151
|
Hicks RJ, Murphy DG, Williams SG. Seduction by Sensitivity: Reality, Illusion, or Delusion? The Challenge of Assessing Outcomes after PSMA Imaging Selection of Patients for Treatment. J Nucl Med 2017; 58:1969-1971. [DOI: 10.2967/jnumed.117.198812] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/18/2017] [Indexed: 01/11/2023] Open
|
152
|
García Garzón JR, de Arcocha Torres M, Delgado-Bolton R, Ceci F, Alvarez Ruiz S, Orcajo Rincón J, Caresia Aróztegui AP, García Velloso MJ, García Vicente AM. 68Ga-PSMA PET/CT in prostate cancer. Rev Esp Med Nucl Imagen Mol 2017; 37:130-138. [PMID: 28941866 DOI: 10.1016/j.remn.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) with 68Ga-PSMA is a non-invasive diagnostic technique to image prostate cancer with increased prostate-specific membrane antigen (PSMA) expression. PSMA is a transmembrane protein present in all prostatic tissues. Increased PSMA expression is seen in several malignancies, although prostate cancer is the tumour where it presents higher concentrations. Almost all prostate adenocarcinomas show PSMA expression in most of lesions, primary and metastatic. Immunohistochemistry has demonstrated that the expression of PSMA increases in patients with de-differentiated, metastatic or hormone-refractory tumours. Moreover, the expression level of PSMA has a prognostic value for disease outcome. PET measures the three-dimensional distribution of 68Ga-PSMA, producing semi-quantitative images that allow for non-invasive assessment of PSMA expression.
Collapse
Affiliation(s)
- J R García Garzón
- Unitat PET/TC CETIR-ERESA, Esplugues de Llobregat, Barcelona, España.
| | - M de Arcocha Torres
- Unidad de Radiofarmacia, Hospital Universitario Marques de Valdecilla, Santander, España
| | - R Delgado-Bolton
- Departamento de Diagnóstico por Imagen y Medicina Nuclear, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, La Rioja, España
| | - F Ceci
- Department of Surgical Sciences, University of Bologna, Bolonia, Italia
| | - S Alvarez Ruiz
- Servicio de Medicina Nuclear, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Orcajo Rincón
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - M J García Velloso
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
| | - A M García Vicente
- Servicio de Medicina Nuclear, Hospital General Universitario, Ciudad Real, España
| | | |
Collapse
|
153
|
Bailey J, Piert M. Performance of 68Ga-PSMA PET/CT for Prostate Cancer Management at Initial Staging and Time of Biochemical Recurrence. Curr Urol Rep 2017; 18:84. [PMID: 28889366 DOI: 10.1007/s11934-017-0736-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF THE REVIEW Recently introduced Gallium-68 labeled PSMA-ligands such as HBED-CC (68Ga-PSMA) have shown promise for unmet diagnostic needs in prostate cancer. RECENT FINDINGS 68Ga-PSMA has demonstrated improved detection rates and specificity for prostate cancer compared to standard imaging approaches. In the setting of primary disease, 68Ga-PSMA appears to preferentially identify treatment-relevant intermediate and high-risk prostate cancer. There is also a growing evidence that 68Ga-PSMA positron emission tomography (PET) outperforms alternative conventional imaging methods including choline-based radiotracers for the localization of disease sites at biochemical recurrence, particularly at lower prostate-specific antigen (PSA) levels (< 1 ng/mL). However, the majority of published work lacks rigorous verification of imaging results. 68Ga-PSMA offers significant promise for both, primary disease and biochemically recurrent prostate cancer. The evidence base to support 68Ga-PSMA is however still underdeveloped, and more rigorous studies substantiating efficacy are needed.
Collapse
Affiliation(s)
- Jason Bailey
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Morand Piert
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA.
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Health System, University Hospital B1G505C, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-0028, USA.
| |
Collapse
|
154
|
Heinzmann K, Carter LM, Lewis JS, Aboagye EO. Multiplexed imaging for diagnosis and therapy. Nat Biomed Eng 2017; 1:697-713. [PMID: 31015673 DOI: 10.1038/s41551-017-0131-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/02/2017] [Indexed: 12/12/2022]
Abstract
Complex molecular and metabolic phenotypes depict cancers as a constellation of different diseases with common themes. Precision imaging of such phenotypes requires flexible and tunable modalities capable of identifying phenotypic fingerprints by using a restricted number of parameters while ensuring sensitivity to dynamic biological regulation. Common phenotypes can be detected by in vivo imaging technologies, and effectively define the emerging standards for disease classification and patient stratification in radiology. However, for the imaging data to accurately represent a complex fingerprint, the individual imaging parameters need to be measured and analysed in relation to their wider spatial and molecular context. In this respect, targeted palettes of molecular imaging probes facilitate the detection of heterogeneity in oncogene-driven alterations and their response to treatment, and lead to the expansion of rational-design elements for the combination of imaging experiments. In this Review, we evaluate criteria for conducting multiplexed imaging, and discuss its opportunities for improving patient diagnosis and the monitoring of therapy.
Collapse
Affiliation(s)
- Kathrin Heinzmann
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Lukas M Carter
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Jason S Lewis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK.
| |
Collapse
|
155
|
Wallitt KL, Khan SR, Dubash S, Tam HH, Khan S, Barwick TD. Clinical PET Imaging in Prostate Cancer. Radiographics 2017; 37:1512-1536. [PMID: 28800286 DOI: 10.1148/rg.2017170035] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Prostate cancer is the second most common cancer in men worldwide, with a wide spectrum of biologic behavior ranging from indolent low-risk disease to highly aggressive castration-resistant prostate cancer. Conventional imaging with computed tomography, magnetic resonance imaging, and bone scintigraphy is limited for the detection of nodal disease and distant bone metastases. In addition, advances in the available therapeutic options, both localized and systemic, drive the requirement for precise diagnostic and prognostic tools to refine the individual therapeutic approach at various times in the management of patients with prostate cancer. Positron emission tomography (PET) has a rapidly evolving role in the assessment of prostate cancer, particularly in the scenario of biochemical relapse. Fluorine 18 (18F) fluorodeoxyglucose, the most widely available PET tracer, has limitations, particularly in indolent prostate cancer. In the past decade, several PET tracers with specific molecular targets have reached the clinical domain. These tracers include 18F-sodium fluoride, which is a bone-specific biomarker of osteoblastic activity; 18F-choline and carbon 11-choline, which are directed at cell membrane metabolism; gallium 68-prostate-specific membrane antigen ligands; and, more recently, an amino acid analog, 18F-fluciclovine (anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid; also known as FACBC), which is also directed at cell membrane turnover. The mechanisms of actions of the clinically available PET tracers are reviewed, as well as their role in the imaging of prostate cancer with reference to relevant guidelines and the technical and imaging pearls and pitfalls of these tracers. ©RSNA, 2017.
