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Nuklearmedizin 2017; 56(06): 225-232
DOI: 10.3413/Nukmed-0917-17-07
Original Article
Schattauer GmbH

PSA levels, PSA doubling time, Gleason score and prior therapy cannot predict measured uptake of [68Ga]PSMA-HBED-CC lesion uptake in recurrent/metastatic prostate cancer

PSA-Werte, PSA-Verdopplungszeit, Gleason Score und Therapiestatus liefern keine Vorhersage zur Traceranreicherung von [68Ga]PSMA-HBED-CC bei von Patienten mit rezidiviertem und/oder metastasiertem PCA
Frederik A. Verburg
1   RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany
2   University Hospital Marburg, Department of Nuclear Medicine, Marburg, Germany
,
David Pfister
4   University Hospital Cologne, Department of Urology, Cologne, Germany
,
Natascha I. Drude
1   RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany
,
Felix M. Mottaghy
1   RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany
3   Maastricht University Medical Center, Department of Nuclear Medicine, Maastricht, the Netherlands
,
Florian F. Behrendt
1   RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany
5   Radiology Institute Aachen Land“, Würselen, Germany
› Author Affiliations
Further Information

Publication History

Received: 25 July 2017

accepted in revised form: 07 October 2017

Publication Date:
11 January 2018 (online)

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Summary

Aim: To assess whether clinical prostate cancer (PCA) related factors and therapy status can predict the degree of tracer uptake on [68Ga]PSMA-HBED-CC PET/CT.

Materials & methods: We retrospectively studied 124 patients with recurrent an/or metastatic PCA who underwent [68Ga]PSMAHBED-CC PET/CT. The maximum standardized uptake value (SUVmax) was determined in the prostate bed as well as in three size categories (≤ 5 mm, > 5–15 mm, > 15 mm) in pelvic lymph node, extrapelvic lymph node, bone and visceral metastases.

Results: Significant positive correlations between lesion size and SUVmax were found in pelvic lymph node metastases > 5 -≤15 mm (Spearmans rho = 0.502, p = 0.002) as well as in extrapelvic lymph node metastases5 mm (rho = 0.314, p = 0.033) and > 5 ≤-15 mm (rho = 0.614, p < 0.001). SUVmax tended to be higher in the largest diameter category in each anatomic station than in the middle and lower categories. We were unable to find evidence for a relationship between SUVmax and PSA, PSAdt, Gleason score, androgen deprivation therapy, radiation therapy or chemotherapy status.

Conclusion: Measured tracer uptake in [68Ga]PSMA-HBED-CC PET/CT in patients with recurrent/metastasized prostate cancer is significantly influenced by lesion size as a result of partial volume effects in the very small lesions. Clinical indicators of aggressive prostate cancer behaviour such as PSA levels, PSA doubling time or the Gleason score of the primary tumour, as well as the androgen deprivation therapy, radiation therapy or chemotherapy status are not related to measured tracer uptake.

Zusammenfassung

Ziel: Beantwortung der Frage ob klinisch bestimmbare Faktoren und Therapiestatus bei Prostatakarzinom (PCA) eine Vorhersage zur Traceranreicherung in [68Ga]PSMA-HBED-CC PET/CT liefern können.

Material & Methoden: 124 Patienten mit rezidiviertem und/oder metastasiertem PCA die [68Ga]PSMA-HBED-CC PET/CT untergingen, wurden retrospektiv untersucht. Der maximum Standardized Uptake Value (SUVmax) wurde in der Prostataloge gemessen sowie in drei Größen-Kategorien ( 5 mm, > 5–15 mm, > 15 mm) in Metastasen in den pelvinen Lymphknoten-, extrapelvinen Lymphknoten-, Knochen- und viszeralen Metastasen. Ergebnisse: Signifikant positive Korrelationen zwischen Läsionsgröße und SUVmax wurden in pelvinen Lymphknotenmetastasen > 5 -≤15 mm (Spearmans rho = 0.502, p = 0.002), extrapelvinen Lymphknotenmetastasen5 mm (rho = 0.314, p = 0.033) und > 5 -≤15 mm (rho = 0.614, p < 0.001) gefunden. Für jede anatomische Lokalisation wurde ein höherer Wert SUVmax innerhalb der größten Kategorie verglichen zu mittleren und kleinsten Kategorie gefunden.

