John W Yaxley1,2,3, Sheliyan Raveenthiran2,3, François-Xavier Nouhaud3,4, Hemamali Samaratunga2,5, William J Yaxley2,3, Geoff Coughlin1,3, Anna J Yaxley6, Troy Gianduzzo7, Boon Kua8, Louise McEwan8, David Wong8. 1. Wesley Urology Clinic, Brisbane, Queensland, Australia. 2. Department of Medicine, University of Queensland, Brisbane, Queensland, Australia. 3. Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 4. Department of Urology, Rouen University Hospital, Rouen, France. 5. Aquesta Uro-pathology, Brisbane, Queensland, Australia. 6. School of Medicine, Griffith University, Brisbane, Queensland, Australia. 7. Brisbane Prostate Clinic, Brisbane, Queensland, Australia. 8. Wesley Medical Imaging, Brisbane, Queensland, Australia.
Abstract
OBJECTIVE: To determine the number of men with 68 gallium-prostate-specific membrane antigen positron emission tomography/computed tomography (68 Ga-PSMA PET/CT) avid metastasis at diagnosis, as most data on 68 Ga-PSMA PET/CT are for the evaluation of recurrent disease after primary treatment and to our knowledge this study is the largest series of primary prostate cancer staging with 68 Ga-PSMA PET/CT. PATIENTS AND METHODS: A retrospective review conducted on 1253 consecutive men referred by urologists or radiation oncologists to our tertiary referral centre for 68 Ga-PSMA PET/CT scan for staging at the initial diagnosis of prostate cancer between July 2014 and June 2018. The primary outcome measure was to determine the risk of metastasis based on 68 Ga-PSMA PET/CT. Patients were risk stratified based on histological biopsy International Society of Urological Pathology (ISUP) grade, prostate-specific antigen (PSA) level, and staging with pre-biopsy multiparametric magnetic resonance imaging (mpMRI). Univariate and multivariate logistic regression were used to analyse results. RESULTS: The median PSA level was 6.5 ng/mL and median ISUP grade was 3, with high-risk disease in 49.7%. The prostate primary was PSMA avid in 91.7% of men. Metastatic disease was identified in 12.1% of men, including 8.2% with a PSA level of <10 ng/mL and 43% with a PSA level of >20 ng/mL. Metastases were identified in 6.4% with ISUP grade 2-3 and 21% with ISUP grade 4-5. Pre-biopsy mpMRI identified metastasis in 8.1% of T2 disease, increasing to 42.4% of T3b. Lymph node metastases were suspected in 107 men, with 47.7% outside the boundaries of an extended pelvic lymph node dissection. Skeletal metastases were identified in 4.7%. In men with intermediate-risk prostate cancer, metastases were identified in 5.2%, compared to 19.9% with high-risk disease. CONCLUSIONS: These results support the use of 68 Ga-PSMA PET/CT for primary staging of prostate cancer. Increasing PSA level, ISUP grade and radiological staging with mpMRI were all statistically significant prognostic factors for metastasis on both univariate and multivariate analysis.
OBJECTIVE: To determine the number of men with 68 gallium-prostate-specific membrane antigen positron emission tomography/computed tomography (68 Ga-PSMA PET/CT) avid metastasis at diagnosis, as most data on 68 Ga-PSMA PET/CT are for the evaluation of recurrent disease after primary treatment and to our knowledge this study is the largest series of primary prostate cancer staging with 68 Ga-PSMA PET/CT. PATIENTS AND METHODS: A retrospective review conducted on 1253 consecutive men referred by urologists or radiation oncologists to our tertiary referral centre for 68 Ga-PSMA PET/CT scan for staging at the initial diagnosis of prostate cancer between July 2014 and June 2018. The primary outcome measure was to determine the risk of metastasis based on 68 Ga-PSMA PET/CT. Patients were risk stratified based on histological biopsy International Society of Urological Pathology (ISUP) grade, prostate-specific antigen (PSA) level, and staging with pre-biopsy multiparametric magnetic resonance imaging (mpMRI). Univariate and multivariate logistic regression were used to analyse results. RESULTS: The median PSA level was 6.5 ng/mL and median ISUP grade was 3, with high-risk disease in 49.7%. The prostate primary was PSMA avid in 91.7% of men. Metastatic disease was identified in 12.1% of men, including 8.2% with a PSA level of <10 ng/mL and 43% with a PSA level of >20 ng/mL. Metastases were identified in 6.4% with ISUP grade 2-3 and 21% with ISUP grade 4-5. Pre-biopsy mpMRI identified metastasis in 8.1% of T2 disease, increasing to 42.4% of T3b. Lymph node metastases were suspected in 107 men, with 47.7% outside the boundaries of an extended pelvic lymph node dissection. Skeletal metastases were identified in 4.7%. In men with intermediate-risk prostate cancer, metastases were identified in 5.2%, compared to 19.9% with high-risk disease. CONCLUSIONS: These results support the use of 68 Ga-PSMA PET/CT for primary staging of prostate cancer. Increasing PSA level, ISUP grade and radiological staging with mpMRI were all statistically significant prognostic factors for metastasis on both univariate and multivariate analysis.
Authors: Daniela A Ferraro; Helena I Garcia Schüler; Urs J Muehlematter; Daniel Eberli; Julian Müller; Alexander Müller; Roger Gablinger; Helmut Kranzbühler; Aurelius Omlin; Philipp A Kaufmann; Thomas Hermanns; Irene A Burger Journal: Eur J Nucl Med Mol Imaging Date: 2019-12-04 Impact factor: 9.236
Authors: Christopher Darr; Nina N Harke; Jan Philipp Radtke; Leubet Yirga; Claudia Kesch; Maarten R Grootendorst; Wolfgang P Fendler; Pedro Fragoso Costa; Christoph Rischpler; Christine Praus; Johannes Haubold; Henning Reis; Thomas Hager; Ken Herrmann; Ina Binse; Boris Hadaschik Journal: J Nucl Med Date: 2020-02-14 Impact factor: 10.057
Authors: Fernando Sabino M Monteiro; Juçara Motta Serafim Eliam; Rafaela Gomes de Jesus; Pedro Cavalcante; Gustavo do Vale Gomes; Bruno Hochhegger; Vinicius K Gonçalves; Laura Von Wallwitz Freitas; Diego H Roman; Andre Poisl Fay Journal: Prostate Int Date: 2020-08-13
Authors: Daniela A Ferraro; Fabienne Lehner; Daniel Eberli; Irene A Burger; Anton S Becker; Benedikt Kranzbühler; Ken Kudura; Iliana Mebert; Michael Messerli; Thomas Hermanns Journal: Eur J Nucl Med Mol Imaging Date: 2020-10-19 Impact factor: 9.236
Authors: Daniela A Ferraro; Jan H Rüschoff; Urs J Muehlematter; Benedikt Kranzbühler; Julian Müller; Michael Messerli; Lars Husmann; Thomas Hermanns; Daniel Eberli; Niels J Rupp; Irene A Burger Journal: Theranostics Date: 2020-05-15 Impact factor: 11.556