A Comprehensive Assessment of 68Ga-PSMA-11 PET in Biochemically Recurrent Prostate Cancer: Results from a Prospective Multicenter Study on 2,005 Patients
Monica Abghari-Gerst, Wesley R Armstrong, Kathleen Nguyen, Jeremie Calais, Johannes Czernin, David Lin, Namasvi Jariwala, Melissa Rodnick, Thomas A Hope, Jason Hearn, Jeffrey S Montgomery, Ajjai Alva, Zachery R Reichert, Daniel E Spratt, Timothy D Johnson, Peter J H Scott, Morand Piert, Monica Abghari-Gerst, Wesley R Armstrong, Kathleen Nguyen, Jeremie Calais, Johannes Czernin, David Lin, Namasvi Jariwala, Melissa Rodnick, Thomas A Hope, Jason Hearn, Jeffrey S Montgomery, Ajjai Alva, Zachery R Reichert, Daniel E Spratt, Timothy D Johnson, Peter J H Scott, Morand Piert
Abstract
We prospectively investigated the performance of the prostate-specific membrane antigen (PSMA) ligand 68Ga-PSMA-11 for detecting prostate adenocarcinoma in patients with elevated levels of prostate-specific antigen (PSA) after initial therapy. Methods:68Ga-PSMA-11 hybrid PET was performed on 2,005 patients at the time of biochemically recurrent prostate cancer after radical prostatectomy (RP) (50.8%), definitive radiation therapy (RT) (19.7%), or RP with postoperative RT (PORT) (29.6%). The presence of prostate cancer was assessed qualitatively (detection rate = positivity rate) and quantitatively on a per-patient and per-region basis, creating a disease burden estimate from the presence or absence of local (prostate/prostate bed), nodal (N1: pelvis), and distant metastatic (M1: distant soft tissue and bone) disease. The primary study endpoint was the positive predictive value (PPV) of 68Ga-PSMA-11 PET/CT confirmed by histopathology. Results: After RP, the scan detection rate increased significantly with rising PSA level (44.8% at PSA < 0.25%-96.2% at PSA > 10 ng/mL; P < 0.001). The detection rate significantly increased with rising PSA level in each individual region, overall disease burden, prior androgen deprivation, clinical T-stage, and Gleason grading from the RP specimen (P < 0.001). After RT, the detection rate for in-gland prostate recurrence was 64.0%, compared with 20.6% prostate bed recurrence after RP and 13.3% after PORT. PSMA-positive pelvic nodal disease was detected in 42.7% after RP, 40.8% after PORT, and 38.8% after RT. In patients with histopathologic validation, the PPV per patient was 0.82 (146/179). The SUVmax of histologically proven true-positive lesions was significantly higher than that of false-positive lesions (median, 11.0 [interquartile range, 6.3-22.2] vs. 5.1 [interquartile range, 2.2-7.4]; P < 0.001). Conclusion: We confirmed a high PPV for 68Ga-PSMA-11 PET in biochemical recurrence and the PSA level as the main predictor of scan positivity.
Keywords: PSMA; disease pattern; hybrid PET; prostate cancer; prostate-specific membrane antigen.
© 2022 by the Society of Nuclear Medicine and Molecular Imaging.
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Source: PubMed