Subscribe to RSS
DOI: 10.1055/a-1542-6064
Clinical impact of whole-body 68Ga-PSMA I&T PET/CT: lesion frequency and added benefit in lower extremities
Klinische Relevanz des Ganzkörper 68Ga-PSMA I&T PET/CT: Läsionsfrequenz und zusätzlicher Nutzen in den unteren Extremitäten![](https://www.thieme-connect.de/media/10.1055-s-00034924/202106/lookinside/thumbnails/nuk-1153_10-1055-a-1542-6064-1.jpg)
Abstract
Aim Few small-scaled studies performed systematic analysis of the benefits of extending prostate specific membrane antigen positron-emission tomography/ computed tomography (68Ga-PSMA I&T PET/CT) to the lower extremities in prostate cancer (PCa) patients. We hypothesized that 68Ga-PSMA I&T PET/CT positive lesions are rare in lower extremities of prostate cancer (PCa) patients, the clinical implication is negligible and may therefore be omitted.
Methods We retrospectively analyzed 1,068 PCa patients who received 68Ga-PSMA I&T PET/CT in a single institution (2016–2018). Of those, 285 (26.7%) were newly diagnosed, 529 (49.5%) had biochemical recurrence (BCR) and 254 (23.8%) were castration-resistant prostate cancer (CRPC) patients.
Results Of 1,068 68Ga-PSMA I&T PET/CTs, positive lesions in the lower extremities were identified in 6.9% patients (n=74). Positive lesions in the lower extremities were most common in CRPC patients (19.7%; n=50), followed by newly diagnosed (3.2%; n=9) and BCR (2.8%; n=15) PCa patients. Only 3 patients presented with exclusive lesions in the lower extremities, respectively 0.8% (n=2) in CRPC and 0.4% (n=1) in newly diagnosed PCa. Both CRPC (94.1%, n=47) and BCR (80.0%, n=12) patients with PSMA-positive lesions predominantly received systemic therapy.
Conclusion Identification of lower extremities lesions with PSMA PET/CT is uncommon and exclusive lesions are rare. PSMA PET/CT findings of the lower extremities did not change therapy management. Thus, scanning of the lower extremities can be omitted in standard protocols.
Zusammenfassung
Ziel Nur wenige, klein angelegte Studien untersuchten systematisch den Nutzen einer Erweiterung der Prostata-spezifischen Membranantigen-Positronen-Emissions-Tomografie/Computertomografie (68Ga-PSMA-I&T-PET/CT) auf die unteren Extremitäten bei Patienten mit Prostatakarzinom (PCa). Wir stellten die Hypothese auf, dass 68Ga-PSMA-I&T-PET/CT-positive Läsionen in den unteren Extremitäten von PCa-Patienten selten sind, die klinische Relevanz geringfügig ist und die Untersuchung daher weggelassen werden kann.
Methoden Wir analysierten retrospektiv 1068 PCa-Patienten, die eine 68Ga-PSMA-I&T-PET/CT in einer einzigen Einrichtung erhielten (2016–2018). Davon hatten 285 (26,7%) eine Erstdiagnose, 529 (49,5%) hatten ein biochemisches Rezidiv (BCR) und 254 (23,8%) hatten ein kastrationsresistentes Prostatakarzinom (CRPC).
Ergebnisse Von 1068 68Ga-PSMA-I&T-PET/CTs wurden bei 6,9% der Patienten (n=74) positive Läsionen in den unteren Extremitäten identifiziert. Positive Läsionen in den unteren Extremitäten waren am häufigsten bei CRPC-Patienten (19,7%; n=50), gefolgt von neu diagnostizierten (3,2%; n=9) und BCR (2,8%; n=15) PCa-Patienten. Nur 3 Patienten wiesen ausschließlich Läsionen in den unteren Extremitäten auf, jeweils 0,8% (n=2) bei CRPC und 0,4% (n=1) bei neu diagnostiziertem PCa. Sowohl CRPC- (94,1%, n=47) als auch BCR-Patienten (80,0%, n=12) mit PSMA-positiven Läsionen erhielten überwiegend eine systemische Therapie.
Schlussfolgerung Die Identifizierung von Läsionen der unteren Extremitäten mit PSMA-PET/CT ist selten und exklusive Läsionen sind selten. PSMA-PET/CT-Befunde der unteren Extremitäten änderten das Therapiemanagement nicht. Daher kann bei Standardprotokollen auf die Untersuchung der unteren Extremitäten verzichtet werden.
