Iranian Journal of Nuclear Medicine

Iranian Journal of Nuclear Medicine

[68Ga]Ga-PSMA-11 PET/CT for staging and patient management of high-risk prostate cancer: A single-center experience from Iran

Document Type : Original Article

Authors
Sara Shakeri 1
Emran Askari 1
Soroush Zarehparvar 1
Fatemeh Farahmandfar 1
Nasim Norouzbeigi 2
Roham Salek 3
Kamran Aryana 1
1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 Nuclear Medicine Department, Razavi Hospital, Imam Reza International University, Mashhad, Iran
3 Department of Radiation Oncology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
Introduction: Accurate staging plays an important role in management of patients with prostate cancer especially in high-risk group. Today, [68Ga]Ga-PSMA-11 PET/CT should be considered as the preferred imaging tool for treatment planning and initial staging of the disease.
Methods: A total number of 628 patients with prostate cancer referred to Razavi hospital nuclear medicine department between March 2016 and December 2019. Among 103 patients in initial staging category, 23 cases met our inclusion criteria and entered the study. All patients performed CT scan or MRI accompanied with bone scintigraphy before [68Ga]Ga-PSMA-11 PET/CT. The scan results were compared with conventional imaging and their treatment plan determined before and after performing[68Ga]Ga-PSMA-11 PET/CT.
Results: The detection rate of [68Ga]Ga-PSMA-11 PET/CT was superior to CT/MRI in local lymph node involvements (56.5% to 21.7%), as well as for distant metastases (47.83% to 13%). The scan findings lead to upstaging in 9 patients and down staging in 4 patients.[68Ga]Ga-PSMA-11 PET/CT results changes the therapeutic plan in 13 patients (56.5%).
Conclusion: [68Ga]Ga-PSMA-11 PET/CTis a promising imaging tool for initial staging of high-risk prostate cancer patients with significant higher detection rate in comparison to the conventional imaging. The study showed 56.5% changes in treatment planning following [68Ga]Ga-PSMA-11 PET/CT study.
Keywords
[68Ga]Ga-PSMA-11
PET/CT
Prostate cancer
High risk
Staging
Subjects
  1. Ergül N, Günes BY, Yücetas U, Toktas MG, Çermik TF. 68Ga-PSMA-11 PET/CT in newly diagnosed prostate adenocarcinoma. Clin Nucl Med. 2018;43(12):e422-e7.
  2. Lengana T, Lawal IO, Boshomane TG, Popoola GO, Mokoala KMG, Moshokoa E, Maes A, Mokgoro NP, Van de Wiele C, Vorster M, Sathekge MM. 68Ga-PSMA PET/CT replacing bone scan in the initial staging of skeletal metastasis in prostate cancer: a fait accompli? Clin Genitourin Cancer. 2018;16(5):392-401.
  3. Thalgott M, Düwel C, Rauscher I, Heck MM, Haller B, Gafita A, Gschwend JE, Schwaiger M, Maurer T, Eiber M. One-stop-shop whole-body 68Ga-PSMA-11 PET/MRI compared with clinical nomograms for preoperative T and N staging of high-risk prostate cancer. J Nucl Med. 2018;59(12):1850-6.
  4. Hirmas N, Al-Ibraheem A, Herrmann K, Alsharif A, Muhsin H, Khader J, Al-Daghmin A, Salah S. [68 Ga] PSMA PET/CT improves initial staging and management plan of patients with high-risk prostate cancer. Mol Imaging Biol. 2019;21(3):574-81.
  5. Wu SY, Boreta L, Shinohara K, Nguyen H, Gottschalk AR, Hsu IC, Roach M 3rd, Westphalen AC, Feng FY, Carroll PR, Chang AJ, Hope TA. Impact of staging 68Ga-PSMA-11 PET scans on radiation treatment plansin patients with prostate cancer. Urology. 2019;125:154-62.
  6. Koerber SA, Stach G, Kratochwil C, Haefner MF, Rathke H, Herfarth K, Kopka K, Holland-Letz T, Choyke PL, Haberkorn U, Debus J, Giesel FL. Lymph node involvement in treatment-naïve prostate cancer patients: correlation of PSMA PET/CT imaging and roach formula in 280 men in radiotherapeutic management. J Nucl Med. 2020;61(1):46-50.
