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. 2021 Mar 25;13(7):1508.
doi: 10.3390/cancers13071508.

Predicting the Risk of Metastases by PSMA-PET/CT-Evaluation of 335 Men with Treatment-Naïve Prostate Carcinoma

Stefan A Koerber  1   2   3 , Johannes Boesch  4 , Clemens Kratochwil  4   5 , Ingmar Schlampp  1   2   3 , Jonas Ristau  1   2   3 , Erik Winter  4 , Stefanie Zschaebitz  6 , Luisa Hofer  7 , Klaus Herfarth  1   2   3   8 , Klaus Kopka  9   10   11 , Tim Holland-Letz  12 , Dirk Jaeger  6 , Markus Hohenfellner  7 , Uwe Haberkorn  4   5   13 , Juergen Debus  1   2   3   8   13   14 , Frederik L Giesel  4   5   13
Affiliations

Predicting the Risk of Metastases by PSMA-PET/CT-Evaluation of 335 Men with Treatment-Naïve Prostate Carcinoma

Stefan A Koerber et al. Cancers (Basel). .

Abstract

Men diagnosed with aggressive prostate cancer are at high risk of local relapse or systemic progression after definitive treatment. Treatment intensification is highly needed for that patient cohort; however, no relevant stratification tool has been implemented into the clinical work routine so far. Therefore, the aim of the current study was to analyze the role of initial PSMA-PET/CT as a prediction tool for metastases. In total, 335 men with biopsy-proven prostate carcinoma and PSMA-PET/CT for primary staging were enrolled in the present, retrospective study. The number and site of metastases were analyzed and correlated with the maximum standardized uptake value (SUVmax) of the intraprostatic, malignant lesion. Receiver operating characteristic (ROC) curves were used to determine sensitivity and specificity and a model was created using multiple logistic regression. PSMA-PET/CT detected 171 metastases with PSMA-uptake in 82 patients. A statistically significant higher SUVmax was found for men with metastatic disease than for the cohort without distant metastases (median 16.1 vs. 11.2; p < 0.001). The area under the curve (AUC) in regard to predicting the presence of any metastases was 0.65. Choosing a cut-off value of 11.9 for SUVmax, a sensitivity and specificity (factor 1:1) of 76.0% and 58.4% was obtained. The current study confirms, that initial PSMA-PET/CT is able to detect a relatively high number of treatment-naïve men with metastatic prostate carcinoma. Intraprostatic SUVmax seems to be a promising parameter for the prediction of distant disease and could be used for treatment stratification-aspects which should be verified within prospective trials.

Keywords: PET; PSMA; intraprostatic SUV; metastases; prostate cancer.

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Conflict of interest statement

S.A.K. reports grants from Viewray Inc., outside the submitted work. U.H., C.K. and F.L.G. have a patent application for quinolone-based FAP-targeting agents for imaging and therapy outside of this work. U.H., C.K. and F.L.G. also have shares of a consultancy group for iTheranostics outside of this work. F.L.G. is a medical advisor for ABX Advanced Biochemical Compound, Sofie Biosciences and Telix Pharmaceuticals and patent application has been filed for PSMA-1007 by U.H. and F.L.G. J.D. reports grants from Viewray Inc., grants from CRI The Clinical Research Institute GmbH, grants from Accuray International Sari, grants from RaySearch Laboratories AB, grants from Vision RT Limited, grants from Merck Serono GmbH, grants from Astellas Pharma GmbH, grants from Astra Zeneca GmbH, grants from Siemens Healthcare GmbH, grants from Solution Akademie GmbH, grants from Egomed PLC Surrey Research Park, grants from Quintiles GmbH, grants from Pharmaceutical Research Associates GmbH, grants from Boehringer Ingelheim Pharma GmbH and CoKG, grants from PTW-Freiburg Dr. Pychlau GmbH, grants from Nanobiotix S.A, outside the submitted work. KK is SAB member of Telix Pharmaceuticals and coinventor on patents of PSMA-617 and PSMA-1007. All other authors have no relevant financial relationships to disclose.

Figures

Figure 1
Figure 1
Boxplot of intraprostatic maximum standardized uptake values (SUVmax) according to M-stage.
Figure 2
Figure 2
PSMA-PET/CT in maximum intensity projection (MIP) (A) of a 70-years old patient with prostate cancer (GS 7b/group grade 3, PSA 4.53 ng/mL) and low intraprostatic SUVmax (3.45) and no metastases (B) PSMA-PET Dx; (C) PSMA PET/CT Dx.
Figure 3
Figure 3
PSMA-PET/CT in MIP (A) of a 83-years old patient with prostate cancer (GS 8/group grade 4; PSA 32 ng/mL) and high intraprostatic SUVmax (49.63) and several metastases; Level of prostate (B) PSMA-PET Dx; (C) PSMA PET/CT Dx; Level of nodal metastases (D) PSMA-PET Dx; (E) PSMA PET/CT Dx.
See this image and copyright information in PMC

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