Collapse
Affiliation(s)
- Kathryn L Wallitt
- From the Departments of Nuclear Medicine (K.L.W., S.D., H.H.T.) and Radiology (S.R.K., S.K., T.D.B.), Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England
| | - Sairah R Khan
- From the Departments of Nuclear Medicine (K.L.W., S.D., H.H.T.) and Radiology (S.R.K., S.K., T.D.B.), Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England
| | - Suraiya Dubash
- From the Departments of Nuclear Medicine (K.L.W., S.D., H.H.T.) and Radiology (S.R.K., S.K., T.D.B.), Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England
| | - Henry H Tam
- From the Departments of Nuclear Medicine (K.L.W., S.D., H.H.T.) and Radiology (S.R.K., S.K., T.D.B.), Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England
| | - Sameer Khan
- From the Departments of Nuclear Medicine (K.L.W., S.D., H.H.T.) and Radiology (S.R.K., S.K., T.D.B.), Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England
| | - Tara D Barwick
- From the Departments of Nuclear Medicine (K.L.W., S.D., H.H.T.) and Radiology (S.R.K., S.K., T.D.B.), Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England
| |
Collapse
|
156
|
Sathianathen NJ, Geurts N, Nair R, Lawrentschuk N, Murphy DG, Lamb AD. The phytological future of prostate cancer staging: PSMA-PET and the dandelion theory. Future Oncol 2017; 13:1801-1807. [DOI: 10.2217/fon-2017-0074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PSMA-PET is changing how we stage prostate cancer, both in the primary setting and with relapse after treatment. It allows us to identify lesions in the bones and lymph nodes that were not previously visible on conventional imaging with bone scan and CT/MRI. In this Special Report we review the ‘state of the art’ for PSMA imaging and discuss the implications for treatment decisions in prostate cancer. We liken early high risk or metastatic prostate to a common phytological problem: the dandelion. In this analogous situation, we consider the additional evidence needed for us to start plucking out the original dandelion and for us to focus attention on killing the seeded weeds that are identifiable elsewhere in the lawn.
Collapse
Affiliation(s)
- Niranjan J Sathianathen
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Nicolas Geurts
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Rajesh Nair
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Victoria, Australia
| | - Declan G Murphy
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
- Australian Prostate Cancer Research Centre, Epworth Healthcare, Richmond, Australia
| | - Alastair D Lamb
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
- Academic Urology Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Nuffield Department of Surgical Sciences, University of Oxford, UK
| |
Collapse
|
157
|
68Ga-PSMA PET/MR–Positive Peritoneal Metastasis in the Falciform Ligament in Recurrent Prostate Cancer. Clin Nucl Med 2017; 42:e388-e389. [DOI: 10.1097/rlu.0000000000001703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
158
|
Schmidtke A, Läppchen T, Weinmann C, Bier-Schorr L, Keller M, Kiefer Y, Holland JP, Bartholomä MD. Gallium Complexation, Stability, and Bioconjugation of 1,4,7-Triazacyclononane Derived Chelators with Azaheterocyclic Arms. Inorg Chem 2017; 56:9097-9110. [DOI: 10.1021/acs.inorgchem.7b01129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alexander Schmidtke
- Department of Nuclear
Medicine, Medical Center − University of Freiburg, Faculty
of Medicine, University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany
| | - Tilman Läppchen
- Department of Nuclear
Medicine, Medical Center − University of Freiburg, Faculty
of Medicine, University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany
- Department of Nuclear
Medicine, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Christian Weinmann
- Department of Nuclear
Medicine, Medical Center − University of Freiburg, Faculty
of Medicine, University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany
| | - Lorenz Bier-Schorr
- Department of Nuclear
Medicine, Medical Center − University of Freiburg, Faculty
of Medicine, University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany
| | - Manfred Keller
- Department of Chemistry, University of Freiburg, D-79104, Freiburg, Germany
| | - Yvonne Kiefer
- Department of Nuclear
Medicine, Medical Center − University of Freiburg, Faculty
of Medicine, University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany
| | - Jason P. Holland
- Department of Nuclear
Medicine, Medical Center − University of Freiburg, Faculty
of Medicine, University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany
- Department of Chemistry, University of Zürich, Winterthurerstrasse 190, CH-8057, Zürich, Switzerland
| | - Mark D. Bartholomä
- Department of Nuclear
Medicine, Medical Center − University of Freiburg, Faculty
of Medicine, University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany
| |
Collapse
|
159
|
Biopsy-Proven Diffuse Mediastinal Prostate Cancer Metastases Negative on 18F-Fluorocholine, Diagnosed on 68Ga-PSMA and 18F-PSMA PET/CT. Clin Nucl Med 2017; 42:801-802. [PMID: 28719448 DOI: 10.1097/rlu.0000000000001766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 72-year-old man with prostate cancer (stage T3b, Gleason score 7) treated by radical prostatectomy was found to have biochemical failure (prostate-specific antigen 8.5 ng/mL) and a suspicious growing nodularity at the left prostate bed on MRI. F-fluorocholine PET/CT failed to demonstrate any site of uptake suggestive of malignancy. A bone scan did exclude bone metastases. Ga-PSMA PET/CT revealed various positive lymph nodes in the supraclavicular, mediastinal, and hilar regions. This was confirmed on F-DCFPyl PET/CT, with the addition of a suspicious right axillary lymph node. Mediastinal biopsy confirmed metastatic prostate cancer.
Collapse
|
160
|
Schwarzenboeck SM, Rauscher I, Bluemel C, Fendler WP, Rowe SP, Pomper MG, Afshar-Oromieh A, Herrmann K, Eiber M. PSMA Ligands for PET Imaging of Prostate Cancer. J Nucl Med 2017; 58:1545-1552. [PMID: 28687599 DOI: 10.2967/jnumed.117.191031] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022] Open
Abstract
Targeting the prostate-specific membrane antigen (PSMA) with 68Ga-labeled and 18F-labeled PET agents has become increasingly important in recent years. Imaging of biochemically recurrent prostate cancer has been established as a widely accepted clinical indication for PSMA ligand PET/CT in many parts of the world because of the results of multiple, primarily retrospective, studies that indicate superior detection efficacy compared with standard-of-care imaging. For high-risk primary prostate cancer, evidence is growing that this modality significantly aids in the detection of otherwise occult nodal and bone metastases. For both clinical indications in recurrent as well as in primary prostate cancer, preliminary data demonstrate a substantial impact on clinical management. Emerging data imply that intraprostatic tumor localization, therapy stratification, and treatment monitoring of advanced disease in specific clinical situations might become future indications. Current criteria for image reporting of PSMA ligand PET are evolving given the expanding body of literature on physiologic and pathologic uptake patterns and pitfalls. This article intends to give an educational overview on the current status of PSMA ligand PET imaging, including imaging procedure and interpretation, clinical indications, diagnostic potential, and impact on treatment planning.
