Added value of 68Ga-PSMA PET/CT for the detection of bone metastases in patients with newly diagnosed prostate cancer and a previous 99mTc bone scintigraphy

Ravn, Søren; Afshar‐Oromieh, Ali; Fledelius, Joan; Ejlersen, June Anita; Petersen, Lars Jelstrup

doi:10.1186/s13550-020-00618-0

Cited by 41 publications

(22 citation statements)

References 22 publications

(40 reference statements)

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“…A study among 112 PCa patients demonstrated that [ 68 Ga]Ga-PSMA-11 PET/CT detects metastatic bone lesions in 10% of patients without metastases on skeletal scintigraphy. 38 These results are congruent with the data presented in chapter 2 of this thesis, in which nine patients with negative skeletal scintigraphy had PET positive bone lesions. Despite the fact that the conservative EAU guidelines still recommend preoperative staging with CT and skeletal | 199 scintigraphy in high-risk PCa patients, skeletal scintigraphy has been replaced by PSMA PET/CT in some hospitals in the Netherlands.…”

Section: Detection Of Bone Metastasessupporting

confidence: 89%

“…Although the first wave of PSMA-related publications focused on its value PCa patients with a BCR, a vast number of initial, mostly small retrospective studies followed and demonstrated promising results of [ 68 Ga]Ga-PSMA PET/CT in initial staging. [38][39][40][41] Subsequently, Hope et al performed a meta-analysis to clarify detection rate of [ 68 Ga]Ga-PSMA-11 PET/CT for lymph node detection in the setting of primary staging of PCa. 42 The study comprised five studies (n = 266 patients, mostly classified as having intermediate to high risk PCa).…”

Section: Psma Pet/ct In Newly Diagnosed Pca ('Primary Staging')mentioning

confidence: 99%

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Spicing up prostate cancer theranostics

Kalmthout¹

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Prostate cancer (PCa) is the most commonly diagnosed malignancy, affecting 1 in 9 men, in the western world. 1 In the Netherlands, approximately 13.557 patients were newly diagnosed in 2019. 2 With 2896 deaths in 2018, PCa represents the second-ranked cause of cancer mortality among men in the Netherlands. 2 Due to increased prostatespecific antigen (PSA)-testing and aging of the population, this number is expected to increase even further in 2025. The majority of all prostate cancers has a relatively indolent behavior that does not lead to significant problems during a patient's life. However, high-risk PCa (according to the National Comprehensive Cancer Network: PSA level >20 ng/ml or Gleason Score 8-10 or T-stage ≥3), comes with a serious mortality risk. Lymph node metastases in PCa patients are considered as an adverse prognostic factor and are associated with systemic metastases. 3 This supports the importance of accurate primary staging of newly diagnosed PCa patients. Thesis introduction and outline | 18After the publication of this meta-analysis, Luiting et al. ( 2020) also reviewed diagnostic performance of [ 68 Ga]Ga-PSMA PET/CT for lymph node detection in primary staging in men with PCa. 43 Eleven studies were included in this review: two prospective studies (n = 63 patients) and nine retrospective studies (n = 696 patients). In all studies, histopathology was referred to as gold standard. Patient-based sensitivity and specificity ranges of respectively 64-100% and 90-95% were found in the prospective studies. Lesion-based sensitivity and specificity ranges were respectively 50-58% and 96-100%. In the retrospective studies, the sensitivity and specificity range was respectively 33.3-100% and 80-100%. With regard to the lesion-based analysis, they found a sensitivity and specificity range of 24.4-96.1% and 98.6-100%, respectively. Especially sensitivity was lower in comparison with the previously discussed meta-analysis by Hope et al. 42 , who included significantly less studies. This reflects that definite diagnostic value of [ 68 Ga]Ga-PSMA PET/CT in primary staging of PCa still needs to be determined by future reviews and meta-analyses including well-designed prospective studies. With regard to diagnostic performance of [ 18 F]F-labelled PSMA tracers in primary staging of PCa however, only a small number of studies has been published. Gorin et al. prospectively evaluated diagnostic performance of preoperative [ 18 F]F-DCFPyL PET/CT in 25 men with high risk PCa being eligible for prostatectomy and ePLND. 44 When compared to histopathology findings, patient-based sensitivity and specificity was respectively 71.4% (95% CI 29.0-96.3%) and 88.9% (95% CI 65.3-98.6%). Lesion-based sensitivity and specificity was 66.7% (95% CI 29.9-92.5%) and 97.7% (95% CI 80.1-98.5%), respectively. At present, the diagnostic performance of [ 18 F]F-DCFPyL and [ 18 F] F-PSMA-1007 in the setting of initial staging of PCa with histopathology reference are currently under investigation in prospective trials conducted at the...

