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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
1   Nuclear Medicine, University of Pretoria, Pretoria, South Africa
,
Ismaheel Lawal
1   Nuclear Medicine, University of Pretoria, Pretoria, South Africa
,
Charl Janse Van Rensburg
2   Biostatistics Unit, Pretoria MRC, South African Medical Research Council, Pretoria, South Africa
,
Kgomotso Mokoala
1   Nuclear Medicine, University of Pretoria, Pretoria, South Africa
,
Evelyn Moshokoa
3   Urology, University of Pretoria, Pretoria, South Africa (Ringgold ID: RIN56410)
,
Sfiso Mazibuko
3   Urology, University of Pretoria, Pretoria, South Africa (Ringgold ID: RIN56410)
,
Christophe Van de Wiele
4   Nuclear Medicine, Universiteit Gent Faculteit Geneeskunde en Gezondheidswetenschappen, Gent, Belgium (Ringgold ID: RIN54498)
,
Alex Maes
5   Department Nuclear Medicine, University Hospital Leuven, Kortrijk, Belgium
,
Mariza Vorster
1   Nuclear Medicine, University of Pretoria, Pretoria, South Africa
,
Mike Machaba Sathekge
1   Nuclear Medicine, University of Pretoria, Pretoria, South Africa
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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 (SUVmax) 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


Publication History

Received: 07 July 2021

Accepted after revision: 22 January 2022

Article published online:
14 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literature

  • 1 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424
    CrossrefPubMedSearch in Google Scholar
  • 2 Jadvar H. Prostate cancer: PET with 18F-FDG, 18F- or 11C-acetate, and 18F- or 11C-choline. J Nucl Med 2011; 52: 81-89
    CrossrefPubMedSearch in Google Scholar
  • 3 Punnen S, Cooperberg MR, D'Amico AV. et al. Management of biochemical recurrence after primary treatment of prostate cancer: a systematic review of the literature. Eur Urol 2013; 64: 905-915
    CrossrefPubMedSearch in Google Scholar
  • 4 Heidenreich A, Bastian PJ, Bellmunt J. et al. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 2014; 65: 467-479
    CrossrefPubMedSearch in Google Scholar
  • 5 Swanson GP, Hussey MA, Tangen CM. et al. Predominant treatment failure in postprostatectomy patients is local: analysis of patterns of treatment failure in SWOG 8794. J Clin Oncol 2007; 25: 2225-2229
    CrossrefPubMedSearch in Google Scholar
  • 6 Kattan MW, Wheeler TM, Scardino PT. Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer. J Clin Oncol 1999; 17: 1499-1507
    CrossrefPubMedSearch in Google Scholar
  • 7 Cornford P, Bellmunt J, Bolla M. et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur Urol 2017; 71: 630-642
    CrossrefPubMedSearch in Google Scholar
  • 8 Zheng QH, Gardner TA, Raikwar S. et al. [11C]Choline as a PET biomarker for assessment of prostate cancer tumor models. Bioorg Med Chem 2004; 12: 2887-2893
    CrossrefPubMedSearch in Google Scholar
  • 9 Afshar-Oromieh A, Haberkorn U, Eder M. et al. 68Ga. Eur J Nucl Med Mol Imaging 2012; 39: 1085-1086
    CrossrefPubMedSearch in Google Scholar
  • 10 Fendler WP, Eiber M, Beheshti M. et al. 68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging 2017; 44: 1014-1024
    CrossrefPubMedSearch in Google Scholar
  • 11 Perera M, Papa N, Christidis D. et al. Sensitivity, Specificity, and Predictors of Positive 68Ga-Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol 2016; 70: 926-937
    CrossrefPubMedSearch in Google Scholar