Collapse
Affiliation(s)
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christina Bluemel
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Wolfgang P Fendler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Steven P Rowe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin G Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Centre, Heidelberg, Germany; and
| | - Ken Herrmann
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
161
|
Evaluation of Practical Interpretation Hurdles in 68Ga-PSMA PET/CT in 55 Patients. Clin Nucl Med 2017; 42:e322-e327. [DOI: 10.1097/rlu.0000000000001672] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
162
|
Patterns of failure after radical prostatectomy in prostate cancer - implications for radiation therapy planning after 68Ga-PSMA-PET imaging. Eur J Nucl Med Mol Imaging 2017. [PMID: 28646463 DOI: 10.1007/s00259-017-3746-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Salvage radiotherapy (SRT) after radical prostatectomy (RPE) and lymphadenectomy (LAE) is the appropriate radiotherapy option for patients with persistent/ recurrent prostate cancer (PC). 68Ga-PSMA-PET imaging has been shown to accurately detect PC lesions in a primary setting as well as for local recurrence or for lymph node (LN) metastases. OBJECTIVE In this study we evaluated the patterns of recurrence after RPE in patients with PC, putting a highlight on the differentiation between sites that would have been covered by a standard radiation therapy (RT) field in consensus after the RTOG consensus and others that would have not. METHODS AND MATERIALS Thirty-one out of 83 patients (37%) with high-risk PC were the subject of our study. Information from 68Ga-PSMA-PET imaging was used to individualize treatment plans to include suspicious lesions as well as possibly boost sites with tracer uptake in LN or the prostate bed. For evaluation, 68Ga-PSMA-PET-positive LN were contoured in a patient dataset with a standard lymph drainage (RTOG consensus on CTV definition of pelvic lymph nodes) radiation field depicting color-coded nodes that would have been infield or outfield of that standard lymph drainage field and thereby visualizing typical patterns of failure of a "blind" radiation therapy after RPE and LAE. RESULTS Compared to negative conventional imaging (CT/MRI), lesions suspicious for PC were detected in 27/31 cases (87.1%) by 68Ga-PSMA-PET imaging, which resulted in changes to the radiation concept. There were 16/31 patients (51.6%) that received a simultaneous integrated boost (SIB) to a subarea of the prostate bed (in only three cases this dose escalation would have been planned without the additional knowledge of 68Ga-PSMA-PET imaging) and 18/31 (58.1%) to uncommon (namely presacral, paravesical, pararectal, preacetabular and obturatoric) LN sites. Furthermore, 14 patients (45.2%) had a changed TNM staging result by means of 68Ga-PSMA-PET imaging. CONCLUSION Compared to conventional CT or MRI staging, 68Ga-PSMA-PET imaging detects more PC lesions and, thus, significantly influences radiation planning in recurrent prostate cancer patients enabling individually tailored treatment.
Collapse
|
163
|
Vinsensia M, Chyoke PL, Hadaschik B, Holland-Letz T, Moltz J, Kopka K, Rauscher I, Mier W, Schwaiger M, Haberkorn U, Mauer T, Kratochwil C, Eiber M, Giesel FL. 68Ga-PSMA PET/CT and Volumetric Morphology of PET-Positive Lymph Nodes Stratified by Tumor Differentiation of Prostate Cancer. J Nucl Med 2017. [PMID: 28637799 DOI: 10.2967/jnumed.116.185033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
68Ga-prostate-specific membrane antigen (PSMA) PET/CT is a new method to detect early nodal metastases in patients with biochemical relapse of prostate cancer. In this retrospective investigation, the dimensions, volume, localization, and SUVmax of nodes identified by 68Ga-PSMA were correlated to their Gleason score (GS) at diagnosis. Methods: All PET/CT images were acquired 60 ± 10 min after intravenous injection of 68Ga-PSMA (mean dose, 176 MBq). In 147 prostate cancer patients (mean age, 68 y; range, 44-87 y) with prostate-specific antigen relapse (mean prostate-specific antigen level, 5 ng/mL; range, 0.25-294 ng/mL), 362 68Ga-PSMA PET-positive lymph nodes (LNs) were identified. These patients were classified on the basis of their histopathology at primary diagnosis into either low- (GS ≤ 6, well differentiated), intermediate- (GS = 7, moderately differentiated), or high-GS cohorts (GS ≥ 8, poorly differentiated prostate cancer). Using semiautomated LN segmentation software (Fraunhofer MEVIS), we measured node volume and short-axis dimensions (SADs) and long-axis dimensions based on CT and compared with the SUVmax Nodes demonstrating uptake of 68Ga-PSMA with an SUVmax of 2.0 or more were considered PSMA-positive, and nodes with an SAD of 8 mm or more were considered positive by morphologic criteria. Results: Mean SUVmax was 13.5 (95% confidence interval [CI], 10.9-16.1), 12.4 (95% CI, 9.9-14.9), and 17.8 (95% CI, 15.4-20.3) within the low-, intermediate-, and high-GS groups, respectively. The morphologic assessment of the 68Ga-PSMA-positive LN demonstrated that the low-GS cohort presented with smaller 68Ga-PSMA-positive LNs (mean SAD, 7.7 mm; n = 113), followed by intermediate- (mean SAD, 9.4 mm; n = 122) and high-GS cohorts (mean SAD, 9.5 mm; n = 127). On the basis of the CT morphology criteria, only 34% of low-GS patients, 56% of intermediate-GS patients, and 53% of high-GS patients were considered CT positive. Overall, 68Ga-PSMA imaging led to a reclassification of stage in 90 patients (61%) from cN0 to cN1 over CT. Conclusion:68Ga-PSMA PET is a promising modality in biochemical recurrent prostate cancer patients for N staging. Conventional imaging underestimates LN involvement compared with PSMA molecular staging score in each GS cohort. The sensitivity of 68Ga-PSMA PET/CT enables earlier detection of subcentimeter LN metastases in the biochemical recurrence setting.
