Abstract
Background: The aim of the present study is to analyze the efficacy of 68Gallium (Ga)-PSMA-11 PET/CT for detecting and localizing recurrent prostate carcinoma (PC) in patients with different prostate-specific antigen (PSA), PSA velocity (PSAvel) and doubling time (PSAdt). Results: The PR of 68Ga-PSMA-11 PET/CT showed a positive relationship with PSA levels. Even at restaging PSA-values (PSAV) of lower than 0.2 ng/ml, PR was 41%. For PSAV of 0.2-<0.5 ng/ml the PR was 45%, 62% for PSAV of 0.5-<1.0 and 72% for PSAV of 1.0-<2.0 ng/ml. The PR increased to 85% for PSAV of 2.0-<5.0 and reached 94% at PSAV of ≥5.0 ng/ml. At PSA of <1 ng/ml/y the PR of PSAvel was 50% and increased to 98% at PSA >5 ng/ml/y. No significant association was found for PSAdt. Methods: PET/CT scans of 660 patients with biochemical recurrence (BCR) after primary therapy of PC were included in the analysis. We correlated serum PSA levels, measured at the time of imaging with PSMA PET/CT-positivity rates (PR) as well as PSAvel (in 225 patients) and PSAdt (660 patients). Additionally we compared the incidence of localized disease to metastases as related to these PSA-biomarkers. Conclusion: We have shown, in a large cohort of patients, that 68Ga-PSMA-11 PET/CT is a sensitive tool for restaging PC and has a high detection efficacy, even in patients with very low PSA levels (<0.2 ng/ml). Thus 68Ga-PSMA-11 PET/CT both identify and localize recurrent disease with implications for a more direct treatment approach (localized vs. systemic therapy).
Highlights
prostate carcinoma (PC) related mortality is almost as high as that of lung cancer and is the most frequent type of cancer in men [1]
We have shown, in a large cohort of patients, that 68Ga-Prostate-specific membrane antigen (PSMA)-11 positron-emission tomography (PET)/computed tomography (CT) is a sensitive tool for restaging PC and has a high detection efficacy, even in patients with very low prostate-specific antigen (PSA) levels (
We aimed to evaluate the dependence of the positivity rates (PR) on PSA level and PSA kinetics, and to identify the lowest PSA threshold that detects local, regional or systemic relapse of PC, using 68Ga-PSMA-11 PET/CT
Summary
PC related mortality is almost as high as that of lung cancer and is the most frequent type of cancer in men [1]. Standard imaging techniques for the localization of recurrent disease (99-technetium bone scan, CT scan and MRI) are not very sensitive and it is likely that other diagnostic tests based on metabolic factors (such as PET with various tracers, MR spectroscopy) will be used for the study of BCR after radiotherapy in the near future [7]. Molecular imaging such as hybrid positron-emission tomography (PET)/CT with specific tracers, based on metabolic factors, should improve diagnostic accuracy. The aim of the present study is to analyze the efficacy of 68Gallium (Ga)-PSMA-11 PET/CT for detecting and localizing recurrent prostate carcinoma (PC) in patients with different prostate-specific antigen (PSA), PSA velocity (PSAvel) and doubling time (PSAdt)
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