Assessment of Bone Metastases in Patients with Prostate Cancer—A Comparison between 99mTc-Bone-Scintigraphy and [68Ga]Ga-PSMA PET/CT

Thomas, Lena; Balmus, Caroline; Ahmadzadehfar, Hojjat; Essler, Markus; Strunk, H.; Bundschuh, Ralph A.

doi:10.3390/ph10030068

Cited by 51 publications

(33 citation statements)

References 20 publications

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“…PSMA PET/CT may represent a more promising imaging biomarker for this purpose because of its high sensitivity and specificity in detecting metastases after biochemical relapse of prostate cancer (12,13) and the increasing availability of the method. Consistently, a recent study indicated the superiority of PSMA PET/CT over conventional bone scintigraphy in the detection of bone metastases (14).…”

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confidence: 52%

EBONI: A Tool for Automated Quantification of Bone Metastasis Load in PSMA PET/CT

2017

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Prostate-specific membrane antigen (PSMA) PET/CT has a high diagnostic accuracy for lesion detection in metastatic prostate cancer, including bone metastases. Novel therapeutic approaches require valid biomarkers for standardized disease staging and for evaluation of progression and therapy response. Here, we introduce EBONI (Evaluation of Bone Involvement), a software tool to automatically quantify the bone metastasis load in PSMA PET/CT. Lesion quantity, mean and maximum lesional SUV, score, and percentage of affected bone volume are determined. EBONI is open source and freely available. To validate EBONI, the results of automated quantification of 38 PSMA PET/CT scans with different levels of bone involvement were compared with visual expert reading. The influence of SUV threshold and Hounsfield unit thresholds was analyzed. A high correlation between bone lesion quantity as determined visually and automatically was found (SUV, = 0.97; SUV, = 0.88; lesion count, = 0.97). The Hounsfield unit threshold had no significant influence, whereas an SUV threshold of 2.5 proved optimal for automated lesion quantification. The systematic error of false-positive tissue misclassification was low, occurred mainly around the salivary and lacrimal glands, and could easily be corrected. There were no false-negative ratings. EBONI analysis is robust, quick (<3 min per scan), and 100% reproducible. It allows rater-independent quantification of bone metastasis in metastatic prostate cancer. It provides lesion quantification equivalent to that of visual assessment, as well as providing complementary information. It can be easily implemented as an add-on to visual analysis of PSMA PET/CT scans and has the potential to reduce turnaround time.

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confidence: 52%

EBONI: A Tool for Automated Quantification of Bone Metastasis Load in PSMA PET/CT

2017

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“…This could be explained due to the small number of patients in the single groups. Therapy assessment with PSMA 11‐PET has been investigated before in patients undergoing radium‐223 therapy . Here, the PSMA 11‐PET seemed to overcome the known limitations of BS and other established PET tracers.…”

Section: Discussionmentioning

confidence: 99%

Response assessment using [⁶⁸Ga]Ga‐PSMA ligand PET in patients undergoing systemic therapy for metastatic castration‐resistant prostate cancer

et al. 2019

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Background To assess which parameters of [68Ga]Ga‐PSMA‐11 positron emission tomography (PSMA‐PET) predict response to systemic therapies in metastatic (m) castration‐resistant prostate cancer (CRPC). In addition, to investigate which of these factors are associated with overall survival (OS). Methods We retrospectively assessed the following PSMA‐PET parameters in 43 patients before and after systemic therapies for mCRPC: PSMA total tumor volume (TTV), mean standardized uptake value (SUVmean), SUVmax, and SUVpeak. prostate‐specific antigen (PSA) levels and PSMA‐PET/CT(magnetic resonance imaging [MRI]) imaging were both performed within 8 weeks before and 6 weeks after systemic therapy. PSMA‐PET and CT (MRI) images were reviewed according to the modified PET Response Criteria in Solid Tumors (PERCIST) and Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Results were compared to PSA response. Univariable survival analyses were performed. Results Overall, 43 patients undergoing 67 systemic therapies were included (9 patients radium‐223, 12 cabazitaxel, 22 docetaxel, 6 abiraterone, and 18 enzalutamide). Median serum PSA level before any therapy was 11.3 ng/mL (interquartile range [IQR] = 3.3, 30.1). Delta (d) PSA after systemic therapies was −41%, dTTV 10.5%, dSUVmean −7.5%, dSUVmax −13.3%, dSUVpeak −12%, and dRECIST −13.3%. Overall, 31 patients had dPSA response (46.3%), 12 stable disease (17.9%), and 24 progressive disease (35.8%). All observed PET parameters, as well as the RECIST evaluation, were significantly associated with PSA response (dTTV P = .003, dSUVmean P = .003, dSUVmax P = .011, dSUVpeak P < 0001, dRECIST P = .012), while RECIST assessment was applicable in 37 out of 67 patients (55.2%). Within a median follow‐up of 33 months (IQR = 26, 38), 10 patients (23.3%) died of PC. On univariable survival analyses, neither the investigated PET parameters nor PSA level or RECIST criteria were associated with OS. Conclusion PSMA‐PET provides reliable parameters for prediction of response to systemic therapies for mCRPC. These parameters, if confirmed, could enhance RECIST criteria, specifically concerning its limitations for sclerotic bone lesions.