Keywords

PSA - PSA doubling time - Gleason score - prostate cancer - [68Ga]PSMA-HBED-CC PET/CT

Schlüsselwörter

PSA - PSA-Verdopplungszeit - Gleason Score - Prostatakarzinom - [68Ga]PSMA-HBED-CC PET/CT
 

  • References

  • 1 Afshar-Oromieh A, Avtzi E, Giesel FL. et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2015; 42: 197-209.
    CrossrefPubMedGoogle Scholar
  • 2 Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA, Holland-Letz T, Giesel FL, Kratochwil C, Haufe S, Haberkorn U, Zechmann CM. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging 2013; 40: 486-495.
    CrossrefPubMedGoogle Scholar
  • 3 Bostwick DG, Pacelli A, Blute M, Roche P, Murphy GP. Prostate specific membrane antigen expression in prostatic intraepithelial neoplasia and adenocarcinoma: a study of 184 cases. Cancer 1998; 82: 2256-2261.
    CrossrefPubMedGoogle Scholar
  • 4 Ceci F, Uprimny C, Nilica B. et al. Ga-PSMA PET/ CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate?. Eur J Nucl Med Mol Imaging 2015; 42: 1284-1294.
    CrossrefPubMedGoogle Scholar
  • 5 Demirci E, Ocak M, Kabasakal L, Decristoforo C, Talat Z, Halac M, Kanmaz B. (68)Ga-PSMA PET/ CT imaging of metastatic clear cell renal cell carcinoma. Eur J Nucl Med Mol Imaging 2014; 41: 1461-1462.
    CrossrefPubMedGoogle Scholar
  • 6 Eder M, Schafer M, Bauder-Wust U, Hull WE, Wangler C, Mier W, Haberkorn U, Eisenhut M. 68Ga-complex lipophilicity and the targeting property of a urea-based PSMA inhibitor for PET imaging. Bioconjug Chem 2012; 23: 688-697.
    CrossrefPubMedGoogle Scholar
  • 7 Eiber M, Maurer T, Souvatzoglou M. et al. Evaluation of Hybrid 68Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy. J Nucl Med 2015; 56: 668-674.
    CrossrefPubMedGoogle Scholar
  • 8 Einspieler I, Rauscher I, Duwel C, Kronke M, Rischpler C, Habl G, Dewes S, Ott A, Wester HJ, Schwaiger M, Maurer T, Eiber M. Detection Efficacy of Hybrid 68Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria. J Nucl Med 2017; 58: 1081-1087.
    CrossrefPubMedGoogle Scholar
  • 9 Giesel FL, Fiedler H, Stefanova M, Sterzing F, Rius M, Kopka K, Moltz JH, Afshar-Oromieh A, Choyke PL, Haberkorn U, Kratochwil C. PSMA PET/CT with Glu-urea-Lys-(Ahx)-[Ga(HBEDCC)] versus 3D CT volumetric lymph node assessment in recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2015; 42: 1794-1800.
    CrossrefPubMedGoogle Scholar
  • 10 Hanscheid H, Sweeney RA, Flentje M, Buck AK, Lohr M, Samnick S, Kreissl M, Verburg FA. PET SUV correlates with radionuclide uptake in peptide receptor therapy in meningioma. Eur J Nucl Med Mol Imaging 2012; 39: 1284-1288.
    CrossrefPubMedGoogle Scholar
  • 11 Kabasakal L, Demirci E, Ocak M, Akyel R, Nematyazar J, Aygun A, Halac M, Talat Z, Araman A. Evaluation of PSMA PET/CT imaging using a 68Ga-HBED-CC ligand in patients with prostate cancer and the value of early pelvic imaging. Nucl Med Commun 2015; 42: 987-988.
    Google Scholar
  • 12 Kratochwil C, Giesel FL, Eder M, Afshar-Oromieh A, Benesova M, Mier W, Kopka K, Haberkorn U. [Lu]Lutetium-labelled PSMA ligand-induced remission in a patient with metastatic prostate cancer. Eur J Nucl Med Mol Imaging 2015; 42: 987-988.
    CrossrefPubMedGoogle Scholar
  • 13 Krohn T, Birmes A, Winz OH, Drude NI, Mottaghy FM, Behrendt FF, Verburg FA. The reconstruction algorithm used for [68Ga]PSMA-HBED-CC PET/CT reconstruction significantly influences the number of detected lymph node metastases and coeliac ganglia. Eur J Nucl Med Mol Imaging 2017; 44: 662-669.
    CrossrefPubMedGoogle Scholar
  • 14 Krohn T, Verburg FA, Pufe T, Neuhuber W, Vogg A, Heinzel A, Mottaghy FM, Behrendt FF. [(68)Ga]PSMA-HBED uptake mimicking lymph node metastasis in coeliac ganglia: an important pitfall in clinical practice. Eur J Nucl Med Mol Imaging 2015; 42: 210-214.
