Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 21;11(1):76.
doi: 10.1186/s13550-021-00818-2.

PSMA-ligand uptake can serve as a novel biomarker in primary prostate cancer to predict outcome after radical prostatectomy

Hui Wang #  1 , Thomas Amiel  2 , Christoph Würnschimmel  3 , Thomas Langbein  4 , Katja Steiger  5 , Isabel Rauscher  4 , Thomas Horn  2 , Tobias Maurer  3   6 , Wolfgang Weber  4 , Hans-Juergen Wester  7 , Karina Knorr #  4 , Matthias Eiber #  4
Affiliations

PSMA-ligand uptake can serve as a novel biomarker in primary prostate cancer to predict outcome after radical prostatectomy

Hui Wang et al. EJNMMI Res. .

Abstract

Background: The prostate-specific membrane antigen (PSMA) is a relevant target in prostate cancer, and immunohistochemistry studies showed associations with outcome. PSMA-ligand positron emission tomography (PET) is increasingly used for primary prostate cancer staging, and the molecular imaging TNM classification (miTNM) standardizes its reporting. We aimed to investigate the potential of PET-imaging to serve as a noninvasive imaging biomarker to predict disease outcome in primary prostate cancer after radical prostatectomy (RP).

Methods: In this retrospective analysis, 186 primary prostate cancer patients treated with RP who had undergone a 68Ga-PSMA-11 PET up to three months prior to the surgery were included. Maximum standardized uptake value (SUVmax), SUVmean, tumor volume (TV) and total lesion (TL) were collected from PET-imaging. Moreover, clinicopathological information, including age, serum prostate-specific antigen (PSA) level, and pathological characteristics, was assessed for disease outcome prediction. A stage group system for PET-imaging findings based on the miTNM framework was developed.

Results: At a median follow-up after RP of 38 months (interquartile range (IQR) 22-53), biochemical recurrence (BCR) was observed in 58 patients during the follow-up period. A significant association between a positive surgical margin and miN status (miN1 vs. miN0, odds ratio (OR): 5.428, p = 0.004) was detected. miT status (miT ≥ 3a vs. miT < 3, OR: 2.696, p = 0.003) was identified as an independent predictor for Gleason score (GS) ≥ 8. Multivariate Cox regression analysis indicated that PSA level (hazard ratio (HR): 1.024, p = 0.014), advanced GS (GS ≥ 8 vs. GS < 8, HR: 3.253, p < 0.001) and miT status (miT ≥ 3a vs. miT < 3, HR: 1.941, p = 0.035) were independent predictors for BCR. For stage I disease as determined by PET-imaging, a shorter BCR-free survival was observed in the patients with higher SUVmax (IA vs. IB stage, log-rank, p = 0.022).

Conclusion: Preoperative miTNM classification from 68Ga-PSMA-11 PET correlates with postoperative GS, surgical margin status and time to BCR. The association between miTNM staging and outcome proposes 68Ga-PSMA-11 PET as a novel non-invasive imaging biomarker and potentially serves for ancillary pre-treatment stratification.

Keywords: 68Ga-PSMA-11 PET; Biochemical recurrence; Prostate cancer; miTNM classification.

PubMed Disclaimer

Conflict of interest statement

ME reports patent application for rhPSMA and prior consulting activities for Blue Earth Diagnostics, Progenics Pharmaceuticals, Point Biopharma and Janssen Pharmaceuticals. Other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Biochemical recurrence-free survival according to miTNM stage. Pairwise comparison: miTNM stage IA versus miTNM stage IB, p = 0.022; miTNM stage IA versus miTNM stage ≥ II, p = 0.001; miTNM stage IB versus miTNM stage ≥ II, p = 0.005
Fig. 2
Fig. 2
Longer biochemical recurrence-free survival was associated with a miT = 2 and b miN = 0
Fig. 3
Fig. 3
Kaplan–Meier curves comparing biochemical recurrence-free survival of selected patients stratified by a tumor volume, b total lesion, c SUVmean and d SUVmax. Longer biochemical recurrence-free survival was associated with lower SUVmean and SUVmax
See this image and copyright information in PMC

References

    1. Schwarzenboeck SM, Rauscher I, Bluemel C, Fendler WP, Rowe SP, Pomper MG, et al. PSMA ligands for PET imaging of prostate cancer. J Nucl Med. 2017;58(10):1545–1552. doi: 10.2967/jnumed.117.191031. - DOI - PubMed
    1. Paller CJ, Antonarakis ES, Eisenberger MA, Carducci MA. Management of patients with biochemical recurrence after local therapy for prostate cancer. Hematol Oncol Clin North Am. 2013;27(6):1205–1219, viii. doi: 10.1016/j.hoc.2013.08.005. - DOI - PMC - PubMed
    1. Qi P, Tsivian M, Abern MR, Bañez LL, Tang P, Moul JW, et al. Long-term oncological outcomes of men undergoing radical prostatectomy with preoperative prostate-specific antigen < 2.5 ng/ml and 2.5–4 ng/ml. Urol Oncol. 2013;31(8):1527–1532. doi: 10.1016/j.urolonc.2012.06.003. - DOI - PubMed
    1. Abdel Raheem A, Chang KD, Alenzi MJ, Ham WS, Han WK, Choi YD, et al. Predictors of biochemical recurrence after Retzius-sparing robot-assisted radical prostatectomy: Analysis of 359 cases with a median follow-up period of 26 months. Int J Urol. 2018;25(12):1006–1014. doi: 10.1111/iju.13808. - DOI - PubMed
    1. Freedland SJ, Presti JC, Amling CL, Kane CJ, Aronson WJ, Dorey F, et al. Time trends in biochemical recurrence after radical prostatectomy: results of the SEARCH database. Urology. 2003;61(4):736–741. doi: 10.1016/S0090-4295(02)02526-8. - DOI - PubMed