Andrea Farolfi1,2, Harun Ilhan3, Andrei Gafita4, Jeremie Calais5, Francesco Barbato2, Manuel Weber2, Ali Afshar-Oromieh6,7, Fabian Spohn6, Axel Wetter8, Christoph Rischpler2, Boris Hadaschik9, Davide Pianori10, Stefano Fanti1, Uwe Haberkorn6,11, Matthias Eiber4, Ken Herrmann2, Wolfgang Peter Fendler12,5. 1. Nuclear Medicine Unit, University of Bologna, S. Orsola Hospital, Bologna, Italy. 2. Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany. 3. Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany. 4. Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany. 5. Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California. 6. Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany. 7. Department of Nuclear Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. 8. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany. 9. Department of Urology, University Hospital Essen, Essen, Germany. 10. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; and. 11. Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany. 12. Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany wolfgang.fendler@uk-essen.de.
Abstract
The aim of this study was to analyze patterns of persistent versus recurrent or new PET lesions in a selected patient cohort with prostate-specific antigen (PSA) persistence after salvage lymph node dissection (SLND) and pre-procedure and post-procedure prostate-specific membrane antigen (PSMA) ligand PET. Methods: Sixteen patients were included in this multicenter study. The inclusion criteria were PSMA PET performed for biochemical recurrence before SLND (pre-SLND PET) and repeat PSMA PET performed for a persistently elevated PSA level (≥0.1 ng/mL) at least 6 wk after SLND (post-SLND PET). Image analysis was performed by 3 independent nuclear medicine physicians applying the molecular imaging TNM system PROMISE. Lesions were confirmed by histopathology, presence on correlative CT/MRI/bone scanning, or PSA response after focal therapy. Results: Post-SLND PET identified prostate cancer lesions in 88% (14/16) of patients with PSA persistence after SLND. Median PSA was 1.2 ng/mL (interquartile range, 0.6-2.8 ng/mL). Disease was confined to the pelvis in 56% of patients (9/16), and most of these men had common iliac (6/16, 38%) and internal iliac lymph node metastases (6/16, 38%). Extrapelvic disease was detected in 31% of patients (5/16). In pre- and post-SLND PET comparison, 10 of 16 had at least one lesion already detected at baseline (63% PET persistence), 4 of 16 had new lesions only (25% PET recurrence), and 2 had no disease on post-SLND PET. All validated regions (11 regions in 9 patients) were true-positive. Nine of 14 (64%) patients underwent repeat local therapies after SLND (7/14 radiotherapy, 2/14 surgery). Conclusion: SLND of pelvic nodal metastases was often not complete according to PSMA PET. About two thirds of patients had PET-positive nodal disease after SLND already seen on pre-SLND PSMA PET. Notably, about one quarter of patients had new lesions, not detected by presurgical PSMA PET.
The aim of this study was to analyze patterns of persistent versus recurrent or new PET lesions in a selected patient cohort with prostate-specific antigen (PSA) persistence after salvage lymph node dissection (SLND) and pre-procedure and post-procedure prostate-specific membrane antigen (PSMA) ligand PET. Methods: Sixteen patients were included in this multicenter study. The inclusion criteria were PSMA PET performed for biochemical recurrence before SLND (pre-SLND PET) and repeat PSMA PET performed for a persistently elevated PSA level (≥0.1 ng/mL) at least 6 wk after SLND (post-SLND PET). Image analysis was performed by 3 independent nuclear medicine physicians applying the molecular imaging TNM system PROMISE. Lesions were confirmed by histopathology, presence on correlative CT/MRI/bone scanning, or PSA response after focal therapy. Results: Post-SLND PET identified prostate cancer lesions in 88% (14/16) of patients with PSA persistence after SLND. Median PSA was 1.2 ng/mL (interquartile range, 0.6-2.8 ng/mL). Disease was confined to the pelvis in 56% of patients (9/16), and most of these men had common iliac (6/16, 38%) and internal iliac lymph node metastases (6/16, 38%). Extrapelvic disease was detected in 31% of patients (5/16). In pre- and post-SLND PET comparison, 10 of 16 had at least one lesion already detected at baseline (63% PET persistence), 4 of 16 had new lesions only (25% PET recurrence), and 2 had no disease on post-SLND PET. All validated regions (11 regions in 9 patients) were true-positive. Nine of 14 (64%) patients underwent repeat local therapies after SLND (7/14 radiotherapy, 2/14 surgery). Conclusion: SLND of pelvic nodal metastases was often not complete according to PSMA PET. About two thirds of patients had PET-positive nodal disease after SLND already seen on pre-SLND PSMA PET. Notably, about one quarter of patients had new lesions, not detected by presurgical PSMA PET.
