Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement

• Published in: European journal of nuclear medicine and molecular imaging 2022-05, Vol.49 (6), p.2077-2085
• Main Authors: Kesler, Mikhail, Kerzhner, Kosta, Druckmann, Ido, Kuten, Jonathan, Levine, Charles, Sarid, David, Keizman, Daniel, Yossepowitch, Ofer, Even-Sapir, Einat
• Format: Article
• Language: English
• Subjects: Biomedical materials; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; Cardiology; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Humans; Imaging; Incidence; Lesions; Male; Medicine; Medicine & Public Health; Mentoring programs; Metastases; Metastasis; Nuclear Medicine; Oncology; Oncology – Genitourinary; Original Article; Orthopedics; Osteoblasts; Osteolysis; Positron emission tomography; Positron Emission Tomography Computed Tomography; Prostate cancer; Prostate-Specific Antigen; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Radiology
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-021-05655-y

Purpose The aim of the study was to elaborate the incidence and type of skeletal involvement in a large cohort of patients with newly diagnosed prostate cancer (PCa) referred for Ga-68 PSMA-11 PET/CT staging in a single center. Methods Study cohort included 963 consecutive patients with newly diagnosed PCa referred for Ga-68 PSMA-11 PET/CT study for staging. The incidence of bone involvement, type of bone metastases, and extent of disease were determined and correlated with the ISUP Grade Group (GG) criteria and PSA levels. Results Bone metastases were found in 188 (19.5%) of 963 patients. Bone metastases were found in 10.7% of patients with PSA  10 ng/dL and in 6.1% of patients with GG ≤ 2/3 and in 8.9% of patients with GG 4/5. In 7.6% of the patients, skeletal involvement was extensive, while 11.9% of patients had oligometastatic disease. Osteoblastic type metastases were the most common type of bone metastases presented in 133 of the patients with malignant bone involvement (70.7%). More than half of them had only osteoblastic lesions (72 patients (38.3%)), while the other (61 patients (32.5%)) had also intramedullary and/or osteolytic type lesions. Intramedullary metastases were found in 97 patients (51.6%), while 41 (21.8%) of them were only intramedullary lesions. Osteolytic metastases were detected in 36 patients (19.2%), of which 8 were only osteolytic lesions. Conclusion Although traditionally bone metastases of PCa are considered osteoblastic, osteolytic and intramedullary metastases are common, as identified on PET with labeled PSMA. Skeletal spread may be present also in patients with GG ≤ 2/3 and PSA