Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement

Kesler, Mikhail; Kerzhner, Kosta; Druckmann, Ido; Kuten, Jonathan; Levine, Charles; Sarid, David; Keizman, Daniel; Yossepowitch, Ofer; Even-Sapir, Einat

doi:10.1007/s00259-021-05655-y

Cited by 14 publications

(5 citation statements)

References 35 publications

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“…In clinical practice, the [ 99m Tc]Tc-methylene diphosphonate bone scan has been conventionally employed for bone metastasis detection. Among the 52 patients who underwent bone scans, our study results indicate that [ 99m Tc]Tc-HYNIC-ALUG SPECT/CT is superior to bone scintigraphy in detecting bone metastases, as it can identify both bone marrow involvement and osteolytic metastases, consistent with previous findings from [ 68 Ga]Ga-PSMA-11 PET/CT ( 30 ). Otherwise, our study reported an 18% detection rate of bone metastasis in PCa patients with a PSA level of <20 ng/mL, which is significantly higher than the 4.7% detection rate observed in a previous study of 857 consecutive PCa patients ( 31 ).…”

Section: Discussionsupporting

confidence: 87%

[99mTc]Tc-HYNIC-ALUG SPECT/CT in the initial staging of 227 consecutive patients with newly diagnosed prostate cancer: a 5-year monocentric retrospective study

Li,

Ding,

Duan

et al. 2024

Front. Endocrinol.

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PurposeThe purpose of this study was to assess the effectiveness of [99mTc]Tc-HYNIC-ALUG SPECT/CT in the initial staging of patients with newly diagnosed PCa.MethodsA retrospective analysis was conducted on 227 consecutive patients who underwent [99mTc]Tc-HYNIC-ALUG SPECT/CT imaging for the primary staging of newly diagnosed PCa. The presence and location of PSMA-positive lesions were determined, and the maximum standardized uptake values (SUVmax) of the primary prostate tumor were also measured. The metastatic findings and SUVmax were stratified according to International Society of Urological Pathology (ISUP) grade, prostate-specific antigen (PSA) levels, and D’Amico classification. Furthermore, the [99mTc]Tc-HYNIC-ALUG SPECT/CT findings were compared to the histopathological findings in patients who had undergone radical prostatectomy with pelvic lymph node dissection (PLND).ResultsOf the 227 patients, 92.1% (209/227) had positive [99mTc]Tc-HYNIC-ALUG SPECT/CT findings. Advanced disease was detected in 38.8% (88/227) of the patients and was positively correlated with increasing ISUP grade and PSA levels. Lymph node metastases (both pelvic and extrapelvic), bone metastases, and visceral metastases were detected in 30.0% (68/227), 25.6% (58/227), and 3.1% (7/227) of the patients, respectively. For the 129 patients who underwent radical prostatectomy with PLND, the sensitivity of [99mTc]Tc-HYNIC-ALUG SPECT/CT in the evaluation of PCa was 90.7% (117/129). The sensitivity, specificity, accuracy, and positive and negative predictive values for detecting pelvic lymph node metastases on [99mTc]Tc-HYNIC-ALUG SPECT/CT were 23.5% (12/51), 93.6% (73/78), 65.9% (85/129), 70.6% (12/17), and 65.2% (73/112), respectively. Among the 209 patients with PSMA-avid primary prostate disease, the SUVmax of the primary prostate tumor was significantly associated with ISUP grade (p<0.0001), PSA levels (p<0.0001), D’Amico classification (p<0.0001), and advanced disease (p<0.0001). Receiver operating characteristic (ROC) analysis revealed that a PSA level >19.8 ng/ml and SUVmax of the primary prostate tumor >7.4 had a sensitivity of 71.6% and 71.6% and specificity of 76.9% and 82.6%, respectively, for detecting metastatic disease.Conclusions[99mTc]Tc-HYNIC-ALUG SPECT/CT emerges as a valuable imaging tool for the initial staging of newly diagnosed PCa. The presence of advanced disease and the SUVmax of the primary prostate tumor were positively correlated with ISUP grade and PSA levels.

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Section: Discussionsupporting

confidence: 87%

[99mTc]Tc-HYNIC-ALUG SPECT/CT in the initial staging of 227 consecutive patients with newly diagnosed prostate cancer: a 5-year monocentric retrospective study

Li,

Ding,

Duan

et al. 2024

Front. Endocrinol.

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“…The incidence of skeletal metastases increases with the increasing stage of the disease [1]. The skeletal system may be the only site of distant prostate cancer metastases in up to 62% of patients and often with a multifocal pattern of involvement [2,3]. The presence of skeletal metastases is predictive of an unfavorable outcome of prostate cancer treatment, including shorter time to treatment failure, poorer overall survival, and poor quality of life resulting from the occurrence of skeletal-related events [2,4].…”

Section: Introductionmentioning

confidence: 99%

Hematologic toxicity profile and efficacy of [225Ac]Ac-PSMA-617 α-radioligand therapy of patients with extensive skeletal metastases of castration-resistant prostate cancer