Collapse
Affiliation(s)
- Maria Vinsensia
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter L Chyoke
- Molecular Imaging Program, National Institutes of Health, Bethesda, Maryland
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.,Department of Urology, University Hospital Essen, Essen, Germany
| | - Tim Holland-Letz
- Department of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Klaus Kopka
- Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Walter Mier
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Department of Molecular and Medical Pharmacology Cooperation Unit Nuclear Medicine (DKFZ), Heidelberg, Germany
| | - Tobias Mauer
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany; and
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany .,Department of Molecular and Medical Pharmacology Cooperation Unit Nuclear Medicine (DKFZ), Heidelberg, Germany
| |
Collapse
|
164
|
Siriwardana A, Thompson J, van Leeuwen PJ, Doig S, Kalsbeek A, Emmett L, Delprado W, Wong D, Samaratunga H, Haynes AM, Coughlin G, Stricker P. Initial multicentre experience of 68
gallium-PSMA PET/CT guided robot-assisted salvage lymphadenectomy: acceptable safety profile but oncological benefit appears limited. BJU Int 2017; 120:673-681. [DOI: 10.1111/bju.13919] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Amila Siriwardana
- St Vincent's Prostate Cancer Centre; St Vincent's Clinic; Sydney NSW Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| | - James Thompson
- St Vincent's Prostate Cancer Centre; St Vincent's Clinic; Sydney NSW Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| | - Pim J. van Leeuwen
- Department of Urology; Erasmus University Medical Centre; Rotterdam The Netherlands
| | | | - Anton Kalsbeek
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| | - Louise Emmett
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
| | | | | | - Hemamali Samaratunga
- School of Medicine; University of Queensland; Brisbane QLD Australia
- Aquesta Pathology; Brisbane QLD Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| | | | - Phillip Stricker
- St Vincent's Prostate Cancer Centre; St Vincent's Clinic; Sydney NSW Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| |
Collapse
|
165
|
Uprimny C. 68Ga-PSMA-11 PET/CT: the rising star of nuclear medicine in prostate cancer imaging? Wien Med Wochenschr 2017; 169:3-11. [PMID: 28577076 DOI: 10.1007/s10354-017-0569-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
Ever since the introduction of 68Ga-prostate-specific membrane antigen 11 positron-emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) a few years ago, it has rapidly achieved great success in the field of prostate cancer imaging. A large number of studies have been published to date, indicating a high potential of 68Ga-PSMA-11 PET/CT in the work-up of prostate cancer patients, including primary diagnosis, staging and biochemical recurrence. The aim of this review is to present the most important data on this novel, highly promising imaging technique, and to formulate recommendations for possible applications of 68Ga-PSMA-11 PET/CT in clinical routine.
Collapse
Affiliation(s)
- Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| |
Collapse
|
166
|
Habl G, Sauter K, Schiller K, Dewes S, Maurer T, Eiber M, Combs SE. 68 Ga-PSMA-PET for radiation treatment planning in prostate cancer recurrences after surgery: Individualized medicine or new standard in salvage treatment. Prostate 2017; 77:920-927. [PMID: 28317152 DOI: 10.1002/pros.23347] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/28/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND 68 Ga-PSMA-PET imaging is a novel promising diagnostic tool to locate early biochemical failure after radical prostatectomy (RP) in prostate cancer (PC) patients. Exact knowledge of the relapse location may result in changes of the therapy concept aside from changes to the TNM stage. To gain data for this approach, we evaluated PC patients receiving 68 Ga-PSMA-PET imaging before salvage radiotherapy (RT). METHODS AND MATERIALS In this study, 100 patients with biochemical failure after RP± prior RT who underwent 68 Ga-PSMA PET/CT or PET/MRI were evaluated undergoing salvage RT in our department. We analyzed TNM staging changes due to 68 Ga-PSMA-PET imaging and its influence on RT planning and treatment. RESULTS Uptake indicative for tumor recurrence in 68 Ga-PSMA-PET was found in 76% of the patients with biochemical recurrent PC. Median PSA level was 1.0 ng/mL (range 0.12-14.7 ng/mL). Of these, 80% showed no morphological correlate in the corresponding CT or MRI. A 43% of all patients experienced a change in TNM stage due to 68 Ga-PSMA-PET imaging. Patients had changes from Tx to rcT+ (28%), 12% from pN0 to rcN1, 1% from pN0/cM0 to rcM1a, and 8% from cM0 to rcM1b. Due to the additional knowledge of 68 Ga-PSMA-PET imaging, initial planned RT planning was adapted in 59% of all cases. An additional simultaneous integrated boost (SIB) to the prostate bed or lymph nodes was given to 32% and 63%, respectively. Ten patients received stereotactic body RT (SBRT) to single bone metastases. CONCLUSION 68 Ga-PSMA-PET imaging showed a high clinical impact on staging and RT management in patients with biochemically recurrent PC, even at low serum PSA levels. With 43% changes in staging and 59% in radiotherapy planning 68 Ga-PSMA-PET could lead to an indispensable tool in guiding radiation treatment in recurrent PC.
Collapse
Affiliation(s)
- Gregor Habl
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
- Zentrum für Stereotaxie und personalisierte Hochpräzisionsstrahlentherapie (StereotakTUM), Technische Universität München (TUM), Munich, Germany
| | - Katharina Sauter
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - Kilian Schiller
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - Sabrina Dewes
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - Tobias Maurer
- Department of Urology, Technical University Munich (TUM), Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University Munich (TUM), Munich, Germany
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
- Zentrum für Stereotaxie und personalisierte Hochpräzisionsstrahlentherapie (StereotakTUM), Technische Universität München (TUM), Munich, Germany
| |
Collapse
|
167
|
Hope TA, Aggarwal R, Chee B, Tao D, Greene KL, Cooperberg MR, Feng F, Chang A, Ryan CJ, Small EJ, Carroll PR. Impact of 68Ga-PSMA-11 PET on Management in Patients with Biochemically Recurrent Prostate Cancer. J Nucl Med 2017; 58:1956-1961. [PMID: 28522741 DOI: 10.2967/jnumed.117.192476] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022] Open
Abstract
The purpose of this prospective study was to estimate the effect of 68Ga-labeled prostate-specific membrane antigen (PSMA)-11 PET on the intended management of patients with biochemically recurrent prostate cancer. Methods: Pre- and postimaging surveys were filled out by the referring providers for patients with biochemical recurrence who were imaged using 68Ga-PSMA-11 PET. The inclusion criterion for this study was a prostate-specific antigen (PSA) doubling time of less than 12 mo after initial treatment (NCT02611882). Of the 150 consecutive patients imaged, 126 surveys were completed (84% response rate). The responses were categorized as major change, minor change, no change, or unknown change. Results: There were 103 patients (82%) with disease detected on 68Ga-PSMA-11 PET. On the basis of the survey results, there were 67 patients (53.2%) with major changes in management and 8 patients (6.4%) with minor changes. The proportion of cases resulting in a change in management did not significantly differ by baseline PSA level. In patients with PSA levels below 0.2 ng/dL, 7 of 12 patients had disease detected on 68Ga-PSMA-11 PET, 5 of whom had a major change in management. Conclusion:68Ga-PSMA-11 PET resulted in a major change in management in 53% of patients with biochemical recurrence. Further studies are warranted to investigate whether PSMA-based management strategies result in improved outcomes for patients.
