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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
1   Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
,
Kambiz Rahbar
1   Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
,
Julia Konnert
1   Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
,
Martin Bögemann
2   Department of Urology, University Hospital Münster, Münster, Germany
,
Lars Stegger
1   Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
› Author Affiliations
Further Information

Publication History

received: 01 September 2016

accepted in revised form: 13 January 2016

Publication Date:
02 January 2018 (online)

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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®
 

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