68Ga-PSMA-11 PET/CT in newly diagnosed prostate cancer: diagnostic sensitivity and interobserver agreement

Basha, Mohammad Abd Alkhalik; Hamed, Maged Abdel Galil; Hussein, Omar; El-Diasty, Tarek; Abdelkhalek, Yasser Ibrahim; Hussein, Yehia Omar; Alasamer, Ahmed Fathy; Mohamed, Heba A.; Deen, Dalia Salah El; Tantawy, Engy Fathy; Metwally, Maha Ibrahim; Zaitoun, Mohamed; Aly, Sameh Abdelaziz; Altohamy, Jehan Ibrahim; Mohamed, Abd El Motaleb; Afifi, Amira Hamed Mohamed; Harb, Ola A.

doi:10.1007/s00261-019-02006-2

Cited by 29 publications

(20 citation statements)

References 32 publications

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“…Agreement for the detection of extra-pelvic nodes and distant metastases (miM) was almost perfect; the agreement for the presence or not of metastases was concordant for all patients (37/43 M0 and 6/43 M1a/1b). This result is in line with a previous study, and accurate interpretation of the presence or not of distant metastases is of particular importance as it has significant impact on treatment decision, ruling out surgical option [12,19].…”

Section: Discussionsupporting

confidence: 91%

“…2 The only case of discordant miM classification was a case of a patient with a vas deferens lesion considered as visceral metastasis by two observers and as inguinal lymph node for the other one study assessed these criteria in a homogeneous population of patients with newly diagnosed PC eligible for surgery. Previous studies also showed [ 68 Ga]Ga-PSMA-11 PET/CT image interpretation substantial agreement in patients with recurrent PC using PROMISE criteria or criteria based on Delphi approach of consensus between experts and in patients with newly diagnosed PC but with non-standardised criteria [5,10,18,19]. Additionally, we demonstrated inter-reader substantial agreement with a less experienced physician resident with 2-year experience [20].…”

Section: Discussionsupporting

confidence: 77%

“…3 The PET/CT images show a case of observers agreement on diffuse [ 68 Ga]Ga-PSMA-11 uptake in the prostate gland but discordance of the number of prostate primary lesions: one left focus and one right focus were described by observers #1 and #2 while two left foci and three right foci were detected by observer #3 the absence of detailed and validated standardized criteria for the definition of a positive prostatic primary lesion based on [ 68 Ga]Ga-PSMA-11 PET/CT: PROMISE criteria focus more on the extent and organ confinement of the primary prostate lesion and do not specifically define a prostatic primary lesion; PSMA-RADS is not applicable on the primary prostate cancer, and Fanti et al criteria were developed to detect prostate cancer recurrent lesions [5][6][7]. However, qualitative examination is usually based on the detection of focal [ 68 Ga]Ga-PSMA-11 uptake higher than prostatic surrounding background [5,19,[21][22][23]. Disagreement in the interpretation of prostatic lesions was also pointed out by Toriihara et al and might have been due to differences in interpretation of moderate foci or diffuse uptake [12].…”

Section: Discussionmentioning

confidence: 99%

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Interobserver agreement of [68Ga]Ga-PSMA-11 PET/CT images interpretation in men with newly diagnosed prostate cancer

Derwael¹,

Lavergne

Lovinfosse

et al. 2020

EJNMMI Res

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Background: Prostate-specific membrane antigen (PSMA) ligand PET/CT has already provided promising results in prostate cancer (PC) imaging, yet simple and reproductible reporting criteria are still lacking. This study aimed at retrospectively evaluating interobserver agreement of [ 68 Ga]Ga-PSMA-11 PET/CT images interpretation according to PC molecular imaging standardized evaluation (PROMISE) criteria and reproducibility of PSMA reporting and data systems (RADS). Methods: Forty-three patients with newly diagnosed, histologically proven intermediate-or high-risk PC, eligible for radical prostatectomy and who underwent [ 68 Ga]Ga-PSMA-11 PET/CT before surgery were retrospectively included. Three nuclear medicine physicians (2 experienced and 1 resident) independently reviewed PET/CT images. Interpretation of [ 68 Ga]Ga-PSMA-11 PET/CT images was based on PROMISE criteria including miTNM staging and lesions miPSMA expression score visual estimation and PSMA-RADS version 1.0 for a given scan. Readers' agreement was measured using Krippendorff's coefficients Results: Agreement between observers was almost perfect (coefficient ≥ 0.81) for miM; it was substantial (coefficient ≥ 0.61) for the following criteria: miT, miN, PSMA-RADS, and miPSMA expression score of primary PC lesion and metastases. However, agreement was moderate (coefficient = 0.41-0.60) for miPSMA score of positive lymph nodes and for detection of PC primary lesion. Conclusion: Visual interpretation of [ 68 Ga]Ga-PSMA-11 PET/CT images in patients with newly diagnosed PC in a clinical setting leads to at least substantial agreement for PROMISE criteria and PSMA-RADS classification except for PC primary lesion detection and for miPSMA expression scoring of positive lymph nodes that might have been hampered by the interindividual variability of reference organs PSMA expression.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Interobserver agreement of [68Ga]Ga-PSMA-11 PET/CT images interpretation in men with newly diagnosed prostate cancer

Derwael¹,

Lavergne

Lovinfosse

et al. 2020

EJNMMI Res

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“…ROC curve analysis showed that ADC had high sensitivity but lower specificity in the detection of PCa. The sensitivity of SUV max in this study (67.2%) was less than that reported in other studies, [ 24 , 31 , 32 ] which may be attributed to differences among the populations and the different cutoff values. The ratio of SUV max /ADC integrates the degree of water molecule diffusion and PSMS expression.…”

