68Ga-PSMA-PET/CT in Patients With Biochemical Prostate Cancer Recurrence and Negative 18F-Choline-PET/CT

• Published in: Clinical nuclear medicine 2016-07, Vol.41 (7), p.515-521
• Main Authors: Bluemel, Christina, Krebs, Markus, Polat, Bülent, Linke, Fränze, Eiber, Matthias, Samnick, Samuel, Lapa, Constantin, Lassmann, Michael, Riedmiller, Hubertus, Czernin, Johannes, Rubello, Domenico, Bley, Thorsten, Kropf, Saskia, Wester, Hans-Juergen, Buck, Andreas K, Herrmann, Ken
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antigens, Surface; Choline - analogs & derivatives; Gallium Radioisotopes - metabolism; Glutamate Carboxypeptidase II; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Positron Emission Tomography Computed Tomography - methods; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - metabolism; Prostatic Neoplasms - pathology
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/RLU.0000000000001197

PURPOSEInvestigating the value of Ga-PSMA-PET/CT in biochemically recurring prostate cancer patients with negative F-choline-PET/CT. PATIENTS AND METHODSOne hundred thirty-nine consecutive patients with biochemical recurrence after curative (surgery and/or radiotherapy) therapy were offered participation in this sequential clinical imaging approach. Patients first underwent an F-choline-PET/CT. If negative, an additional Ga-PSMA-PET/CT was offered. One hundred twenty-five of 139 eligible patients were included in the study; 32 patients underwent additional Ga-PSMA-PET/CT. Patients with equivocal findings (n = 5) on F-choline-PET/CT and those who declined the additional Ga-PSMA-PET/CT (n = 9) were excluded. Images were analyzed visually for the presence of suspicious lesions. Findings on PET/CT were correlated with PSA level, PSA doubling time (dt), and PSA velocity (vel). RESULTSThe overall detection rates were 85.6% (107/125) for the sequential imaging approach and 74.4% (93/125) for F-choline-PET/CT alone. Ga-PSMA-PET/CT detected sites of recurrence in 43.8% (14/32) of the choline-negative patients. Detection rates of the sequential imaging approach and F-choline-PET/CT alone increased with higher serum PSA levels and PSA vel. Subgroup analysis of Ga-PSMA-PET/CT in F-choline negative patients revealed detection rates of 28.6%, 45.5%, and 71.4% for PSA levels of 0.2 or greater to less than 1 ng/mL, 1 to 2 ng/mL, and greater than 2 ng/mL, respectively. CONCLUSIONSThe sequential imaging approach designed to limit Ga-PSMA imaging to patients with negative choline scans resulted in high detection rates. Ga-PSMA-PET/CT identified sites of recurrent disease in 43.8% of the patients with negative F-choline PET/CT scans.