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68Ga-PSMA PET/CT in early relapsed prostate cancer patients after radical therapy. Sci Rep 2022; 12:20500. [PMID: 36443430 PMCID: PMC9705359 DOI: 10.1038/s41598-022-24688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
Biochemical recurrence (BCR) of prostate cancer (PCa) occurs in about 25% of patients treated with radical prostatectomy (RP) and up to 45% in patients who receive external beam radiotherapy (RT). Early diagnosis of PCa recurrence is of high importance for successful salvage therapy. The aim of the present study is to analyze the efficacy of 68 Ga-PSMA PET/CT in detecting the presence of local and/or systemic disease in patients with a history of PCa who have BCR. A total of 52 PCa patients with BCR referred for 68 Ga-PSMA PET/CT were recruited from the American University of Beirut Medical Center between November 2017 and December 2019. We compared the performance of PSMA PET/CT to the results and clinical factors based on follow up: PSA, PSA kinetics, primary treatment, and Gleason score. The relationship between the PET/CT findings and clinical indicators of disease were assessed by univariate and multivariate logistic regression. From a total of 52 patients, 34 (65.4%) had positive PSMA-PET/CT scans. Among those, 8/34 (23.5%) received primary RT. For all patients with a positive PSMA-PET: the detection rate was 2/4 (50%) for PSA < 0.2, 5/10 (50%) for PSA 0.2-0.49, 3/6 (50%) for PSA 0.5-0.99, 6/12 (50%) for PSA 1-1.99, 8/9 (88.9%) for PSA 2-3.99, and 10/11 (90.9%) for PSA 4-10.PSMA-PET/CT positivity was significantly associated with PSA level at time of PET scan, PSA doubling time, Gleason score and TNM staging. However, it did not show a significant correlation with radiotherapy as primary treatment, ongoing androgen deprivation therapy (ADT), time to relapse, and initial PSA before therapy. In our single center prospective trial, 68 Ga-PSMA PET/CT successfully detected the recurrence of PCa in patients with BCR. Scan positivity was significantly associated with PSA level at time of PET scan, PSA doubling time, Gleason score, and TNM staging. PSMA- PET/CT is a highly promising modality in the work up of patients with PCa in the setting of BCR for earlier detection of disease recurrence.
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[ 18F]fluciclovine vs. [ 18F]fluorocholine Positron Emission Tomography/Computed Tomography: A Head-to-Head Comparison for Early Detection of Biochemical Recurrence in Prostate Cancer Patients. Tomography 2022; 8:2709-2722. [PMID: 36412685 PMCID: PMC9680271 DOI: 10.3390/tomography8060226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Nowadays, there is still no consensus on the most accurate PET radiopharmaceutical to early detect prostate cancer (PCa) relapse. A tailored radiotracer choice based on a specific patient's profile could ensure prompt disease detection and an improvement in patients management. We aimed to compare the [18F]fluciclovine and [18F]fluorocholine PET/CT detection rate (DR) in PCa patients restaged for early biochemical recurrence (BCR), according to clinical and biochemical features. A cohort of 138 PCa patients with early BCR (mean age: 71 y, range: 50-87 y) were homogeneously randomized 1:1 to a [18F]fluciclovine or a [18F]fluorocholine PET/CT group. The respective PET/CT DR, according to per-patient and per-region analysis, and the impact of the biochemical, clinical, and histological parameters, were compared. The PSA cut-off values predictive of a positive scan were also calculated. Overall, the [18F]fluciclovine PET/CT DR was 64%, significantly higher than the [18F]fluorocholine PET/CT DR of 35% (p = 0.001). Similarly, in the per-region analysis, the [18F]fluciclovine PET/CT DR was 51% in the prostate region, significantly higher compared to 15% of [18F]fluorocholine (p < 0.0001). Furthermore, a statistically significant higher DR in per-patient and per-region (prostate/prostate bed) analysis was observed in the [18F]fluciclovine group for 0.5-1 ng/mL (p = 0.018, p = 0.049) and >1 ng/mL (p = 0.040, p < 0.0001) PSA values. A PSA of 0.45 ng/mL for [18F]fluciclovine and of 0.94 ng/mL for [18F]fluorocholine was identified as the optimal cut-off value in predicting a positive PET/CT scan. Our results demonstrated a better [18F]fluciclovine PET/CT DR compared to [18F]fluorocholine for restaging PCa patients in early BCR, particularly in the detection of locoregional recurrence. The significantly higher [18F]fluciclovine DR for low PSA values (PSA < 1 ng/mL) supports its use in this setting of patients.
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Kim DY, Lee WW, Song YS, Hong SK, Byun SS, Kim JS. Detection of Recurrence Sites using 18F-fluorocholine PET/CT in Prostate Cancer Patients with PSA failure. Prostate Int 2022. [DOI: 10.1016/j.prnil.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jimbo M, Andrews JR, Ahmed ME, Dundar A, Karnes RJ, Bryce AH, Kendi AT, Kwon ED, Lowe VJ, Bold MS. Prognostic role of 11C-choline PET/CT scan in patients with metastatic castrate resistant prostate cancer undergoing primary docetaxel chemotherapy. Prostate 2022; 82:41-48. [PMID: 34633087 DOI: 10.1002/pros.24246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND We sought to assess the prognostic utility of 11C-choline positron emission tomography/computed tomography (PET/CT) in patients with metastatic castrate resistant prostate cancer (mCRPC) undergoing primary docetaxel chemotherapy. METHODS We performed a single institution retrospective analysis of 77 mCRPC patients who were treated with 6 cycles of docetaxel chemotherapy, and who also underwent 11C-choline PET/CT scans at baseline (before chemotherapy), mid-course (after 3 cycles), and posttherapy (after 6 cycles). We evaluated treatment response based on percent change in blood pool-corrected maximum standardized uptake value (SUVmax) of the target lesion on PET/CT, as well as percent change in serum prostate specific antigen (PSA). Logistic regression analysis was used to identify factors associated with complete treatment response. Progression free survival (PFS) analysis was performed using log-rank test and shown on Kaplan-Meier plot. RESULTS Percent change in blood pool-corrected SUVmax on mid-course scan was a significant predictor of complete response (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.96-0.99, p = .0003), whereas percent change in PSA was not (OR: 0.99, 95% CI: 0.99-1.01, p = .6025). 57 of 77 patients (74%) achieved ≥20% reduction in blood pool-corrected SUVmax on mid-course; these patients were 3.6 times more likely to achieve complete response after full 6 cycles of docetaxel chemotherapy, compared to patients with <20% reduction in blood pool-corrected SUVmax (OR: 3.56, 95% CI: 1.04-16.52, p = .0420). Median PFS in the complete response group was 35.1 months (95% CI: 26.0-52.7 months), compared to 9.4 months (95% CI: 6.9-13.0 months) in the incomplete response group (p = .0005). CONCLUSIONS Our study showed that mid-course and posttherapy 11C-choline PET/CT evaluation for mCRPC patients undergoing primary docetaxel chemotherapy can predict full course treatment response and PFS, respectively. 11C-choline PET/CT imaging may provide valuable prognostic information to guide treatment choices for patients with mCRPC.