    CrossrefPubMedGoogle Scholar
  • 15 Mannweiler S, Amersdorfer P, Trajanoski S, Terrett JA, King D, Mehes G. Heterogeneity of prostate-specific membrane antigen (PSMA) expression in prostate carcinoma with distant metastasis. Pathol Oncol Res 2009; 15: 167-172.
    CrossrefPubMedGoogle Scholar
  • 16 Marchal C, Redondo M, Padilla M, Caballero J, Rodrigo I, Garcia J, Quian J, Boswick DG. Expression of prostate specific membrane antigen (PSMA) in prostatic adenocarcinoma and prostatic intraepithelial neoplasia. Histol Histopathol 2004; 19: 715-718.
    PubMedGoogle Scholar
  • 17 Meller B, Bremmer F, Sahlmann CO, Hijazi S, Bouter C, Trojan L, Meller J, Thelen P. Alterations in androgen deprivation enhanced prostate-specific membrane antigen (PSMA) expression in prostate cancer cells as a target for diagnostics and therapy. EJNMMI Res 2015; 5: 66.
    CrossrefPubMedGoogle Scholar
  • 18 Ross JS, Sheehan CE, Fisher HA, Kaufman Jr RP, Kaur P, Gray K, Webb I, Gray GS, Mosher R, Kallakury BV. Correlation of primary tumor prostate-specific membrane antigen expression with disease recurrence in prostate cancer. Clin Cancer Res 2003; 9: 6357-6362.
    PubMedGoogle Scholar
  • 19 Rowe SP, Gage KL, Faraj SF. et al. (1)(8)F-DCFBC PET/CT for PSMA-Based Detection and Characterization of Primary Prostate Cancer. J Nucl Med 2015; 56: 1003-1010.
    CrossrefPubMedGoogle Scholar
  • 20 Sachpekidis C, Eder M, Kopka K, Mier W, Hadaschik BA, Haberkorn U, Dimitrakopoulou-Strauss A. Ga-PSMA-11 dynamic PET/CT imaging in biochemical relapse of prostate cancer. Eur J Nucl Med Mol Imaging 2016; 41: e473-e479.
    Google Scholar
  • 21 Sahlmann CO, Meller B, Bouter C, Ritter CO, Strobel P, Lotz J, Trojan L, Meller J, Hijazi S. Biphasic (6)(8)Ga-PSMA-HBED-CC-PET/CT in patients with recurrent and high-risk prostate carcinoma. Eur J Nucl Med Mol Imaging 2016; 43: 898-905.
    CrossrefPubMedGoogle Scholar
  • 22 Schmittgen TD, Teske S, Vessella RL, True LD, Zakrajsek BA. Expression of prostate specific membrane antigen and three alternatively spliced variants of PSMA in prostate cancer patients. Int J Cancer 2003; 107: 323-329.
    CrossrefPubMedGoogle Scholar
  • 23 Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res 1997; 3: 81-85.
    PubMedGoogle Scholar
  • 24 Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th ed. New-York: Wiley-Blackwell,; 2009
    Google Scholar
  • 25 Stewart SB, Cheville JC, Sebo TJ. et al. Gleason grading after neoadjuvant hormonal therapy retains prognostic value for systemic progression following radical prostatectomy. Prostate Cancer Prostatic Dis 2014; 17: 332-337.
    CrossrefPubMedGoogle Scholar
  • 26 Uprimny C, Kroiss AS, Decristoforo C, Fritz J, von Guggenberg E, Kendler D, Scarpa L, di Santo G, Roig LG, Maffey-Steffan J, Horninger W, Virgolini IJ. 68Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Med Mol Imaging 2017; 44: 941-949.
    CrossrefPubMedGoogle Scholar
  • 27 Verburg FA, Krohn T, Heinzel A, Mottaghy FM, Behrendt FF. First evidence of PSMA expression in differentiated thyroid cancer using [Ga]PSMAHBED-CC PET/CT. Eur J Nucl Med Mol Imaging 2015; 42: 1622-1623.
    CrossrefPubMedGoogle Scholar
  • 28 Verburg FA, Pfister D, Heidenreich A, Vogg A, Drude NI, Voo S, Mottaghy FM, Behrendt FF. Extent of disease in recurrent prostate cancer determined by [Ga]PSMA-HBED-CC PET/CT in relation to PSA levels, PSA doubling time and Gleason score. Eur J Nucl Med Mol Imaging 2015; 43: 397-403.
    PubMedGoogle Scholar
  • 29 Zielinski A, Behrendt FF, Verburg FA, Mottaghy FM, Krohn T. Phantom studies and clinical application of high resolution, image reconstruction using (18)F-fluoromethylcholine PET/CT for prostate cancer. Hell J Nucl Med 2014; 17: 194-199.
    PubMedGoogle Scholar