Single Lesion on Prostate-specific Membrane Antigen-ligand Positron Emission Tomography and Low Prostate-specific Antigen Are Prognostic Factors for a Favorable Biochemical Response to Prostate-specific Membrane Antigen-targeted Radioguided Surgery in Recurrent Prostate Cancer

Horn, Thomas; Krönke, Markus; Rauscher, Isabel; Haller, Bernhard; Robu, Stephanie; Wester, Hans‐Jürgen; Schottelius, Margret; Leeuwen, Fijs W. B. van; Poel, Henk G. van der; Heck, Matthias; Gschwend, Jürgen E.; Weber, Wolfgang; Eiber, Matthias; Maurer, Tobias

doi:10.1016/j.eururo.2019.03.045

Cited by 89 publications

(74 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Increased sensitivity of extended PLND can further increase the specificity of 68 Ga‐PSMA PET. This is demonstrated by Horn et al , who detected metastatic tissue in 120 of 121 patients with a positive 68 Ga‐PSMA PET using PSMA‐targeted radioguided surgery. Owing to the high specificity and positive predictive value of 68 Ga‐PSMA PET in detecting pelvic lymph node metastases, it is not always necessary to obtain histology to confirm lymph node metastasis in case of a positive 68 Ga‐PSMA PET result.…”

Section: Discussionmentioning

confidence: 85%

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

Luiting¹,

Leeuwen

Busstra³

et al. 2019

BJU International

Self Cite

View full text Add to dashboard Cite

ObjectivesTo review the literature to determine the sensitivity and specificity of gallium-68 prostate-specific membrane antigen ( 68 Ga-PSMA) positron-emission tomography (PET) for detecting pelvic lymph node metastases in patients with primary prostate cancer (PCa), and the positive predictive value in patients with biochemical recurrence (BCR) after initial curative treatment, and, in addition, to determine the detection rate and management impact of 68 Ga-PSMA PET in patients with BCR after radical prostatectomy (RP). Materials and MethodsWe performed a comprehensive literature search. Search terms used in MEDLINE, EMBASE and Science Direct were '(PSMA, 68 Ga-PSMA, 68 Gallium-PSMA, Ga-68-PSMA or prostate-specific membrane antigen)' and '(histology, lymph node, staging, sensitivity, specificity, positive predictive value, recurrence, recurrent or detection)'. Relevant abstracts were reviewed and full-text articles obtained where possible. References to and from obtained articles were searched to identify further relevant articles. ResultsNine retrospective and two prospective studies described the sensitivity and specificity of 68 Ga-PSMA PET for detecting pelvic lymph node metastases before initial treatment, which ranged from 33.3% to 100% and 80% to 100%, respectively. In eight retrospective studies, the positive predictive value of 68 Ga-PSMA PET in patients with BCR before salvage lymph node dissection ranged from 70% to 100%. The detection rate of 68 Ga-PSMA PET in patients with BCR after RP in the PSA subgroups <0.2 ng/mL, 0.2-0.49 ng/mL and 0.5 to <1.0 ng/ mL ranged from 11.3% to 50.0%, 20.0% to 72.7% and 25.0% to 87.5%, respectively. ConclusionThe review results showed that 68 Ga-PSMA PET had a high specificity for the detection of pelvic lymph node metastases in primary PCa. Furthermore, 68 Ga-PSMA PET had a very high positive predictive value in detecting lymph node metastases in patients with BCR. By contrast, sensitivity was only moderate; therefore, based on the currently available literature, 68 Ga-PSMA PET cannot yet replace pelvic lymph node dissection to exclude lymph node metastases. In the salvage phase, 68 Ga-PSMA PET had both a high detection rate and impact on radiotherapy planning in early BCR after RP. Keywords 68Ga-PSMA PET/CT, pelvic lymph node dissection, detection rate, pelvic lymph node metastases, #ProstateCancer, #PCSM Use of 68Ga-PSMA PET/CT after RP: review IQR, interquartile range; LNM, lymph node metastases. *Gallium-68 prostate-specific membrane antigen positron-emission tomography ( 68 Ga-PSMA PET)/MRI was used instead of 68 Ga-PSMA PET/CT. 208

show abstract

Section: Discussionmentioning

confidence: 85%

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

Luiting¹,

Leeuwen

Busstra³

et al. 2019

BJU International

Self Cite

View full text Add to dashboard Cite

show abstract

“…By targeting PSMA on cancer cells with 111 In-or 99m Tclabelled PSMA ligands, RGS was successfully introduced for intraoperative use with a γ-probe and acoustic feedback by Maurer et al [11,21,25,26,28]. As those previous works analysed so-called "mixed-tissue samples" containing LN, LNM and fibrofatty tissue, a more specific investigation of the [ 111 In]PSMA-617 tracer uptake at a single LN level was done by our group [11].…”

Section: Discussionmentioning

confidence: 99%

“…Positronemitting tracers are highly suitable for PET imaging but inappropriate for locating LNM during surgery because the γ-energy of their annihilation photons is too high for standard γ-probe devices. More appropriate for tracking of radioactively tagged LNM during surgery are γemitting tracers such as [ 111 In]PSMA-I&T [22], [ 99m Tc]PMSA-I&S [23] or [ 111 In]PSMA-DKFZ-617 [24] which also allow imaging as the PET tracers but with reduced spatial resolution, sensitivity and contrast due to the single photon emission computer tomography (SPECT) imaging technique [11,[25][26][27]. Without any doubt, there is a clear need to improve the identification of LNM during difficult surgery, regardless if at primary LA or at salvage LA [6,11,26,28].…”