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Affiliation(s)
- Masaya Jimbo
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jack R Andrews
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamed E Ahmed
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayca Dundar
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alan H Bryce
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Ayse T Kendi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael S Bold
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Semiautomatic assessment of whole-body tumor burden with 18F-PSMA-1007 in biochemical recurrent prostate cancer. Nucl Med Commun 2021; 43:332-339. [PMID: 34954764 DOI: 10.1097/mnm.0000000000001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the 18F-PSMA-1007 PET/computed tomography (CT) semiautomatic volumetric parameters to assess the whole-body tumor burden and its correlation with prostate-specific antigen (PSA) and Gleason score in patients with biochemically recurrent prostate cancer (PCa). MATERIALS AND METHODS A total of 110 patients referred for 18F-PSMA-1007 PET/CT due to biochemical recurrence were retrospectively analyzed. Whole-body total lesion prostate-specific membrane antigen (wbTl-PSMA) and whole-body PSMA-derived tumor volume (wbPSMA-TV) metrics on 18F-PSMA-1007 were obtained semiautomatically in dedicated software. A Spearman test was performed to explore the correlation of volumetric imaging parameters with PSA levels and Gleason score. To analyze the association between volumetric measures and PSA subgroups, we used a Kruskal-Wallis test and a Dunn's test to identify each group causing an observed difference. RESULTS A total of 492 metastatic lesions were analyzed, and a significant correlation was found between wbTL-PSMA (R = 0.63, P < 0.0001) and wbPSMA-TV (R = 0.49, P < 0.0001) with serum PSA. A statistically significant difference with wbTL-PSMA was found in patients with a PSA less than or equal 0.5 ng/ml and PSA in the range of 0.51-1.0 ng/ml. CONCLUSION 18F-PSMA-1007 PSMA volumetric parameters can provide a quantitative imaging biomarker for whole-body tumor burden.
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Artigas C, Diamand R, Shagera QA, Plouznikoff N, Fokoue F, Otte FX, Gil T, Peltier A, Van Gestel D, Flamen P. Oligometastatic Disease Detection with 68Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact. Cancers (Basel) 2021; 13:cancers13194982. [PMID: 34638466 PMCID: PMC8508549 DOI: 10.3390/cancers13194982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Metastasis-directed therapy (MDT) in oligometastatic prostate cancer has the potential of delaying the start of androgen deprivation therapy (ADT) and disease progression. We aimed to analyze the efficacy of PSMA-PET/CT in detecting oligometastatic disease (OMD), to look for predictive factors of OMD, and to evaluate the impact of PSMA-PET/CT findings on clinical management. We retrospectively analyzed a homogeneous population of 196 hormone-sensitive prostate cancer patients (HSPC), considered potential candidates for MDT, with a PSMA-PET/CT performed at biochemical recurrence (BCR) after radical prostatectomy (RP). Multivariable logistic regression analysis was performed based on several clinico-pathological factors. Changes in clinical management before and after PSMA-PET/CT were analyzed. The OMD detection rate was 44% for a total positivity rate of 60%. PSMA-PET/CT positivity was independently related to PSA (OR (95% CI), p) (1.7 (1.3-2.3), p < 0.0001) and PSAdt (0.4 (0.2-0.8), p = 0.013), and OMD detection was independently related to PSA (1.6 (1.2-2.2), p = 0.001) and no previous salvage therapy (0.3 (0.1-0.9), p = 0.038). A treatment change was observed in 58% of patients, mostly to perform MDT after OMD detection (60% of changes). This study showed that PSMA-PET/CT is an excellent imaging technique to detect OMD early in HSPC patients with BCR after RP, changing therapeutic management mostly into MDT.
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Affiliation(s)
- Carlos Artigas
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium; (Q.A.S.); (F.F.); (P.F.)
- Correspondence: ; Tel.: +32-2-541-32-40
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium; (R.D.); (A.P.)
| | - Qaid Ahmed Shagera
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium; (Q.A.S.); (F.F.); (P.F.)
| | - Nicolas Plouznikoff
- Department of Nuclear Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada;
| | - Fabrice Fokoue
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium; (Q.A.S.); (F.F.); (P.F.)
| | - François-Xavier Otte
- Department of Radiation Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium; (F.-X.O.); (D.V.G.)
| | - Thierry Gil
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium;
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium; (R.D.); (A.P.)
| | - Dirk Van Gestel
- Department of Radiation Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium; (F.-X.O.); (D.V.G.)
| | - Patrick Flamen
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium; (Q.A.S.); (F.F.); (P.F.)
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Negative 11C-choline PET/computed tomography imaging in restaging of patients with prostate cancer with serum prostate-specific antigen values >20 ng/mL. Nucl Med Commun 2021; 41:1178-1182. [PMID: 32804916 DOI: 10.1097/mnm.0000000000001266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Several studies have reported about the performance of C-choline-PET/computed tomography (CT) (choline) in patients with biochemical recurrent (BCR) prostate cancer, but there is a lack of information regarding negative choline in the same clinical setting. Our aim was to retrospectively analyse negative choline in a cohort of BCR-patients with high prostate-specific antigen (PSA). METHODS AND RESULTS We retrospectively analysed all choline-scans performed at two high-volume imaging centres between 2005 and 2018, selecting those of interest according to the following inclusion criteria: (1) proven prostate cancer treated either with radical prostatectomy or primary external beam radiation therapy (EBRT), (2) BCR after radical prostatectomy or EBRT, (3) PSA serum values >20 ng/mL at the time of scan and (4) scan reported as negative for active disease. Overall, among 5792 scans performed for BCR-prostate cancer, 14 matched the inclusion criteria and were classified as follows: 5/14(36%) inaccurate reports, 3/14(21%) questionable underestimation of positive findings, originally described as unclear, 6/14(43%) negatives. Choline showed a high detection rate in BCR-prostate cancer patients with PSA >20 ng/mL. CONCLUSIONS Although negative reports can be found in this clinical setting, in our review various disease-relevant findings were identified in more than half of the cases originally reported as negative warranting a double reading in such cases to avoid false-negative reports.