  • 12 Pianou NK, Stavrou PZ, Vlontzou E. et al. More advantages in detecting bone and soft tissue metastases from prostate cancer using (18)F-PSMA PET/CT. Hell J Nucl Med 2019; 22: 6-9
    CrossrefPubMedSearch in Google Scholar
  • 13 Giesel FL, Hadaschik B, Cardinale J. et al. F-18 labelled PSMA-1007: biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. Eur J Nucl Med Mol Imaging 2017; 44: 678-688
    CrossrefPubMedSearch in Google Scholar
  • 14 Cardinale J, Schafer M, Benesova M. et al. Preclinical Evaluation of (18)F-PSMA-1007, a New Prostate-Specific Membrane Antigen Ligand for Prostate Cancer Imaging. J Nucl Med 2017; 58: 425-431
    CrossrefPubMedSearch in Google Scholar
  • 15 Pfob CH, Ziegler S, Graner FP. et al. Biodistribution and radiation dosimetry of (68)Ga-PSMA HBED CC-a PSMA specific probe for PET imaging of prostate cancer. Eur J Nucl Med Mol Imaging 2016; 43: 1962-1970
    CrossrefPubMedSearch in Google Scholar
  • 16 Giesel FL, Will L, Lawal I. et al. Intraindividual Comparison of (18)F-PSMA-1007 and (18)F-DCFPyL PET/CT in the Prospective Evaluation of Patients with Newly Diagnosed Prostate Carcinoma: A Pilot Study. J Nucl Med 2018; 59: 1076-1080
    CrossrefPubMedSearch in Google Scholar
  • 17 Koschel S, Taubman K, Sutherland T. et al. Patterns of disease detection using [(18)F]DCFPyL PET/CT imaging in patients with detectable PSA post prostatectomy being considered for salvage radiotherapy: a prospective trial. Eur J Nucl Med Mol Imaging 2021; 48: 3712-3722
    CrossrefPubMedSearch in Google Scholar
  • 18 Wondergem M, Jansen BHE, van der Zant FM. et al. Early lesion detection with (18)F-DCFPyL PET/CT in 248 patients with biochemically recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2019; 46: 1911-1918
    CrossrefPubMedSearch in Google Scholar
  • 19 Sun J, Lin Y, Wei X. et al. Performance of 18F-DCFPyL PET/CT Imaging in Early Detection of Biochemically Recurrent Prostate Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11: 649171
    CrossrefPubMedSearch in Google Scholar
  • 20 Perry E, Talwar A, Taubman K. et al. (18)F]DCFPyL PET/CT in detection and localization of recurrent prostate cancer following prostatectomy including low PSA. Eur J Nucl Med Mol Imaging 2021; 48: 2038-2046
    CrossrefPubMedSearch in Google Scholar
  • 21 Witkowska-Patena E, Gizewska A, Dziuk M. et al. Diagnostic performance of 18F-PSMA-1007 PET/CT in biochemically relapsed patients with prostate cancer with PSA levels </= 2.0 ng/ml. Prostate Cancer Prostatic Dis 2020; 23: 343-348
    CrossrefPubMedSearch in Google Scholar
  • 22 Sachpekidis C, Afshar-Oromieh A, Kopka K. et al. (18)F-PSMA-1007 multiparametric, dynamic PET/CT in biochemical relapse and progression of prostate cancer. Eur J Nucl Med Mol Imaging 2020; 47: 592-602
    CrossrefPubMedSearch in Google Scholar
  • 23 Giesel FL, Knorr K, Spohn F. et al. Detection Efficacy of (18)F-PSMA-1007 PET/CT in 251 Patients with Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy. J Nucl Med 2019; 60: 362-368
    CrossrefPubMedSearch in Google Scholar
  • 24 Dietlein M, Kobe C, Kuhnert G. et al. Comparison of [(18)F]DCFPyL and [ (68)Ga]Ga-PSMA-HBED-CC for PSMA-PET Imaging in Patients with Relapsed Prostate Cancer. Mol Imaging Biol 2015; 17: 575-584
    CrossrefPubMedSearch in Google Scholar
  • 25 Hofman MS, Hicks RJ, Maurer T. et al. Prostate-specific Membrane Antigen PET: Clinical Utility in Prostate Cancer, Normal Patterns, Pearls, and Pitfalls. Radiographics 2018; 38: 200-2017
    CrossrefPubMedSearch in Google Scholar
  • 26 https://www.mskcc.org/nomograms/prostate/psa_doubling_time. 2020
    PubMedSearch in Google Scholar
