Pattern of Prostate Cancer Recurrence Assessed by 68Ga-PSMA-11 PET/CT in Men Treated with Primary Local Therapy.

Ismaheel O Lawal,Kgomotso M G Mokoala,Mankgopo M Kgatle,Akintunde T Orunmuyi,Gbenga O Popoola,Thabo Lengana,Mike M Sathekge

doi:10.3390/jcm10173883

Abstract

Imaging plays a vital role in detecting the recurrence of prostate cancer (PCa) to guide the choice of salvage therapy. Gallium-68 prostate-specific membrane antigen positron-emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) is useful for detecting PCa recurrence. We assessed the pattern of PCa recurrence stratified by serum prostate-specific antigen level and type of primary local treatment in men with biochemical recurrence (BCR) after primary local therapy with radical prostatectomy or external beam radiotherapy (EBRT) using 68Ga-PSMA-11 PET/CT. We reviewed patients imaged with 68Ga-PSMA-11 PET/CT for the localization of the site of PCa recurrence. We determined the site and number of lesions due to PCa recurrence at different PSA levels. A total of 247 men (mean age of 65.72 ± 7.51 years and median PSA of 2.70 ng/mL (IQR = 0.78–5.80)) were included. 68Ga-PSMA-11 PET/CT detected the site of recurrence in 81.4% of patients with a median number of lesions per patient of 1 (range = 1–5). 68Ga-PSMA-11 PET/CT positivity was 43.6%, 75.7%, 83.3%, 90.0%, and 95.8% at PSA levels of <0.5, 0.5–1.0., 1.1–2.0, 2.1–5.0, and 5.0–10.0, respectively. The most common site of recurrence was in the prostate gland/bed at all PSA levels. Pelvic, extra-pelvic, and combined pelvic and extra-pelvic sites of recurrence were seen in 118, 50, and 33 patients, respectively. The risk of extra-pelvic recurrence increases with rising PSA levels. 68Ga-PSMA-11 PET/CT has a high lesion detection rate for biochemical recurrence of PCa in patients previously treated with primary local therapy.

Highlights

We reviewed the medical records of all included patients to extract relevant diseaserelated information, including demographic data, serum prostate-specific antigen (PSA) level within four weeks before 68 Ga-Prostate-specific membrane antigen (PSMA)-11 positron emission tomography/computed tomography (PET/computed tomography (CT)) scan, Gleason score, ISUP (International Society of Urological Pathology) grade group, and the type of local radical therapy received
A total of 247 men with biochemical recurrence of prostate cancer (PCa) following radical local therapy with either Radical prostatectomy (RP) or external beam radiotherapy (EBRT) without prior salvage therapy were included in this study
68 Ga-PSMA-11 PET/CT identified the site of recurrence in 201 patients with an imaging positivity rate of 81.4% and a median number of sites of recurrence of 1

Summary

Introduction

Radical prostatectomy (RP) or external beam radiotherapy (EBRT) is offered to men with organ-confined and locally advanced prostate cancer (PCa) as a definitive primary local treatment [1,2]. Within 10 years of definitive radical treatment, 20–40% of patients treated by RP and 30–50% of patients treated by EBRT will experience disease recurrence [3,4,5]. Disease recurrence, which is heralded by a rise in serum prostate-specific antigen (PSA) levels, is often not accompanied by clinical symptoms. Plays a vital role in determining the site of disease recurrence to guide the choice of therapy. Radiopharmaceuticals targeting cancer cell membrane lipid biosynthesis have been used for positron emission tomography/computed tomography (PET/CT) imaging for

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