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“…Other groups have already reported comparisons between 68 Ga-PSMA PET/ CT and planar BS with (24) or without (25,26) routinely performed SPECT. These reports had some remarkable limitations; for example, the mean intervals between the imaging modalities were 21 d (range not reported) (25), up to 80 d (24), or up to 100 d (26).…”

Section: Discussionmentioning

confidence: 99%

Intraindividual Comparison of ^99mTc-Methylene Diphosphonate and Prostate-Specific Membrane Antigen Ligand ^99mTc-MIP-1427 in Patients with Osseous Metastasized Prostate Cancer

et al. 2018

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The objective of this study was to evaluate the rate of detection of bone metastases obtained with the prostate-specific membrane antigen (PSMA)-targeting tracer Tc-MIP-1427, as opposed to conventional bone scanning withTc-methylene diphosphonate (Tc-MDP), in a collective of patients with known advanced-stage osseous metastasized prostate cancer. Twenty-one patients with known metastatic disease were staged with both conventional bone scanning and PSMA ligand scintigraphy within a time frame of less than 10 d. Imaging included planar whole-body scanning and SPECT or SPECT/CT with 2 bed positions 3 h after injection of either 500-750 MBq ofTc-MIP-1427 or 600-750 MBq of Tc-MDP. Lesions were scored as typical tumor, equivocal (benign/malignant), or normal within a standard reporting schema divided into defined anatomic regions. Masked and consensus readings were performed with sequential unmasking: planar scans first, then SPECT/CT, the best evaluable comparator (including MRI), PET/CT, and follow-up examinations. Eleven patients had PSMA-positive visceral metastases that were predictably not diagnosed with conventional bone scanning. However, SPECT/CT was required to distinguish between soft-tissue uptake and overlapping bone. Four patients had extensive Tc-MDP-negative bone marrow lesions. Seven patients had superscan characteristics on bone scans; in contrast, the extent of red marrow involvement was more evident on PSMA scans. Only 3 patients had equivalent results on bone scans and PSMA scans. In 16 patients, more suspect lesions were detected with PSMA scanning than with bone scanning. In 2 patients (10%), a PSMA-negative tumor phenotype was present. PSMA scanning provided a clear advantage over bone scanning by reducing the number of equivocal findings in most patients. SPECT/CT was pivotal for differentiating bone metastases from extraosseous tumor lesions.

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Assessment of Bone Metastases in Patients with Prostate Cancer—A Comparison between 99mTc-Bone-Scintigraphy and [68Ga]Ga-PSMA PET/CT

Cited by 51 publications

References 20 publications

EBONI: A Tool for Automated Quantification of Bone Metastasis Load in PSMA PET/CT

EBONI: A Tool for Automated Quantification of Bone Metastasis Load in PSMA PET/CT

Response assessment using [⁶⁸Ga]Ga‐PSMA ligand PET in patients undergoing systemic therapy for metastatic castration‐resistant prostate cancer

Intraindividual Comparison of ^99mTc-Methylene Diphosphonate and Prostate-Specific Membrane Antigen Ligand ^99mTc-MIP-1427 in Patients with Osseous Metastasized Prostate Cancer

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Assessment of Bone Metastases in Patients with Prostate Cancer—A Comparison between 99mTc-Bone-Scintigraphy and [68Ga]Ga-PSMA PET/CT

Cited by 51 publications

References 20 publications

EBONI: A Tool for Automated Quantification of Bone Metastasis Load in PSMA PET/CT

EBONI: A Tool for Automated Quantification of Bone Metastasis Load in PSMA PET/CT

Response assessment using [68Ga]Ga‐PSMA ligand PET in patients undergoing systemic therapy for metastatic castration‐resistant prostate cancer

Intraindividual Comparison of 99mTc-Methylene Diphosphonate and Prostate-Specific Membrane Antigen Ligand 99mTc-MIP-1427 in Patients with Osseous Metastasized Prostate Cancer

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Response assessment using [⁶⁸Ga]Ga‐PSMA ligand PET in patients undergoing systemic therapy for metastatic castration‐resistant prostate cancer

Intraindividual Comparison of ^99mTc-Methylene Diphosphonate and Prostate-Specific Membrane Antigen Ligand ^99mTc-MIP-1427 in Patients with Osseous Metastasized Prostate Cancer