[68Ga]PSMA PET/CT Improves Initial Staging and Management Plan of Patients with High-Risk Prostate Cancer

Hirmas, Nader; Al‐Ibraheem, Akram; Herrmann, Ken; Alsharif, Abedalatif; Muhsin, Haider; Khader, Jamal; Al-Daghmin, Ali; Salah, Samer

doi:10.1007/s11307-018-1278-8

Cited by 44 publications

(27 citation statements)

References 23 publications

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“…Six publications investigating the impact of PSMA-PET on management were published between 2018 and 2019 including a total of 396 patients, showing a range of management change from 21 to 52% [3,[8][9][10][11][12]. PSMA-PET was considered useful for improved patient selection for focal therapies, or to change therapy modalities based on the PET findings as shown also in a study from our group that found a change in management in 27% of patients based on the staging PSMA-PET [10,13].…”

Section: Introductionmentioning

confidence: 81%

Improved oncological outcome after radical prostatectomy in patients staged with 68Ga-PSMA-11 PET: a single-center retrospective cohort comparison

Ferraro

Lehner

Becker

et al. 2020

Eur J Nucl Med Mol Imaging

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Background Positron emission tomography (PET) targeting the prostate-specific membrane antigen (PSMA) has superior sensitivity over conventional imaging (CI) to stage prostate cancer (PCa) and therefore is increasingly used in staging to stratify patients before radical therapy. Whether this improved diagnostic accuracy translates into improved outcome after radical prostatectomy (RPE) has not yet been shown. Therefore, the aim of this study was to compare the oncological outcome after RPE between patients that underwent preoperative staging with CI or PSMA-PET for intermediate and high-risk PCa. Methods We retrospectively selected all patients that underwent RPE for intermediate- or high-risk PCa at our institution before PSMA-PET introduction (between March 2014 and September 2016) and compared the oncologic outcome of patients staged with PSMA-PET (between October 2016 and October 2018). Oncological pre-surgical risk parameters (age, PSA, D’Amico score, biopsy-ISUP, and cT stage) were compared between the groups. Oncological outcome was determined as PSA persistence, nerve-sparing rate, and surgical margin status. Wilcoxon rank-sum, Fisher’s, and chi-square tests where used for statistical testing. Results One hundred five patients were included, 53 in the CI group and 52 in the PSMA-group. Patients in the PSMA group had higher ISUP grade (p < 0.001) and D’Amico score (p < 0.05). The rate of free surgical margins and PSA persistence after RPE was 64% and 17% for the CI and 77% and 6% for the PSMA group (p = 0.15 and 0.13, respectively). Subgroup analysis with high-risk patients revealed PSA persistence in 7% (3/44) in the PSMA group and 25% (7/28) in the CI group (p = 0.04). Limitations include the retrospective design and choline-PET for some patients in the CI group. Conclusion Immediate outcome after RPE was not worse in the PSMA group compared with the CI group, despite a higher-risk cohort. In a comparison of only high-risk patients, PSMA-PET staging was associated with a significantly lower rate of postsurgical PSA persistence.

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Section: Introductionmentioning

confidence: 81%

Improved oncological outcome after radical prostatectomy in patients staged with 68Ga-PSMA-11 PET: a single-center retrospective cohort comparison

Ferraro

Lehner

Becker

et al. 2020

Eur J Nucl Med Mol Imaging

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Section: Introductionmentioning

confidence: 99%

“…Prostate cancer is the most common solid malignancy in men and the third leading cause of cancer-related mortality in the western world (1). There is strong emerging evidence to suggest that using positron emission tomography (PET) probes that target prostate-specific membrane antigen (PSMA) can improve diagnostic accuracy and management of patients with prostate cancer (1)(2)(3)(4)(5)(6)(7)(8). A variety of radiopharmaceuticals including the 68 Ga-labelled PSMA inhibitor Glu-NH-CO-NH-Lys(Ahx)-HBED-CC have been widely studied as imaging probes for PET and been shown to increase detection of prostate cancer in patients with biochemical recurrence (9,10) and in patients with new diagnosis of prostate cancer (11).…”

Section: Introductionmentioning

confidence: 99%

“…A variety of radiopharmaceuticals including the 68 Ga-labelled PSMA inhibitor Glu-NH-CO-NH-Lys(Ahx)-HBED-CC have been widely studied as imaging probes for PET and been shown to increase detection of prostate cancer in patients with biochemical recurrence (9,10) and in patients with new diagnosis of prostate cancer (11). Although only recently implemented into clinical practice, 68 Ga-PSMA PET demonstrated improved sensitivity and specificity compared to traditional imaging modalities such as bone scintigraphy, CT, and MRI in patients with primary intermediate-or high-risk disease (1,6,12).…”