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Correlations between whole body volumetric parameters of 68Ga-PSMA PET/CT and biochemical-histopathological parameters in castration-naive and resistant prostate cancer patients. Ann Nucl Med 2021; 35:540-548. [PMID: 33586097 DOI: 10.1007/s12149-021-01594-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the relationship between whole body volumetric (Wbv) results of 68Ga-PSMA PET/CT with biochemical and histopathological parameters. METHODS One hundred twenty-one prostate cancer patients who underwent 68Ga-PSMA PET/CT between January 2018 and December 2019 were included. Imaging was conducted for staging upon new diagnosis with moderate- and high-risk disease and for confirming the progression of castration resistance. The relationships between the Wbv 68Ga-PSMA PET/CT parameters and prostate-specific antigen (PSA) levels, PSA doubling time and Gleason score (GS) were evaluated. RESULTS The median GS and mean PSA levels were similar between the castration-naive and resistant patients. The PSA levels were positively correlated with MTVwb (p: 0.009, r: 0.286) and TLPwb (p: 0.002, r: 0.344). Gleason scores were positively correlated with MTVwb (p: 0.050, r: 0.216), TLPwb (p: 0.007, r: 0.296) and highest standard uptake value (HSUV) max (p: 0.047, r: 0.220). In the castration-naive group, Gleason scores (from p < 0.001 to p = 0.04 and r = 0.331 to 0.549) and PSA levels (from p = 0.002 to p = 0.045 and from r = 0.323 to 0.473) correlated with all 68Ga-PSMA-PET/CT parameters. PSA doubling time was negatively correlated with whole-body metabolic tumour volume (MTVwb) (p: 0.050, r: 0.232) and whole-body total lesion PSMA (TLPwb) (p: 0.026, r: 0.262). The MTVwb, TLPwb and HSUVpeak values of the patients with biochemical recurrence (BR) of 0-6 months (n = 18) were higher than those with BR > 2 years (n = 35) (p = 0.046, 0.047 and 0.042, respectively). CONCLUSIONS Wbv 68Ga-PSMA PET/CT results were correlated with PSA levels and Gleason scores. The correlation was relatively stronger in the castration-naive group. The prognostic accuracy of PSA in the resistant group may be weaker than in the naive group. The difference in volumetric parameters of patients with short BR compared to long BR supports the idea that 68Ga-PSMA PET/CT can distinguish patients with rapid relapse from others.
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Vatsa R, Kumar R, Shukla J, Rana N, Vadi SK, Lal A, Singh SK, Mittal BR. F-18 fluorocholine positron emission tomography- computed tomography in initial staging and recurrence evaluation of prostate carcinoma: A prospective comparative study with diffusion-weighted magnetic resonance imaging and whole-body skeletal scintigraphy. World J Nucl Med 2021; 20:156-163. [PMID: 34321968 PMCID: PMC8286002 DOI: 10.4103/wjnm.wjnm_46_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/30/2020] [Accepted: 09/26/2020] [Indexed: 11/04/2022] Open
Abstract
Prostate cancer (PCa) is one of the major causes of death due to cancer in men. Conventional imaging modalities such as magnetic resonance imaging (MRI) provide locoregional status, but fall short in identifying distant metastasis. C-11 choline F-18 fluorocholine (F-18 FCH) has been shown to be useful in imaging of PCa. The present prospective study evaluates and compares the role of F-18 FCH positron emission tomography-computed tomography (PET-CT) with locoregional MRI and whole-body bone scintigraphy in PCa patients for initial staging and recurrence evaluation. This study included a total of 50 patients. Tc-99m skeletal scintigraphy, F-18 FCH PET-CT, and diffusion-weighted MRI of the pelvic region were performed within a span of 2-3 weeks of each other, in random order. For the primary site, core biopsy findings of the lesion were considered as gold standard. The kappa test was used to measure agreement between bone scintigraphy, F-18 FCH, and MRI. For comparing Tc-99m bone scintigraphy, F-18 FCH, and MRI, McNemar's test was applied. F-18 FCH PET-CT and MRI were able to detect primary lesion in all initial staging patients. The sensitivity and specificity of F-18 FCH PET-CT versus MRI were found to be 92.8% versus 89.2% and 100 versus 80%, respectively, for the recurrence at the primary site. A total of 55 bony lesions at distant sites were detected on F-18 FCH PET-CT in comparison to 43 bone lesions on whole-body bone scintigraphy. F-18 FCH PET/CT also detected additional lung lesions in 2 patients and abdominal lymph nodes in 12 patients. F-18 FCH PET-CT could detect primary lesions, local metastasis, bone metastasis, and distant metastasis in a single study and is also a useful modality in recurrence evaluation in PCa patients.
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Affiliation(s)
- Rakhee Vatsa
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohit Kumar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaya Shukla
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nivedita Rana
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shelvin Kumar Vadi
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Lal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Santos A, Mattiolli A, Carvalheira JB, Ferreira U, Camacho M, Silva C, Costa F, Matheus W, Lima M, Etchebehere E. PSMA whole-body tumor burden in primary staging and biochemical recurrence of prostate cancer. Eur J Nucl Med Mol Imaging 2021; 48:493-500. [PMID: 32789680 DOI: 10.1007/s00259-020-04981-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this study was to evaluate whether 68Ga-PSMA PET/CT whole-body tumor burden (PSMAwbtb) is associated with clinical parameters and laboratory parameters in prostate cancer patients. METHODS We retrospectively evaluated prostate cancer patients submitted to PSMA PET/CT for primary staging purposes or due to biochemical recurrence (BR). PSMAwbtb metrics (total volume of PSMA-avid tumor (PSMA-TV)) and total uptake of PSMA-avid lesions (PSMA-TL) were calculated semi-automatically. Spearman's rank correlations between PSMAwbtb metrics and clinical, laboratory parameters (age, time-to-BR, years of diagnosis of prostate cancer, free and total serum PSA levels, and the Gleason score) and with the highest SUVmax of a lesion (hSUVmax) were analyzed. RESULTS Among the 257 PSMA PET/CT studies, there were 46 scans (17.9%) performed for primary staging and 211 (82.1%) for BR. PSMA-TV and PSMA-TL were calculated for the 157 positive scans (58.8%), which were 43 patients (93.5%) in the primary staging group and 114 patients (54.0%) in the BR group. In the primary staging group, we observed a significant correlation between PSMA-TL and hSUVmax (p = 0.0021). In the BR group, there was a significant direct correlation between PSMA-TL and the variables age (p = 0.0031), total serum PSA values (p = < 0.0001), free serum PSA values (p = < 0.0001), and the hSUVmax (p = < 0.0001). Similar results were obtained for PSMA-TV. CONCLUSION PSMAwbtb has a direct and positive correlation with serum PSA values and age in prostate cancer patients with BR.
