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. 2017 Nov 10;12(1):176.
doi: 10.1186/s13014-017-0902-0.

Detection level and pattern of positive lesions using PSMA PET/CT for staging prior to radiation therapy

Nina-Sophie Schmidt-Hegemann  1 , Wolfgang Peter Fendler  2 , Alexander Buchner  3 , Christian Stief  3 , Paul Rogowski  1 , Maximilian Niyazi  1 , Chukwuka Eze  1 , Minglun Li  1 , Peter Bartenstein  2 , Claus Belka  1 , Ute Ganswindt  4   5
Affiliations

Detection level and pattern of positive lesions using PSMA PET/CT for staging prior to radiation therapy

Nina-Sophie Schmidt-Hegemann et al. Radiat Oncol. .

Abstract

Background: To determine the potential role of 68Ga-PSMA positron emission tomography/computed tomography (PET/CT) in radiotherapy (RT) planning for prostate cancer (PCa).

Methods: One hundred twenty-nine patients (pts) with 68Ga-PSMA PET/CT were retrospectively analysed. Potentially influencing factors (androgen deprivation therapy, amount of 68Ga-PSMA-HBED-CC, PSA doubling time ≤/> 10 months, PSA before PET/CT, T-/N-category and Gleason score) were evaluated by logistic regression analysis. The detection rate of PSMA PET/CT was compared to contrast enhanced CT and its impact on RT management analysed.

Results: One hundred twenty-nine patients (pts) (20 at initial diagnosis, 49 with PSA relapse and 60 with PSA persistence after radical prostatectomy) received PSMA PET/CT prior to RT. The majority of pts. (71.3%) had PET-positive findings (55.1% of pts. with PSA recurrence, 75% of pts. with PSA persistence and 100% of newly diagnosed pts). Median PSA before PET/CT in pts. with pathological findings (n = 92) was 1.90 ng/ml and without (n = 37) 0.30 ng/ml. PSA level at time of PET/CT was the only factor associated with PET-positivity. In pts. with a PSA ≤ 0.2 ng/ml, the detection rate of any lesion was 33.3%, with a PSA of 0.21-0.5 ng/ml 41.2% and with a PSA of 0.51-1.0 ng/ml 69.2%, respectively. Regarding the anatomic distribution of lesions, 42.2% and 14.7% of pts. with relapse or persistence had pelvic lymph node and distant metastases. In pts. at initial diagnosis the detection rate of pelvic lymph nodes and distant metastases was 20% and 10%. 68Ga-PSMA PET/CT had a high detection rate of PCa recurrence outside the prostatic fossa in pts. being considered for salvage RT (22.4% PET-positive pelvic lymph nodes and 4.1% distant metastases). Compared to CT, PSMA PET/CT had a significantly higher sensitivity in diagnosing rates of local recurrence/primary tumour (10.1% vs. 38%), lymph nodes (15.5% vs. 38.8%) and distant metastases (5.4% vs. 14.0%). This resulted in a modification of RT treatment in 56.6% of pts.

Conclusions: The detection of PCa is strongly associated with PSA level at time of 68Ga-PSMA PET/CT. PSMA PET/CT differentiates between local, regional and distant metastatic disease with implications for disease management. PSMA PET/CT allows for tumour detection in post-prostatectomy pts. with PSA ≤ 0.5 ng/ml considered for salvage RT.

Keywords: 68Ga-PSMA PET/CT; Prostate cancer; Radical prostatectomy; Radiotherapy.

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Conflict of interest statement

Ethics approval and consent to participate

All patients gave written consent to undergo 68Ga-PSMA PET/CT. This retrospective analysis is in compliance with the principles of the Declaration of Helsinki and its subsequent amendments [21] and was approved by the Ethics Committee of the LMU Medical Faculty.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Probability of a pathological 68Ga-PSMA PET/CT depending on PSA levels in 129 patients. Corresponding table shows the rates of PET/CTs with/without pathological radiotracer uptake in % according to PSA level
Fig. 2
Fig. 2
Probability of a pathological 68Ga-PSMA PET/CT depending on GS in 129 patients. Corresponding table shows the rates of PET/CTs with/without pathological radiotracer uptake in % according to GS class
Fig. 3
Fig. 3
Lesion based analysis (PET-positive local recurrence/primary tumour and PET-positive lymph node and distant metastases) according to sub-grouping of patients (patients before definitive RT at initial diagnosis, patients before salvage RT with PSA recurrence, patients before Salvage RT with PSA < 0.5 ng/ml, patients before additive RT with PSA persistence, patients before additive RT with PSA persistence with PSA < 0.5 ng/ml)
Fig. 4
Fig. 4
Radiotherapy treatment planning in three patients based on PSMA PET/CT information. 68Ga-PSMA PET/CT (B, D, F) and target volumes with simultaneously integrated boost volumes (A, C, E) are shown. Figs. A and B show a patient with PSA recurrence and evidence of lymph node metastasis in 68Ga-PSMA PET/CT who was treated with a simultaneously integrated boost to the lymph node. Figs. C and D show a patient with PSA recurrence due to local relapse in the region of the former prostate gland. This local relapse was treated with a simultaneously integrated boost volume. Figs. F and E show a patient with singular osseous metastasis that was treated with a simultaneously integrated boost
See this image and copyright information in PMC

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