Collapse
Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California .,Department of Radiology, San Francisco VA Medical Center, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Rahul Aggarwal
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.,Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Bryant Chee
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Dora Tao
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Kirsten L Greene
- Department of Urology, University of California San Francisco, San Francisco, California; and
| | - Matthew R Cooperberg
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.,Department of Urology, University of California San Francisco, San Francisco, California; and
| | - Felix Feng
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.,Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Albert Chang
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Charles J Ryan
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.,Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Eric J Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.,Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Peter R Carroll
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.,Department of Urology, University of California San Francisco, San Francisco, California; and
| |
Collapse
|
168
|
Schmuck S, von Klot CA, Henkenberens C, Sohns JM, Christiansen H, Wester HJ, Ross TL, Bengel FM, Derlin T. Initial Experience with Volumetric 68Ga-PSMA I&T PET/CT for Assessment of Whole-Body Tumor Burden as a Quantitative Imaging Biomarker in Patients with Prostate Cancer. J Nucl Med 2017; 58:1962-1968. [DOI: 10.2967/jnumed.117.193581] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/10/2017] [Indexed: 12/25/2022] Open
|
169
|
Maurer T, Murphy DG, Hofman MS, Eiber M. PSMA-PET for Lymph Node Detection in Recurrent Prostate Cancer: How do we use the Magic Bullet? Theranostics 2017. [PMID: 28638485 PMCID: PMC5479286 DOI: 10.7150/thno.20855] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
170
|
Ballas LK, de Castro Abreu AL, Quinn DI. What Medical, Urologic, and Radiation Oncologists Want from Molecular Imaging of Prostate Cancer. J Nucl Med 2017; 57:6S-12S. [PMID: 27694176 DOI: 10.2967/jnumed.115.170142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 12/25/2022] Open
Abstract
As molecular imaging better delineates the state of prostate cancer, clinical management will evolve. The currently licensed imaging modalities are limited by lack of specificity or sensitivity for the extent of cancer and for predicting outcome in response to therapy. Clinicians want molecular imaging that-by being more reliable in tailoring treatment and monitoring response for each patient-will become a key facet of precision medicine, surgery, and radiation therapy. Identifying patients who are candidates for specific or novel treatments is important, but equally important is the finding that a given patient may not be a good candidate for single-modality therapy. This article presents prostate cancer scenarios in which managing clinicians would welcome molecular imaging innovations to help with decision making. The potential role of newer techniques that may help fill this wish list is discussed.
Collapse
Affiliation(s)
- Leslie K Ballas
- Department of Radiation Oncology, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California
| | - Andre Luis de Castro Abreu
- Department of Urology, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California; and
| | - David I Quinn
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California
| |
Collapse
|
171
|
Wondergem M, van der Zant FM, Knol RJJ, Lazarenko SV, Pruim J, de Jong IJ. 18F-DCFPyL PET/CT in the Detection of Prostate Cancer at 60 and 120 Minutes: Detection Rate, Image Quality, Activity Kinetics, and Biodistribution. J Nucl Med 2017; 58:1797-1804. [PMID: 28450569 DOI: 10.2967/jnumed.117.192658] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/11/2017] [Indexed: 01/12/2023] Open
Abstract
There is increasing interest in PET/CT with prostate-specific membrane antigen (PSMA) tracers for imaging of prostate cancer because of the higher detection rates of prostate cancer lesions than with PET/CT with choline. For 68Ga-PSMA-11 tracers, late imaging at 180 min after injection instead of imaging at 45-60 min after injection improves the detection of prostate cancer lesions. For 18F-DCFPyL, improved detection rates have recently been reported in a small pilot study. In this study, we report the effects of PET/CT imaging at 120 min after injection of 18F-DCFPyL in comparison to images acquired at 60 min after injection in a larger clinical cohort of 66 consecutive patients with histopathologically proven prostate cancer. Methods: Images were acquired 60 and 120 min after injection of 18F-DCFPyL. We report the positive lesions specified for anatomic locations (prostate, seminal vesicles, local lymph nodes, distant lymph nodes, bone, and others) at both time points by visual analysis, the image quality at both time points, and a semiquantitative analysis of the tracer activity in both prostate cancer lesions as well as normal tissues at both time points. Results: Our data showed a significantly increasing uptake of 18F-DCFPyL between 60 and 120 min after injection in 203 lesions characteristic for prostate cancer (median, 10.78 vs. 12.86, P < 0.001, Wilcoxon signed-rank test). By visual analysis, 38.5% of all patients showed more lesions using images at 120 min after injection than using images at 60 min after injection, and in 9.2% a change in TNM staging was found. All lesions seen on images 60 min after injection were also visible on images 120 min after injection. A significantly better mean signal-to-noise ratio of 11.93 was found for images acquired 120 min after injection (P < 0.001, paired t test; signal-to-noise ratio at 60 min after injection, 11.15). Conclusion:18F-DCFPyL PET/CT images at 120 min after injection yield a higher detection rate of prostate cancer characteristic lesions than images at 60 min after injection. Further studies are needed to elucidate the best imaging time point for 18F-DCFPyL.
Collapse
Affiliation(s)
- Maurits Wondergem
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep locatie Alkmaar, Alkmaar, The Netherlands .,Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Friso M van der Zant
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep locatie Alkmaar, Alkmaar, The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep locatie Alkmaar, Alkmaar, The Netherlands
| | - Sergiy V Lazarenko
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep locatie Alkmaar, Alkmaar, The Netherlands
| | - Jan Pruim
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and.,Department of Nuclear Medicine, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Igle J de Jong
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
172
|
PET and PET/CT with radiolabeled choline in prostate cancer: a critical reappraisal of 20 years of clinical studies. Eur J Nucl Med Mol Imaging 2017; 44:1751-1776. [PMID: 28409220 DOI: 10.1007/s00259-017-3700-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/31/2017] [Indexed: 12/12/2022]
Abstract
We here aim to provide a comprehensive and critical review of the literature concerning the clinical applications of positron emission tomography/computed tomography (PET/CT) with radiolabeled choline in patients with prostate cancer (PCa). We will initially briefly summarize the historical context that brought to the synthesis of [11C]choline, which occurred exactly 20 years ago. We have arbitrarily grouped the clinical studies in three different periods, according to the year in which they were published and according to their relation with their applications in urology, radiotherapy and oncology. Studies at initial staging and, more extensively, studies in patients with biochemical failure, as well as factors predicting positive PET/CT will be reviewed. The capability of PET/CT with radiolabeled choline to provide prognostic information on PCa-specific survival will also be examined. The last sections will be devoted to the use of radiolabeled choline for monitoring the response to androgen deprivation therapy, radiotherapy, and chemotherapy. The accuracy and the limits of the technique will be discussed according to the information available from standard validation processes, including biopsy or histology. The clinical impact of the technique will be discussed on the basis of changes induced in the management of patients and in the evaluation of the response to therapy. Current indications to PET/CT, as officially endorsed by guidelines, or as routinely performed in the clinical practice will be illustrated. Emphasis will be made on methodological factors that might have influenced the results of the studies or their interpretation. Finally, we will briefly highlight the potential role of positron emission tomography/magnetic resonance and of new radiotracers for PCa imaging.