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Affiliation(s)
- Allan Santos
- Medicina Nuclear de Campinas, Campinas, São Paulo, Brazil
- Division of Nuclear Medicine of the Department of Radiology, Campinas State University (UNICAMP), Rua Vital Brazil 251, Campinas, 13083-888, Brazil
| | | | - José Bc Carvalheira
- Division of Oncology of the Department of Internal Medicine, Campinas State University (UNICAMP), Campinas, Brazil
| | - Ubirajara Ferreira
- Division of Urology of the Department of Surgery, Campinas State University (UNICAMP), Campinas, Brazil
| | | | - Cleide Silva
- Department of Biostatistics, Campinas State University (UNICAMP), Campinas, Brazil
| | | | - Wagner Matheus
- Division of Urology of the Department of Surgery, Campinas State University (UNICAMP), Campinas, Brazil
| | - Mariana Lima
- Medicina Nuclear de Campinas, Campinas, São Paulo, Brazil
- Division of Nuclear Medicine of the Department of Radiology, Campinas State University (UNICAMP), Rua Vital Brazil 251, Campinas, 13083-888, Brazil
| | - Elba Etchebehere
- Medicina Nuclear de Campinas, Campinas, São Paulo, Brazil.
- Division of Nuclear Medicine of the Department of Radiology, Campinas State University (UNICAMP), Rua Vital Brazil 251, Campinas, 13083-888, Brazil.
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Michael J, Khandani AH, Basak R, Tan HJ, Royce TJ, Wallen E, Whang Y, Rose TL, Milowsky M, Bjurlin MA. Patterns of Recurrence, Detection Rates, and Impact of 18-F Fluciclovine PET/CT on the Management of Men With Recurrent Prostate Cancer. Urology 2021; 155:192-198. [PMID: 33516829 DOI: 10.1016/j.urology.2021.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the characteristics of FACBC PET/CT in detecting recurrent prostate cancer after radiation or prostatectomy. The secondary aim was to determine the impact of FACBC PET/CT on radiation treatment recommendations in men with biochemical recurrence postprostatectomy. METHODS This is a single center retrospective study of men who underwent an FACBC PET/CT for rising PSA after definitive prostate cancer therapy. Detection rates in men with recurrence following any definitive treatment were compared at different PSA levels and anatomical sites. Radiotherapy treatment recommendations for patients postprostatectomy based on conventional imaging findings were compared to recommendations based on FACBC PET/CT findings. RESULTS A total of 103 men underwent imaging with FACBC PET/CT. 74.8% (77) had lesions consistent with sites of prostate cancer recurrence. At PSA thresholds of <1, 1-2, and >2 ng/mL lesions were detected in 35.5%, 63.6%, and 95.2% of patients respectively (P <.001). The most common site of recurrence was outside of the pelvis (37). Detection of extraprostatic or extrapelvic recurrence was observed in 45.5% of men in the PSA tertile <1ng/mL. FACBC PET/CT results led to changes to the recommended radiotherapy treatment plan in 44.1% (15/34) of men with recurrence following radical prostatectomy. CONCLUSION FACBC PET/CT demonstrated increased detection of recurrent prostate cancer with increasing PSA levels. Most recurrences were found outside the pelvis. Results of FACBC PET/CT changed radiotherapy management decisions in men treated with prostatectomy, supporting its use in localizing sites of disease recurrence in men with prostate cancer.
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Affiliation(s)
- Jamie Michael
- University of North Carolina, School of Medicine, NC
| | - Amir H Khandani
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ramsankar Basak
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hung-Jui Tan
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eric Wallen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Young Whang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Medicine-Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tracy L Rose
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Medicine-Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Medicine-Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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12
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Assadi M, Jokar N, Ghasemi M, Nabipour I, Gholamrezanezhad A, Ahmadzadehfar H. Precision Medicine Approach in Prostate Cancer. Curr Pharm Des 2021; 26:3783-3798. [PMID: 32067601 DOI: 10.2174/1381612826666200218104921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 12/19/2022]
Abstract
Prostate cancer is the most prevalent type of cancer and the second cause of death in men worldwide. Various diagnostic and treatment procedures are available for this type of malignancy, but High-grade or locally advanced prostate cancers showed the potential to develop to lethal phase that can be causing dead. Therefore, new approaches are needed to prolong patients' survival and to improve their quality of life. Precision medicine is a novel emerging field that plays an essential role in identifying new sub-classifications of diseases and in providing guidance in treatment that is based on individual multi-omics data. Multi-omics approaches include the use of genomics, transcriptomics, proteomics, metabolomics, epigenomics and phenomics data to unravel the complexity of a disease-associated biological network, to predict prognostic biomarkers, and to identify new targeted drugs for individual cancer patients. We review the impact of multi-omics data in the framework of systems biology in the era of precision medicine, emphasising the combination of molecular imaging modalities with highthroughput techniques and the new treatments that target metabolic pathways involved in prostate cancer.