  • 27 Pierorazio PM, Walsh PC, Partin AW. et al. Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 2013; 111: 753-760
    CrossrefPubMedSearch in Google Scholar
  • 28 Stephenson AJ, Scardino PT, Kattan MW. et al. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 2007; 25: 2035-2041
    CrossrefPubMedSearch in Google Scholar
  • 29 Banerjee SR, Pullambhatla M, Byun Y. et al. 68Ga-labeled inhibitors of prostate-specific membrane antigen (PSMA) for imaging prostate cancer. J Med Chem 2010; 53: 5333-5341
    CrossrefPubMedSearch in Google Scholar
  • 30 Eder M, Schafer M, Bauder-Wust U. et al. 68Ga-complex lipophilicity and the targeting property of a urea-based PSMA inhibitor for PET imaging. Bioconjug Chem 2012; 23: 688-697
    CrossrefPubMedSearch in Google Scholar
  • 31 Afaq A, Alahmed S, Chen SH. et al. Impact of (68)Ga-Prostate-Specific Membrane Antigen PET/CT on Prostate Cancer Management. J Nucl Med 2018; 59: 89-92
    CrossrefPubMedSearch in Google Scholar
  • 32 Lengana T, Lawal IO, Boshomane TG. et al. (68)Ga-PSMA PET/CT Replacing Bone Scan in the Initial Staging of Skeletal Metastasis in Prostate Cancer: A Fait Accompli?. Clin Genitourin Cancer 2018; 16: 392-401
    CrossrefPubMedSearch in Google Scholar
  • 33 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
    CrossrefPubMedSearch in Google Scholar
  • 34 Fendler WP, Calais J, Eiber M. et al. Assessment of 68Ga-PSMA-11 PET Accuracy in Localizing Recurrent Prostate Cancer: A Prospective Single-Arm Clinical Trial. JAMA Oncol 2019; 5: 856-863
    CrossrefPubMedSearch in Google Scholar
  • 35 Ceci F, Uprimny C, Nilica B. et al. (68)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
    CrossrefPubMedSearch in Google Scholar
  • 36 von Eyben FE, Picchio M, von Eyben R. et al. (68)Ga-Labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography/Computed Tomography for Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2018; 4: 686-693
    CrossrefPubMedSearch in Google Scholar
  • 37 Rahbar K, Afshar-Oromieh A, Seifert R. et al. Diagnostic performance of (18)F-PSMA-1007 PET/CT in patients with biochemical recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2018; 45: 2055-2061
    CrossrefPubMedSearch in Google Scholar
  • 38 Hoffmann MA, Buchholz HG, Wieler HJ. et al. PSA and PSA Kinetics Thresholds for the Presence of (68)Ga-PSMA-11 PET/CT-Detectable Lesions in Patients With Biochemical Recurrent Prostate Cancer. Cancers (Basel) 2020; 12: 398
    CrossrefPubMedSearch in Google Scholar
  • 39 Sartor O, Eisenberger M, Kattan MW. et al. Unmet needs in the prediction and detection of metastases in prostate cancer. Oncologist 2013; 18: 549-557
    CrossrefPubMedSearch in Google Scholar
  • 40 Pereira Mestre R, Treglia G, Ferrari M. et al. Correlation between PSA kinetics and PSMA-PET in prostate cancer restaging: A meta-analysis. Eur J Clin Invest 2019; 49: e13063
    CrossrefPubMedSearch in Google Scholar
  • 41 Verburg FA, Pfister D, Heidenreich A. et al. Extent of disease in recurrent prostate cancer determined by [(68)Ga]PSMA-HBED-CC PET/CT in relation to PSA levels, PSA doubling time and Gleason score. Eur J Nucl Med Mol Imaging 2016; 43: 397-403
    CrossrefPubMedSearch in Google Scholar
  • 42 Afshar-Oromieh A, Holland-Letz T, Giesel FL. et al. Diagnostic performance of 68Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging 2017; 44: 1258-1268
    CrossrefPubMedSearch in Google Scholar
  • 43 Ekmekcioglu O, Busstra M, Klass ND. et al. Bridging the Imaging Gap: PSMA PET/CT Has a High Impact on Treatment Planning in Prostate Cancer Patients with Biochemical Recurrence-A Narrative Review of the Literature. J Nucl Med 2019; 60: 1394-1398
    CrossrefPubMedSearch in Google Scholar
  • 44 Emmett L, van Leeuwen PJ, Nandurkar R. et al. Treatment Outcomes from (68)Ga-PSMA PET/CT-Informed Salvage Radiation Treatment in Men with Rising PSA After Radical Prostatectomy: Prognostic Value of a Negative PSMA PET. J Nucl Med 2017; 58: 1972-1976
    CrossrefPubMedSearch in Google Scholar
  • 45 Pfitzenmaier J, Pahernik S, Tremmel T. et al. Positive surgical margins after radical prostatectomy: do they have an impact on biochemical or clinical progression?. BJU Int 2008; 102: 1413-1418
    CrossrefPubMedSearch in Google Scholar
  • 46 Freitag MT, Radtke JP, Afshar-Oromieh A. et al. Local recurrence of prostate cancer after radical prostatectomy is at risk to be missed in (68)Ga-PSMA-11-PET of PET/CT and PET/MRI: comparison with mpMRI integrated in simultaneous PET/MRI. Eur J Nucl Med Mol Imaging 2017; 44: 776-787
    CrossrefPubMedSearch in Google Scholar
  • 47 Watabe T, Uemura M, Soeda F. et al. High detection rate in [(18)F]PSMA-1007 PET: interim results focusing on biochemical recurrence in prostate cancer patients. Ann Nucl Med 2021; 35: 523-528
    CrossrefPubMedSearch in Google Scholar
  • 48 Emmett L, Metser U, Bauman G. et al. Prospective, Multisite, International Comparison of (18)F-Fluoromethylcholine PET/CT, Multiparametric MRI, and (68)Ga-HBED-CC PSMA-11 PET/CT in Men with High-Risk Features and Biochemical Failure After Radical Prostatectomy: Clinical Performance and Patient Outcomes. J Nucl Med 2019; 60: 794-800
    CrossrefPubMedSearch in Google Scholar
  • 49 Dietlein F, Kobe C, Hohberg M. et al. Intraindividual Comparison of (18)F-PSMA-1007 with Renally Excreted PSMA Ligands for PSMA PET Imaging in Patients with Relapsed Prostate Cancer. J Nucl Med 2020; 61: 729-734
    CrossrefPubMedSearch in Google Scholar
  • 50 Corkum MT, Mendez LC, Chin J. et al. A Novel Salvage Option for Local Failure in Prostate Cancer, Reirradiation Using External Beam or Stereotactic Radiation Therapy: Systematic Review and Meta-Analysis. Adv Radiat Oncol 2020; 5: 965-977
    CrossrefPubMedSearch in Google Scholar
  • 51 Perera M, Papa N, Roberts M. et al. Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer-Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate-specific Membrane Antigen-avid Lesions: A Systematic Review and Meta-analysis. Eur Urol 2020; 77: 403-417
    CrossrefPubMedSearch in Google Scholar
  • 52 Rahbar K, Afshar-Oromieh A, Bogemann M. et al. (18)F-PSMA-1007 PET/CT at 60 and 120 minutes in patients with prostate cancer: biodistribution, tumour detection and activity kinetics. Eur J Nucl Med Mol Imaging 2018; 45: 1329-1334
    CrossrefPubMedSearch in Google Scholar
  • 53 Sathekge M, Lengana T, Modiselle M. et al. (68)Ga-PSMA-HBED-CC PET imaging in breast carcinoma patients. Eur J Nucl Med Mol Imaging 2017; 44: 689-694
    CrossrefPubMedSearch in Google Scholar
  • 54 Chang SS, Reuter VE, Heston WD. et al. Five different anti-prostate-specific membrane antigen (PSMA) antibodies confirm PSMA expression in tumor-associated neovasculature. Cancer Res 1999; 59: 3192-3198
    PubMedSearch in Google Scholar
  • 55 Rauscher I, Kronke M, Konig M. et al. Matched-Pair Comparison of (68)Ga-PSMA-11 PET/CT and (18)F-PSMA-1007 PET/CT: Frequency of Pitfalls and Detection Efficacy in Biochemical Recurrence After Radical Prostatectomy. J Nucl Med 2020; 61: 51-57
    CrossrefPubMedSearch in Google Scholar