Clinical Impact of 68Ga-PSMA PET/CT in a Patient With Biochemical Recurrence of Prostate Cancer (original) (raw)
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European Journal of Nuclear Medicine and Molecular Imaging, 2018
Purpose We studied the usefulness of 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT for detecting relapse in a prospective series of patients with biochemical recurrence (BCR) of prostate cancer (PCa) after radical treatment. Methods Patients with BCR of PCa after radical surgery and/or radiotherapy with or without androgen-deprivation therapy were included in the study. 68 Ga-PSMA PET/CT scans performed from the top of the head to the mid-thigh 60 min after intravenous injection of 150 ± 50 MBq of 68 Ga-PSMA were interpreted by two nuclear medicine physicians. The results were correlated with prostate-specific antigen (PSA) levels at the time of the scan (PSApet), PSA doubling time, Gleason score, tumour stage, postsurgery tumour residue, time from primary therapy to BCR, and patient age. When available, 68 Ga-PSMA PET/CT scans were compared with negative 18 F-choline PET/CT scans routinely performed up to 1 month previously. Results From November 2015 to October 2017, 314 PCa patients with BCR were evaluated. Their median age was 70 years (range 44-92 years) and their median PSApet was 0.83 ng/ml (range 0.003-80.0 ng/ml). 68 Ga-PSMA PET/CT was positive (one or more suspected PCa lesions detected) in 197 patients (62.7%). Lesions limited to the pelvis, i.e. the prostate/prostate bed and/or pelvic lymph nodes (LNs), were detected in 117 patients (59.4%). At least one distant lesion (LNs, bone, other organs, separately or combined with local lesions) was detected in 80 patients (40.6%). PSApet was higher in PET-positive than in PET-negative patients (P < 0.0001). Of 88 patients negative on choline PET/CT scans, 59 (67%) were positive on 68 Ga-PSMA PET/CT. Conclusion We confirmed the value of 68 Ga-PSMA PET/CT in restaging PCa patients with BCR, highlighting its superior performance and safety compared with choline PET/CT. Higher PSApet was associated with a higher relapse detection rate.
Scripta Scientifica Medica, 2022
INTRODUCTION: Currently 68 Ga-PSMA PET/CT is making a significant shift in the diagnosis, staging and restaging of prostate cancer (PC) patients. Мany questions have been raised concerning the indications and the sensitivity of the method. Most of them are related to the PSA values in biochemical progression, specifically in the low PSA values of up to 2.00 ng/mL. AIM: The aim of this study was to analyze the influence of PSA values in biochemical progression on 68 Ga-PSMA PET/CT sensitivity, detection rate and the association with regional or metastatic lesions incidence in patients after radical prostatectomy (RP) with a focus on the impact of the lower ranges of the PSA values. MATERIAL AND METHODS: We performed a retrospective analysis in 144 consecutive patients with radical prostatectomy (RP) who underwent 68 Ga-PSMA PET/CT from July 2019 to February 2020. The patients were divided into six groups according to the PSA value: 1) ≤0.040 ng/mL; 2) 0.041-0.160 ng/mL; 3) 0.161-0.500 ng/mL; 4) 0.501-1.0 ng/mL; 5) 1.001-2.00 ng/mL; 6) >2.00 ng/mL. RESULTS AND DISCUSSION: The mean age of the patients was 67.3 (7) years and the mean PSA level was 11.0 (52.28) ng/mL. A total of 62 patients (43.1%) showed at least one positive lesion. 68 Ga-PSMA PET/CT detection rate varied into the different groups between 12.0% and 94.0%. There was a significant relationship between the PSA level and the ability of 68 Ga-PSMA PET/CT to detect the lesions. Local recurrence was determined in patients with higher PSA values. Regional metastatic lymph nodes incidence in the 6 groups was between 17.0% and 50.0%. Bone metastases were most commonly diagnosed in patients with low PSA levels. Distant lymph nodes involvement in the studied groups ranged between 0.0% and 75.0%. Distant metastases were detected most commonly in patients with low levels of PSA. The PSA-based assessment of the overall sensitivity and specificity of 68 Ga-PSMA PET/CT was
68Ga-PSMA PET/CT and PET/MRI in high-risk prostate cancer patients
Nuclear Medicine Communications, 2018
Treatment of high-risk prostate cancer (HRPCa) is challenging. Local staging and metastatic evaluation are important for the patient management. Recently, prostatespecific membrane antigen (PSMA)-based imaging modalities such as PSMA PET/CT and PET/MRI have received significant attention for detection of recurrent prostate cancer sites with elevated prostate-specific antigen levels, after therapy. Current evidence suggests that these imaging modalities may also have a role for the management of patients with HRPCa. In this review, we discuss PSMA-based imaging modalities in the management of patients with HRPCa. Nucl Med Commun
The Journal of Urology, 2018