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Affiliation(s)
- Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Narges Jokar
- The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mojtaba Ghasemi
- Laboratory of Computational Biotechnology and Bioinformatics (CBB), Department of Plant Breeding and Biotechnology (PBB), Faculty of Agriculture, University of Zabol, Zabol, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033, United States
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13
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Selnæs KM, Krüger-Stokke B, Elschot M, Johansen H, Steen PA, Langørgen S, Aksnessæther BY, Indrebø G, Sjøbakk TAE, Tessem MB, Moestue SA, Knobel H, Tandstad T, Bertilsson H, Solberg A, Bathen TF. Detection of Recurrent Prostate Cancer With 18F-Fluciclovine PET/MRI. Front Oncol 2020; 10:582092. [PMID: 33425735 PMCID: PMC7786298 DOI: 10.3389/fonc.2020.582092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/20/2020] [Indexed: 01/16/2023] Open
Abstract
Objective Simultaneous PET/MRI combines soft-tissue contrast of MRI with high molecular sensitivity of PET in one session. The aim of this prospective study was to evaluate detection rates of recurrent prostate cancer by 18F-fluciclovine PET/MRI. Methods Patients with biochemical recurrence (BCR) or persistently detectable prostate specific antigen (PSA), were examined with simultaneous 18F-fluciclovine PET/MRI. Multiparametric MRI (mpMRI) and PET/MRI were scored on a 3-point scale (1-negative, 2-equivocal, 3-recurrence/metastasis) and detection rates (number of patients with suspicious findings divided by total number of patients) were reported. Detection rates were further stratified based on PSA level, PSA doubling time (PSAdt), primary treatment and inclusion criteria (PSA persistence, European Association of Urology (EAU) Low-Risk BCR and EAU High-Risk BCR). A detailed investigation of lesions with discrepancy between mpMRI and PET/MRI scores was performed to evaluate the incremental value of PET/MRI to mpMRI. The impact of the added PET acquisition on further follow-up and treatment was evaluated retrospectively. Results Among patients eligible for analysis (n=84), 54 lesions were detected in 38 patients by either mpMRI or PET/MRI. Detection rates were 41.7% for mpMRI and 39.3% for PET/MRI (score 2 and 3 considered positive). There were no significant differences in detection rates for mpMRI versus PET/MRI. Disease detection rates were higher in patients with PSA≥1ng/mL than in patients with lower PSA levels but did not differ between patients with PSAdt above versus below 6 months. Detection rates in patients with primary radiation therapy were higher than in patients with primary surgery. Patients categorized as EAU Low-Risk BCR had a detection rate of 0% both for mpMRI and PET/MRI. For 15 lesions (27.8% of all lesions) there was a discrepancy between mpMRI score and PET/MRI score. Of these, 10 lesions scored as 2-equivocal by mpMRI were changed to a more definite score (n=4 score 1 and n=6 score 3) based on the added PET acquisition. Furthermore, for 4 of 10 patients with discrepancy between mpMRI and PET/MRI scores, the added PET acquisition had affected the treatment choice. Conclusion Combined 18F-fluciclovine PET/MRI can detect lesions suspicious for recurrent prostate cancer in patients with a range of PSA levels. Combined PET/MRI may be useful to select patients for appropriate treatment, but is of limited use at low PSA values or in patients classified as EAU Low-Risk BCR, and the clinical value of 18F-fluciclovine PET/MRI in this study was too low to justify routine clinical use.
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Affiliation(s)
- Kirsten Margrete Selnæs
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Brage Krüger-Stokke
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mattijs Elschot
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håkon Johansen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Per Arvid Steen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sverre Langørgen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Gunnar Indrebø
- Department of Oncology, Ålesund Hospital, More and Romsdal Hospital Trust, Ålesund, Norway
| | - Torill Anita Eidhammer Sjøbakk
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - May-Britt Tessem
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Siver Andreas Moestue
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Knobel
- The Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Helena Bertilsson
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Urology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Arne Solberg
- The Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone Frost Bathen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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14
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Jadvar H, Ballas LK, Choyke PL, Fanti S, Gulley JL, Herrmann K, Hope TA, Klitzke AK, Oldan JD, Pomper MG, Rowe SP, Subramaniam RM, Taneja SS, Vargas HA, Ahuja S. Appropriate Use Criteria for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer After Definitive Primary Treatment. J Nucl Med 2020; 61:552-562. [PMID: 32238495 DOI: 10.2967/jnumed.119.240929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Hossein Jadvar
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Leslie K Ballas
- American Society for Radiation Oncology, Arlington, Virginia
| | - Peter L Choyke
- American Society of Clinical Oncology, Alexandria, Virginia
| | - Stefano Fanti
- European Association of Nuclear Medicine, Vienna, Austria
| | - James L Gulley
- American College of Physicians, Philadelphia, Pennsylvania
| | - Ken Herrmann
- European Association of Nuclear Medicine, Vienna, Austria
| | - Thomas A Hope
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Jorge D Oldan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Clinical Oncology, Alexandria, Virginia
| | | | - Steven P Rowe
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Rathan M Subramaniam
- American College of Nuclear Medicine, Reston, Virginia.,American College of Radiology, Reston, Virginia; and
| | - Samir S Taneja
- American Urological Association, Linthicum Heights, Maryland
| | | | - Sukhjeet Ahuja
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
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15
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Detection Rate of 18F-Fluorethylcholine-PET/CT in relation to PSA Value in PCA Patients Referred with Biochemical Relapse. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:4320178. [PMID: 32848525 PMCID: PMC7439168 DOI: 10.1155/2020/4320178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/19/2020] [Accepted: 04/27/2020] [Indexed: 11/18/2022]
Abstract
Attempts to predict the likelihood of positive morphological imaging related with PSA value in patients referred with biochemical recurrence were the focus of many studies. Using nuclear medicine modalities, numerous studies likewise had been performed for the same purpose, however mostly using C-11-labeled choline. For this purpose, we selected 193 prostate cancer patients from our database between 2006 and 2010. They had been referred to our department to undergo 18F-fluorethylcholine (FECH)-PET/CT due to biochemical recurrence after potentially curative procedures. As a result, in 84 out of 193 patients, 18F-FECH-PET demonstrated positive findings with an overall detection rate of 44%. Statistically, there was a significant difference in PSA values in positive findings vs. negative findings (p < 0.001), and there was a linear correlation between the detection rate and PSA value (r = 0.91). Moreover, there was a relation between initial therapy and recurrence type. So, the local relapse was the most frequent recurrence (>70%) after radiation therapy alone. By contrast, patients after radical prostatectomy followed by salvage radiotherapy showed a low likelihood of local recurrence. In conclusion, PSA value was confirmed to have a determinant role in 18F-FECH-PET outcome. Moreover, there was a link between recurrence type and initial therapy, which—if prospectively confirmed—may play a guiding role in selecting the appropriate diagnostic methods.
