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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-11-2018 | Original Article

Diagnostic performance of ¹⁸F-PSMA-1007 PET/CT in patients with biochemical recurrent prostate cancer

Authors: Kambiz Rahbar, Ali Afshar-Oromieh, Robert Seifert, Stefan Wagner, Michael Schäfers, Martin Bögemann, Matthias Weckesser

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2018

Abstract

Purpose

The introduction of ligands targeting prostate-specific membrane antigen (PSMA), especially ⁶⁸Ga-PSMA-11, has changed the management of patients with prostate cancer (PCa). ¹⁸F-Labelled ligands can be produced in larger amounts and therefore can improve availability for a larger group of patients. The aim of this study was to evaluate the diagnostic performance of the recently introduced ¹⁸F-PSMA-1007 in patients with recurrent PCa.

Methods

This retrospective analysis included 100 consecutive patients with biochemical relapse (mean age 68.75 ± 7.6 years) referred for PSMA PET/CT. Whole-body PET/CT imaging (from the lower limbs to the skull) was performed in all patients 120 min after injection of 338 ± 44.31 MBq ¹⁸F-PSMA-1007. Prostatectomy, radiation beam therapy of the prostate bed and androgen-deprivation therapy had been performed in 92%, 45% and 27% of the patients, respectively. Radiation beam therapy of the prostate bed had been performed in addition to surgery in 38 patients (38%) and 10 patients (10%) had received all three therapy modalities. The probability of a ¹⁸F-PSMA-1007 PET/CT scan suggestive of pathology was compared with the Gleason score (GS) and PSA level.

Results

Of the 100 patients, 95 (95%) showed at least one pathological finding on ¹⁸F-PSMA-1007 PET/CT. The overall median PSA level was 1.34 ng/ml (range 0,04–41.3 ng/ml). The rates of pathological scans were 86%, 89%, 100% and 100% among patients with PSA levels ≤0.5, 0.51–1.0, 1.1–2.0 and > 2.0 ng/ml, respectively. The median GS was 7 (range 5–10). The majority of patients (70) with a GS available had a score in the range 7–9. The rate of pathological scans in these patients was 93% (65/70). The median SUV_max values of the pathological findings were 10.25, 14.32, 13.16 and 28.87 in patients with PSA levels ≤0.5, 0.51–1.0, 1.1–2.0 and >2.0 ng/ml, respectively. The median SUV_max in patients with a PSA level of >2.0 ng/ml was significantly higher than in all other PSA groups.

Conclusion

¹⁸F-PSMA-1007 PET/CT can detect recurrent PCa in a high percentage of patients with biochemical relapse. The probability of a pathological ¹⁸F-PSMA-1007 PET/CT scan seems to be high even in patients with a low PSA level ≤0.5 ng/ml, and this may have a significant impact on the management of this relevant group of patients.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29. https://doi.org/10.3322/caac.21254.CrossRef

Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42(2):197–209. https://doi.org/10.1007/s00259-014-2949-6.CrossRefPubMed

Afshar-Oromieh A, Holland-Letz T, Giesel FL, Kratochwil C, Mier W, Haufe S, et al. Diagnostic performance of 68Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging. 2017;44(8):1258–68. https://doi.org/10.1007/s00259-017-3711-7.CrossRefPubMedPubMedCentral

Rahbar K, Weckesser M, Huss S, Semjonow A, Breyholz HJ, Schrader AJ, et al. Correlation of Intraprostatic tumor extent with 68Ga-PSMA distribution in patients with prostate cancer. J Nucl Med. 2016;57(4):563–7. https://doi.org/10.2967/jnumed.115.169243.CrossRefPubMed

Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG, et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2014;41(1):11–20. https://doi.org/10.1007/s00259-013-2525-5.CrossRefPubMed

Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA, et al. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013;40(4):486–95. https://doi.org/10.1007/s00259-012-2298-2.CrossRefPubMed

Israeli RS, Powell CT, Corr JG, Fair WR, Heston WD. Expression of the prostate-specific membrane antigen. Cancer Res. 1994;54(7):1807–11.PubMed

Sweat SD, Pacelli A, Murphy GP, Bostwick DG. Prostate-specific membrane antigen expression is greatest in prostate adenocarcinoma and lymph node metastases. Urology. 1998;52(4):637–40.CrossRef

Wright GL Jr, Grob BM, Haley C, Grossman K, Newhall K, Petrylak D, et al. Upregulation of prostate-specific membrane antigen after androgen-deprivation therapy. Urology. 1996;48(2):326–34.CrossRef

10.