Section: Introductionmentioning

confidence: 99%

“…More appropriate for tracking of radioactively tagged LNM during surgery are γemitting tracers such as [ 111 In]PSMA-I&T [22], [ 99m Tc]PMSA-I&S [23] or [ 111 In]PSMA-DKFZ-617 [24] which also allow imaging as the PET tracers but with reduced spatial resolution, sensitivity and contrast due to the single photon emission computer tomography (SPECT) imaging technique [11,[25][26][27]. Without any doubt, there is a clear need to improve the identification of LNM during difficult surgery, regardless if at primary LA or at salvage LA [6,11,26,28]. 111 In-labelled PSMA ligands were successfully introduced recently for imaging as well as for intraoperative use (radio-guided surgery (RGS)) [11,21,[28][29][30].…”

Section: Introductionmentioning

confidence: 99%

“…Based on the investigation of 31 patients with nodal PCa recurrence undergoing a salvage LND with the use of a γ-probe, they could show (specimen based) an impressive sensitivity of 83.6%, a specificity of 100% and an accuracy of 93% [25]. However, the identification of an optimal tracer for RGS salvage LND is still under investigation [26], and RGS is applied differently at the institutions offering this kind of experimental approach [11,26,31].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Results from extended lymphadenectomies with [111In]PSMA-617 for intraoperative detection of PSMA-PET/CT-positive nodal metastatic prostate cancer

et al. 2020

View full text Add to dashboard Cite

Purpose: Identification of suspicious PSMA-PET/CT-positive lymph node (LN) metastases (LNM) from prostate cancer (PCa) during lymphadenectomy (LA) is challenging. We evaluated an 111 In-labelled PSMA ligand (DKFZ-617, referred to as [ 111 In]PSMA-617) as a γ-emitting tracer for intraoperative γ-probe application for resected tissue samples in PCa patients. Forty-eight hours prior to LA, [ 111 In]PSMA-617 was administered intravenously in 23 patients with suspected LNM on PSMA-PET/CT (n = 21 with biochemical relapse, n = 2 at primary therapy). Resected tissue samples (LN, LNM and fibrofatty tissue) were measured ex situ by a γ-probe expressed as counts per second (CPS norm ). [ 111 In]PSMA-617 tissue sample uptake was measured by a germanium detector for verification and calculated as %IA lbm (percent injected activity per kilogram lean body mass at time of surgery). Based on a clinical requirement for a specificity > 95%, thresholds for both ex situ measurements were chosen accordingly. Correlation of the results from PET/CT, γ-probe and germanium detector with histopathology was done. Results: Eight hundred sixty-four LNs (197 LNM) were removed from 275 subregions in 23 patients, on average 8.6 ± 14.9 LNM per patient. One hundred four of 275 tissue samples showed cancer. Median γ-probe and germanium detector results were significantly different between tumour-affected (33.5 CPS norm , 0.71 %IA lbm ) and tumour-free subregions (3.0 CPS norm , 0.03 %IA lbm ) (each p value < 0.0001). For the chosen γ-probe cut-off (CPS norm > 23) and germanium detector cut-off (%IA lbm > 0.27), 64 and 74 true-positive and 158 true-negative samples for both measurements were identified. Thirty-nine and 30 false-negative and 6 and 5 false-positive tissue samples were identified by γ-probe and germanium detector measurements.Conclusion: [ 111 In]PSMA-617 application for LA is feasible in terms of an intraoperative real-time measurement with a γ-probe for detection of tumour-affected tissue samples. γ-probe results can be confirmed by precise germanium detector measurements and were significantly different between tumour-affected and tumour-free samples.

show abstract

Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer

et al. 2022

View full text Add to dashboard Cite

Objective: To evaluate the relationship between pre-operative PSA value, 68 Ga-prostate-specific-membrane-antigen (PSMA) PET performance and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa).Patients and methods: The study included 164 patients diagnosed with ≤2 pelvic lymph-node recurrence(s) of PCa documented on 68 Ga-PSMA PET scan and treated with pelvic AE retroperitoneal sLND at 11 high-volume centres between 2012 and 2019. Pathologic findings were correlated to PSA values at time of sLND, categorized in early (<0.5 ng/ml), low (0.5-0.99 ng/ml), moderate (1-1.5 ng/ml) and high (>1.5 ng/ml). Clinical recurrence (CR)-free survival after sLND was calculated using multivariable analyses and plotted over pre-operative PSA value.Results: Median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml, and 131 (80%) patients had one positive spot at PET scan. All patients received pelvic sLND, whereas 91 (55%) men received also retroperitoneal dissection. Median (IQR) number of node removed was 15 (6, 28). The rate of positive pathology increased as a function of pre-operative PSA value, with highest rates for patients with preoperative PSA > 1.5 ng/ml (pelvic-only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, PSA ≤ 0.3 ng/ml was detected in 67 (41%) men. On multivariable analyses, pre-operative PSA was associated with PSA response (p < 0.0001). There were 51 CRs after sLND. After adjusting for confounders, we found a significant,

show abstract

Single Lesion on Prostate-specific Membrane Antigen-ligand Positron Emission Tomography and Low Prostate-specific Antigen Are Prognostic Factors for a Favorable Biochemical Response to Prostate-specific Membrane Antigen-targeted Radioguided Surgery in Recurrent Prostate Cancer

Cited by 89 publications

References 26 publications

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

Results from extended lymphadenectomies with [111In]PSMA-617 for intraoperative detection of PSMA-PET/CT-positive nodal metastatic prostate cancer

Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer

Contact Info

Product

Resources

About