68Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate?

Ceci, Francesco; Uprimny, Christian; Nilica, Bernhard; Geraldo, Llanos; Kendler, Dorota; Kroiss, Alexander; Bektic, Jasmin; Horninger, Wolfgang; Lukáš, Peter; Decristoforo, Clemens; Castellucci, Paolo; Fanti, Stefano; Virgolini, Irene

doi:10.1007/s00259-015-3078-6

Cited by 236 publications

(155 citation statements)

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“…Most recently, Perera et al presented a review of 68 Ga-PSMA ligand PET, demonstrating a pooled detection rate of 76% for 68 Ga-PSMA ligand PET/CT (11), considerably exceeding the pooled 62% detection rate for 11 C-choline PET (12). However, most 68 Ga-PSMA ligand PET/CT studies have either evaluated an inhomogeneous patient population, including predominantly patients showing BCR after radical prostatectomy and including also a low proportion of patients after EBRT as well as progressive disease, or completely focused on the group of patients after radical prostatectomy (10,13,14).…”

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confidence: 99%

Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

et al. 2017

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The aim of this retrospective study was to evaluate the detection rate of Glu-NH-CO-NH-Lys-(Ahx)-[ 68 Ga(HBED-CC)] ( 68 Ga-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 68 Ga-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 5 0.0377). 68 Ga-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 5 0.0381), but independent from primary Gleason score $ 8 (92.0%) versus # 7 (90.2%, P 5 0.6346). SUV max and SUV mean were significantly associated with PSA and ADT (P 5 0.018 and 0.004 for SUV max , respectively; P 5 0.025 and 0.007 for SUV mean , respectively). Conclusion: 68 Ga-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. 68 Ga-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.

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confidence: 99%

Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

et al. 2017

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“…Although this might influence the likelihood of response, it might also indicate a more indolent disease process in which an observational strategy may limit side effects without adversely affecting survival. Consistent with this hypothesis, PSA doubling time has also been shown to be a predictive factor for a positive PSMA PET/CT (27,28). An exception to the general rule that a negative scan implies either small volume or low-grade prostate cancer is the observation that neuroendocrine differentiation can be associated with low PSMA expression (29), and yet this is known to be an adverse prognostic group and can have low PSA levels (30).…”

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confidence: 54%

Seduction by Sensitivity: Reality, Illusion, or Delusion? The Challenge of Assessing Outcomes after PSMA Imaging Selection of Patients for Treatment

2017

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“…PSMA ligand PET imaging has proven to correlate highly with histopathological findings (16,17,19) and is more sensitive than computed tomographic-based 3D volumetric assessment for lymph node relapse after primary prostate cancer therapy (20). To our knowledge, there are no general recommendations for the optimal PSA detection threshold and there is always the risk of non-detection of metastases in patients with low PSA levels, although some data suggest a detection threshold of at least 0.83 ng/ml (21). In our analysis, the median PSA at the time of 68 Ga-PSMA ligand PET/CT was 2.75 ng/ml.…”

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confidence: 99%

68Ga-PSMA Ligand PET/CT-based Radiotherapy for Lymph Node Relapse of Prostate Cancer After Primary Therapy Delays Initiation of Systemic Therapy

Henkenberens

Klot

Roß

et al. 2017

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Among patients with prostate cancer, tumor relapse after primary therapy particularly occurs in high-risk groups. The standard of care for distant relapse of prostate cancer is androgen-deprivation therapy (ADT), which has a negative impact on the patient's quality of life (1). Recently alternative local treatment strategies have been proposed for patients with oligometastatic disease, who have a better prognosis than patients with extensive disease (2). Local therapies such as radiotherapy could provide effective local control, delay disease progression and therefor reduce the need to initiate systemic therapies (3). The identification of patients with oligometastatic prostate cancer is challenging due to the lack of sufficiently sensitive imaging for detection of low-volume recurrent and metastatic disease in patients with low prostatespecific antigen (PSA) levels (2). In general, positronemission tomography-computed tomography (PET/CT) for radiotherapy has proven helpful in patient selection and target volume delineation, with promising results regarding clinical outcome and toxicity (4, 5). A new diagnostic option in this context is the use of prostate-specific membrane antigen (PSMA) ligands for PET/CT. 68 Ga-PSMA ligand PET/CT has been reported to have a substantially higher diagnostic accuracy for the detection of prostate cancer metastases than choline-based PET/CT, particularly in the case of lymph node metastases (6-10). Data on the effectiveness of 68 Ga-PSMA ligand PET/CT-based radiotherapy for prostate cancer lymph node metastases after primary therapy are limited.The aim of the present study was to assess the clinical outcome and time of initiation of systemic therapies (ADT or chemotherapy) of patients with isolated prostate cancer lymph node metastases after primary therapy treated with 68 Ga-labelled PSMA ligand PET/CT-guided 3D conformal radiotherapy. Patients and MethodsStudy population. Between June 2014 and March 2016, 23 patients with biochemical failure and a PSA above 0.5 ng/ml after primary therapy of prostate cancer underwent 68 Ga-PSMA ligand PET/CT for restaging purposes and were treated with radiotherapy of the 68 Ga-PSMA ligand PET/CT-positive lymph nodes. All cases were discussed 1273

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68Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate?

Abstract: The great potential of (68)Ga-PSMA PET/CT in patients with rPCa and BR was confirmed. PSA and PSAdt were valuable predictors of pathological (68)Ga-PSMA PET/CT findings.

Cited by 236 publications

References 32 publications

Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

Seduction by Sensitivity: Reality, Illusion, or Delusion? The Challenge of Assessing Outcomes after PSMA Imaging Selection of Patients for Treatment

68Ga-PSMA Ligand PET/CT-based Radiotherapy for Lymph Node Relapse of Prostate Cancer After Primary Therapy Delays Initiation of Systemic Therapy

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68Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate?

Abstract: The great potential of (68)Ga-PSMA PET/CT in patients with rPCa and BR was confirmed. PSA and PSAdt were valuable predictors of pathological (68)Ga-PSMA PET/CT findings.

Cited by 236 publications

References 32 publications

Detection Efficacy of Hybrid 68Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

Detection Efficacy of Hybrid 68Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

Seduction by Sensitivity: Reality, Illusion, or Delusion? The Challenge of Assessing Outcomes after PSMA Imaging Selection of Patients for Treatment

68Ga-PSMA Ligand PET/CT-based Radiotherapy for Lymph Node Relapse of Prostate Cancer After Primary Therapy Delays Initiation of Systemic Therapy

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Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria

Detection Efficacy of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria