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Nuklearmedizin 2019; 58(06): 443-450
DOI: 10.1055/a-1035-9052
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Determination of whole-body tumour burden on [68Ga]PSMA-11 PET/CT for response assessment of [177Lu]PSMA-617 radioligand therapy: a retrospective analysis of serum PSA level and imaging derived parameters before and after two cycles of therapy

Bestimmung der mittels [68Ga]PSMA-11 PET/CT bestimmten Ganzkörper-Tumorlast zur Abschätzung des Therapieansprechens: Eine retrospektive Analyse des Serum-PSA-Wertes und bildgebender Parameter vor und nach 2 Zyklen [177Lu]PSMA-617-Radioligandentherapie
Kerstin Michalski
  Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
,
Michael Mix
  Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
,
Philipp T. Meyer
  Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
,
Juri Ruf
  Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
› Author Affiliations
Further Information

Publication History

04 July 2019

24 October 2019

Publication Date:
13 November 2019 (online)

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Abstract

Aim In patients with metastasized castration-resistant prostate cancer a reliable imaging-based therapy response assessment in addition to PSA kinetics is desirable. Recently, measurements of whole-body tumour burden by [68Ga]PSMA-11 PET/CT have been reported for response assessment in oligometastasic patients. The present study investigated the association of PSMA PET derived parameters and serum PSA level before and after [177Lu]PSMA-617 radioligand therapy (RLT).

Methods This retrospective study assessed whole-body PSMA tumour volume (PSMA-TV) in 10 patients with multifocal to diffuse metastases before and after 2 cycles of RLT using volume of interest (VOI) analysis. A standardized uptake value (SUV) threshold-based approach was used to semi-automatically delineate all voxels with a SUV ≥ 2.0 g/ml using the software ROVER® (ABX Radeberg, Germany). Voxels with physiological tracer uptake (e. g. kidneys) were excluded manually. Correlations between PSMA-TV and serum PSA level before and after two cycles of RLT as well as changes thereof (ΔPSMA-TV and ΔPSA, respectively) were calculated.

Results Changes of ΔPSMA-TV and ΔPSA were concordant in 7 of 10 patients. Whereas a good correlation was found between PSMA-TV and PSA before RLT (ρ = 0.81, p = 0.0049), this correlation was attenuated after RLT (ρ = 0.64, p = 0.0479). Consequently, no association was found between ΔPSMA-TV and ΔPSA (ρ = 0.39, p = 0.26).

Conclusion The attenuation of the correlation of PSA and PSMA-TV after RLT suggests that in patients with advanced disease the comparison of imaging based parameters such as PSMA-TV and PSA level might be useful for an adequate monitoring of treatment response.

Zusammenfassung

Ziel Bei Patienten mit fortgeschrittenem metastasiertem Prostatakarzinom stehen neben dem PSA-Verlauf nur eingeschränkt Bildgebungsresponsekriterien zur Verfügung. Studien legen jedoch bei oligometastasierten Patienten nach Chemotherapie oder antihormoneller Therapie eine bildgebende Responseabschätzung anhand PET-basierter Ganzkörper-PSMA-Tumorlast nahe. Ziel dieser Studie war es, den Zusammenhang zwischen PSMA-PET-basierten Parametern und dem PSA-Wert bei Patienten vor und nach [177Lu]PSMA-617-Radioligandentherapie (RLT) zu untersuchen.

Methodik Das Ganzkörper-PSMA-Tumorvolumen (PSMA-TV) und der PSA-Wert wurden bei 10 Patienten mit ausgeprägter, teils disseminierter Knochenmetastasierung vor und nach 2 Zyklen RLT retrospektiv bestimmt. Unter Verwendung eines absoluten Schwellwertes von SUV > 2,0 g/ml wurden alle Tumorareale semiautomatisch mittels der Software ROVER® (ABX Radeberg, Germany) konturiert. Nach der Entfernung von Voxeln mit physiologischer Tracerbelegung (z. B. Nieren) wurde das PSMA-TV bestimmt. Die Korrelation zwischen PSMA-TV und PSA-Wert vor bzw. nach 2 Zyklen RLT sowie die der jeweiligen prozentualen Änderung (ΔPSMA-TV und ΔPSA) wurden bestimmt.

Ergebnisse Es fand sich eine Übereinstimmung der prozentualen Änderung von ΔPSMA-TV und ΔPSA bei 7 von 10 Patienten. Während sich vor RLT eine gute Korrelation zwischen den PSA- und PSMA-TV-Werten (ρ = 0,81; p = 0,0049) zeigte, nahm diese nach 2 Zyklen ab (ρ = 0,64; p = 0,0479). Entsprechend zeigte sich keine Korrelation zwischen ΔPSMA-TV und ΔPSA (ρ = 0,39; p = 0,26).

Schlussfolgerungen Die Abnahme der Korrelation von PSMA-TV und PSA nach RLT suggeriert, dass bei Patienten mit fortgeschrittener Erkrankung die Bestimmung bildgebender Parameter, wie z. B. PSMA-TV, zusätzlich zur PSA-Messung sinnvoll sein könnte, um das Therapieansprechen besser abschätzen zu können.

Key words

[68Ga]PSMA-11 PET/CT - [177Lu]PSMA-617 radioligand therapy - TL-PSMA - PSMA-TV - whole-body tumour burden

Schlüsselwörter

[68Ga]PSMA-11 PET/CT - [177Lu]PSMA-617 Radioligandentherapie - TL-PSMA - PSMA-TV - Ganzkörpertumorlast

Supplement

 

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