Diagnostic performance of 68Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients

Abstract

PurposeSince the clinical introduction of 68Ga-PSMA-11 PET/CT, this imaging method has rapidly spread and is now regarded as a significant step forward in the diagnosis of recurrent prostate cancer (PCa). The aim of this study was to analyse the influence of several variables with possible influence on PSMA ligand uptake in a large cohort.MethodsWe performed a retrospective analysis of 1007 consecutive patients who were scanned with 68Ga-PSMA-11 PET/CT (1 h after injection) from January 2014 to January 2017 to detect recurrent disease. Patients with untreated primary PCa or patients referred for PSMA radioligand therapy were excluded. The possible effects of different variables including PSA level and PSA doubling time (PSADT), PSA velocity (PSAVel), Gleason score (GSC, including separate analysis of GSC 7a and 7b), ongoing androgen deprivation therapy (ADT), patient age and amount of injected activity were evaluated.ResultsIn 79.5% of patients at least one lesion with characteristics suggestive of recurrent PCa was detected. A pathological (positive) PET/CT scan was associated with PSA level and ADT. GSC, amount of injected activity, patient age, PSADT and PSAVel were not associated with a positive PET/CT scan in multivariate analysis.Conclusion 68Ga-PSMA-11 PET/CT detects tumour lesions in a high percentage of patients with recurrent PCa. Tumour detection is clearly associated with PSA level and ADT. Only a tendency for an association without statistical significance was found between higher GSC and a higher probability of a pathological PET/CT scan. No associations were found between a pathological 68Ga-PSMA-11 PET/CT scan and patient age, amount of injected activity, PSADT or PSAVel. Electronic supplementary materialThe online version of this article (doi:10.1007/s00259-017-3711-7) contains supplementary material, which is available to authorized users.

Near Complete Response to 177Lu-PSMA-DKFZ-617 Therapy in a Patient with Metastatic Castration Resistant Prostate Cancer

“…In this patient, we observed an excellent correlation between intrim 68 Ga-PSMA-HBED-CC PET/CT scans and sPSA response. In agreement with our indings, a retrospective analysis involving 1007 recurrent prostate cancer patients demonstrated a strong association of tumour detection and radiotracer avidity with sPSA levels [8].…”

“…Ga-PSMA-HBED-CC PET/CT imaging has remarkably improved the accuracy of restaging the disease in recurrent prostate cancer [8]. Currently, 68 Ga-PSMA-HBED-CC PET/CT is the most widely accepted agent in the imaging of recurrent prostate cancer.…”

PSMA Ligands for PET Imaging of Prostate Cancer

“…Positive findings exclusively detected by 18 F-fluorocholine PET/CT were rare (36). Three large retrospective studies (including 319, 248, and 1,007 patients, respectively) reported detection rates for 68 Ga-PSMA-11 PET/CT in BCR of 88%, almost 90%, and 79.5%, respectively (38)(39)(40). In patients after curative treatment with a very low PSA level of less than 0.5 ng/mL the reported detection rate of PSMA ligand PET/CT ranged from 50% to 58% in different studies (36,(38)(39)(40).…”

“…Three large retrospective studies (including 319, 248, and 1,007 patients, respectively) reported detection rates for 68 Ga-PSMA-11 PET/CT in BCR of 88%, almost 90%, and 79.5%, respectively (38)(39)(40). In patients after curative treatment with a very low PSA level of less than 0.5 ng/mL the reported detection rate of PSMA ligand PET/CT ranged from 50% to 58% in different studies (36,(38)(39)(40). A recent study including only patients after prior radiotherapy (median PSA of 5.8 ng/mL) presented detection rates of 33.3% for a PSA of less than 0.5 ng/mL, 71.4% for a PSA of 0.5 to less than 1 ng/mL, and 93.3% for a PSA of 1 to less than 2 ng/mL.…”

The Effect of Including Bone in Dixon-Based Attenuation Correction for 18F-Fluciclovine PET/MRI of Prostate Cancer

“…shown promise for the detection of primary and recurrent prostate cancer (3)(4)(5)(6)(7). Since the introduction of integrated PET/MRI scanners, these complementary data sets can be simultaneously acquired, thereby potentially improving the diagnostic accuracy in comparison to either modality alone (3,4,8,9).…”