Section: Discussioncontrasting

confidence: 93%

68Ga-PSMA-11 PET/CT combining ADC value of MRI in the diagnosis of naive prostate cancer

Wang¹,

Yu²,

Zang³

et al. 2020

Medicine

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68 Ga-PSMA-11 positron emission computed tomography /computed tomography (PET/CT) is more sensitive than magnetic resonance imaging (MRI) in detecting prostate cancer (PCa). We evaluated the value of 68 Ga-PSMA-11 PET/CT with MRI in treatment-naive PCa. This retrospective study was approved by the hospital ethics committee. The MRI and 68 Ga-PSMA-11 PET/CT imaging data of 63 cases of highly suspected PCa were enrolled in this study. The SUV max and apparent diffusion coefficient (ADC), and their ratio, were assessed as diagnostic markers to distinguish PCa from benign disease. There were 107 prostate lesions detected in 63 cases. Forty cases with 64 malignant primary lesions were confirmed PCa, whereas 23 cases had 43 benign lesions. PSMA-avid lesions correlated with hypointense signal on ADC maps and hyperintense signal on diffusion-weighted imaging. The ADC of PCa was lower than that of benign lesions, and SUV max and SUV max /ADC of PCa was higher than that of benign lesions ( P < .01). ADC had significant negative correlation with Gleason score (GS) and SUV max , SUV max , and SUV max /ADC positively correlated with GS. From ROC analysis, we established cutoff values of ADC, SUV max , and SUV max /ADC at 1.02 × 10 −3 mm 2 /s, 11.72, and 12.35, respectively, to differentiate PCa from benign lesions. The sensitivity, specificity, and AUC were 90.6%, 58.1%, and 0.816 for ADC, 67.2%, 97.7%, and 0.905 for SUV max , and 81.2%, 88.4%, and 0.929 for SUV max /ADC, respectively. 68 Ga-PSMA-11 PET/CT combined with MRI offers higher diagnostic efficacy in the detection of PCa than either modality alone.

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“…The SUVmax of a radiotracer has a significant role in the diagnosis and treatment selection for different types of tumors, e.g. lymphoma [20], head and neck squamous cell carcinoma [21], pancreatic tumor [22], neuroendocrine tumors [23] or even prostate cancer [24]. A recent pilot study on 14 prostate cancer patients showed that patients with a PSA response ≥ 50% after treatment with 177 Lu PSMA had a significantly higher baseline SUVmax in a pre-therapeutic scan with 68 Ga PSMA-PET (44 vs. 17) [10].…”

Section: Discussionmentioning

confidence: 99%

Explorative analysis of a score predicting the therapy response of patients with metastatic, castration resistant prostate cancer undergoing radioligand therapy with 177Lu-labeled prostate-specific membrane antigen

et al. 2020

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Objective Up to 60% of patients with metastatic, castration-resistant prostate cancer (mCRPC) treated with 177Lu prostate-specific membrane antigen (PSMA) radioligand therapy (RLT) achieves a partial biochemical response with a decrease of > 50% in prostate-specific antigen (PSA) levels. The remaining fractions, however, do not respond to RLT. The aim of this explorative analysis was to identify pre-therapeutic factors for the prediction of response. Methods 46 patients [age = 68 years (50–87)] with mCRPC who consecutively underwent RLT with 177Lu PSMA [median applied activity = 6 GBq (2.9–6.2)] were included and analysed retrospectively. The association of different clinical and laboratory factors and parameters from pre-therapeutic 68Ga PSMA positron emission tomography (PET) with the outcome of RLT was tested (Fisher’s test). Outcome was defined as PSA changes 8 weeks after second RLT [partial response (PR), PSA decrease > 50%; progressive disease (PD), PSA increase ≥ 25%; stable disease (SD), others]. Significant predictive factors were combined in a predictive score. Results 30% showed a post-treatment PR (median 73% PSA decrease), 35% SD (median 17% PSA decrease) and 35% PD (median 42% PSA increase). Significant predictors for PD were alkaline phosphatase (ALP) > 135 U/l (p = 0.002), PSA > 200 ng/ml (p = 0.036), and maximum standardized uptake value (SUVmax) of the “hottest lesion” in pre-therapeutic PET < 45 (p = 0.005). The predictive score including PSA, ALP and SUVmax could separate 2 distinct groups of patients: ≤ 2 predictive factors (19% PD) and 3 predictive factors (90% PD). Conclusion The presented predictive score allowed a pre-therapeutic estimate of the expected response to 2 cycles of RLT. As our study was retrospective, prospective trials are needed for validation.

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68Ga-PSMA-11 PET/CT in newly diagnosed prostate cancer: diagnostic sensitivity and interobserver agreement

Cited by 29 publications

References 32 publications

Interobserver agreement of [68Ga]Ga-PSMA-11 PET/CT images interpretation in men with newly diagnosed prostate cancer

Interobserver agreement of [68Ga]Ga-PSMA-11 PET/CT images interpretation in men with newly diagnosed prostate cancer

68Ga-PSMA-11 PET/CT combining ADC value of MRI in the diagnosis of naive prostate cancer

Explorative analysis of a score predicting the therapy response of patients with metastatic, castration resistant prostate cancer undergoing radioligand therapy with 177Lu-labeled prostate-specific membrane antigen

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