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. 2017 Nov 14;8(67):111073-111083.
doi: 10.18632/oncotarget.22441. eCollection 2017 Dec 19.

Diagnostic performance of 68Gallium-PSMA-11 PET/CT to detect significant prostate cancer and comparison with 18FEC PET/CT

Manuela A Hoffmann  1   2   3 , Matthias Miederer  2 , Helmut J Wieler  3 , Christian Ruf  4 , Frank M Jakobs  5 , Mathias Schreckenberger  2
Affiliations

Diagnostic performance of 68Gallium-PSMA-11 PET/CT to detect significant prostate cancer and comparison with 18FEC PET/CT

Manuela A Hoffmann et al. Oncotarget. .

Abstract

Background: Radiolabeled prostate-specific membrane antigen (PSMA) has proven to be a highly accurate method to detect recurrence and metastases of prostate cancer, but only sparse data is available about its performance in the diagnosis of clinically significant primary prostate cancer.

Methods: We compared 68Ga-PSMA-11 PET/CT in 25 patients with 18FEC PET/CT in 40 patients with suspected prostate carcinoma based on an increased PSA level.The PET/CT results were compared with the histopathologic Gleason Score (GS) of biopsies.

Results: The 68Ga-PSMA-11 PET/CT revealed highly suspect prostatic lesions (maximum standardized uptake value/SUVmax >2.5) in 21/25 patients (84%), associated with GS≥6 (low-grade/high-grade carcinoma). Two histopathologic non-malignancy-relevant cases (GS<6) had PSMA-SUVmax ≤2.5; all histopathologic high-grade cases (GS≥7b) showed PSMA-SUVmax >12.0 which further increased with rising GS. There were 2 false positives and no false negative findings for high-grade prostate cancer using a cut off-level for SUVmax of 2.5.In contrast, the 18FEC PET/CT showed suspected malignant lesions in 38/40 patients (95%), which included 3 lesions with GS<6. The mean SUVmax values did not differ with different GS. There were 11 false positives and 1 false negative for detection of high-grade prostate cancer (cut off 2.5).By means of ROC analysis a SUVmax of 5.4 was found to be an optimal cut off-level to distinguish between low- and high-grade carcinoma in 68Ga-PSMA-11 PET/CT (AUC=0.9692; 95% CI 0.9086;1.0000;SD(AUC)=0.0309)). Choosing a cut off-level of SUVmax5.4, 68Ga-PSMA-11 PET/CT was able to distinguish between GS ≤7a/≥7b with a sensitivity of 84%, a specificity of 100%, a negative predictive value (NPV) of 67%, and an efficiency of 88% (p<0.001).The ROC analysis revealed a SUVmax 6.5 as an optimal cut off-level to distinguish between low- and high-grade carcinoma in 18FEC PET/CT (AUC=0.7470; 95% CI 0.5919;0.9020;SD(AUC)=0.0791) with a sensitivity of 61% and a specificity of 92%; but the efficiency was only 70% and the NPV 50% (p=0.01).

Conclusion: 68Ga-PSMA-11 PET/CT guided biopsy of the prostate increases diagnostic precision and is likely to help to reduce overtreatment of low-grade malignant disease as well as detect the foci of the highest Gleason pattern. Both methods (68Ga-PSMA-11,18FEC) were suitable to detect primary prostate cancer, but the excellent image quality, the higher specificity and the good correlation of positive scans with GS are advantages of 68Ga-PSMA-11.

Keywords: choline; detection of significant cancer; positron emission tomography/computed tomography; prostate cancer; prostate-specific membrane antigen.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest. They reveal to the Editors any relationships that they believe could be construed as resulting in an actual, potential, or perceived conflict of interest with regard to the manuscript submitted for review.

Figures

Figure 1
Figure 1. Relation between PSA and prostatic SUVmax of 68Ga-PSMA-11 PET/CT and 18FEC PET/CT in patients without metastases (68Ga-PSMA PET/CT: R 0.42, p= 0.082; 18FEC PET/CT: R 0.033; p = 0.875)
Figure 2
Figure 2. Distribution between GS and SUVmaxin 68Ga-PSMA PET/CT scans and 18FEC PET/CT scans for prostate cancer
Figure 3
Figure 3. ROC curve according to the SUVmax values of our patients
See this image and copyright information in PMC

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