Authors: Guillaume Ploussard; Giorgio Gandaglia; Hendrik Borgmann; Pieter de Visschere; Isabel Heidegger; Alexander Kretschmer; Romain Mathieu; Cristian Surcel; Derya Tilki; Igor Tsaur; Massimo Valerio; Roderick van den Bergh; Piet Ost; Alberto Briganti Journal: Eur Urol Date: 2018-10-31 Impact factor: 20.096
Authors: Ken Herrmann; Wolfgang Peter Fendler; Andrea Farolfi; Andrei Gafita; Jeremie Calais; Matthias Eiber; Ali Afshar-Oromieh; Fabian Spohn; Francesco Barbato; Manuel Weber; Harun Ilhan; Veronica Cervati; Axel Wetter; Boris Hadaschik; Alberto Briganti; Jochen Walz; Davide Pianori; Stefano Fanti; Uwe Haberkorn Journal: J Urol Date: 2019-06-24 Impact factor: 7.450
Authors: Matthias Eiber; Ken Herrmann; Jeremie Calais; Boris Hadaschik; Frederik L Giesel; Markus Hartenbach; Thomas Hope; Robert Reiter; Tobias Maurer; Wolfgang A Weber; Wolfgang P Fendler Journal: J Nucl Med Date: 2017-11-09 Impact factor: 10.057
Authors: Matthias Eiber; Tobias Maurer; Michael Souvatzoglou; Ambros J Beer; Alexander Ruffani; Bernhard Haller; Frank-Philipp Graner; Hubert Kübler; Uwe Haberkorn; Michael Eisenhut; Hans-Jürgen Wester; Jürgen E Gschwend; Markus Schwaiger Journal: J Nucl Med Date: 2015-03-19 Impact factor: 10.057
Authors: Wolfgang P Fendler; Jeremie Calais; Matthias Eiber; Robert R Flavell; Ashley Mishoe; Felix Y Feng; Hao G Nguyen; Robert E Reiter; Matthew B Rettig; Shozo Okamoto; Louise Emmett; Helle D Zacho; Harun Ilhan; Axel Wetter; Christoph Rischpler; Heiko Schoder; Irene A Burger; Jeannine Gartmann; Raven Smith; Eric J Small; Roger Slavik; Peter R Carroll; Ken Herrmann; Johannes Czernin; Thomas A Hope Journal: JAMA Oncol Date: 2019-06-01 Impact factor: 31.777
Authors: Ali Afshar-Oromieh; Eleni Avtzi; Frederik L Giesel; Tim Holland-Letz; Heinz G Linhart; Matthias Eder; Michael Eisenhut; Silvan Boxler; Boris A Hadaschik; Clemens Kratochwil; Wilko Weichert; Klaus Kopka; Jürgen Debus; Uwe Haberkorn Journal: Eur J Nucl Med Mol Imaging Date: 2014-11-20 Impact factor: 9.236
Authors: Cordula A Jilg; Vanessa Drendel; H Christian Rischke; Teresa Beck; Werner Vach; Kathrin Schaal; Ulrich Wetterauer; Wolfgang Schultze-Seemann; Philipp T Meyer Journal: Theranostics Date: 2017-04-10 Impact factor: 11.556
Authors: Jeremie Calais; Francesco Ceci; Matthias Eiber; Thomas A Hope; Michael S Hofman; Christoph Rischpler; Tore Bach-Gansmo; Cristina Nanni; Bital Savir-Baruch; David Elashoff; Tristan Grogan; Magnus Dahlbom; Roger Slavik; Jeannine Gartmann; Kathleen Nguyen; Vincent Lok; Hossein Jadvar; Amar U Kishan; Matthew B Rettig; Robert E Reiter; Wolfgang P Fendler; Johannes Czernin Journal: Lancet Oncol Date: 2019-07-30 Impact factor: 41.316