68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study

Dyrberg, Eva; Hendel, Helle Westergren; Huynh, Tri Hien Viet; Klausen, Tobias Wirenfeldt; Løgager, Vibeke; Madsen, Claus; Pedersen, Erik Morre; Pedersen, Maria; Thomsen, Henrik S.

doi:10.1007/s00330-018-5682-x

Cited by 72 publications

(56 citation statements)

References 45 publications

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“…PSMA PET/CT showed superior diagnostic performance compared to anatomical imaging for lymph node staging in studies where comparative data were reported. Since studies have shown PSMA PET/CT to outperform bone scans, with or without SPECT/CT, for the detection of skeletal metastases [45][46][47][48], PSMA PET/CT may turn out to be a one-stop modality for staging in these patients.…”

Section: Resultsmentioning

confidence: 99%

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

Petersen

Zacho

2020

Cancer Imaging

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Background: PSMA PET is a promising method for primary lymph node staging in prostate cancer. However, recent systematic reviews have identified only a limited number of studies with histopathology as a reference test. Methods: A systematic search was performed in PubMed and the Cochrane Library. An expedited systematic review was performed where we identified diagnostic studies in prostate cancer where a preoperative PSMA PET for primary lymph node staging was compared to histopathology. The trials must have diagnostic data on a patient level. Results: Eighteen eligible clinical trials included 969 patients. The median patient number per study was 32 (range 10 to 208). Five trials were prospective, and nine trials had a consecutive enrolment of patients. Sixteen studies used Ga-68-PSMA-11; there was one study with Cu-64-PSMA and one study with F-18-DCDFPyL. Twelve studies used PET/CT, four trials used PET/MR. Most trials included patients with intermediate and high-risk. Diagnostic accuracy varied notably among the studies; sensitivity ranged from 23 to 100%, specificity 67-100%, positive predictive value 20-100%, and negative predictive value 41-100%. Weighted sensitivity was 59%, weighted specificity was 93%. Four studies compared PSMA PET with anatomical imaging (CT or MRI); in all cases, sensitivity and specificity were superior with PSMA PET. Three studies compared PSMA PET with multi-parametric or diffusion-weighted MRI with mixed results. Conclusions: PSMA PET showed promising diagnostic accuracy for primary lymph node staging with pathology as reference. Recommendation for PSMA PET for high-risk patients in clinical guidelines should be supported by confirmatory, prospective trials with patient-relevant outcomes.

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Section: Resultsmentioning

confidence: 99%

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

Petersen

Zacho

2020

Cancer Imaging

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“…For example, Zacho et al recently performed a prospective study on 68 patients with biochemically recurrent PCa and found that Na 18 F and a 68 Galabeled PSMA-targeted PET radiotracer had similarly high rates for identifying PCa bone metastases (22). Further, a patient-level analysis by Dyrberg et al of patients with PCa undergoing imaging with both Na 18 F and a 68 Ga-labeled PSMA-targeted PET radiotracer also found no difference in diagnostic ability between the agents (23).…”

Section: Discussionmentioning

confidence: 99%

Prospective Comparison of PET Imaging with PSMA-Targeted ¹⁸F-DCFPyL Versus Na¹⁸F for Bone Lesion Detection in Patients with Metastatic Prostate Cancer

