Diagnostic value of additional 68Ga-PSMA-PET before 223Ra-dichloride therapy in patients with metastatic prostate carcinoma

Axel Bräuer; Kambiz Rahbar; Julia Konnert; Martin Bögemann; Lars Stegger

doi:10.3413/Nukmed-0846-16-09

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2017; 56(01): 14-22
DOI: 10.3413/Nukmed-0846-16-09

Original article

Schattauer GmbH

Diagnostic value of additional ⁶⁸Ga-PSMA-PET before ²²³Ra-dichloride therapy in patients with metastatic prostate carcinoma

Der diagnostische Nutzen des ⁶⁸Ga-PSMA-PET vor einer ²²³Ra-Dichlorid-Therapie bei Patienten mit metastasiertem Prostatakarzinom

Axel Bräuer

¹Department of Nuclear Medicine, University Hospital Münster, Münster, Germany

,

Kambiz Rahbar

¹Department of Nuclear Medicine, University Hospital Münster, Münster, Germany

,

Julia Konnert

¹Department of Nuclear Medicine, University Hospital Münster, Münster, Germany

,

Martin Bögemann

²Department of Urology, University Hospital Münster, Münster, Germany

,

Lars Stegger

¹Department of Nuclear Medicine, University Hospital Münster, Münster, Germany

› Institutsangaben

Abstract

Summary

Purpose: Medical imaging plays an important role in selecting patients with metastatic castration-resistant prostate cancer for ²²³Ra- dichloride therapy of bone metastases. The purpose of this study was to investigate whether ⁶⁸Ga-PSMA-PET has incremental value over conventional imaging for selecting patients suitable for ²²³Ra-dichloride therapy. Methods: In 27 consecutive patients referred for ²²³Ra-dichloride therapy additional ⁶⁸Ga-PSMA-PET/CT was performed and tracer distribution was evaluated systematically with respect to the detection of visceral metastases and bone metastases with inadequate uptake on bone scintigraphy. Results: In 4 patients (15 %) ⁶⁸Ga- PSMA-PET revealed previously unknown visceral metastases (3 liver, 1 adrenal gland), which changed the therapeutic decision in 2 cases. PET revealed more extended tumour involvement in the bone compared to bone scintigraphy in 9 patients (33 %). In 3 of these, the mismatch was extensive enough to question suitability for ²²³Ra-dichloride therapy. Conclusions: Additional ⁶⁸Ga-PSMA-PET as a gatekeeper between conventional staging and ²²³Ra-dichloride therapy can provide valuable additional information with regard to visceral metastases and tumour manifestations without adequate bone mineral turnover. It may lead to a change in therapeutic management in a significant number of patients and should therefore be considered in future clinical trials.

Zusammenfassung

Ziel: Die Bildgebung spielt eine wichtige Rolle für die Auswahl derjenigen Patienten mit einem metastasierten, kastrastionsrefraktärem Prostatakarzinom, die sich für eine ²²³Ra-Di- chlorid-Therapie von Knochenmetastasen eignen. Das Ziel dieser Studie war zu untersuchen, ob eine zusätzliche ⁶⁸Ga-PSMA-PET ei nen inkrementellen Nutzen gegenüber der konventionellen Bildgebung für die Auswahl geeigneter Patienten für diese Therapie auf- weist.Methoden: Bei 27 konsekutiv für eine ²²³Ra-Dichlorid-Therapie vorgestellten Patienten wurde eine zusätzliche ⁶⁸Ga-PSMA- PET/CT durchgeführt. Die Tracerverteilung wurde systematisch ausgewertet in Hinblick auf die Detektion von viszeralen Metastasen und auf ossäre Metastasen ohne adäquate Speicherung in der Skelettszintigraphie. Ergebnisse: Zusätzliche viszerale Metastasen wurden bei 4 Patienten (15%) mittels ⁶⁸Ga- PSMA-PET detektiert (3 Leber, 1 Nebenniere), wobei das therapeutische Vorgehen bei 2 der 4 Patienten geändert wurde. Mit der PET wurde eine ausgedehntere Knochenmetastasierung im Vergleich zur Skelettszintigraphie bei 9 Patienten (33%) nachgewiesen. Bei dreien dieser Patienten war der „Mismatch” ausgedehnt genug, um die Durchführung der ²²³Ra-Dichlorid-Therapie in Frage zu stellen. Schlussfolgerung: Die zusätzliche ⁶⁸Ga- PSMA-PET als Torwächter zwischen konventioneller Bildgebung und der ²²³Ra-Dichlorid- Therapie kann wichtige zusätzliche Informationen liefern über das Vorliegen von viszeralen Metastasen und von Tumormanifestationen ohne adäquaten Knochenstoffwechsel. Dieses kann bei einer signifikanten Zahl von Patienten zu einer Änderung des therapeutischen Managements führen und sollte für zukünftige klinische Studien berücksichtigt werden.

Keywords

prostate cancer - bone metastases - bone scintigraphy - ⁶⁸Ga-PSMA-PET - ²²³Ra-dichloride - Xofigo^®

Schlüsselwörter

Prostatakarzinom - Knochenmetastasen - Skelett szintigraphie - ⁶⁸Ga-PSMA-PET - ²²³Ra-Dichlo rid - Xofigo®

Volltext

Referenzen

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