Evaluation of Hybrid 68Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

PurposeThis study was designed to investigate the prognostic role of preoperative 68Ga-PSMA-11 PET/CT in predicting biochemical recurrence (BCR) of localized prostate cancer (PCa) after radical prostatectomy (RP).MethodsA total of 77 biopsy-confirmed PCa patients with 68Ga-PSMA-11 PET/CT prior to RP were included. A PSMA-ligand PET/CT-based risk model with SUVmax, maximum diameter of the index tumor and T stage was developed for prediction of 2-year BCR using Cox regression analysis. Also, the efficacy of the developed risk model was compared with European Association of Urology risk stratification (D’Amico) and the Cancer of the Prostate Risk Assessment (CAPRA) score. C-index and calibration plot were used to assess discrimination and calibration with internal validation.ResultsWith a median follow-up of 25 months, 23 (29.9%) patients experienced BCR within 2 years after RP. Patients experienced BCR had a significant higher PSA at diagnosis (p<0.001), a higher ISUP grade of biopsy (p=0.044), as well as a higher ISUP grade (p=0.001), a higher possibility of T3 diseases (p=0.001) and positive margin (p=0.008) on postoperative pathology. SUVmax, maximum diameter of the index tumor and T stage on preoperative PSMA-ligand PET/CT were significantly associated with BCR (all p<0.01). PSMA-ligand PET/CT-based risk model had a superior discrimination (c-index 78.5%) and good calibration at internal validation. The efficacy of this model in predicting 2-year BCR after RP was better, compared with CAPRA (c-index 66.3%) and D’Amico (c-index 66.2%). The addition of the PSMA-ligand PET/CT-derived variables also improved the efficacy of the existing models in predicting 2-year BCR (C-index of 78.9% for modified CAPRA and 79.3% for modified D’Amico, respectively).ConclusionA PSMA-ligand PET/CT-based risk model showed good efficacy in predicting 2-year BCR after RP, which needed to be validated by further prospective studies.

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Oligometastatic Disease Detection with 68Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact

Cancers ◽

10.3390/cancers13194982 ◽

2021 ◽

Vol 13 (19) ◽

pp. 4982

Author(s):

Carlos Artigas ◽

Romain Diamand ◽

Qaid Ahmed Shagera ◽

Nicolas Plouznikoff ◽

Fabrice Fokoue ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Predictive Factors ◽

Clinical Management ◽

Biochemical Recurrence ◽

Oligometastatic Disease ◽

Psma Pet ◽

Pet Ct ◽

Hormone Sensitive

Metastasis-directed therapy (MDT) in oligometastatic prostate cancer has the potential of delaying the start of androgen deprivation therapy (ADT) and disease progression. We aimed to analyze the efficacy of PSMA-PET/CT in detecting oligometastatic disease (OMD), to look for predictive factors of OMD, and to evaluate the impact of PSMA-PET/CT findings on clinical management. We retrospectively analyzed a homogeneous population of 196 hormone-sensitive prostate cancer patients (HSPC), considered potential candidates for MDT, with a PSMA-PET/CT performed at biochemical recurrence (BCR) after radical prostatectomy (RP). Multivariable logistic regression analysis was performed based on several clinico-pathological factors. Changes in clinical management before and after PSMA-PET/CT were analyzed. The OMD detection rate was 44% for a total positivity rate of 60%. PSMA-PET/CT positivity was independently related to PSA (OR (95%CI), p) (1.7 (1.3–2.3), p < 0.0001) and PSAdt (0.4 (0.2–0.8), p = 0.013), and OMD detection was independently related to PSA (1.6 (1.2–2.2), p = 0.001) and no previous salvage therapy (0.3 (0.1–0.9), p = 0.038). A treatment change was observed in 58% of patients, mostly to perform MDT after OMD detection (60% of changes). This study showed that PSMA-PET/CT is an excellent imaging technique to detect OMD early in HSPC patients with BCR after RP, changing therapeutic management mostly into MDT.

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Detection efficacy of 18F-rhPSMA-7.3 PET/CT and impact on patient management in patients with biochemical recurrence of prostate cancer after radical prostatectomy and prior to potential salvage treatment

10.1055/s-0041-1726704 ◽

2021 ◽

Author(s):

I Rauscher ◽

A Karimzadeh ◽

K Schiller ◽

T Horn ◽

WA Weber ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Patient Management ◽

Salvage Treatment ◽

Pet Ct

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Clinical impact of 68Ga-PSMA PET/CT on the management of patients experiencing biochemical recurrence after radical prostatectomy

European Urology Supplements ◽

10.1016/s1569-9056(18)33277-9 ◽

2018 ◽

Vol 17 (8) ◽

pp. 293-294

Author(s):

L. Bianchi ◽

M. Borghesi ◽

U. Barbaresi ◽

F. Mineo Bianchi ◽

P. Castellucci ◽

...

Keyword(s):

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Clinical Impact ◽

Psma Pet ◽

Pet Ct

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A positive PSMA PET/CT predicts more aggressive disease progression in patients with biochemical recurrence after radical prostatectomy

European Urology Open Science ◽

10.1016/s2666-1683(20)33768-x ◽

2020 ◽

Vol 19 ◽

pp. e1745

Author(s):

D. Robesti ◽

G. Gandaglia ◽

N. Fossati ◽

V. Cucchiara ◽

L. Nocera ◽

...