Section: Introductionmentioning

confidence: 99%

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Factors Predicting Metastatic Disease in ⁶⁸Ga-PSMA-11 PET–Positive Osseous Lesions in Prostate Cancer

et al. 2020

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Bone is the most common site of distant metastatic spread in prostate adenocarcinoma. Prostatespecific membrane antigen uptake has been described in both benign and malignant bone lesions, which can lead to false-positive findings on 68 Ga-prostate-specific membrane antigen-11 positron emission tomography (68 Ga-PSMA-11 PET). The purpose of this study was to evaluate the diagnostic accuracy of 68 Ga-PSMA-11 PET for osseous prostate cancer metastases and improve bone uptake interpretation using semi-quantitative metrics. METHODS. 56 prostate cancer patients (18 pre-prostatectomy, 38 biochemical recurrence) who underwent 68 Ga-PSMA-11 PET/MRI or PET/CT examinations with osseous PSMA-ligand uptake were included in the study. Medical records were reviewed retrospectively by boardcertified nuclear radiologists to determine true or false positivity based on a composite endpoint. For each avid osseous lesion, biological volume, size, PSMA-RADS rating, maximum standardized uptake value (SUVmax), and ratio of lesion SUVmax to liver, blood pool, and background bone SUVmax were measured. Differences between benign and malignant lesions were evaluated for statistical significance, and cutoff values for these parameters were determined to maximize diagnostic accuracy. RESULTS. Among 56 participants, 13 patients (22.8%) had false-positive osseous 68 Ga-PSMA-11 findings and 43 patients (76.8%) had true-positive osseous 68 Ga-PSMA-11 findings. Twentytwo patients (39%) had 1 osseous lesion, 18 (32%) had 2-4 lesions, and 16 (29%) had 5 or more lesions. Cutoff values resulting in statistically significant (p<0.005) differences between benign and malignant lesions were: PSMA-RADS ≥4, SUVmax ≥4.1, SUVmax ratio of lesion to blood by on November 1, 2020. For personal use only. jnm.snmjournals.org Downloaded from pool ≥2.11, to liver ≥0.55, and to bone ≥4.4. These measurements corresponded to lesion-based 68 Ga-PSMA-11 PET lesion detection rate for malignancy of 80%, 93%, 89%, 21%, 89%, and a specificity of 73%, 73%, 73%, 93%, 60%, respectively. CONCLUSION. PSMA-RADS rating, SUVmax, and SUVmax ratio of lesion to blood pool can help differentiate benign from malignant lesions on 68 Ga-PSMA-11 PET. SUVmax ratio to blood pool above 2.2 is a reasonable parameter to support image interpretation and presented superior lesion detection rate and specificity when compared to visual interpretation by PSMA RADS. These parameters hold clinical value by improving diagnostic accuracy for metastatic prostate cancer on 68 Ga-PSMA-11 PET/MRI and PET/CT.

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“…In this setting, PSMA PET/CT is changing the 44 approach to recurrent PCa evaluation and management 45 [13,14]. high-risk (HR) PCa are limited [15][16][17][18][19]. In this study, we…”

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confidence: 98%

Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Compared with Conventional Imaging for Initial Staging of Treatment-naïve Intermediate- and High-risk Prostate Cancer: A Retrospective Single-center Study

Pooli

Lec

Sadun

et al. 2022

European Urology Oncology

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Background: The role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging in the initial staging of men with prostate cancer (PCa) has yet to be evaluated adequately. Objective: To investigate the concordance of PSMA PET/CT with conventional imaging (CI) with cross-sectional abdominopelvic and/or radionuclide bone imaging in the initial staging of patients with treatment-naïve PCa. Design, setting, and participants: We performed a post hoc retrospective cohort study of patients enrolled in a prospective single-arm trial (NCT03368547). We included patients with intermediate-risk (IR) and high-risk (HR) PCa who underwent PSMA PET/CT within 6 mo of CI. Patients with any treatment prior to PSMA PET/CT were excluded. Patient-and tumor-specific data, and imaging findings were obtained. Outcome measurements and statistical analysis: Our primary outcome measurement was the concordance rate of PSMA PET/CT with CI for the identification of N, M1a, M1b, and M1c disease. Descriptive statistics were used. Results and limitations: A total of 168 patients with treatment-naïve IR and HR PCa met the inclusion criteria. HR disease accounted for 124/168 (73.8%) patients. The median prostate-specific antigen was 11.4 (6.8-24.6) ng/ml. The rates of nonconcordance between PSMA PET/CT and CI were 34/162 (21.0%), 5/70 (7.1%), 8/92 y These authors shared co-first authorship. z These authors shared co-senior authorship.

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[68Ga]PSMA PET/CT Improves Initial Staging and Management Plan of Patients with High-Risk Prostate Cancer

Abstract: [Ga]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.

Cited by 44 publications

References 23 publications

Improved oncological outcome after radical prostatectomy in patients staged with 68Ga-PSMA-11 PET: a single-center retrospective cohort comparison

Improved oncological outcome after radical prostatectomy in patients staged with 68Ga-PSMA-11 PET: a single-center retrospective cohort comparison

Factors Predicting Metastatic Disease in ⁶⁸Ga-PSMA-11 PET–Positive Osseous Lesions in Prostate Cancer

Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Compared with Conventional Imaging for Initial Staging of Treatment-naïve Intermediate- and High-risk Prostate Cancer: A Retrospective Single-center Study

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[68Ga]PSMA PET/CT Improves Initial Staging and Management Plan of Patients with High-Risk Prostate Cancer

Abstract: [Ga]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.

Cited by 44 publications

References 23 publications

Improved oncological outcome after radical prostatectomy in patients staged with 68Ga-PSMA-11 PET: a single-center retrospective cohort comparison

Improved oncological outcome after radical prostatectomy in patients staged with 68Ga-PSMA-11 PET: a single-center retrospective cohort comparison

Factors Predicting Metastatic Disease in 68Ga-PSMA-11 PET–Positive Osseous Lesions in Prostate Cancer

Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Compared with Conventional Imaging for Initial Staging of Treatment-naïve Intermediate- and High-risk Prostate Cancer: A Retrospective Single-center Study

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Factors Predicting Metastatic Disease in ⁶⁸Ga-PSMA-11 PET–Positive Osseous Lesions in Prostate Cancer