Ga-68 PSMA PET-CT in Initial Staging First Line Imaging of Prostate Cancer: The Clinical Impact of Oligometastatic Disease

Background: Imaging plays an essential role in the evaluation of prostate cancer patients. In recent years, much attention has been focused on 68Ga-PSMA PET-CT in prostate cancer patients and has been widely used for staging, especially biochemical relapse-restaging and therapy response for these patients. This study aimed to evaluate 68 Ga PSMA PET-CT imaging in initial staging-first line imaging of prostate cancer from low to high risk patients. Materials & Methods: Patients with low, intermediate and high risk newly diagnosed prostate cancer referred for initial staging of prostate cancer were included in the study. Histopathology and follow-up clinical and radiological information after PET/CT scanning served as the standard of reference. Results: The study included a total of 176 consecutive patients underwent 68 Ga PSMA PET-CT for initial staging with prostate cancer final histopathology result. The study included a total of 27 low-risk, 35 intermediate risk, and 114 high-risk patients SUVmax in the primary tumor was correlated significantly with PSA levels and patient risk group. Mean SUVmax values of the primary prostate lesion were 16.6 %, 25.8 % and 35.2 % in low, intermediate and high risk patients, respectively. Oligometastases were detected in low and intermediate groups in similar proportions and slightly less in high risk patients (22 %, 22.8 % and 15.7 % in low, intermediate and high risk patients respectively), In contrast, in low, intermediate, and high-risk patients, multiple metastases were detected significantly higher in high-risk group patients (3.7 %, 8.6 %, and 52.6 %, respectively). Conclusions: Oligometastases were detected with a relatively high rate in low- and intermediate-risk group patients. Ga-68 PSMA PET-CT imaging in newly diagnosed prostate cancer patients, even in low-risk patients, was quite valuable in the current studyGa-68 PSMA imaging should be done in all risk groups as a first-line imaging modality. This finding should be supported by other studies with the large number of patients.

Keywords:

68 Ga PSMA PET-CT, Prostate Cancer, Initial Staging,

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1. Perera, M., Papa, N., Christidis, D., Wetherell, D., Hofman, M. S., Murphy, D. G., Bolton, D., & Lawrentschuk, N. (2016). Sensitivity, Specificity, and Predictors of Positive 68Ga-Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer: A Systematic Review and Meta-analysis. European urology, 70(6), 926–937. https://doi.org/10.1016/j.eururo.2016.06.021
2. Mottet, N., Bellmunt, J., Bolla, M., Briers, E., Cumberbatch, M. G., De Santis, M., Fossati, N., Gross, T., Henry, A. M., Joniau, S., Lam, T. B., Mason, M. D., Matveev, V. B., Moldovan, P. C., van den Bergh, R., Van den Broeck, T., van der Poel, H. G., van der Kwast, T. H., Rouvière, O., Schoots, I. G., … Cornford, P. (2017). EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. European urology, 71(4), 618–629. https://doi.org/10.1016/j.eururo.2016.08.003
3. Heidenreich, A., Bastian, P. J., Bellmunt, J., Bolla, M., Joniau, S., van der Kwast, T., Mason, M., Matveev, V., Wiegel, T., Zattoni, F., Mottet, N., & European Association of Urology (2014). EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. European urology, 65(1), 124–137. https://doi.org/10.1016/j.eururo.2013.09.046
4. Larson, S. M., Morris, M., Gunther, I., Beattie, B., Humm, J. L., Akhurst, T. A., Finn, R. D., Erdi, Y., Pentlow, K., Dyke, J., Squire, O., Bornmann, W., McCarthy, T., Welch, M., & Scher, H. (2004). Tumor localization of 16beta-18F-fluoro-5alpha-dihydrotestosterone versus 18F-FDG in patients with progressive, metastatic prostate cancer. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 45(3), 366–373
5. Maurer, T., Gschwend, J. E., Rauscher, I., Souvatzoglou, M., Haller, B., Weirich, G., Wester, H. J., Heck, M., Kübler, H., Beer, A. J., Schwaiger, M., & Eiber, M. (2016). Diagnostic Efficacy of (68)Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer. The Journal of urology, 195(5), 1436–1443. https://doi.org/10.1016/j.juro.2015.12.025
6. Dewes, S., Schiller, K., Sauter, K., Eiber, M., Maurer, T., Schwaiger, M., Gschwend, J. E., Combs, S. E., & Habl, G. (2016). Integration of (68)Ga-PSMA-PET imaging in planning of primary definitive radiotherapy in prostate cancer: a retrospective study. Radiation oncology (London, England), 11, 73. https://doi.org/10.1186/s13014-016-0646-2
7. Shakespeare T. P. (2015). Effect of prostate-specific membrane antigen positron emission tomography on the decision-making of radiation oncologists. Radiation oncology (London, England), 10, 233. https://doi.org/10.1186/s13014-015-0548-8
8. Roach, P. J., Francis, R., Emmett, L., Hsiao, E., Kneebone, A., Hruby, G., Eade, T., Nguyen, Q. A., Thompson, B. D., Cusick, T., McCarthy, M., Tang, C., Ho, B., Stricker, P. D., & Scott, A. M. (2018). The Impact of 68Ga-PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 59(1), 82–88. https://doi.org/10.2967/jnumed.117.197160
9. Fendler, W. P., Schmidt, D. F., Wenter, V., Thierfelder, K. M., Zach, C., Stief, C., Bartenstein, P., Kirchner, T., Gildehaus, F. J., Gratzke, C., & Faber, C. (2016). 68Ga-PSMA PET/CT Detects the Location and Extent of Primary Prostate Cancer. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 57(11), 1720–1725. https://doi.org/10.2967/jnumed.116.172627
10. Kuten, J., Mabjeesh, N. J., Lerman, H., Levine, C., Barnes, S., & Even-Sapir, E. (2019). Ga-PSMA PET/CT Staging of Newly Diagnosed Intermediate- and High-Risk Prostate Cancer. The Israel Medical Association journal : IMAJ, 21(2), 100–104
11. Sweat, S. D., Pacelli, A., Murphy, G. P., & Bostwick, D. G. (1998). Prostate-specific membrane antigen expression is greatest in prostate adenocarcinoma and lymph node metastases. Urology, 52(4), 637–640. https://doi.org/10.1016/s0090-4295(98)00278-7
12. Agus, D. B., Golde, D. W., Sgouros, G., Ballangrud, A., Cordon-Cardo, C., & Scher, H. I. (1998). Positron emission tomography of a human prostate cancer xenograft: association of changes in deoxyglucose accumulation with other measures of outcome following androgen withdrawal. Cancer research, 58(14), 3009–3014
13. Liu, H., Moy, P., Kim, S., Xia, Y., Rajasekaran, A., Navarro, V., Knudsen, B., & Bander, N. H. (1997). Monoclonal antibodies to the extracellular domain of prostate-specific membrane antigen also react with tumor vascular endothelium. Cancer research, 57(17), 3629–3634
14. Herlemann, A., Wenter, V., Kretschmer, A., Thierfelder, K. M., Bartenstein, P., Faber, C., Gildehaus, F. J., Stief, C. G., Gratzke, C., & Fendler, W. P. (2016). 68Ga-PSMA Positron Emission Tomography/Computed Tomography Provides Accurate Staging of Lymph Node Regions Prior to Lymph Node Dissection in Patients with Prostate Cancer. European urology, 70(4), 553–557. https://doi.org/10.1016/j.eururo.2015.12.051
15. Hijazi, S., Meller, B., Leitsmann, C., Strauss, A., Meller, J., Ritter, C. O., Lotz, J., Schildhaus, H. U., Trojan, L., & Sahlmann, C. O. (2015). Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68Ga-PSMA-positron emission tomography/computerized tomography. The Prostate, 75(16), 1934–1940. https://doi.org/10.1002/pros.23091
16. Pyka, T., Okamoto, S., Dahlbender, M., Tauber, R., Retz, M., Heck, M., Tamaki, N., Schwaiger, M., Maurer, T., & Eiber, M. (2016). Comparison of bone scintigraphy and 68Ga-PSMA PET for skeletal staging in prostate cancer. European journal of nuclear medicine and molecular imaging, 43(12), 2114–2121. https://doi.org/10.1007/s00259-016-3435-0
17. Giesel, F. L., Fiedler, H., Stefanova, M., Sterzing, F., Rius, M., Kopka, K., Moltz, J. H., Afshar-Oromieh, A., Choyke, P. L., Haberkorn, U., & Kratochwil, C. (2015). PSMA PET/CT with Glu-urea-Lys-(Ahx)-[⁶⁸Ga(HBED-CC)] versus 3D CT volumetric lymph node assessment in recurrent prostate cancer. European journal of nuclear medicine and molecular imaging, 42(12), 1794–1800. https://doi.org/10.1007/s00259-015-3106-6
18. Budäus, L., Leyh-Bannurah, S. R., Salomon, G., Michl, U., Heinzer, H., Huland, H., Graefen, M., Steuber, T., & Rosenbaum, C. (2016). Initial Experience of (68)Ga-PSMA PET/CT Imaging in High-risk Prostate Cancer Patients Prior to Radical Prostatectomy. European urology, 69(3), 393–396. https://doi.org/10.1016/j.eururo.2015.06.010
19. Hofman, M. S., Lawrentschuk, N., Francis, R. J., Tang, C., Vela, I., Thomas, P., Rutherford, N., Martin, J. M., Frydenberg, M., Shakher, R., Wong, L. M., Taubman, K., Ting Lee, S., Hsiao, E., Roach, P., Nottage, M., Kirkwood, I., Hayne, D., Link, E., Marusic, P., … proPSMA Study Group Collaborators (2020). 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 (London, England), 395(10231), 1208–1216. https://doi.org/10.1016/S0140-6736(20)30314-7
20. Barakat, A., Yacoub, B., Homsi, M. E., Saad Aldine, A., El Hajj, A., & Haidar, M. B. (2020). Role of Early PET/CT Imaging with 68Ga-PSMA in Staging and Restaging of Prostate Cancer. Scientific reports, 10(1), 2705. https://doi.org/10.1038/s41598-020-59296-6
21. Donswijk, M. L., van Leeuwen, P. J., Vegt, E., Cheung, Z., Heijmink, S., van der Poel, H. G., & Stokkel, M. (2020). Clinical impact of PSMA PET/CT in primary prostate cancer compared to conventional nodal and distant staging: a retrospective single center study. BMC cancer, 20(1), 723. https://doi.org/10.1186/s12885-020-07192-7
22. Asli Ayan, Sumeyye Alkan and Bengul Gunalp. The Value of Ga-68 PSMA PET /CT in Primary Staging of Prostate Cancer. Journal of Nuclear Medicine May 2018, 59 (supplement 1) 1450.

Başlangıç: 2021
Yayıncı: Mersin Üniversitesi

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