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Section: Detection Of Bone Metastasessupporting

confidence: 89%

Section: Psma Pet/ct In Newly Diagnosed Pca ('Primary Staging')mentioning

confidence: 99%

Spicing up prostate cancer theranostics

Kalmthout¹

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“…Many studies comparing PSMA to 99m Tc-MDP have used PMSA-labeled PET tracers such as 18 F-DCFPyL PET/CT 38 and 68 Ga. 25 , 39 These studies also reported a higher sensitivity in PSMA-labeled PET tracers compared with 99m Tc-MDP, with sensitivity ranging from 96% to 100% and that of MDP being as low as 73%. One of the limitations of comparing our study to the above is the use of different imaging modalities with different resolutions (superior resolution on PET/CT 27 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

Comparing 99mTc-PSMA to 99mTc-MDP in Prostate Cancer Staging of the Skeletal System

et al. 2021

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Purpose This prospective study was aimed at assessing the ability of 99m Tc-PSMA scan to detect bone metastases in prostate cancer (PCa) against 99m Tc-MDP scan as a standard and assess the correlation of these modalities in PCa staging of bone involvement. Patients and Methods Forty-one patients (41) with histologically confirmed PCa were scanned using both methods. Planar imaging was performed with additional regional SPECT/CT 3 to 4 hours posttracer injection. Scans were reported as positive, negative, or equivocal. In the case of positive scans, lesions were quantified by each of the 3 reporters separately. Planar and SPECT/CT images were reported together to obtain the final report on each scan. Results Our preliminary results showed no significant difference in the detection of bone metastases between the 2 scans. 99m Tc-PSMA detected 52 of the 55 bone lesions detected on 99m Tc-MDP. However, 99m Tc-PSMA provided extra information by reporting lymph nodal metastases in 7 patients and residual disease in the prostate in 2 patients with biochemical progression after radical therapy. In 1 patient, the PSMA scan resulted in change in management with patient now on 177 Lu-PSMA radioligand therapy. Equivocal findings were reported in 4 patients on 99m Tc-MDP and none on 99m Tc-PSMA. Conclusions 99m Tc-PSMA was comparable to 99m Tc-MDP in detection of bone metastases and demonstrated an additional benefit of providing information on visceral disease. 99m Tc-PSMA may be a better alternative to 99m Tc-MDP in staging, restaging, and assessment of patients with biochemical progression after radical therapy of PCa in a resource-limited setup like ours while also assisting to detect patients eligible for PSMA-labeled radioligand therapy.

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“…It has been shown to be superior to traditional bone scintigraphy (BS) as it allows for detection of lytic type and early marrow-based metastases in addition to osteoblastic-type metastases seen on BS [ 2 , 3 , 4 ]. In a recent study involving 112 prostate cancer patients, 68Ga-PSMA-11 PET/CT revealed bone metastases in 10% of the patients who were deemed to be non-metastatic on BS and in 36% of the patients with indeterminate BS [ 5 ]. 68Ga-PSMA-11 PET/CT is also valuable for identifying skeletal involvement in patients with biochemical failure after treatment [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

68Ga-PSMA-11 PET/CT Follow-Up of Patients with Prostate Cancer with Bone Metastases Who Had Reduced Bone Density after Androgen Deprivation Therapy

et al. 2021

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Bone metastases from prostate cancer (PCa) often show an increase in density on computed tomography (CT) after successful androgen deprivation therapy (ADT). Density may be reduced, however, as the disease progresses or, contrarily, when disease is no longer active. The current study investigated the role of 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) in differentiating between these two conditions. Methods: The study cohort included 15 PCa patients with sclerotic/blastic bone metastasis in whom reduction in bone density of metastasis was noted on follow-up 68Ga-PSMA-11 PET/CT after ADT. Each patient had two PET/CT scans. Prior to the first scan, six patients were castration naïve and nine patients were already treated. All patients had ADT between the two PET/CT scans. PET parameters (SUVmax and tumor-to-background ratio), and CT parameters (HUmax) were determined and compared for each lesion on both scans. Patient’s response was based on prostate-specific antigen (PSA) levels and appearance of new lesions. The Kolmogorov–Smirnov test was used to evaluate normal distribution of the continuous variables. Results: Post-ADT reduction in bone density was identified in 37 lesions. The mean HUmax was 883.9 ± 175.1 on the first scan and 395.6 ± 157.1 on the second scan (p < 0.001). Twenty-one of the 37 lesions showed no increased tracer uptake on the second PET/CT scan raising the likelihood of a response. The other 16 lesions were associated with increased uptake suggestive of an active resistant disease. Bone density was not different in lesions that no longer showed an increased uptake as compared with those that did. Seven of the study patients responded to therapy, and none of the 16 lesions found in these patients showed increased 68Ga-PSMA-11 uptake. In eight patients with progressive disease, all 12 lesions in five of them showed increased 68Ga-PSMA-11 uptake, there was mixed response in two patients (having two lesions with increased uptake and one without) and although all three lesions no longer showed an increased uptake, new lesions were detected in the eighth patient. Conclusion: A decrease in density of bone lesions may reflect clinical progression, or contrarily, a response to therapy in patients with PCa and skeletal involvement treated with ADT. Uptake of 68Ga-PSMA-11 may separate between these two vastly opposing conditions.

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Added value of 68Ga-PSMA PET/CT for the detection of bone metastases in patients with newly diagnosed prostate cancer and a previous 99mTc bone scintigraphy

Cited by 41 publications

References 22 publications

Spicing up prostate cancer theranostics

Spicing up prostate cancer theranostics

Comparing 99mTc-PSMA to 99mTc-MDP in Prostate Cancer Staging of the Skeletal System

68Ga-PSMA-11 PET/CT Follow-Up of Patients with Prostate Cancer with Bone Metastases Who Had Reduced Bone Density after Androgen Deprivation Therapy

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