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16
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18F-fluciclovine PET CT detection of biochemical recurrent prostate cancer at specific PSA thresholds after definitive treatment. Urol Oncol 2020; 38:636.e1-636.e6. [DOI: 10.1016/j.urolonc.2020.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 02/29/2020] [Accepted: 03/21/2020] [Indexed: 11/17/2022]
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17
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Jensen IS, Hathway J, Cyr P, Gauden D, Gardiner P. Cost-consequence analysis of 18F-fluciclovine for the staging of recurrent prostate cancer. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1749362. [PMID: 32341772 PMCID: PMC7170335 DOI: 10.1080/20016689.2020.1749362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/13/2020] [Accepted: 03/24/2020] [Indexed: 06/11/2023]
Abstract
Background: Current detection methodologies are often unable to identify the location and extent of recurrent prostate cancer (PCa) leading potentially to 'futile' local therapies in the presence of metastatic disease. The use of 18 F-fluciclovine PET/CT may lead to better patient management. Objective: The aim of this study was to quantify the economic impact and cost-consequence of using 18 F-fluciclovine PET/CT in PCa recurrence. Study design: A decision analytic model based on recurrent PCa imaging guidelines. Setting: US hospital. Participants: PCa patients experiencing biochemical recurrence. Intervention: 18 F-fluciclovine PET/CT was compared to conventional imaging. Main outcome measure: Budget impact, correct diagnoses, futile treatments, and cost-consequence (cost per correct diagnosis) Results: For a hypothetical hospital serving 500,000 individuals, the model showed the use of 18 F-fluciclovine reduced 'futile' therapies by 19.2%. Re-imaging costs were reduced by 40.2% ($8.2 million); however, when assuming diagnostic and staging costs only, the total costs increased from $31.2 to $34.6 million (10.9%), driven by 18 F-fluciclovine imaging agent and procedure costs. The cost per 'correct' diagnosis declined $30,673 (46.8%). When including subsequent 5-year patient management, the cost per 'correct' diagnosis declined $410,206 (49.2%). Conclusion: 18 F-fluciclovine PET/CT imaging may improve the clinical management of men with recurrent PCa with minimal increase in healthcare spending.
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Affiliation(s)
| | | | - Philip Cyr
- Precision Xtract, Boston, MA, USA
- College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, USA
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18
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Mena E, Lindenberg ML, Turkbey IB, Shih JH, Harmon SA, Lim I, Lin F, Adler S, Eclarinal P, McKinney YL, Citrin D, Dahut W, Wood BJ, Krishnasamy V, Chang R, Levy E, Merino M, Pinto P, Eary JF, Choyke PL. 18F-DCFPyL PET/CT Imaging in Patients with Biochemically Recurrent Prostate Cancer After Primary Local Therapy. J Nucl Med 2019; 61:881-889. [PMID: 31676732 DOI: 10.2967/jnumed.119.234799] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/07/2019] [Indexed: 11/16/2022] Open
Abstract
Our objective was to investigate the lesion detection rate of 18F-DCFPyL PET/CT, a prostate-specific membrane antigen (PSMA)-targeted PET agent, in patients with biochemically relapsed prostate cancer after primary local therapy. Methods: This was a prospective institutional review board-approved study of 90 patients with documented biochemical recurrence (median prostate-specific antigen [PSA], 2.5 ng/mL; range, 0.21-35.5 ng/mL) and negative results on conventional imaging after primary local therapies, including radical prostatectomy (n = 38), radiation (n = 27), or a combination of the two (n = 25). Patients on androgen deprivation therapy were excluded. Patients underwent whole-body 18F-DCFPyL PET/CT (299.9 ± 15.5 MBq) at 2 h after injection. The PSMA PET lesion detection rate was correlated with PSA, PSA kinetics, and original primary tumor grade. Results: Seventy patients (77.8%) showed positive PSMA PET results, with a total of 287 lesions identified: 37 prostate bed foci, 208 lesions in lymph nodes, and 42 in distant sites in bones or organs, Eleven patients had negative results, and 9 patients showed indeterminate lesions, which were considered negative in this study. The detection rates were 47.6% (n = 10/21), 50% (n = 5/10), 88.9% (n = 8/9), and 94% (n = 47/50) for PSA levels of >0.2 to <0.5, 0.5 to <1.0, 1 to <2.0, and ≥2.0 ng/mL, respectively. In postsurgical patients, PSA, PSA doubling time, and PSA velocity correlated with PET results, but the same was not true for postradiation patients. These parameters also correlated with the extent of disease on PET (intrapelvic vs. extrapelvic). There was no significant difference in the rate of positive scans between patients with higher-grade and lower-grade primary tumors (Gleason score of ≥4 + 3 vs. <3 + 4). Tumor recurrence was histology-confirmed in 40% (28/70) of patients. On a per-patient basis, positive predictive value was 93.3% (95% confidence interval, 77.6%-99.2%) by histopathologic validation and 96.2% (95% confidence interval, 86.3%-99.7%) by the combination of histology and imaging/clinical follow-up. Conclusion: 18F-DCFPyL PET/CT imaging offers high detection rates in biochemically recurrent prostate cancer patients and is positive in about 50% of patients with a PSA level of less than 0.5 ng/mL, which could substantially impact clinical management. In postsurgical patients, 18F-DCFPyL PET/CT correlates with PSA, PSA doubling time, and PSA velocity, suggesting it may have prognostic value. 18F-DCFPyL PET/CT is highly promising for localizing sites of recurrent prostate cancer.
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Affiliation(s)
- Esther Mena
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria Liza Lindenberg
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ismail Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Joanna H Shih
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stephanie A Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ilhan Lim
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Frank Lin
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stephen Adler
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Philip Eclarinal
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Yolanda L McKinney
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William Dahut
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Venkatesh Krishnasamy
- Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Richard Chang
- Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Elliot Levy
- Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Janet F Eary
- Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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19
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Kim SJ, Lee SW. The role of 18F-fluciclovine PET in the management of prostate cancer: a systematic review and meta-analysis. Clin Radiol 2019; 74:886-892. [PMID: 31358294 DOI: 10.1016/j.crad.2019.06.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Abstract
AIM To investigate the diagnostic performance of 18F-fluciclovine positron-emission tomography (PET) or combined PET and computed tomography (PET/CT) for diagnosis of primary cancer, preoperative lymph node (LN) staging, and detection of recurrent disease of prostate cancer (PCa) through a systematic review and meta-analysis. MATERIALS AND METHODS The PubMed and EMBASE databases were searched from the earliest available date of indexing through 31 December 2018, for studies evaluating the diagnostic performance of 18F-fluciclovine PET or PET/CT for the management of PCa patients. The sensitivities, specificities, and positive and negative likelihood ratios (LR+ and LR-) across the studies were calculated and summary receiver operating characteristic curves were constructed. RESULTS Across 13 studies (563 patients), the pooled sensitivity for 18F-fluciclovine PET or PET/CT for diagnosis of primary PCa was 0.87 (95% confidence interval [CI]: 0.77-0.93) and a pooled specificity of 0.84 (95% CI: 0.68-0.93). For LN staging, the pooled sensitivity was 0.56 (95% CI: 0.37-0.74) and a pooled specificity of 0.98 (95% CI: 0.88-1.00). For detection of recurrent disease, the pooled sensitivity was 0.79 (95% CI: 0.60-0.91) and a pooled specificity of 0.69 (95% CI: 0.59-0.77). In meta-regression analysis, no definite variable was the source of the study heterogeneity. CONCLUSION The current meta-analysis showed the moderate sensitivity and specificity of 18F-fluciclovine PET or PET/CT for the diagnosis of primary cancer, preoperative LN staging, and detection of recurrent PCa. Further large multicentre studies will be necessary to substantiate the diagnostic accuracy of 18F-fluciclovine PET/CT for management of PCa patients.