, we selected those who performed an early scan for the detection of prostate fossae recurrences and had a PSA levels <2 ng/mL at PET time. 75 subjects met the inclusion criteria. All these patients underwent an early static (after 2 minutes from the FCH injection; 1 bed; 5 minutes/bed) and late whole-body (after 60 minutes from FCH injection; 7 beds; 3 minutes/ bed) PET/CT acquisition. A correlation among terapeutic factors, Gleason Score, PSA levels, PSA doubling time (PSAdt), PSA velocity (PSA vel) and early PET/CT findings were assessed by using the chisquare test and Mann-Whitney test. The agreement between early and late PET/CT acquisitions was studied by K-statistic. ROC analysis was used to evaluate the optimal cutoff point for PSA able to distinguish positive and negative PET/CT finding. A p<0.05 was considered statistically significant. RESULTS: PET/CT showed a pathological tracer uptake in 25 patients (33.3%); in 15 cases confined to the prostatic bed, in 4 to lymph nodes, in 4 to the bone, in 2 to both prostatic fossae and lymph nodes and in 3 to both bone and lymph nodes. Therefore, the detection rate of PET/CT was higher for local recurrences (18/25; 72%). PSA values increased in patients with a positive PET/CT finding compared to subjects with a negative scan. Similarly, PSAdt and PSAvel values were different between patients with a positive and a negative PET/CT scan (6.9 versus 10.2 mo and 0.6 versus 0.4 ng/mL/year, respectively). 15 patients had positive early scans and only 4/15 were positive for both early and late PET/CT acquisition (Kappa value ¼ 0.368; p< 0.001). No correlation was found between the PSAdt or PSAvel and positive or negative early PET/CT images. At ROC analysis a PSA value of 0.67 ng/mL showed a sensitivity and specificity of 69% and 64%, respectively, to distinguish patients with positive or negative PET findings. Using this cutoff value, FCH PET/CT was positive in 23% of patients with PSA < 0.67 ng/mL; 12% of patients had a positive early PET/CT and therefore 88% had negative early scans. CONCLUSIONS: From this study emerges that, in patients with PSA < 2 ng/mL, local recurrence is more often detect by FCH PET/CT finding. An early PET acquisition is able to improve the detection rate, expecially in prostatic fossae, and we reported in this study that local findings were increased to 70%. Our results suggest that the selection of patients ungergoing a "dual phase" PET/CT should be based not only on PSA value but also on PSA kinetic.
68Ga-PSMA PET/CT versus CT and bone scan for investigation of PSA failure post radical prostatectomy
Asian Journal of Urology, 2020
To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (68 Ga-PSMA PET/CT), compared with conventional CT abdomen/pelvis (CTAP) and whole body single photon emission CT bone scan (BS), for detection of local or distant metastasis following biochemical failure/recurrence in post-prostatectomy patients. Methods: We conducted a review of our prospectively maintained, institutional database to identify 384 patients with post-prostatectomy biochemical failure/recurrence who underwent PSMA PET/CT, CTAP and BS from February 2015 to August 2017 in Nepean Hospital, tertiary referral centre. The results of the three imaging modalities were analysed for their ability to detect local recurrence and distant metastases. PSMA PET/CT and CTAP imaging were separately performed on the same day and the BS was performed within several days (mostly in 24 h). Difference in detection rates was determined between the modalities and the Chi square test was used to determine significance. Results: A total of 384 patients were identified with a median prostate-specific antigen (PSA) of 0.465 ng/mL (interquartile range Z0.19e2.00 ng/mL). Overall, PSMA PET/CT was positive for 245 (63.8%) patients whereas CTAP and BS were positive in 174 patients (45.3%). A total of 98 patients (25.5%) had local or distant metastasis detected on PSMA only, while 20 patients (5.2%) had recurrences detected on CTAP but not on PSMA PET/CT.
Cancers and Benign Processes on 68Ga PSMA PET-CT Imaging Other than Prostate Cancer
World Journal of Nuclear Medicine
Background Imaging plays an important role in the evaluation of prostate cancer patients. In recent years, much attention has been focused on gallium 68 prostate-specific membrane antigen positron emission tomography-computed tomography (68Ga PSMA PET-CT) in prostate cancer patients and has been widely used for staging, restaging, and therapy response for these patients. The aim of this study was to report 68Ga PSMA PET-CT in other cancers and benign processes incidentally detected on 68Ga PSMA PET-CT in patients with prostate cancer. Materials and Methods A total of 600 68Ga PSMA PET-CT scans were performed for initial staging, restaging, detection of suspected recurrence, and therapy response in prostate cancer patients between December 2018 and June 2020. A total of 38 patients with histopathologically proven prostate cancer were included in the current study with other malignancies and benign processes. Mainly histopathology in most of cases and clinical and radiological follow-...
