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

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

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 SUVmax 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 SUVmax 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.

Keywords: Biochemical relapse; PSMA-1007; Prostate cancer.

Conflict of interest statement

Conflicts of interest

The University of Münster received consulting fees from ABX GmbH, Radeberg, Germany, for K.R. and M.B. Additionally K.R. is a scientific consultant/advisor to ABX GmbH. The authors declare they have no conflict of interest according to the subject and matter of the present article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not describe any studies with animals performed by any of the authors. According to data protection guidelines, formal ethical approval for retrospective studies is not necessary.

Figures

Fig. 1
Fig. 1
Flow chart of patient selection
Fig. 2
Fig. 2
18F-PSMA-1007 PET/CT imaging (left axial images, right sagittal images) in a 72-year-old patient with biochemical relapse (PSA level 0.86 ng/ml) and with a Gleason score of 7b (4 + 3). The images show focal right-sided tracer uptake in the prostate bed
Fig. 3
Fig. 3
18F-PSMA-1007 PET/CT imaging (axial images: left PET, centre CT, right fused PET/CT) in a 73-year-old patient with biochemical relapse (PSA level 1.05 ng/ml) after radical prostatectomy and prior antiandrogen therapy and radiation to prostate bed (Gleason score not available). The images show bone metastases in the left pelvis and in the adjacent os sacrum. An additional presacral lesion is seen on the left side suggestive of lymph node metastasis
Fig. 4
Fig. 4
18F-PSMA-1007 PET/CT imaging (axial images: left PET, centre CT, right fused PET/CT) in a 59-year-old patient with biochemical relapse (PSA level 0.54 ng/ml) after radical prostatectomy and with a Gleason score of 7b (4 + 3). Images show a 5-mm lymph node lesion (arrow) with high tracer uptake along the left iliac artery
Fig. 5
Fig. 5
Probability of pathological 18F-PSMA-1007 PET/CT in relation to PSA level (a) in 100 patients and in relation to Gleason score (b) in 76 patients. Blue columns show the number and percentage of patients with a pathological 18F-PSMA-1007 PET/CT scan. Grey columns show the number and percentage of patients with a negative PET scan

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29. doi: 10.3322/caac.21254.
    1. 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. doi: 10.1007/s00259-014-2949-6.
    1. 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):1258–1268. doi: 10.1007/s00259-017-3711-7.
    1. 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):563–567. doi: 10.2967/jnumed.115.169243.
    1. 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. doi: 10.1007/s00259-013-2525-5.
    1. 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):486–495. doi: 10.1007/s00259-012-2298-2.
    1. Israeli RS, Powell CT, Corr JG, Fair WR, Heston WD. Expression of the prostate-specific membrane antigen. Cancer Res. 1994;54(7):1807–1811.
    1. 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):637–640. doi: 10.1016/S0090-4295(98)00278-7.
    1. 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):326–334. doi: 10.1016/S0090-4295(96)00184-7.
    1. Kesch C, Kratochwil C, Mier W, Kopka K, Giesel FL. 68Ga or 18F for prostate cancer imaging? J Nucl Med. 2017;58(5):687–688. doi: 10.2967/jnumed.117.190157.
    1. 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):1076–1077. doi: 10.1007/s00259-018-3952-0.
    1. 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):678–688. doi: 10.1007/s00259-016-3573-4.
    1. 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–e499. doi: 10.1016/j.clgc.2016.12.029.
    1. 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):1329–1334. doi: 10.1007/s00259-018-3989-0.
    1. 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):425–431. doi: 10.2967/jnumed.116.181768.
    1. 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):860–877. doi: 10.1007/s00259-017-3922-y.
    1. 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):632–635. doi: 10.2967/jnumed.117.196329.
    1. 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):668–674. doi: 10.2967/jnumed.115.154153.

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