Collapse
|
173
|
Jilg CA, Drendel V, Rischke HC, Beck T, Vach W, Schaal K, Wetterauer U, Schultze-Seemann W, Meyer PT. Diagnostic Accuracy of Ga-68-HBED-CC-PSMA-Ligand-PET/CT before Salvage Lymph Node Dissection for Recurrent Prostate Cancer. Am J Cancer Res 2017; 7:1770-1780. [PMID: 28529650 PMCID: PMC5436526 DOI: 10.7150/thno.18421] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/21/2017] [Indexed: 12/27/2022] Open
Abstract
Background: By targeting the prostate-specific membrane antigen (PSMA) on prostate cancer (PCa) cells PSMA-PET/CT shows great potential in locating the site of biochemical recurrence even at low PSA (Prostate-specific antigen)-levels. Accurate imaging of PCa recurrent lymph node metastases (LNM) is crucial for metastases directed therapies such as salvage-lymph node dissection (salvage-LND). Objective: To evaluate the diagnostic accuracy of PSMA-PET/CT for detection of affected lymph-node regions at salvage-LND for nodal recurrence of PCa. Design, setting and participants: 30 patients with the suspicion of exclusively nodal PCa-relapse after primary therapy underwent a template pelvic and/or retroperitoneal salvage-LND after whole body 68-Ga-PSMA-PET/CT. The diagnostic accuracy of PET/CT was evaluated in comparison to the histopathology of 965 resected lymph nodes (LN) dissected from 68 main regions (pelvic left/right, retroperitoneal) and 289 subregions (common iliac, external iliac, obturator, internal iliac, presacral, aortic-bifurcation, aortal, caval). LNM and tumor deposits in LNM were measured bidimensionally in the histopathology. PSMA-expression was analyzed by immunohistochemistry in LNM. Results: LNM were present in 11.4% of the resected LN (110/965) resulting in 45 positive main regions and 85 positive subregions. PET/CT was true positive in 41 main regions and 69 subregions. Three PET-negative main regions and 16 PET-negative subregions finally contained LNM, the majority of these false negative subregions (13/16) were in neighboring regions of true-positive subregions. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were: main region-based 93.2%, 100%, 100%, 88.9% and 95.6%, subregion-based 81.2%, 99.5%, 98.6%, 92.7 and 94.1%. Median short diameters of tumor deposits in LNM resected from false-negative subregions (1.3 mm) were significantly smaller than in LNM removed from true-positive subregions (5.5 mm, p<0.0001). Based on anatomical subregions containing just one LNM, the necessary short diameter of tumor deposits in LNM required to reach a detection rate of 50% and 90% was estimated to be ≥ 2.3 mm and ≥ 4.5 mm, respectively. Conclusion: In men with biochemical PCa-relapse and positive PSMA-PET/CT, PET/CT detects metastatic affected anatomical regions with high accuracy at a main region and at a subregion-level. If the decision for salvage-LND is prompted by a positive PSMA-PET/CT, the size of metastases is crucial for accurate detection of affected regions. All LNM showed a clear PSMA-expression in the immunohistochemistry. Further studies need to investigate how to translate the high anatomical correlation observed between PET/CT and surgical findings into optimal approaches for target salvage-LND.
Collapse
|
174
|
Schmuck S, Nordlohne S, von Klot CA, Henkenberens C, Sohns JM, Christiansen H, Wester HJ, Ross TL, Bengel FM, Derlin T. Comparison of standard and delayed imaging to improve the detection rate of [68Ga]PSMA I&T PET/CT in patients with biochemical recurrence or prostate-specific antigen persistence after primary therapy for prostate cancer. Eur J Nucl Med Mol Imaging 2017; 44:960-968. [DOI: 10.1007/s00259-017-3669-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
|
175
|
Udovicich C, Perera M, Hofman MS, Siva S, Del Rio A, Murphy DG, Lawrentschuk N. 68Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography in advanced prostate cancer: Current state and future trends. Prostate Int 2017; 5:125-129. [PMID: 29188197 PMCID: PMC5693469 DOI: 10.1016/j.prnil.2017.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 02/19/2017] [Indexed: 01/20/2023] Open
Abstract
The early and accurate detection of prostate cancer is important to ensure timely management and appropriate individualized treatment. Currently, conventional imaging has limitations particularly in the early detection of metastases and at prostate-specific antigen (PSA) levels < 2.0 ng/mL. Furthermore, disease management such as salvage radiotherapy is best at low PSA levels. Thus, it is critical to capture the disease in the oligometastatic stage as disease progression and commencement of systemic therapies can be delayed by metastasis-directed therapy. Prostate-specific membrane antigen (PSMA) is overexpressed in prostatic cancer cells. Novel imaging modalities using radiolabeled tracers with PSMA such as 68Ga-PSMA-positron emission tomography (PET)/computed tomography (CT) have shown promising results. We review the literature regarding 68Ga-PSMA-PET/CT in the setting of primary prostate cancer and biochemical recurrence. At present, the best utilization of 68Ga-PSMA-PET/CT appears to be in biochemical recurrence. 68Ga-PSMA-PET/CT has high diagnostic accuracy for lymph node metastases and has been shown to have superior detection rates to conventional imaging, especially at low PSA levels. The exact role of 68Ga-PSMA-PET/CT in primary prostate cancer is not yet entirely clear. It has an improved detection rate for smaller lesions and may be able to identify nodal or distant metastatic disease at an earlier stage. While still experimental, there may also be value in combining 68Ga-PSMA-PET to multiparametric magnetic resonance imaging for staging of intraprostatic disease. To date, 68Ga-PSMA-PET/CT has been shown to have considerable clinical value and to impact treatment selection for patients with prostate cancer. Still in its infancy, the results of future clinical trials will be excitedly awaited.
Collapse
Affiliation(s)
- Cristian Udovicich
- Department of Surgery, Mildura Base Hospital, Melbourne, Australia.,Department of Surgery, Western Health, Melbourne, Australia.,Department of Surgery, Alfred Health, Melbourne, Australia
| | - Marlon Perera
- Department of Surgery, Austin Health, The University of Melbourne, Victoria, Australia
| | - Michael S Hofman
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andres Del Rio
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, The University of Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Australia
| |
Collapse
|
176
|
Incidental Detection of Thyroid Metastases From Renal Cell Carcinoma Using 68Ga-PSMA PET/CT to Assess Prostate Cancer Recurrence. Clin Nucl Med 2017; 42:221-222. [PMID: 28033223 DOI: 10.1097/rlu.0000000000001522] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ga-PSMA PET/CT is increasingly used to assess prostate cancer. Avid Ga-PSMA uptake by thyroid cancer and renal cell carcinoma (RCC) has been reported in few cases. A 75-year-old man who received a diagnosis of RCC in 2006 and prostate cancer in 2009 presented with elevated prostate-specific antigen levels (0.7 ng/mL) following prostatectomy. Ga-PSMA PET/CT showed avid Ga-PSMA uptake in 1 pelvic and 1 retroperitoneal lymph node and focal Ga-PSMA accumulation in the thyroid. Excised retroperitoneal lymph node and thyroid tissues showed metastases from RCC, whereas the pelvic lymph node exhibited metastasis from prostate cancer.
