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. 2016 Jul;41(7):515-21.
doi: 10.1097/RLU.0000000000001197.

68Ga-PSMA-PET/CT in Patients With Biochemical Prostate Cancer Recurrence and Negative 18F-Choline-PET/CT

Christina Bluemel  1 , Markus Krebs, Bülent Polat, Fränze Linke, Matthias Eiber, Samuel Samnick, Constantin Lapa, Michael Lassmann, Hubertus Riedmiller, Johannes Czernin, Domenico Rubello, Thorsten Bley, Saskia Kropf, Hans-Juergen Wester, Andreas K Buck, Ken Herrmann
Affiliations

68Ga-PSMA-PET/CT in Patients With Biochemical Prostate Cancer Recurrence and Negative 18F-Choline-PET/CT

Christina Bluemel et al. Clin Nucl Med. 2016 Jul.

Abstract

Purpose: Investigating the value of Ga-PSMA-PET/CT in biochemically recurring prostate cancer patients with negative F-choline-PET/CT.

Patients and methods: One hundred thirty-nine consecutive patients with biochemical recurrence after curative (surgery and/or radiotherapy) therapy were offered participation in this sequential clinical imaging approach. Patients first underwent an F-choline-PET/CT. If negative, an additional Ga-PSMA-PET/CT was offered. One hundred twenty-five of 139 eligible patients were included in the study; 32 patients underwent additional Ga-PSMA-PET/CT. Patients with equivocal findings (n = 5) on F-choline-PET/CT and those who declined the additional Ga-PSMA-PET/CT (n = 9) were excluded. Images were analyzed visually for the presence of suspicious lesions. Findings on PET/CT were correlated with PSA level, PSA doubling time (dt), and PSA velocity (vel).

Results: The overall detection rates were 85.6% (107/125) for the sequential imaging approach and 74.4% (93/125) for F-choline-PET/CT alone. Ga-PSMA-PET/CT detected sites of recurrence in 43.8% (14/32) of the choline-negative patients. Detection rates of the sequential imaging approach and F-choline-PET/CT alone increased with higher serum PSA levels and PSA vel. Subgroup analysis of Ga-PSMA-PET/CT in F-choline negative patients revealed detection rates of 28.6%, 45.5%, and 71.4% for PSA levels of 0.2 or greater to less than 1 ng/mL, 1 to 2 ng/mL, and greater than 2 ng/mL, respectively.

Conclusions: The sequential imaging approach designed to limit Ga-PSMA imaging to patients with negative choline scans resulted in high detection rates. Ga-PSMA-PET/CT identified sites of recurrent disease in 43.8% of the patients with negative F-choline PET/CT scans.

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Conflict of interest statement

and sources of funding: S.K. and H.J.W. are CEOs and shareholders of Scintomics, the company distributing PSMA-directed peptide ligands. Both coauthors have not influenced data acquisition or analysis but contributed to conception/design, drafting of manuscript, administrative, technical or material support, and supervision.

Figures

FIGURE 1
FIGURE 1
Flow diagram: sequential imaging approach (n = 139 patients).
FIGURE 2
FIGURE 2
Detection rates in relation to PSA levels (A), PSA doubling time (B), and PSA velocity (C) at the time point of PET/CT (n = 125; PSA kinetics in 1 patient unavailable).
FIGURE 3
FIGURE 3
A 64-year-old patient with PSA relapse (T3aN0; Gleason score, 8; PSA level, 4.0 ng/mL; PSA doubling time, 5.9 months) radical prostatectomy, lymphadenectomy, and radiotherapy. 18F-choline-PET/CT showed no suspicious lesion (A–C); 68Ga-PSMA-PET/CT (D–F) showed multiple iliac and retroperitoneal lymph node metastases (arrows) without 18F-choline-uptake (arrows in panel A, B).
FIGURE 4
FIGURE 4
A 72-year-old patient with PSA relapse (T2cN0; Gleason score, 7; PSA level, 1.43 ng/mL; PSA doubling, 17.6 months) after radical prostatectomy and lymphadenectomy. 18F-choline-PET/CT showed no suspicious lesion (A–C), but 68Ga-PSMA-PET/CT demonstrated local recurrence (D–F, arrow).
See this image and copyright information in PMC

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