Keyword(s):

Radical Prostatectomy ◽

Disease Progression ◽

Biochemical Recurrence ◽

Aggressive Disease ◽

Psma Pet ◽

Pet Ct

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Role of 68GA-PSMA pet/ct after radical prostatectomy in patients with biochemical recurrence: Results of a monocentric retrospective study

European Urology Open Science ◽

10.1016/s2666-1683(20)35396-9 ◽

2020 ◽

Vol 20 ◽

pp. S62

Author(s):

A. Pecoraro

Keyword(s):

Retrospective Study ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Psma Pet ◽

Pet Ct

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68Ga-PSMA ligand PET/CT in patients with biochemical recurrence after prostate cancer treatment – initial data

European Urology Supplements ◽

10.1016/s1569-9056(18)32633-2 ◽

2018 ◽

Vol 17 (5) ◽

pp. e2226

Author(s):

A. Freimanis ◽

V. Lietuvietis ◽

E. Vjaters ◽

L. Roznere ◽

L. Zemniece ◽

...

Keyword(s):

Prostate Cancer ◽

Initial Data ◽

Cancer Treatment ◽

Biochemical Recurrence ◽

Prostate Cancer Treatment ◽

Psma Ligand ◽

Pet Ct

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Prospective evaluation of the performance of 68Ga-PSMA 11-PET CT/MRI imaging for lymph node staging in patients with biochemical recurrence after radical prostatectomy

European Urology Supplements ◽

10.1016/s1569-9056(18)31245-4 ◽

2018 ◽

Vol 17 (2) ◽

pp. e582 ◽

Cited By ~ 1

Author(s):

M. Abufaraj ◽

B. Grubmüller ◽

M. Hartenbach ◽

G. Kramer ◽

A. Haitel ◽

...

Keyword(s):

Lymph Node ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Lymph Node Staging ◽

Prospective Evaluation ◽

Mri Imaging ◽

Pet Ct

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Outcome after PSMA-PET/CT-based salvage radiotherapy for nodal recurrence after radical prostatectomy

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-021-05557-z ◽

2021 ◽

Author(s):

Paul Rogowski ◽

Christian Trapp ◽

Rieke von Bestenbostel ◽

Chukwuka Eze ◽

Ute Ganswindt ◽

...

Keyword(s):

Multivariate Analysis ◽

Radical Prostatectomy ◽

Lymph Nodes ◽

Biochemical Recurrence ◽

Local Therapy ◽

Salvage Radiotherapy ◽

Free Survival ◽

Kaplan Meier ◽

Psma Pet ◽

Pet Ct

Abstract Purpose Nodal recurrent prostate cancer (PCa) represents a common state of disease, amenable to local therapy. PSMA-PET/CT detects PCa recurrence at low PSA levels. The aim of this study was to evaluate the outcome of PSMA-PET/CT-based salvage radiotherapy (sRT) for lymph node (LN) recurrence. Methods A total of 100 consecutive patients treated with PSMA-PET/CT-based salvage elective nodal radiotherapy (sENRT) for LN recurrence were retrospectively examined. Patients underwent PSMA-PET/CT scan due to biochemical persistence (bcP, 76%) or biochemical recurrence (bcR, 24%) after radical prostatectomy (RP). Biochemical recurrence-free survival (BRFS) defined as PSA < post-RT nadir + 0.2 ng/ml and distant metastasis-free survival (DMFS) were calculated using the Kaplan–Meier method and uni- and multivariate analysis was performed. Results Median follow-up was 37 months. Median PSA at PSMA-PET/CT was 1.7 ng/ml (range 0.1–40.1) in patients with bcP and 1.4 ng/ml (range 0.3–5.1) in patients with bcR. PSMA-PET/CT detected 1, 2, and 3 or more LN metastases in 35%, 23%, and 42%, respectively. Eighty-three percent had only pelvic, 2% had only paraaortic, and 15% had pelvic and paraaortic LN metastases. Cumulatively, a total dose converted to EQD21.5 Gy of 66 Gy (60–70 Gy) was delivered to the prostatic fossa, 70 Gy (66–72 Gy) to the local recurrence, if present, 65.1 Gy (56–66 Gy) to PET-positive lymph nodes, and 47.5 Gy (42.4–50.9 Gy) to the lymphatic pathways. Concomitant androgen deprivation therapy (ADT) was administered in 83% of patients. One-, 2-, and 3-year BRFS was 80.7%, 71.6%, and 65.8%, respectively. One-, 2-, and 3-year DMFS was 91.6%, 79.1%, and 66.4%, respectively. In multivariate analysis, concomitant ADT, longer ADT duration (≥ 12 vs. < 12 months) and LN localization (pelvic vs. paraaortic) were associated with improved BRFS and concomitant ADT and lower PSA value before sRT (< 1 vs. > 1 ng/ml) with improved DMFS, respectively. No such association was seen for the number of affected lymph nodes. Conclusions Overall, the present analysis shows that the so far, unmatched sensitivity and specificity of PSMA-PET/CT translates in comparably high BRFS and DMFS after PSMA-PET/CT-based sENRT for patients with PCa LN recurrence. Concomitant ADT, duration of ADT, PSA value before sRT, and localization of LN metastases were significant factors for improved outcome.

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