Schlüsselwörter
Prostatakarzinom - Knochenmetastasen - biochemisches Rezidiv - CRPC - PSMA-PET/CT - primäres StagingKeywords
prostate cancer - bone metastases - biochemical recurrence - CRPC - PSMA-PET/CT - primary stagingPublication History
Received: 07 December 2020
Accepted after revision: 01 July 2021
Article published online:
20 August 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 EAU Guidelines: Prostate Cancer | Uroweb. Im Internet: https://uroweb.org/guideline/prostate-cancer/#5
- 2 Hofman MS, Lawrentschuk N, Francis RJ. et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. The Lancet 2020; 395: 1208-1216 DOI: 10.1016/S0140-6736(20)30314-7. (PMID: 32209449)
- 3 Simsek DH, Sanli Y, Kuyumcu S. et al. Clinical Impact of Lower-Limb Imaging in 68Ga-PSMA PET/CT for Patients with Prostate Cancer. Journal of Nuclear Medicine Technology 2019; 47: 233-237 DOI: 10.2967/jnmt.118.224303. (PMID: 31019043)
- 4 Pomykala KL, Czernin J, Grogan TR. et al. Total-Body 68Ga-PSMA-11 PET/CT for Bone Metastasis Detection in Prostate Cancer Patients: Potenzial Impact on Bone Scan Guidelines. Journal of Nuclear Medicine 2020; 61: 405-411 DOI: 10.2967/jnumed.119.230318. (PMID: 31541035)
- 5 Parker CC, James ND, Brawley CD. et al. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. The Lancet 2018; 392: 2353-2366 DOI: 10.1016/S0140-6736(18)32486-3. (PMID: 30355464)
- 6 Rauscher I, Maurer T, Fendler WP. et al. 68Ga-PSMA ligand PET/CT in patients with prostate cancer: How we review and report. Cancer Imaging 2016; 16: 14 DOI: 10.1186/s40644-016-0072-6. (PMID: 27277843)
- 7 Ceci F, Fanti S. Standardisation of PSMA images interpretation: why do we need it?. Clin Transl Imaging 2018; 6: 331-333 DOI: 10.1007/s40336-018-0301-z.
- 8 Eiber M, Herrmann K, Calais J. et al. Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE): Proposed miTNM Classification for the Interpretation of PSMA-Ligand PET/CT. J Nucl Med 2018; 59: 469-478 DOI: 10.2967/jnumed.117.198119. (PMID: 29123012)
- 9 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 DOI: 10.1007/s00259-017-3670-z. (PMID: 28283702)
- 10 Weineisen M, Simecek J, Schottelius M. et al. Synthesis and preclinical evaluation of DOTAGA-conjugated PSMA ligands for functional imaging and endoradiotherapy of prostate cancer. EJNMMI Research 2014; 4: 63 DOI: 10.1186/s13550-014-0063-1. (PMID: 26116124)
- 11 Berliner C, Tienken M, Frenzel T. et al. Detection rate of PET/CT in patients with biochemical relapse of prostate cancer using [68Ga]PSMA I&T and comparison with published data of [68Ga]PSMA HBED-CC. Eur J Nucl Med Mol Imaging 2017; 44: 670-677 DOI: 10.1007/s00259-016-3572-5. (PMID: 27896369)
- 12 Rausch I, Ruiz A, Valverde-Pascual I. et al. Performance Evaluation of the Vereos PET/CT System According to the NEMA NU2–2012 Standard. J Nucl Med 2019; 60: 561-567 DOI: 10.2967/jnumed.118.215541. (PMID: 30361382)
- 13 Team RC. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria 2012. URL http://www.R-project.org 2018
- 14 Professionals S-O. EAU Guidelines: Prostate Cancer. Uroweb.. Im Internet: https://uroweb.org/guideline/prostate-cancer/
- 15 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 DOI: 10.1007/s00259-017-3711-7. (PMID: 28497198)
- 16 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 DOI: 10.2967/jnumed.115.154153. (PMID: 25791990)
- 17 Sweeney CJ, Chen Y-H, Carducci M. et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of Medicine 2015; 373: 737-746 DOI: 10.1056/NEJMoa1503747. (PMID: 29384722)