Abstract
PurposeTo evaluate the performance of [68Ga]Ga-PSMA-11 PET/CT in the diagnosis of recurrent prostate cancer (PC) after prostatectomy in a large multicentre cohort.MethodsThe centres, which contributed to this study, were the departments of nuclear medicine of Heidelberg (Germany), Technical University of Munich (Germany) and Albert Einstein Hospital of São Paulo (Brazil). A total of 2533 patients who were scanned with [68Ga]Ga-PSMA-11 PET/CT at 1 h p.i. due to recurrent PC after prostatectomy were included in this retrospective analysis. Exclusion criteria were as follows: patients with untreated primary tumour, previous chemotherapy or Xofigo®; those previously treated with exclusively external beam radiation therapy or HIFU; those referred for PSMA-therapy; and those treated with ADT (including first- and second-generation ADT) within the last 6 months. Potential influences of different factors such as PSA level, PSA doubling-time (PSADT), PSA velocity (PSAVel), Gleason Score (GSC, including the separate analysis of 7a and 7b), age and amount of injected tracer were evaluated in a multivariable analysis.ResultsThe rate of pathologic PET/CT-scans was 43% for PSA ≤ 0.2 ng/ml, 58% for PSA > 0.2 to ≤ 0.5, 72% for PSA > 0.5 to ≤ 1.0 and increased to a maximum of 93% for PSA > 10 ng/ml. A pathological PET/CT was significantly (p = 0.001) associated with PSA level and higher GSC. Amount of injected tracer, age, PSADT and PSAVel were not associated with a higher probability of a pathological scan.Conclusion[68Ga]Ga-PSMA-11 PET/CT at 1 h p.i. confirmed its high performance in the largest patient cohort yet analysed. Tumour detection showed a clear association with higher PSA and higher GSC. No association was found between a pathological [68Ga]Ga-PSMA-11 PET/CT and age, amount of injected tracer, PSADT or PSAVel.
Highlights
The detection of recurrent prostate cancer (PC) with conventional imaging modalities such as bone scan (BS), computed tomography (CT) or magnetic resonance imaging (MRI) remains challenging
Patients with initial exclusive external beam radiation therapy or high-intensity focused ultrasound (HIFU) of the primary tumours should not be mixed with prostatectomy patients since the prostate-specific antigen (PSA) values of both groups cannot be compared in the setting of biochemical relapse of PC
Patients with untreated primary tumour, previous chemotherapy or Xofigo®, those previously treated with exclusively external beam radiation therapy or HIFU, those referred for prostate-specific membrane antigen (PSMA)-therapy and those treated with androgen deprivation therapy (ADT) within the last 6 months
Summary
The detection of recurrent prostate cancer (PC) with conventional imaging modalities such as bone scan (BS), computed tomography (CT) or magnetic resonance imaging (MRI) remains challenging. The focus of some publications has been the interplay of possible factors that could predict PET positivity or tumour detection in patients with recurrent PC [2,3,4, 6,7,8]. One of the critical characteristics of the majority of these publications is the inhomogeneity in the patient cohorts, e.g. including patients with different initial therapies. Patients with initial exclusive external beam radiation therapy or high-intensity focused ultrasound (HIFU) of the primary tumours should not be mixed with prostatectomy patients since the prostate-specific antigen (PSA) values of both groups cannot be compared in the setting of biochemical relapse of PC. The inclusion of individuals with previous chemotherapy, Xofigo® or second-generation androgen deprivation therapy (ADT) is critical since all these options indicate an advanced disease instead of a proper recurrence after initial therapy
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