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Affiliation(s)
- S-J Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, South Korea; BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, South Korea; Department of Nuclear Medicine, College of Medicine, Pusan National University, Yangsan, 50612, South Korea.
| | - S W Lee
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, South Korea; Department of Nuclear Medicine, Kyungpook National University Medical Center and School of Medicine, Daegu, South Korea
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20
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Triviño-Ibáñez EM, Puche-Sanz I, Gómez-Río M, Cózar Olmo JM, Llamas-Elvira JM, Rodríguez-Fernández A. Usefulness of 18F-fluorocoline PET/CT in prostate cancer patients with biochemical recurrence: Influence of PSA kinetics and hormone therapy. Med Clin (Barc) 2019; 153:56-62. [PMID: 30660434 DOI: 10.1016/j.medcli.2018.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/22/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the capacity of 18f-fluorocholine positron emission tomography/computed tomography (FCH PET/CT) to detect biochemical recurrence of prostate cancer and to determine the correlation with PSA kinetics and influence of antiandrogen hormone therapy. PATIENTS AND METHODS Observational and retrospective study, which included patients with prostate cancer and criteria for biochemical recurrence and/or resistance to castration, according to the European Association of Urology. FCH PET/CT results were classified as positive or negative, using as gold standard the pathology report, findings of other imaging test, and/or clinical follow-up results. The correlation between FCH PET/CT and PSA kinetics (PSA at the time of exploration [PSA-trigger], doubling time [PSAdt] and velocity [PSAva]) was studied and the influence of hormone therapy was analysed. RESULTS The study included 203 patients. The FCH PET/CT detection rate was 43.3%. The group of patients with FCH PET/CT positive showed more aggressive PSA kinetics (PSAdt: 7.5 months and PSAva 8.37±14.8ng/ml/a) than the FCH PET/CT negative group (PSAdt: 14.5±7.6 months and PSAva: 1.8±3.7ng/ml/a). The detection rate of FCH PET/CT in the subgroup with castration resistance was 89.1%, significantly higher than in the group with radical treatment at 29.9%, p<.001. CONCLUSIONS FCH PET/CT is useful to detect biochemical recurrence of prostate cancer, especially in patients who receive hormone therapy or more aggressive PSA kinetics.
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Affiliation(s)
- Eva María Triviño-Ibáñez
- UGC Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España; IBS Granada, Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Ignacio Puche-Sanz
- UGC Urología, Hospital Universitario Virgen de las Nieves, Granada, España; IBS Granada, Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Manuel Gómez-Río
- UGC Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España; IBS Granada, Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - José Manuel Cózar Olmo
- UGC Urología, Hospital Universitario Virgen de las Nieves, Granada, España; IBS Granada, Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - José Manuel Llamas-Elvira
- UGC Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España; IBS Granada, Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Antonio Rodríguez-Fernández
- UGC Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España; IBS Granada, Instituto de Investigación Biosanitaria de Granada, Granada, España.
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21
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68Ga-PSMA PET/CT-based metastasis-directed radiotherapy for oligometastatic prostate cancer recurrence after radical prostatectomy. World J Urol 2019; 37:1535-1542. [PMID: 30824985 DOI: 10.1007/s00345-019-02701-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 02/21/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The aim of this communication was to assess the efficacy of directed oligometastatic radiotherapy (RT) based on 68Ga-PSMA PET/CT in patients with prostate cancer (PCa) biochemical relapse (BCR) after primary treatment with curative intent. METHODS This is a retrospective analysis of a monocentric cohort of PCa patients diagnosed with oligometastatic disease on 68Ga-PSMA PET/CT and treated with metastasis-directed RT. Inclusion criteria were: histologically proven PCa, BCR after primary treatment with curative intent, oligometastatic disease defined as ≤ 3 metastatic lesions. To evaluate the efficacy of the therapy, biochemical response defined as a decrease of > 50% of PSA (PSA50) was measured at 1 and 4 months. Patients were followed up until progression and start of androgen deprivation therapy (ADT). BCR-free survival and ADT-free survival were calculated. RESULTS 20 patients met the inclusion criteria. Median PSA value: 1.4 ng/ml (IQR, 0.3-2.3 ng/ml). A total of 30 PSMA-positive lesions were treated: 18 lymph nodes (60%), nine bone (30%) and three visceral lesions (10%). Median follow-up was 15 months (range 4-33 months). Biochemical response at 1 and 4 months was found in 3/20 patients (15%) and 14/20 (70%), respectively. BCR-free survival rate at 1 year was 79% and 53% at 2 years. ADT-free survival at 2 years was 74%. CONCLUSION This retrospective study suggests that metastasis-directed RT based on 68Ga-PSMA PET/CT may be a valuable treatment in patients with PCa oligometastatic disease, providing promising BCR-free survival rates and potentially postponing ADT for at least 2 years in 74% of the patients. Response assessment should not be measured before 4 months after treatment.
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Kirk PS, Borza T, Caram MEV, Shumway DA, Makarov DV, Burns JA, Shelton JB, Leppert JT, Chapman C, Chang M, Hollenbeck BK, Skolarus TA. Characterising potential bone scan overuse amongst men treated with radical prostatectomy. BJU Int 2018; 124:55-61. [PMID: 30246937 DOI: 10.1111/bju.14551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To characterise bone scan use, and potential overuse, after radical prostatectomy (RP) using data from a large, national integrated delivery system. Overuse of imaging is well documented in the setting of newly diagnosed prostate cancer, but whether overuse persists after RP remains unknown. PATIENTS AND METHODS We identified 12 269 patients with prostate cancer treated with RP between 2005 and 2008 using the Veterans Administration Central Cancer Registry. We used administrative and laboratory data to examine rates of bone scan use, including preceding prostate-specific antigen (PSA) levels, and receipt of adjuvant or salvage therapy. We then performed multivariable logistic regression to identify factors associated with post-RP bone scan use. RESULTS At a median follow-up of 6.8 years, one in five men (22%) underwent a post-RP bone scan at a median PSA level of 0.2 ng/mL. Half of bone scans (48%) were obtained in men who did not receive further treatment with androgen-deprivation or radiation therapy. After adjustment, post-RP bone scan was associated with a prior bone scan (adjusted odds ratio [aOR] 1.55, 95% confidence interval [CI] 1.32-1.84), positive surgical margin (aOR 1.68, 95% CI 1.40-2.01), preoperative PSA level (aOR 1.02, 95% CI 1.01-1.03), as well as Hispanic ethnicity, Black race, and increasing D'Amico risk category, but not with age or comorbidity. CONCLUSION We found a substantial rate of bone scan utilisation after RP. The majority were performed for PSA levels of <1 ng/mL where the likelihood of a positive test is low. More judicious use of imaging appears warranted in the post-RP setting.
