Impact of Ga-68-PSMA PET/CT on management in prostate cancer patients with very early biochemical recurrence after radical prostatectomy.

Abstract

PURPOSE:

With the availability of ultra-sensitive PSA assays, early biochemical relapse (eBCR) of prostate cancer is increasingly being detected at values much lower than the conventional threshold of 0.2 ng/ml. Accurate localisation of disease in this setting may allow treatment modification and improved outcomes, especially in patients with pelvis-confined or extra-pelvic oligometastasis (defined as up to three pelvic nodal or distant sites). We aimed to measure the detection rate of [68]Ga-PSMA-HBNED-CC (PSMA)-PET/CT and its influence on patient management in eBCR of prostate cancer following radical prostatectomy (RP).

METHODS:

We retrospectively identified 28 patients who underwent PSMA-PET/CT for post-RP eBCR (PSA < 0.5 ng/ml) at our tertiary care cancer centre. Two nuclear medicine physicians independently recorded the sites of PSMA-PET/CT positivity. Multidisciplinary meeting records were accessed to determine changes in management decisions following PSMA-PET/CT scans.

RESULTS:

The mean age of patients was 65.6 years (range: 50-76.2 years); median PSA was 0.22 ng/ml (interquartile range: 0.15 ng/ml to 0.34 ng/ml). Thirteen patients (46.4%) had received radiotherapy in the past. PSMA-PET/CT was positive in 17 patients (60.7%). Only one patient had polymetastasis (> 3 sites); the remainder either had prostatectomy bed recurrence (n = 2), pelvic oligometastasis (n = 10), or extra-pelvic oligometastasis (n = 4). PSMA-PET/CT resulted in management change in 12 patients (42.8%), involving stereotactic body radiotherapy (n = 6), salvage radiotherapy (n = 4), and systemic treatment (n = 2).

CONCLUSIONS:

Our findings show that PSMA-PET/CT has a high detection rate in the eBCR setting following RP, with a large proportion of patients found to have fewer than three lesions. PSMA-PET/CT may be of value in patients with early PSA failure, and impact on the choice of potentially curative salvage treatments.

• Authors: Usman Bashir, Alison Tree, Erik Mayer, Daniel Levine, Chris Parker, David Dearnaley, Wim J G Oyen
• Journal: European journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 46 Issue 4 Pg. 901-907 (Apr 2019) ISSN: 1619-7089 [Electronic] Germany
• PMID: 30617554 (Publication Type: Journal Article)

Chemical References

• Gallium Isotopes
• Gallium Radioisotopes
• Membrane Glycoproteins
• Organometallic Compounds
• gallium 68 PSMA-11

Topics

• Aged
• Gallium Isotopes
• Gallium Radioisotopes
• Humans
• Male
• Membrane Glycoproteins
• Middle Aged
• Organometallic Compounds
• Positron Emission Tomography Computed Tomography
• Prostatectomy
• Prostatic Neoplasms (diagnostic imaging, metabolism, surgery)
• Recurrence
• Retrospective Studies