Lawal

Morgenstern

Vorster

et al. 2022

Eur J Nucl Med Mol Imaging

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Purpose: Actinium-225-labeled prostate-specific membrane antigen ([ 225 Ac]Ac-PSMA-617) is safe and effective in the treatment of metastatic castration-resistant prostate cancer (mCRPC). No study has specifically assessed its safety in patients with extensive skeletal metastases of mCRPC. We aimed to investigate the hematologic toxicity and efficacy of [ 225 Ac]Ac-PSMA-617 therapy in patients with extensive skeletal metastases of mCRPC. Methods:We retrospectively reviewed the medical record of patients treated with [ 225 Ac]Ac-PSMA-617 for mCRPC. We included patients with a superscan pattern of skeletal metastases and those with 20 or more multifocal sites of skeletal metastases on baseline [ 68 Ga]Ga-PSMA-11 PET/CT. We reviewed the levels of hemoglobin, white blood cell (WBC), and platelet prior to each cycle of treatment and determined the presence of impaired bone marrow function at baseline and the grade of toxicity in the hematologic parameters induced by treatment. We evaluated the predictors of hematologic toxicity using binary logistic regression analysis. We also determined the presence of renal dysfunction before or during treatment. We assessed response to treatment using prostate-specific antigen response and the progression-free survival (PFS) and overall survival (OS).Results: A total of 106 patients were included. Skeletal metastasis was in the superscan pattern in 34 patients (32.1%) and multifocal in 72 patients (67.9%). The median treatment cycle was 4 (range = 1-9). Ninety-eight patients (92.5%) had abnormal baseline hematologic parameters. One patient had grade 4 thrombocytopenia. Grade 3 anemia, leukopenia, and thrombocytopenia were seen in 1 (0.9%), 3 (2.8%), and 2 (1.9%) patients, respectively. Age, the number of treatment cycles, and the presence of renal dysfunction were significant predictors of hematologic toxicity. Eighty-five patients (80.2%) achieved PSA response. The median PFS and OS of the study population were 14:00 (95%CI: 8.15-19.86) months and 15.0 (95%CI: 12.8-17.2) months, respectively.Conclusions: [ 225 Ac]Ac-PSMA-617 induces a good anti-tumor effect in about 80% of patients with extensive skeletal metastases of mCRPC with a rare incidence of severe hematologic toxicity. Age, number of treatment cycles, and the presence of renal dysfunction were significant risk factors for hematologic toxicity of [ 225 Ac]Ac-PSMA-617 therapy.

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“…[15] reporting a 4.7% bone metastasis rate (but 19.9% for high‐risk men), while Kesler et al. [16] reported skeletal metastases in 19.5% of differing morphologies (osteoblastic, osteolytic, intramedullary) in 963 patients, but without WBBS correlation. We note that only two other studies have either prospectively or retrospectively compared the skeletal metastatic detection rate on PSMA PET/CT compared to WBBS in treatment‐naïve patients undergoing staging at initial diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Multinomial regression of concordance of PSMA PET/CT and bone scan (WBBS) metastasis classification. al [16]. reported skeletal metastases in 19.5% of differing morphologies (osteoblastic, osteolytic, intramedullary) in 963 patients, but without WBBS correlation.…”

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confidence: 99%

Intra‐individual comparison of prostate‐specific membrane antigen positron emission tomography/computed tomography versus bone scan in detecting skeletal metastasis at prostate cancer diagnosis

Shanmugasundaram,

Saad,

Heyworth

et al. 2023

BJU International

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ObjectivesTo compare the diagnostic performance and radiological staging impact of 68Ga‐prostate‐specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) compared to 99Tc whole‐body bone scan (WBBS) for the detection of skeletal metastasis in the primary staging of prostate cancer (PCa).Patients and MethodsA prospective institutional database was retrospectively examined for patients who underwent both PSMA PET and WBBS within a 1 week interval for PCa primary staging. Lesions were categorised as ‘negative’, ‘equivocal’, or ‘definite’ based on nuclear medicine physician interpretation. Metastatic burden was characterised for each imaging modality according to three groups: (i) local disease (no skeletal metastases), (ii) oligometastatic disease (three or fewer skeletal metastases), or (iii) polymetastatic disease (more than three skeletal metastases).ResultsThere were 667 patients included. The median (interquartile range) prostate‐specific antigen level was 9.2 (6.2–16) ng/mL and 60% of patients were high risk according to a modified D'Amico risk classification. The overall distribution of skeletal metastasis detection changed across the two scans overall (P = 0.003), being maintained within high‐risk (P = 0.030) and low‐risk (P = 0.018) groups. PSMA PET/CT identified more definite skeletal metastases compared to WBBS overall (10.3% vs 7.3%), and according to risk grouping (high: 12% vs 9%, intermediate: 4% vs 1%). Upstaging was more common with PSMA PET/CT than WBBS (P = 0.001). The maximum standardised uptake value (SUVmax) of the primary tumour was associated with upstaging of skeletal metastases on PSMA PET/CT (P = 0.025), while age was associated with upstaging on WBBS (P = 0.021). The SUVmax of the primary tumour and metastases were both higher according to extent of metastatic disease (P = 0.001 and P < 0.001, respectively).ConclusionsMore skeletal metastases were detected with PSMA PET/CT than WBBS, resulting in a higher upstaging rate mostly in high‐risk patients. The SUVmax of the primary tumour and metastases was associated with upstaging.

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Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement

Cited by 14 publications

References 35 publications

[99mTc]Tc-HYNIC-ALUG SPECT/CT in the initial staging of 227 consecutive patients with newly diagnosed prostate cancer: a 5-year monocentric retrospective study

[99mTc]Tc-HYNIC-ALUG SPECT/CT in the initial staging of 227 consecutive patients with newly diagnosed prostate cancer: a 5-year monocentric retrospective study

Hematologic toxicity profile and efficacy of [225Ac]Ac-PSMA-617 α-radioligand therapy of patients with extensive skeletal metastases of castration-resistant prostate cancer

Intra‐individual comparison of prostate‐specific membrane antigen positron emission tomography/computed tomography versus bone scan in detecting skeletal metastasis at prostate cancer diagnosis

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