The Diagnostic Performance of 18F-PSMA-1007 PET/CT in Prostate Cancer Patients with Early Recurrence after Definitive Therapy with a PSA <10 ng/ml

Thabo Lengana; Ismaheel Lawal; Charl Janse Van Rensburg; Kgomotso Mokoala; Evelyn Moshokoa; Sfiso Mazibuko; Christophe Van de Wiele; Alex Maes; Mariza Vorster; Mike Machaba Sathekge

doi:10.1055/a-1759-1603

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2022; 61(02): 120-129
DOI: 10.1055/a-1759-1603

Original Article

The Diagnostic Performance of ¹⁸F-PSMA-1007 PET/CT in Prostate Cancer Patients with Early Recurrence after Definitive Therapy with a PSA <10 ng/ml

Diagnostische Leistung der ¹⁸F-PSMA-1007 PET/CT bei Prostatakarzinom-Patienten mit frühem Rezidiv nach definitiver Therapie und einem PSA <10 ng/ml

Thabo Lengana

¹Nuclear Medicine, University of Pretoria, Pretoria, South Africa

,

Ismaheel Lawal

¹Nuclear Medicine, University of Pretoria, Pretoria, South Africa

,

Charl Janse Van Rensburg

²Biostatistics Unit, Pretoria MRC, South African Medical Research Council, Pretoria, South Africa

,

Kgomotso Mokoala

¹Nuclear Medicine, University of Pretoria, Pretoria, South Africa

,

Evelyn Moshokoa

³Urology, University of Pretoria, Pretoria, South Africa (Ringgold ID: RIN56410)

,

Sfiso Mazibuko

³Urology, University of Pretoria, Pretoria, South Africa (Ringgold ID: RIN56410)

,

Christophe Van de Wiele

⁴Nuclear Medicine, Universiteit Gent Faculteit Geneeskunde en Gezondheidswetenschappen, Gent, Belgium (Ringgold ID: RIN54498)

,

Alex Maes

⁵Department Nuclear Medicine, University Hospital Leuven, Kortrijk, Belgium

,

Mariza Vorster

¹Nuclear Medicine, University of Pretoria, Pretoria, South Africa

,

Mike Machaba Sathekge

¹Nuclear Medicine, University of Pretoria, Pretoria, South Africa

› Author Affiliations

Abstract

Aim The prostate bed is one of the common sites of early recurrence of prostate cancer. The currently used PSMA ligands (⁶⁸Ga-PSMA-11 and ^99mTc-PSMA) undergo early urinary clearance resulting in interfering physiological activity within and surrounding the prostate. This can result in sites of cancer recurrence being obscured. ¹⁸F-PSMA-1007 has an advantage of delayed urinary clearance thus the prostate region is reviewed without any interfering physiological activity. The aim of this study was to determine the diagnostic performance of ¹⁸F-PSMA-1007 PET/CT in patients with early biochemical recurrence after definitive therapy.

Methods Forty-six Prostate cancer (mean age 66.7±7.5, range 48–87 years) presenting with biochemical recurrence (median PSA 1.6ng/ml, range 0.1–10.0) underwent non-contrast-enhanced ¹⁸F-PSMA-1007 PET/CT. PET/CT findings were evaluated qualitatively and semiquantitatively (SUVmax) and compared to the results of histology, Gleason grade, and conventional imaging.

Results Twenty-four of the 46 (52.2%) patients demonstrated a site of recurrence on ¹⁸F-PSMA-1007 PET/CT. Oligometastatic disease was detected in 15 (32.6%) of these patients. Of these 10 (37.5%) demonstrated intra-prostatic recurrence, lymph node disease was noted in 11 (45.8%) whilst two patients demonstrated skeletal metastases. The detection rates for PSA levels 0–<0.5, 0.5–<1, 1–2, >2 were 31.3%, 33.3%, 55.6% and 72.2% respectively. 7 (29.2%) of the positive patients had been described as negative or equivocal on conventional imaging. An optimal PSA cut-off level of 1.3ng/ml was found.

Conclusion ¹⁸F-PSMA-1007 demonstrated good diagnostic performance detecting sites of recurrence. Its ability to detect sites of recurrence in the setting of early biochemical recurrence will have a significant impact on patient management.

Zusammenfassung

Ziel Das Prostatabett ist eine der häufigsten Stellen für das Auftreten eines frühen Rezidivs bei Prostatakarzinom. Die derzeit verwendeten PSMA-Liganden (68Ga-PSMA-11 und 99mTc-PSMA) werden frühzeitig mit dem Urin ausgeschieden, was zu einer Beeinträchtigung der physiologischen Aktivität in und um die Prostata führt. Dies kann dazu führen, dass Stellen, an denen der Krebs wieder auftritt, verborgen bleiben. 18F-PSMA-1007 hat den Vorteil einer verzögerten Urinausscheidung, sodass die Prostataregion ohne störende physiologische Aktivität untersucht wird. Ziel dieser Studie war es, die diagnostische Leistung von 18F-PSMA-1007-PET/CT bei Patienten mit frühem biochemischem Rezidiv nach definitiver Therapie zu bestimmen.

Methoden 46 Patienten mit Prostatakarzinom (Durchschnittsalter 66,7 ±7,5 Jahre, Bereich 48–87 Jahre) und biochemischem Rezidiv (medianes PSA 1,6ng/ml, Bereich 0,1–10,0) unterzogen sich einer nicht kontrastverstärkten 18F-PSMA-1007-PET/CT. Die PET/CT-Befunde wurden qualitativ und semiquantitativ (SUV_max) ausgewertet und mit den Ergebnissen der Histologie, dem Gleason-Score und der konventionellen Bildgebung verglichen.

Ergebnisse 24 der 46 Patienten (52,2%) wiesen im 18F-PSMA-1007-PET/CT ein Rezidiv auf. Bei 15 (32,6%) dieser Patienten wurde eine oligometastatische Erkrankung festgestellt. Von diesen wiesen 10 (37,5%) ein intraprostatisches Rezidiv auf, bei 11 (45,8%) wurde ein Lymphknotenbefall festgestellt, während 2 Patienten Knochenmetastasen aufwiesen. Die Detektionsraten betrugen 31,3% für PSA-Werte von 0–<0,5, 33,3% für 0,5–<1, 55, 6% für 1–2 und 72,2% für >2. Sieben der positiven Patienten (29,2%) waren bei der konventionellen Bildgebung als negativ oder grenzwertig beschrieben worden. Für PSA wurde ein optimaler Cut-off-Wert von 1,3ng/ml ermittelt.

Schlussfolgerung 18F-PSMA-1007 zeigte eine gute diagnostische Leistung bei der Lokalisation des Rezidivs. Diese Fähigkeit, das Rezidiv bei einem frühen biochemischen Rezidiv zu lokalisieren, wird sich erheblich auf das Patientenmanagement auswirken.

Schlüsselwörter

¹⁸F-PSMA-1007 PET/CT - 68Ga-PSMA-11 PET/CT - biochemisches Rezidiv - Prostatakarzinom

Keywords

¹⁸F-PSMA-1007 PET/CT - 68Ga-PSMA-11 PET/CT - biochemical recurrence - prostate cancer

Full Text

References

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