Purpose: In this retrospective study, we compared the diagnostic value of 68Gallium prostate specific membrane antigen positron emission tomography computed tomography ([68Ga]PSMA PET/CT) in primary staging of patients with high-risk prostate cancer (PCa), in comparison to CT, magnetic resonance imaging (MRI), and bone scans, and we explored its overall impact on patients’ management plan. Procedures: Patients with pathological confirmation of PCa with high-risk disease were included in this study. Information on patient demographics, clinical and histopathological findings with Gleason score and initial prostate specific antigen PSA levels, and radiological findings for CT, MRI, bone scan, and [68Ga]PSMA PET/CT were retrieved. We stratified the concordance and discordance of each imaging modality on per-patient and per-lesion-site bases. Results: Twenty-one patients with high-risk disease were included in this study. [68Ga]PSMA PET/CT revealed a significantly higher concordance rate (90%) compared to the concordance rates of bone scan (75%), MRI (73%), and CT (60%). [68Ga]PSMA PET/CT had a similar accuracy to MRI in detecting prostate lesions but a higher accuracy for suspicious pelvic lymph nodes (95.2% vs. 80%). It also superseded CT scan in detecting suspicious pelvic lymph nodes (95.2% vs. 75%) and extra-pelvic lymph nodes (100% vs. 75%), as well as bone lesions via bone scan (100% vs. 62.5%). [68Ga]PSMA PET/CT changed the management in 11 patients (52%). Conclusions: [68Ga]PSMA PET/CT is an invaluable imaging modality in the assessment of primary high-risk PCa with great potential for the detection of lymph node spread and bone metastases that would impact the management plan.
Journal of Nuclear Medicine
Prostate-specific membrane antigen (PSMA)-targeted PET imaging recently emerged as a new method for the staging and restaging of prostate cancer. Most published studies investigated the diagnostic potential of 68 Ga-labeled PSMA agents that are excreted renally. 18 F-PSMA-1007 is a novel PSMA ligand that has excellent preclinical characteristics and that is only minimally excreted by the urinary tract, a potential advantage for pelvic imaging. The aim of this study was to investigate the diagnostic efficacy of 18 F-PSMA-1007 for biochemical recurrence (BCR) after radical prostatectomy. Methods: From 3 academic centers, 251 patients with BCR after radical prostatectomy were evaluated in a retrospective analysis. Patients who had received second-line androgen deprivation therapy (ADT) or chemotherapy were excluded, but prior first-line ADT exposure was allowed. The median prostate-specific antigen (PSA) level was 1.2 ng/mL (range, 0.2-228 ng/mL). All patients underwent PSMA PET/CT at 92 ± 26 min after injection of 301 ± 46 MBq of 18 F-PSMA-1007. The rate of detection of presumed recurrence sites was correlated with the PSA level and original primary Gleason score. A comparison to a subset of patients treated previously with ADT was undertaken. Results: Of the 251 patients, 204 (81.3%) had evidence of recurrence on 18 F-PSMA-1007 PET/CT. The detection rates were 94.0% (79/84), 90.9% (50/55), 74.5% (35/47), and 61.5% (40/65) for PSA levels of greater than or equal to 2, 1 to less than 2, 0.5 to less than 1, and 0.2 to less than 0.5 ng/mL, respectively. 18 F-PSMA-1007 PET/CT revealed local recurrence in 24.7% of patients (n 5 62). Lymph node metastases were present in the pelvis in 40.6% of patients (n 5 102), in the retroperitoneum in 19.5% of patients (n 5 49), and in supradiaphragmatic locations in 12.0% of patients (n 5 30). Bone and visceral metastases were detected in 40.2% of patients (n 5 101) and in 3.6% of patients (n 5 9), respectively. In tumors with higher Gleason scores (#7 vs. $8), detection efficacy trended higher (76.3% vs. 86.7%) but was not statistically significant (P 5 0.32). However, detection efficacy was higher in patients who had received ADT (91.7% vs. 78.0%) within 6 mo before imaging (P 5 0.0179). Conclusion: 18 F-PSMA-1007 PET/CT offers high detection rates for BCR after radical prostatectomy that are comparable to or better than those published for 68 Ga-labeled PSMA ligands.
Cancer imaging : the official publication of the International Cancer Imaging Society, 2017
68Ga-labelled prostate specific membrane antigen (PSMA) ligand PET/CT is a promising modality in primary staging (PS) and biochemical relapse (BCR) of prostate cancer (PC). However, pelvic nodes or local recurrences can be difficult to differentiate from radioactive urine. CT urography (CT-U) is an established method, which allows assessment of urological malignancies. The study presents a novel protocol of 68Ga-PSMA-11 PET/CT-U in PS and BCR of PC. A retrospective review of PSMA PET/CT-U preformed on 57 consecutive patients with prostate cancer. Fifty mL of IV contrast was administered 10 min (range 8-15) before the CT component of a combined PET/CT study, acquired approximately 60 min (range 40-85) after administration of 166 MBq (range 91-246) of 68Ga-PSMA-11. PET and PET/CT-U were reviewed by two nuclear medicine physicians and CT-U by a radiologist. First, PET images were reviewed independently followed by PET/CT-U images. Foci of activity which could not unequivocally be asses...