  7. Ferraro DA, Garcia Schüler HI, Muehlematter UJ, Eberli D, Müller J, Müller A, Gablinger R, Kranzbühler H, Omlin A, Kaufmann PA, Hermanns T, Burger IA. Impact of 68 Ga-PSMA-11 PET staging on clinical decision-making in patients with intermediate or high-risk prostate cancer. Eur J Nucl Med Mol Imaging. 2020;47(3):652-64.
  8. Kimura S, Abufaraj M, Janisch F, Iwata T, Parizi MK, Foerster B, Fossati N, Briganti A, Egawa S, Hartenbach M, Shariat SF. Performance of [68 Ga] Ga-PSMA 11 PET for detecting prostate cancer in the lymph nodes before salvage lymph node dissection: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2020 Mar;23(1):1-10.
  9. Perera M, Papa N, Christidis D, Wetherell D, Hofman MS, Murphy DG, Bolton D, Lawrentschuk N. 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(6):926-37.
  10. Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G, Wester HJ, Heck M, Kübler H, Beer AJ, Schwaiger M, Eiber M. Diagnostic efficacy of 68gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol 2016;195(5):1436-43.
  11. Esen T, Kılıç M, Seymen H, Acar Ö, Demirkol MO. Can Ga-68 PSMA PET/CT replace conventional imaging modalities for primary lymph node and bone staging of prostate cancer? Eur Urol focus. 2020;6(2):218-20.
  12. Pyka T, Okamoto S, Dahlbender M, Tauber R, Retz M, Heck M, Tamaki N, Schwaiger M, Maurer T, Eiber M. Comparison of bone scintigraphy and 68 Ga-PSMA PET for skeletal staging in prostate cancer. Eur J Nucl Med Mol Imaging. 2016;43(12):2114-21.
  13. Pomykala KL, Czernin J, Grogan TR, Armstrong WR, Williams J, Calais J. Total-body 68Ga-PSMA-11 PET/CT for bone metastasis detection in prostate cancer patients: Potential impact on bone scan guidelines. J Nucl Med. 2020;61(3):405-11.
  14. Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, Rutherford N, Martin JM, Frydenberg M, Shakher R, Wong LM, Taubman K, Ting Lee S, Hsiao E, Roach P, Nottage M, Kirkwood I, Hayne D, Link E, Marusic P, Matera A, Herschtal A, Iravani A, Hicks RJ, Williams S, Murphy DG. 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. Lancet. 2020;395(10231):1208-16.
  15. Dadgar H, Emami F, Norouzbeigi N, Vafaee MS, Jafari E, Gholamrezanezhad A, Assadi M, Ahmadzadehfar H. Application of [(68)Ga]PSMA PET/CT in diagnosis and management of prostate cancer patients. Mol Imaging Biol. 2020 Aug;22(4):1062-1069.
  16. Fendler WP, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S, Giesel F, Haberkorn U, Hope TA, Kopka K, Krause BJ, Mottaghy FM, Schöder H, Sunderland J, Wan S, Wester HJ, Fanti S, Herrmann K. 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(6):1014-24.
  17. Roach PJ, Francis R, Emmett L, Hsiao E, Kneebone A, Hruby G, Eade T, Nguyen QA, Thompson BD, Cusick T, McCarthy M, Tang C, Ho B, Stricker PD, Scott AM. The impact of 68Ga-PSMA PET/CT on management intent in prostate cancer: results of an Australian prospective multicenter study. J Nucl Med. 2018;59(1):82-8.
  18. Han S, Woo S, Kim YJ, Suh CH. Impact of (68)Ga-PSMA PET on the management of patients with prostate cancer: A systematic review and meta-analysis. Eur Urol. 2018;74(2):179-90.
