﻿68Ga-RM2 PET in PSMA- positive and -negative prostate cancer patients

Sebastian Hoberück; Enrico Michler; Gerd Wunderlich; Steffen Löck; Tobias Hölscher; Michael Froehner; Anja Braune; Platzek Ivan; Danilo Seppelt; Klaus Zöphel; Jörg Kotzerke

doi:10.1055/a-0990-8898

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2019; 58(05): 352-362
DOI: 10.1055/a-0990-8898

Original Article

⁶⁸Ga-RM2 PET in PSMA- positive and -negative prostate cancer patients

⁶⁸Ga-RM2 PET bei PSMA-positiven und -negativen Prostatakarzinompatienten

Sebastian Hoberück

¹Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Enrico Michler

¹Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Gerd Wunderlich

¹Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Steffen Löck

²OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany

,

Tobias Hölscher

³Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Michael Froehner

⁴Department of Urology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Anja Braune

¹Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Platzek Ivan

⁵Department of Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Danilo Seppelt

⁵Department of Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Klaus Zöphel

¹Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

,

Jörg Kotzerke

¹Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany

› Author Affiliations

Abstract

Aim ⁶⁸Ga-PSMA-11 is the gold standard for molecular imaging of prostate cancer. However, recurrent tumor manifestations or metastases cannot be detected in every case. Therefore, we investigated if there is an additive value of the gastrin-releasing peptide receptor (GRP-R) ligand ⁶⁸Ga-RM2 compared to the well-established ⁶⁸Ga-PSMA-11 in patients with (Group 1) and without (Group 2) pathologic PSMA-expression in different tumor stages.

Patients and Methods Sixteen men (median age: 74 years, range 50–80 years) with prostate cancer in different stages who had a recent negative (n = 8) or pathologic (n = 8) PSMA PET underwent a subsequent ⁶⁸Ga-RM2 PET. Both examinations were analyzed qualitatively and quantitatively and compared in terms of pathologic and physiologic tracer distribution.

Results None of the PSMA-negative patients showed any pathological RM2-accumulation. Pathologic PSMA-uptake was observed in 8 patients of whom 5 had pathologic RM2-uptake. The number of patients with a local recurrence was equal in both scans (n = 3). Bone metastases and lymph node metastases were detected in less patients in RM2 PET compared to PSMA PET (n = 4 vs. 7 and n = 2 vs. 5, respectively). In one patient, PSMA-positive liver metastases were not detected in RM2. RM2 PET revealed two additional lesions indicative for bone metastases in two patients with multiple PSMA-positive bone metastases, which had no therapeutic consequence.

Conclusion At least in our small and heterogeneous patient population, ⁶⁸Ga-RM2 showed no clinically relevant, additional benefit compared to ⁶⁸Ga-PSMA-11 PET.

Zusammenfassung

Ziel ⁶⁸Ga-PSMA-11 ist der Goldstandard in der molekularen Bildgebung des Prostatakarzinoms. Jedoch gelingt die Detektion von primären Tumorrezidiven oder Metastasen nicht in jedem Fall. Daher wurde untersucht, ob der Gastrin Releasing Peptidrezeptor Ligand (GRP-L) ⁶⁸Ga-RM2 einen Zusatznutzen bei Patienten mit (Gruppe 1) und ohne (Gruppe 2) pathologischer PSMA-Anreicherung in verschiedenen Tumorstadien bietet.

Patienten und Methoden Sechzehn Patienten mit Prostatakarzinom (Medianes Alter: 74, Min-Max: 50–80 Jahre) verschiedener Stadien wurden nach rezenter PSMA-11-PET/CT mit (n = 8) bzw. ohne (n = 8) pathologischer PSMA-Liganden-Anreicherung anschließend mittels ⁶⁸Ga-RM2 PET untersucht. Die pathologischen Anreicherungen sowie die physiologische Radiotracerverteilung beider Untersuchungen wurden qualitativ und quantitativ bewertet und verglichen.

Ergebnisse Keiner der 8 PSMA-negativen Patienten zeigte eine pathologische ⁶⁸Ga-RM2-Anreicherung. Acht PSMA-positiven Patienten standen insgesamt 5 RM2-positve Patienten gegenüber. Während sich die Anzahl der detektierten Lokalrezidive (n = 3) zwischen beiden Tracern nicht unterschied, wurden in der RM2-Studie weniger Patienten mit mindestens einer Knochenmetastase (n = 4 vs. 7) und mit mindestens einer Lymphknotenmetastase (n = 2 vs. 5) detektiert. PSMA-positive Lebermetastasen eines Patienten zeigten ebenfalls kein RM2-Korrelat. Insgesamt wurden mittels ⁶⁸Ga-RM2 lediglich zwei zusätzliche Metastasen typische ossäre Läsionen bei Patienten mit zahlreichen PSMA-positiven Knochenmetastasen detektiert. In der untersuchten Kohorte konnte durch die ⁶⁸Ga-RM2-Diagnostik kein Zusatznutzen bezüglich eines veränderten therapeutischen Procederes ermittelt werden.

Schlussfolgerung Zumindest in unserem kleinen und heterogenen Patientenkollektiv zeigte ⁶⁸Ga-RM2 keinen klinisch relevanten Zusatznutzen gegenüber der ⁶⁸Ga-PSMA-11 PET.

Key words

PSMA - Bombesin - RM2 - prostate cancer - PET

Schlüsselwörter

PSMA - Bombesin - RM2 - Prostatakarzinom - PET

Full Text

References

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﻿68Ga-RM2 PET in PSMA- positive and -negative prostate cancer patients

⁶⁸Ga-RM2 PET in PSMA- positive and -negative prostate cancer patients