Kesch C, Kratochwil C, Mier W, Kopka K, Giesel FL. 68Ga or 18F for prostate cancer imaging? J Nucl Med. 2017;58(5):687–8. https://doi.org/10.2967/jnumed.117.190157.CrossRefPubMed

11.

Rahbar K, Weckesser M, Ahmadzadehfar H, Schafers M, Stegger L, Bogemann M. Advantage of 18F-PSMA-1007 over 68Ga-PSMA-11 PET imaging for differentiation of local recurrence vs. urinary tracer excretion. Eur J Nucl Med Mol Imaging. 2018;45(6):1076–7. https://doi.org/10.1007/s00259-018-3952-0.CrossRefPubMed

12.

Giesel FL, Hadaschik B, Cardinale J, Radtke J, Vinsensia M, Lehnert W, et al. F-18 labelled PSMA-1007: biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. Eur J Nucl Med Mol Imaging. 2017;44(4):678–88. https://doi.org/10.1007/s00259-016-3573-4.CrossRefPubMed

13.

Giesel FL, Kesch C, Yun M, Cardinale J, Haberkorn U, Kopka K, et al. 18F-PSMA-1007 PET/CT detects micrometastases in a patient with biochemically recurrent prostate cancer. Clin Genitourin Cancer. 2017;15(3):e497–9. https://doi.org/10.1016/j.clgc.2016.12.029.CrossRefPubMed

14.

Rahbar K, Afshar-Oromieh A, Bogemann M, Wagner S, Schafers M, Stegger L, et al. (18)F-PSMA-1007 PET/CT at 60 and 120 minutes in patients with prostate cancer: biodistribution, tumour detection and activity kinetics. Eur J Nucl Med Mol Imaging. 2018;45(8):1329–34. https://doi.org/10.1007/s00259-018-3989-0.CrossRefPubMed

15.

Cardinale J, Schafer M, Benesova M, Bauder-Wust U, Leotta K, Eder M, et al. Preclinical evaluation of 18F-PSMA-1007, a new prostate-specific membrane antigen ligand for prostate cancer imaging. J Nucl Med. 2017;58(3):425–31. https://doi.org/10.2967/jnumed.116.181768.CrossRefPubMed

16.

Backhaus P, Noto B, Avramovic N, Grubert LS, Huss S, Bogemann M, et al. Targeting PSMA by radioligands in non-prostate disease-current status and future perspectives. Eur J Nucl Med Mol Imaging. 2018;45(5):860–77. https://doi.org/10.1007/s00259-017-3922-y.CrossRefPubMed

17.

Giesel FL, Will L, Kesch C, Freitag M, Kremer C, Merkle J, et al. Biochemical recurrence of prostate cancer: initial results with [(18)F]PSMA-1007 PET/CT. J Nucl Med. 2018;59(4):632–5. https://doi.org/10.2967/jnumed.117.196329.CrossRefPubMed

18.

Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid 68Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015;56(5):668–74. https://doi.org/10.2967/jnumed.115.154153.CrossRefPubMed

Title: Diagnostic performance of 18F-PSMA-1007 PET/CT in patients with biochemical recurrent prostate cancer
Authors: Kambiz Rahbar
Ali Afshar-Oromieh
Robert Seifert
Stefan Wagner
Michael Schäfers
Martin Bögemann
Matthias Weckesser
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-018-4089-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Diagnostic performance of ¹⁸F-PSMA-1007 PET/CT in patients with biochemical recurrent prostate cancer

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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