Collapse
|
177
|
Einspieler I, Rauscher I, Düwel C, Krönke M, Rischpler C, Habl G, Dewes S, Ott A, Wester HJ, Schwaiger M, Maurer T, Eiber M. Detection Efficacy of Hybrid 68Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria. J Nucl Med 2017; 58:1081-1087. [PMID: 28209912 DOI: 10.2967/jnumed.116.184457] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/24/2017] [Indexed: 01/04/2023] Open
Abstract
The aim of this retrospective study was to evaluate the detection rate of Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] (68Ga-PSMA ligand; PSMA is prostate-specific membrane antigen) PET/CT in patients with biochemical recurrent prostate cancer defined by Phoenix criteria after external-beam radiotherapy or brachytherapy as primary treatment. Methods: One hundred eighteen patients with a median prostate-specific antigen (PSA) of 6.4 ng/mL (range, 2.2-158.4 ng/mL; interquartile range, 4.2-10.2 ng/mL) were finally eligible for this retrospective analysis. Seventy-seven and 41 patients had been treated by external-beam radiotherapy or brachytherapy, respectively. Of the 118 patients, 45 were receiving androgen-deprivation therapy (ADT) within at least 6 mo before the PET/CT. The detection rates were stratified by PSA. The influence of primary Gleason score and ADT was assessed. Relationships between SUV and clinical as well as pathologic features in patients with positive findings were analyzed using univariate and multivariable linear regression models. Results: One hundred seven of 118 patients (90.7%) showed pathologic findings indicative for tumor recurrence in 68Ga-PSMA ligand PET/CT. The detection rates were 81.8% (36/44), 95.3% (41/43), and 96.8% (30/31) for PSA of 2 to <5, 5 to <10, and ≥10 ng/mL, respectively (P = 0.0377). 68Ga-PSMA ligand PET/CT indicated local recurrence in 68 of 107 patients (63.5%), distant lesions in 64 of 107 patients (59.8%), and local recurrence as well as distant lesions in 25 of 107 patients (23.4%). The detection rate was significantly higher in patients with ADT (97.7%) versus without ADT (86.3%, P = 0.0381), but independent from primary Gleason score ≥ 8 (92.0%) versus ≤ 7 (90.2%, P = 0.6346). SUVmax and SUVmean were significantly associated with PSA and ADT (P = 0.018 and 0.004 for SUVmax, respectively; P = 0.025 and 0.007 for SUVmean, respectively). Conclusion:68Ga-PSMA ligand PET/CT demonstrates high detection rates in patients with biochemical recurrence of prostate cancer after primary radiation therapy. The detection rate was positively associated to increasing PSA as well as concomitant ADT. 68Ga-PSMA ligand PET/CT enables discrimination of local versus metastatic disease and thus might have a crucial impact on further clinical management. A major limitation of this study is the lack of histopathologic proof in most patients.
Collapse
Affiliation(s)
- Ingo Einspieler
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany .,Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Charlotte Düwel
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus Krönke
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gregor Habl
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabrina Dewes
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Armin Ott
- Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany; and
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
178
|
Abstract
The role of gallium-68 (68Ga) prostate-specific membrane antigen (PSMA) PET imaging is evolving and finding its place in the imaging armamentarium for prostate cancer (PCa). Despite the progress of conventional imaging strategies, significant limitations remain, including identification of small-volume disease and assessment of bone. Clinical studies have demonstrated that 68Ga-PSMA is a promising tracer for detection of PCa metastases, even in patients with low prostate-specific antigen. To provide an accurate interpretation of 68Ga-PSMA PET/computed tomography, nuclear medicine specialists and radiologists should be familiar with physiologic 68Ga-PSMA uptake, common variants, patterns of locoregional and distant spread of PCa, and inherent pitfalls.
Collapse
Affiliation(s)
- Michael S Hofman
- Department of Cancer Imaging, Centre for Molecular Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia; University of Melbourne, Melbourne, Victoria 3000, Australia.
| | - Amir Iravani
- Department of Cancer Imaging, Centre for Molecular Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| |
Collapse
|
179
|
Afshar-Oromieh A, Sattler LP, Mier W, Hadaschik BA, Debus J, Holland-Letz T, Kopka K, Haberkorn U. The Clinical Impact of Additional Late PET/CT Imaging with 68Ga-PSMA-11 (HBED-CC) in the Diagnosis of Prostate Cancer. J Nucl Med 2017; 58:750-755. [DOI: 10.2967/jnumed.116.183483] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/08/2016] [Indexed: 11/16/2022] Open
|
180
|
Albisinni S, Artigas C, Aoun F, Biaou I, Grosman J, Gil T, Hawaux E, Limani K, Otte FX, Peltier A, Sideris S, Sirtaine N, Flamen P, van Velthoven R. Clinical impact of 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer with rising prostate-specific antigen after treatment with curative intent: preliminary analysis o. BJU Int 2017; 120:197-203. [DOI: 10.1111/bju.13739] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Simone Albisinni
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Carlos Artigas
- Department of Nuclear Medicine; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Fouad Aoun
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Ibrahim Biaou
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Julien Grosman
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Thierry Gil
- Department of Oncology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Eric Hawaux
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Ksenija Limani
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Francois-Xavier Otte
- Department of Radiation Oncology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Alexandre Peltier
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Spyridon Sideris
- Department of Oncology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Nicolas Sirtaine
- Department ofPathology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Patrick Flamen
- Department of Nuclear Medicine; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Roland van Velthoven
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| |
Collapse
|
181
|
Local recurrence of prostate cancer after radical prostatectomy is at risk to be missed in 68Ga-PSMA-11-PET of PET/CT and PET/MRI: comparison with mpMRI integrated in simultaneous PET/MRI. Eur J Nucl Med Mol Imaging 2016; 44:776-787. [PMID: 27988802 DOI: 10.1007/s00259-016-3594-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/06/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE The positron emission tomography (PET) tracer 68Ga-PSMA-11, targeting the prostate-specific membrane antigen (PSMA), is rapidly excreted into the urinary tract. This leads to significant radioactivity in the bladder, which may limit the PET-detection of local recurrence (LR) of prostate cancer (PC) after radical prostatectomy (RP), developing in close proximity to the bladder. Here, we analyze if there is additional value of multi-parametric magnetic resonance imaging (mpMRI) compared to the 68Ga-PSMA-11-PET-component of PET/CT or PET/MRI to detect LR. METHODS One hundred and nineteen patients with biochemical recurrence after prior RP underwent both hybrid 68Ga-PSMA-11-PET/CTlow-dose (1 h p.i.) and -PET/MRI (2-3 h p.i.) including a mpMRI protocol of the prostatic bed. The comparison of both methods was restricted to the abdomen with focus on LR (McNemar). Bladder-LR distance and recurrence size were measured in axial T2w-TSE. A logistic regression was performed to determine the influence of these variables on detectability in 68Ga-PSMA-11-PET. Standardized-uptake-value (SUVmean) quantification of LR was performed. RESULTS There were 93/119 patients that had at least one pathologic finding. In addition, 18/119 Patients (15.1%) were diagnosed with a LR in mpMRI of PET/MRI but only nine were PET-positive in PET/CT and PET/MRI. This mismatch was statistically significant (p = 0.004). Detection of LR using the PET-component was significantly influenced by proximity to the bladder (p = 0.028). The PET-pattern of LR-uptake was classified into three types (1): separated from bladder; (2): fuses with bladder, and (3): obliterated by bladder). The size of LRs did not affect PET-detectability (p = 0.84), mean size was 1.7 ± 0.69 cm long axis, 1.2 ± 0.46 cm short-axis. SUVmean in nine men was 8.7 ± 3.7 (PET/CT) and 7.0 ± 4.2 (PET/MRI) but could not be quantified in the remaining nine cases (obliterated by bladder). CONCLUSION The present study demonstrates additional value of hybrid 68Ga-PSMA-11-PET/MRI by gaining complementary diagnostic information compared to the 68Ga-PSMA-11-PET/CTlow-dose for patients with LR of PC.
