Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

Open Access 01-08-2021 | Prostate Cancer | Original Article

Prospective comparison of ¹⁸F-PSMA-1007 PET/CT, whole-body MRI and CT in primary nodal staging of unfavourable intermediate- and high-risk prostate cancer

Authors: Simona Malaspina, Mikael Anttinen, Pekka Taimen, Ivan Jambor, Minna Sandell, Irina Rinta-Kiikka, Sami Kajander, Jukka Schildt, Ekaterina Saukko, Tommi Noponen, Jani Saunavaara, Peter B. Dean, Roberto Blanco Sequeiros, Hannu J. Aronen, Jukka Kemppainen, Marko Seppänen, Peter J. Boström, Otto Ettala

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 9/2021

Abstract

Purpose

To prospectively compare ¹⁸F-prostate-specific membrane antigen (PSMA)-1007 positron emission tomography (PET)/CT, whole-body magnetic resonance imaging (WBMRI) including diffusion-weighted imaging (DWI) and standard computed tomography (CT), in primary nodal staging of prostate cancer (PCa).

Methods

Men with newly diagnosed unfavourable intermediate- or high-risk PCa prospectively underwent ¹⁸F-PSMA-1007 PET/CT, WBMRI with DWI and contrast-enhanced CT within a median of 8 days. Six readers (two for each modality) independently reported pelvic lymph nodes as malignant, equivocal or benign while blinded to the other imaging modalities. Sensitivity, specificity and accuracy were reported according to optimistic (equivocal lesions interpreted as benign) and pessimistic (equivocal lesions interpreted as malignant) analyses. The reference standard diagnosis was based on multidisciplinary consensus meetings where available histopathology, clinical and follow-up data were used.

Results

Seventy-nine patients completed all the imaging modalities, except for one case of interrupted WBMRI. Thirty-one (39%) patients had pelvic lymph node metastases, which were detected in 27/31 (87%), 14/31 (45%) and 8/31 (26%) patients by ¹⁸F-PSMA-1007 PET/CT, WBMRI with DWI and CT, respectively (optimistic analysis). In 8/31 (26%) patients, only ¹⁸F-PSMA-1007 PET/CT detected malignant lymph nodes, while the other two imaging modalities were reported as negative. At the patient level, sensitivity and specificity values for ¹⁸F-PSMA-1007 PET/CT, WBMRI with DWI and CT in optimistic analysis were 0.87 (95%CI 0.71–0.95) and 0.98 (95%CI 0.89–1.00), 0.37 (95%CI 0.22–0.55) and 0.98 (95%CI 0.89–1.00) and 0.26 (95%CI 0.14–0.43) and 1.00 (95%CI 0.93–1.00), respectively.

Conclusion

¹⁸F-PSMA-1007 PET/CT showed significantly greater sensitivity in nodal staging of primary PCa than did WBMRI with DWI or CT, while maintaining high specificity.

Clinical trial registration

Clinicaltrials.gov ID: NCT03537391

Available only for authorised users

Daneshmand S, Quek ML, Stein JP, Lieskovsky G, Cai J, Pinski J, et al. Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results. J Urol. 2004;172:2252–5.CrossRef

Bernstein AN, Shoag JE, Golan R, Halpern JA, Schaeffer EM, Hsu WC, et al. Contemporary incidence and outcomes of prostate cancer lymph node metastases. J Urol. 2018;199:1510–7.CrossRef

Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71:618–29.CrossRef

Hövels AM, Heesakkers RAM, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008;63:387–95 [cited 2020 Jan 11]. Available from: https://www.sciencedirect.com/science/article/pii/S0009926007003340?via%3Dihub.CrossRef

Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confi rmatory study. www.thelancet.com [Internet]. 2017 [cited 2017 Dec 19];389. Available from: https://ac.els-cdn.com/S0140673616324011/1-s2.0-S0140673616324011-main.pdf?_tid=b9cd608e-e4c5-11e7-9ee7-00000aab0f6b&acdnat=1513692533_a34dba27c3144cdee43c911f1def4c4a.