Rowe

Trock

et al. 2019

J Nucl Med

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Bone metastases in prostate cancer (PCa) have important prognostic significance, and imaging modalities used for PCa staging should have high sensitivity for detecting such lesions. Prostatespecific membrane antigen (PSMA)-targeted PET radiotracers are promising new agents for imaging PCa. We undertook a head-tohead comparison of PSMA-targeted 2-(3-{1-carboxy-5-[(6-18 Ffluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18 F-DCFPyL) PET to Na 18 F PET to determine which modality was more sensitive for the detection of lesions suggestive of bone metastases in a group of patients with metastatic PCa. Methods: Patients with progressive, metastatic PCa were prospectively imaged with both 18 F-DCFPyL and Na 18 F PET/CT, with both scans occurring within 24 h of each other. A consensus 2-reader central review was performed to identify all bone lesions suggestive of sites of PCa involvement on both scans, and maximized SUVs corrected for body weight (SUV max) and lean body mass (SUL max) were recorded. Soft-tissue lesions were also noted on both scans, and SUV max , SUL max , and PSMA reporting and data system (RADS) version 1.0 scores were recorded. Data from the 2 scans were compared using a generalized estimating equation. Results: In total, 16 patients meeting all inclusion criteria were enrolled in this study, and 15 of the 16 (93.8%) were imaged with both PET radiotracers. In total, 405 bone lesions suggestive of sites of PCa were identified on at least 1 scan. On 18 F-DCFPyL PET/CT, 391 (96.5%) were definitively positive, 4 (1.0%) were equivocally positive, and 10 (2.5%) were negative. On Na 18 F PET/CT, the corresponding values were 388 (95.8%), 4 (1.0%), and 13 (3.2%). Of the definitively negative lesions on 18 F-DCFPyL PET, 8 of 10 (80.0%) were sclerotic and 2 of 10 (20.0%) were infiltrative or marrow-based. Additionally, 12 of 13 (92.3%) of the definitively negative lesions on Na 18 F PET were infiltrative or marrow-based and 1 of 13 (7.7%) was lytic. Also identified were 78 PSMA-RADS-4, 17 PSMA-RADS-5, and 1 PSMA-RADS-3C soft-tissue lesions. Conclusion: PET/CT imaging using 18 F-DCFPyL and Na 18 F PET had nearly identical sensitivities for the detection of bone lesions in patients with metastatic PCa. As would be expected, PSMA-targeted PET provides more information on soft-tissue disease. There may be little additional value to imaging PCa patients with Na 18 F after a PSMA-targeted PET scan has already been performed.

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“…When 18 F-FDG and 18 F-NaF are compared, the latter is more sensitive for detecting bone metastases at BCR even at PSA levels as low as 2-4 ng/mL, albeit at the expense of specificity (46)(47)(48). For PSMA tracers, mostly in a mixed primary and recurrent population, studies show a similar pattern, with 18 F-NaF detecting more bone lesions at the expense of decreased specificity (49-51); 1 study showed no significant difference (52). A consistent result is that, compared with other PET tracers, 18 F-NaF is more sensitive for bone lesions at the expense of specificity.…”

Section: Clinical Categories and Auc Scoresmentioning

confidence: 95%

Appropriate Use Criteria for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer After Definitive Primary Treatment

et al. 2020

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68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study

Abstract: • PSMA-PET/CT assessed the presence of bone metastases correctly in all 55 patients • PSMA-PET/CT was more advantageous compared to WB-MRI • No difference was found between PSMA-PET/CT and NaF-PET/CT.

Cited by 72 publications

References 45 publications

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

Prospective Comparison of PET Imaging with PSMA-Targeted ¹⁸F-DCFPyL Versus Na¹⁸F for Bone Lesion Detection in Patients with Metastatic Prostate Cancer

Appropriate Use Criteria for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer After Definitive Primary Treatment

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68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study

Abstract: • PSMA-PET/CT assessed the presence of bone metastases correctly in all 55 patients • PSMA-PET/CT was more advantageous compared to WB-MRI • No difference was found between PSMA-PET/CT and NaF-PET/CT.

Cited by 72 publications

References 45 publications

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

Prospective Comparison of PET Imaging with PSMA-Targeted 18F-DCFPyL Versus Na18F for Bone Lesion Detection in Patients with Metastatic Prostate Cancer

Appropriate Use Criteria for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer After Definitive Primary Treatment

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Prospective Comparison of PET Imaging with PSMA-Targeted ¹⁸F-DCFPyL Versus Na¹⁸F for Bone Lesion Detection in Patients with Metastatic Prostate Cancer