Collapse
|
182
|
Sathianathen NJ, Lamb A, Nair R, Geurts N, Mitchell C, Lawrentschuk NL, Moon DA, Murphy DG. Updates of prostate cancer staging: Prostate-specific membrane antigen. Investig Clin Urol 2016; 57:S147-S154. [PMID: 27995218 PMCID: PMC5161015 DOI: 10.4111/icu.2016.57.s2.s147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/08/2016] [Indexed: 11/23/2022] Open
Abstract
The ability to accurately stage prostate cancer in both the primary and secondary staging setting can have a major impact on management. Until recently radiological staging has relied on computer tomography, magnetic resonance imaging, and nuclear bone scans to evaluate the extent of disease. However, the utility of these imaging technologies has been limited by their sensitivity and specificity especially in detecting early recurrence. Functional imaging using positron-emission tomography with a radiolabeled ligand targeted to prostate-specific membrane antigen has transformed the prostate cancer imaging landscape. Initial results suggest that it is a substantial improvement over conventional imaging in the setting of recurrence following primary therapy by having a superior ability to detect disease and to do so at an earlier stage. Additionally, it appears that the benefits seen in the secondary staging setting may also exist in the primary staging setting.
Collapse
Affiliation(s)
| | - Alastair Lamb
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
| | - Rajesh Nair
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
| | - Nicolas Geurts
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
| | | | | | - Daniel A Moon
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
| | - Declan G Murphy
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
| |
Collapse
|
183
|
von Eyben FE, Picchio M, von Eyben R, Rhee H, Bauman G. 68Ga-Labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography/Computed Tomography for Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2016; 4:686-693. [PMID: 28753806 DOI: 10.1016/j.euf.2016.11.002] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/28/2016] [Accepted: 11/03/2016] [Indexed: 12/14/2022]
Abstract
CONTEXT 68Gallium prostate-specific membrane antigen (PSMA) ligand 68Ga-HBED-CC-PSMA (68Ga-PSMA) is a promising radiotracer for positron emission tomography (PET)/computed tomography (CT) of prostate cancer. OBJECTIVE To conduct a meta-analysis to evaluate detection rate, diagnostic test accuracy, and adverse effects of 68Ga-PSMA PET/CT or PET/magnetic resonance imaging (MRI) for staging of prostate cancer and for restaging of rising prostate-specific antigen (PSA) after initial treatment. EVIDENCE ACQUISITION Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, our systematic review searched for articles in PubMed and EMBASE databases from 2012 to July 2016. The reference standard was pathology after biopsy or surgery. The analyses used a random effect model and a hierarchical summary receiver operating characteristic model. EVIDENCE SYNTHESIS Fifteen 68Ga-PSMA PET/CT studies with 1256 patients met the inclusion criteria. Seven studies of staging PET/CT or PET/MRI detected a regional site of cancer for 203 of 273 patients (74%). Nine studies of restaging PET/CT detected sites of recurrence in 799 of 983 patients (81%) with a 50% detection rate (74 of 147 patients) for restaging PSA of 0.2-0.49 ng/ml and a 53% detection rate (56 of 195 patients) for restaging PSA of 0.50-0.99 ng/ml. Staging 68Ga-PSMA PET/CT in the studies had higher detection rates of sites in the prostate bed than restaging 68Ga-PSMA PET/CT (mean 57% vs 14%, p=0.031, t test). Both staging and restaging 68Ga-PSMA PET/CT found that a subgroup of the patients had metastatic sites in pelvic lymph nodes or distant organs. Eight studies of staging PET/CT undertook histologic correlations. We performed prostate-segment-based analysis specifically regarding the primary cancer lesion for four of these studies, and patient-based analysis specifically regarding pelvic lymph node metastases for four other studies. The pooled sensitivities for staging in the two groups of studies were 70% and 61%, and the pooled specificities were 84% and 97%. None of the studies reported complications from the PET/CT imaging. CONCLUSIONS 68Ga-PSMA PET/CT has clinical relevance to detect sites of recurrence for patients with PSA recurrence after radical prostatectomy (RP) with PSA levels less than 1.0 ng/ml. PATIENT SUMMARY Choline positron emission tomography (PET)/computed tomography (CT) can detect sites of recurrent prostate cancer in an earlier phase of prostate-specific antigen (PSA) recurrence than bone scans and CT scans, but choline PET/CT is rarely positive for patients with restaging PSA levels under 1 ng/ml. A new radiotracer called 68Ga-PSMA for PET/CT was able to detect sites of recurring cancer in up to 50% of patients who had an early rise in PSA exceeding 0.5 ng/ml after initial radical prostatectomy. The published studies did not report adverse effects of 68Ga-PSMA PET/CT imaging.
Collapse
Affiliation(s)
| | - Maria Picchio
- Department of Nuclear Medicine, IRCCS San Rafaele Scientific Institute, Milan, Italy
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University, San Francisco, CA, USA
| | - Handoo Rhee
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
| | - Glenn Bauman
- Department of Radiation Oncology, University of Western Ontario in London, ON, Canada
| |
Collapse
|
184
|
de Boer P, Piet AHM, Oprea-Lager DE, Slotman BJ, Dahele MR. PET-Guided Stereotactic Irradiation of Prostate Cancer Lymph Node Metastases. J Nucl Med 2016; 58:183-184. [PMID: 27539838 DOI: 10.2967/jnumed.116.181149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter de Boer
- VU Medical Center Meibergdreef 9 Amsterdam, 1105AZ, The Netherlands E-mail:
| | | | | | | | | |
Collapse
|