Johnston EW, Latifoltojar A, Sidhu HS, Ramachandran N, Sokolska M, Bainbridge A, et al. Multiparametric whole-body 3.0-T MRI in newly diagnosed intermediate- and high-risk prostate cancer: diagnostic accuracy and interobserver agreement for nodal and metastatic staging. Eur Radiol. Eur Radiol. 2019;29:3159–69.CrossRef

Bouchelouche K, Choyke PL, Capala J. Prostate specific membrane antigen- a target for imaging and therapy with radionuclides. Discov Med. 2010;9:55–61.PubMedPubMedCentral

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;44:678–88.CrossRef

Kroenke M, Mirzoyan L, Horn T, Peeken JC, Wurzer A, Wester H-J, et al. Matched-pair comparison of 68 Ga-PSMA-11 and 18 F-rhPSMA-7 PET/CT in patients with primary and biochemical recurrence of prostate cancer: frequency of non-tumor related uptake and tumor positivity. J Nucl Med. 2020:jnumed.120.251447.

10.

Anttinen M, Ettala O, Malaspina S, Jambor I, Sandell M, Kajander S, et al. A prospective comparison of 18F-prostate-specific membrane antigen-1007 positron emission tomography computed tomography, whole-body 1.5 t magnetic resonance imaging with diffusion-weighted imaging, and single-photon emission computed tomography/computed. Eur Urol Oncol. 2020:1–10.

11.

Sprute K, Kramer V, Koerber S, Meneses M, Fernandez R, Soza-Ried C, et al. Diagnostic accuracy of 18 F-PSMA-1007-PET/CT imaging for lymph node staging of prostate carcinoma in primary and biochemical recurrence. J Nucl Med. 2020:jnumed.120.246363.

12.

Jansen BHE, Bodar YJL, Zwezerijnen GJC, Meijer D, van der Voorn JP, Nieuwenhuijzen JA, et al. Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial. Eur J Nucl Med Mol Imaging. 2020.

13.

Krönke M, Wurzer A, Schwamborn K, Ulbrich L, Jooß L, Maurer T, et al. Histologically-confirmed diagnostic efficacy of ¹⁸ F-rhPSMA-7 positron emission tomography for N-staging of patients with primary high risk prostate cancer. J Nucl Med [Internet]. 2019;jnumed.119.234906. Available from: http://jnm.snmjournals.org/lookup/doi/10.2967/jnumed.119.234906.

14.

Cardinale J, Martin R, Remde Y, Schäfer M, Hienzsch A, Hübner S, et al. Procedures for the GMP-compliant production and quality control of [18F]PSMA-1007: a next generation radiofluorinated tracer for the detection of prostate cancer. Pharmaceuticals. 2017;10.

15.

Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208 [cited 2020 Jan 11]. Available from: https://www.sciencedirect.com/science/article/pii/S1532046419301261?via%3Dihub.CrossRef

16.

Fendler WP, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S, et al. 68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2017;44:1014–24.CrossRef

17.

van Leeuwen PJ, Emmett L, Ho B, Delprado W, Ting F, Nguyen Q, et al. Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU Int. 2017;119:209–15.CrossRef

18.

Öbek C, Doğanca T, Demirci E, Ocak M, Kural AR, Yıldırım A, et al. The accuracy of 68Ga-PSMA PET/CT in primary lymph node staging in high-risk prostate cancer. Eur J Nucl Med Mol Imaging. 2017;44:1806–12.CrossRef

19.

van Kalmthout LWM, van Melick HHE, Lavalaye J, Meijer RP, Kooistra A, de Klerk JMH, et al. Prospective validation of Gallium-68 prostate specific membrane antigen-positron emission tomography/computerized tomography for primary staging of prostate cancer. J Urol. 2020;203:537–45.CrossRef

20.

Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. 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;395:1208–16. https://doi.org/10.1016/S0140-6736(20)30314-7.CrossRef

21.

Tulsyan S, Das CJ, Tripathi M, Seth A, Kumar R, Bal C. Comparison of 68 Ga-PSMA PET/CT and multiparametric MRI for staging of high-risk prostate cancer 68 Ga-PSMA PET and MRI in prostate cancer. Nucl Med Commun. 2017;38:1094–102.CrossRef

22.

Petersen LJ, Nielsen JB, Langkilde NC, Petersen A, Afshar-Oromieh A, De Souza NM, et al. 68Ga-PSMA PET/CT compared with MRI/CT and diffusion-weighted MRI for primary lymph node staging prior to definitive radiotherapy in prostate cancer: a prospective diagnostic test accuracy study. World J Urol. 2019.

23.

Tiguert R, Gheiler EL, Tefilli MV, Oskanian P, Banerjee M, Grignon DJ, et al. Lymph node size does not correlate with the presence of prostate cancer metastasis. Urology. 1999;53:367–71.CrossRef

24.

Heesakkers RA, Hövels AM, Jager GJ, van den Bosch HC, Witjes JA, Raat HP, et al. MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study. Lancet Oncol. 2008;9:850–6.CrossRef

25.

Ettala O, Malaspina S, Tuokkola T, Luoto P, Löyttyniemi E, Boström PJ, et al. Prospective study on the effect of short-term androgen deprivation therapy on PSMA uptake evaluated with 68Ga-PSMA-11 PET/MRI in men with treatment-naïve prostate cancer. Eur J Nucl Med Mol Imaging. 2020;47:665–73.CrossRef

26.

Emmett L, Yin C, Crumbaker M, Hruby G, Kneebone A, Epstein R, et al. Rapid modulation of PSMA expression by androgen deprivation: serial 68Ga-PSMA-11 PET in men with hormone-sensitive and castrate-resistant prostate cancer commencing androgen blockade. J Nucl Med. 2019;60:950–4.CrossRef

Title: Prospective comparison of 18F-PSMA-1007 PET/CT, whole-body MRI and CT in primary nodal staging of unfavourable intermediate- and high-risk prostate cancer
Authors: Simona Malaspina
Mikael Anttinen
Pekka Taimen
Ivan Jambor
Minna Sandell
Irina Rinta-Kiikka
Sami Kajander
Jukka Schildt
Ekaterina Saukko
Tommi Noponen
Jani Saunavaara
Peter B. Dean
Roberto Blanco Sequeiros
Hannu J. Aronen
Jukka Kemppainen
Marko Seppänen
Peter J. Boström
Otto Ettala
Publication date: 01-08-2021
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computed Tomography
Metastasis
Computed Tomography
Prostate Cancer
Positron Emission Tomography
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 9/2021
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-021-05296-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prospective comparison of ¹⁸F-PSMA-1007 PET/CT, whole-body MRI and CT in primary nodal staging of unfavourable intermediate- and high-risk prostate cancer

Abstract

Purpose

Methods

Results

Conclusion

Clinical trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Clinical trial registration

Please log in to get access to this content

Other articles of this Issue 9/2021

Response to the Letter to the Editor: Prospective comparison of 18F-PSMA-1007 PET/CT, whole-body MRI and CT in primary nodal staging of unfavourable intermediate- and high-risk prostate cancer

Deep learning-based auto-delineation of gross tumour volumes and involved nodes in PET/CT images of head and neck cancer patients

Diagnostic value of 18F-FDG PET/CT in patients with biochemical recurrent prostate cancer and negative 68Ga-PSMA PET/CT

Give to Fryback what is Fryback’s, and to new PET technologies what is new PET technologies’

Comparing the diagnostic performance of radiotracers in recurrent prostate cancer: a systematic review and network meta-analysis

The EANM practice guidelines for parathyroid imaging