Stephan G Nekolla; Jeremie Calais; Antonia Richter; Bernhard Haller; Ken Herrmann; Wolfgang A Weber; Johannes Czernin; Matthias Eiber Journal: J Nucl Med Date: 2019-07-19 Impact factor: 10.057