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Comparative Study
. 2020 Aug 5;20(1):723.
doi: 10.1186/s12885-020-07192-7.

Clinical impact of PSMA PET/CT in primary prostate cancer compared to conventional nodal and distant staging: a retrospective single center study

Maarten L Donswijk  1 , Pim J van Leeuwen  2 , Erik Vegt  3   4 , Zing Cheung  3 , Stijn W T P J Heijmink  5 , Henk G van der Poel  2 , Marcel P M Stokkel  3
Affiliations
Comparative Study

Clinical impact of PSMA PET/CT in primary prostate cancer compared to conventional nodal and distant staging: a retrospective single center study

Maarten L Donswijk et al. BMC Cancer. .

Abstract

Background: To evaluate the impact of Gallium-68 [68Ga] labeled prostate specific membrane antigen (PSMA) positron emission tomography (PET)/X-ray computed tomography (CT) compared with conventional imaging on staging and clinical management of men evaluated for primary prostate cancer (PCa).

Methods: Men with newly diagnosed biopsy-proven PCa who had been staged with a conventional staging protocol including bone scintigraphy (BS) and additionally underwent [68Ga]PSMA PET/CT, were evaluated retrospectively. Imaging findings from BS, magnetic resonance imaging (MRI) and/or CT were categorized regarding locoregional nodal (N) and distant metastasis (M) status as negative, positive or equivocal before and after addition of the information of PET/CT. Also, the imaging-based level of confidence (LoC) in correct assessment of N and M status was scored. Impact of PET/CT on clinical management was evaluated by the percentage of treatment category changes after PET/CT as determined in the multidisciplinary tumour board.

Results: Sixty-four men with intermediate and high-risk PCa were evaluated. With additional information of PET/CT, N status was upstaged in 23%, and downstaged in 9%. M status was upstaged in 13%, and downstaged in 23%. A net increase in LoC of 20% was noted, mainly regarding M status. Treatment category changed from palliative to curative in 9%, and from curative to palliative in 3%. An undecided treatment plan changed to curative in 14%, as well as to palliative in another 9%. In total, a 36% treatment category change was noted. High negative predictive value of PET/CT for M status was indicated by 27 patients that underwent robot-assisted radical prostatectomy and reached postoperative biochemical disease-free status or had a likely other site of disease recurrence.

Conclusions: PSMA PET/CT can cause considerable changes in N and M staging, as well as in management compared to conventional staging. Findings of this study support the replacement of BS and CT by PSMA PET/CT in staging primary PCa.

Keywords: Impact; Management; PSMA; Prostate; Staging.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flowchart of staging and treatment intent changes after PSMA PET/CT compared to conventional staging. * predominant Gleason pattern 4 or higher, and/or cT3 or higher, and/or PSA blood level ≥ 20
Fig. 2
Fig. 2
Example of staging change of PSMA PET/CT compared with conventional imaging. A man presented with a clinical T2c Gleason 7b (predominant Gleason score 4) PCa with an iPSA of 16. Planar BS (a) showed a faint spot in the left proximal femur (red arrow) which was confirmed on SPECT/CT (b) as a sclerotic lesion with osteoblastic activity (red arrow). The lesion was interpreted as suspicious for bone metastasis. Other areas with increased osteoblastic activity (green arrows) were interpreted as degenerative. A [68Ga]PSMA PET/CT (c) 36 days later shows a PSMA positive bilateral PCa (blue arrow), but no PSMA expression in the sclerotic lesion in the left proximal femur (d, red arrow). Based on PSMA PET/CT the lesion in the left proximal femur was regarded as not suspicious for bone metastasis; M stage changed from positive to negative and treatment intent changed from palliative to curative
See this image and copyright information in PMC

References

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