  19. Trabulsi EJ, Rumble RB, Jadvar H, Hope T, Pomper M, Turkbey B, Rosenkrantz AB, Verma S, Margolis DJ, Froemming A, Oto A, Purysko A, Milowsky MI, Schlemmer HP, Eiber M, Morris MJ, Choyke PL, Padhani A, Oldan J, Fanti S, Jain S, Pinto PA, Keegan KA, Porter CR, Coleman JA, Bauman GS, Jani AB, Kamradt JM, Sholes W, Vargas HA. Optimum imaging strategies for advanced prostate cancer: ASCO guideline. J Clin Oncol. 2020:JCO. 19.02757.
  20. Grubmüller B, Baltzer P, D'Andrea D, Korn S, Haug AR, Hacker M, Grubmüller KH, Goldner GM, Wadsak W, Pfaff S, Babich J, Seitz C, Fajkovic H, Susani M, Mazal P, Kramer G, Shariat SF, Hartenbach M. (68)Ga-PSMA 11 ligand PET imaging in patients with biochemical recurrence after radical prostatectomy - diagnostic performance and impact on therapeutic decision-making. Eur J Nucl Med Mol Imaging. 2018;45(2):235-42.
  21. Müller J, Ferraro DA, Muehlematter UJ, Garcia Schüler HI, Kedzia S, Eberli D, Guckenberger M, Kroeze SGC, Sulser T, Schmid DM, Omlin A, Müller A, Zilli T, John H, Kranzbuehler H, Kaufmann PA, von Schulthess GK, Burger IA. Clinical impact of (68)Ga-PSMA-11 PET on patient management and outcome, including all patients referred for an increase in PSA level during the first year after its clinical introduction. Eur J Nucl Med Mol Imaging. 2019;46(4):889-900.
  22. Henkenberens C, VON Klot CA, Ross TL, Bengel FM, Wester HJ, Katja H, Christiansen H, Derlin T. 68Ga-PSMA ligand PET/CT-based radiotherapy for lymph node relapse of prostate cancer after primary therapy delays initiation of systemic therapy. Anticancer Res. 2017;37(3):1273-9.
  23. Albisinni S, Artigas C, Aoun F, Biaou I, Grosman J, Gil T, Hawaux E, Limani K, Otte FX, Peltier A, Sideris S, Sirtaine N, Flamen P, van Velthoven R. Clinical impact of (68) Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer with rising prostate-specific antigen after treatment with curative intent: preliminary analysis of a multidisciplinary approach. BJU Int. 2017;120(2):197-203.
  24. Calais J, Fendler WP, Eiber M, Gartmann J, Chu FI, Nickols NG, Reiter RE, Rettig MB, Marks LS, Ahlering TE, Huynh LM, Slavik R, Gupta P, Quon A, Allen-Auerbach MS, Czernin J, Herrmann K. Impact of 68Ga-PSMA-11 PET/CT on the management of prostate cancer patients with biochemical recurrence. J Nucl Med. 2018;59(3):434-41.
  25. Calais J, Kishan AU, Cao M, Fendler WP, Eiber M, Herrmann K, Ceci F, Reiter RE, Rettig MB, Hegde JV, Shaverdian N, King CR, Steinberg ML, Czernin J, Nickols NG. Potential impact of (68)Ga-PSMA-11 PET/CT on the planning of definitive radiation therapy for prostate cancer. J Nucl Med. 2018;59(11):1714-21.
  26. Calais J, Cao M, Nickols NG. The Utility of PET/CT in the planning of external radiation therapy for prostate cancer. J Nucl Med. 2018;59(4):557-67.
  27. Sterzing F, Kratochwil C, Fiedler H, Katayama S, Habl G, Kopka K, Afshar-Oromieh A, Debus J, Haberkorn U, Giesel FL. 68 Ga-PSMA-11 PET/CT: a new technique with high potential for the radiotherapeutic management of prostate cancer patients. Eur J Nucl Med Mol Imaging. 2016;43(1):34-41.
  28. Dewes S, Schiller K, Sauter K, Eiber M, Maurer T, Schwaiger M, Gschwend JE, Combs SE, Habl G. Integration of (68)Ga-PSMA-PET imaging in planning of primary definitive radiotherapy in prostate cancer: a retrospective study. Radiat Oncol. 2016;11:73