Abstract
PurposeProstate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) imaging significantly improved the detection of recurrent prostate cancer (PCa). However, the value of PSMA PET imaging in patients with advanced hormone-sensitive or hormone-resistant PCa is still largely unknown. The aim of this study was to analyze the detection rate and distribution of lesions using PSMA PET imaging in patients with advanced PCa and ongoing androgen deprivation therapy (ADT).MethodsA total of 84 patients diagnosed with hormone-sensitive or hormone-resistant PCa who underwent 68Ga-PSMA-11 PET/magnetic resonance imaging (MRI) or computer tomography (CT) under ongoing ADT were retrospectively analyzed. We assessed the detection of PSMA-positive lesions overall and for three PSA subgroups (0 to < 1 ng/mL, 1 to < 20 ng/mL and > 20 ng/mL). In addition, PSMA-positive findings were stratified by localization (prostatic fossa, pelvic, para-aortic, mediastinal/supraclavicular and axillary lymph nodes, bone lesions and visceral lesions) and hormone status (hormone-sensitive vs. hormone-resistant). Furthermore, we assessed how many patients would be classified as having oligometastatic disease (≤ 3 lesions) and theoretically qualify for metastasis-directed radiotherapy (MDRT) in a personalized patient management.ResultsWe detected PSMA-positive lesions in 94.0% (79 of 84) of all patients. In the three PSA subgroups detection rates of 85.2% (0 to < 1 ng/mL, n = 27), 97.3% (1 to < 20 ng/mL, n = 37) and 100% (> 20 ng/mL, n = 20) were observed, respectively. PSMA-positive visceral metastases were observed only in patients with a PSA > 1 ng/mL. Detection of PSMA-positive lesions did not significantly differ between patients with hormone-sensitive and hormone-resistant PCa. Oligometastatic PCa was detected in 19 of 84 patients (22.6%). Almost all patients, 94.7% (n = 18) would have been eligible for MDRT.ConclusionsIn this study, we observed an overall very high detection rate of 94% using PSMA PET imaging in patients with advanced PCa and ongoing ADT. Even in a majority of patients with very low PSA values < 1 ng/ml PSMA-positive lesions were found.
Highlights
Prostate cancer (PCa) is still the most frequently diagnosed cancer and second most common cause of cancer-related death in men worldwide [1]
Given that the influence of androgen deprivation therapy (ADT) on Prostate-specific membrane antigen (PSMA) expression is not fully understood with first clinical data suggesting a higher PSMA uptake on positron emission tomography (PET) in men treated with ADT [6, 7], a separate analysis of PET detection in patients under ADT is needed
Patient characteristics including prostate-specific antigen (PSA) level at time of diagnosis and at time of scan, primary tumor stage, Gleason Score, surgical margin status and primary therapy regime were retrieved from patient records. 68Ga-PSMA-11 PET imaging detection rate was analyzed overall and for three PSA subgroups (0 to < 1 ng/mL, 1 to < 20 ng/mL and > 20 ng/mL)
Summary
Prostate cancer (PCa) is still the most frequently diagnosed cancer and second most common cause of cancer-related death in men worldwide [1]. Prostate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) in combination with computerized tomography (CT) or magnetic resonance imaging (MRI) significantly improved the detection of primary and recurrent PCa [2, 3]. Current guidelines recommend PSMA PET imaging for the early detection of recurrent disease if the results will influence subsequent treatment decisions [4]. Annals of Nuclear Medicine (2021) 35:1109–1116 the performance of PSMA PET imaging for patients with advanced PCa is still largely unknown [5]. First results suggest a very high detection rate of PSMA PET imaging in hormone-resistant PCa patients previously diagnosed as non-metastatic by conventional imaging [8].
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