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Affiliation(s)
- Peter S Kirk
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Tudor Borza
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Megan E V Caram
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.,VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Dean A Shumway
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Danil V Makarov
- Departments of Urology and Population Health, NYU Langone Medical Center, New York, NY, USA.,Veterans Affairs (VA) New York Healthcare System, New York, NY, USA
| | - Jennifer A Burns
- VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Christina Chapman
- VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael Chang
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ted A Skolarus
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.,VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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23
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Schiavina R, Chessa F, Borghesi M, Gaudiano C, Bianchi L, Corcioni B, Castellucci P, Ceci F, Ceravolo I, Barchetti G, Del Monte M, Campa R, Catalano C, Panebianco V, Nanni C, Fanti S, Minervini A, Porreca A, Brunocilla E. State-of-the-art imaging techniques in the management of preoperative staging and re-staging of prostate cancer. Int J Urol 2018; 26:18-30. [DOI: 10.1111/iju.13797] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/18/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Riccardo Schiavina
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Francesco Chessa
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Marco Borghesi
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Caterina Gaudiano
- Radiology Unit; Department of Diagnostic Medicine and Prevention; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Lorenzo Bianchi
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Beniamino Corcioni
- Radiology Unit; Department of Diagnostic Medicine and Prevention; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Paolo Castellucci
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Francesco Ceci
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
- Ahmanson Translational Imaging Division; Department of Molecular and Medical Pharmacology; University of California at Los Angeles; Los Angeles California USA
| | - Isabella Ceravolo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Giovanni Barchetti
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Maurizio Del Monte
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Riccardo Campa
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Carlo Catalano
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Valeria Panebianco
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Cristina Nanni
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Stefano Fanti
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Andrea Minervini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery; Abano Terme Hospital; Abano Terme Italy
| | - Eugenio Brunocilla
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
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24
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Soydal C, Urun Y, Suer E, Nak D, Ozkan E, Kucuk NO. Predictor of 68Ga PSMA PET/CT positivity in patients with prostate cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 64:226-230. [PMID: 29745629 DOI: 10.23736/s1824-4785.18.03056-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate predictive factors of 68Gallium (68Ga) prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) positivity. METHODS Relationships between serum prostate specific antigen (PSA), lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) levels, Gleason Score (GS) and positivity of 68Ga PSMA PET in patients who underwent 68Ga PSMA PET/CT for restaging for PCa were evaluated retrospectively. RESULTS One hundred and four (median age: 67; range: 51-88) patients were included in this study. Of these patients, PSMA PET was positive in 75 (72%) patients. Mean serum PSA levels for PET negative and positive groups were 0.76±1.00 and 180.85±324.93 ng/mL (P<0.001). The sensitivity and specificity of 68Ga PSMA PET/CT for detection of disease recurrence were calculated as 92% and 80%, respectively, for the 1.4 ng/mL PSA cut-off and 92% and 90%, respectively, for the 2 ng/mL PSA cut-off values. The positivity rates for patients with PSA levels <1.4 ng/mL and ≥1.4 ng/mL were 21% and 90%, respectively (P<0.001). CONCLUSIONS 68Ga PSMA PET/CT seems to be a highly sensitive in patients with early PSA recurrence. Patients with higher GS and early PSA recurrence could benefit from 68Ga PSMA PET/CT.
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Affiliation(s)
- Cigdem Soydal
- Department of Nuclear Medicine, Ankara University Medical Faculty, Ankara, Turkey -
| | - Yuksel Urun
- Department of Medical Oncology, Ankara University Medical Faculty, Ankara, Turkey
| | - Evren Suer
- Department of Urology, Ankara University Medical Faculty, Ankara, Turkey
| | - Demet Nak
- Ankara University Medical Faculty, Ankara, Turkey
| | - Elgin Ozkan
- Ankara University Medical Faculty, Ankara, Turkey
| | - Nuriye O Kucuk
- Department of Nuclear Medicine, Ankara University Medical Faculty, Ankara, Turkey
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25
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Mena E, Lindenberg ML, Shih JH, Adler S, Harmon S, Bergvall E, Citrin D, Dahut W, Ton AT, McKinney Y, Weaver J, Eclarinal P, Forest A, Afari G, Bhattacharyya S, Mease RC, Merino MJ, Pinto P, Wood BJ, Jacobs P, Pomper MG, Choyke PL, Turkbey B. Clinical impact of PSMA-based 18F-DCFBC PET/CT imaging in patients with biochemically recurrent prostate cancer after primary local therapy. Eur J Nucl Med Mol Imaging 2018; 45:4-11. [PMID: 28894899 PMCID: PMC7983162 DOI: 10.1007/s00259-017-3818-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of our study was to assess 18F-DCFBC PET/CT, a PSMA targeted PET agent, for lesion detection and clinical management of biochemical relapse in prostate cancer patients after primary treatment. METHODS This is a prospective IRB-approved study of 68 patients with documented biochemical recurrence after primary local therapy consisting of radical prostatectomy (n = 50), post radiation therapy (n = 9) or both (n = 9), with negative conventional imaging. All 68 patients underwent whole-body 18F-DCFBC PET/CT, and 62 also underwent mpMRI within one month. Lesion detection with 18F-DCFBC was correlated with mpMRI findings and pre-scan PSA levels. The impact of 18F-DCFBC PET/CT on clinical management and treatment decisions was established after 6 months' patient clinical follow-up. RESULTS Forty-one patients (60.3%) showed at least one positive 18F-DCFBC lesion, for a total of 79 lesions, 30 in the prostate bed, 39 in lymph nodes, and ten in distant sites. Tumor recurrence was confirmed by either biopsy (13/41 pts), serial CT/MRI (8/41) or clinical follow-up (15/41); there was no confirmation in five patients, who continue to be observed. The 18F-DCFBC and mpMRI findings were concordant in 39 lesions (49.4%), and discordant in 40 lesions (50.6%); the majority (n = 32/40) of the latter occurring because the recurrence was located outside the mpMRI field of view. 18F-DCFBC PET positivity rates correlated with PSA values and 15%, 46%, 83%, and 77% were seen in patients with PSA values <0.5, 0.5 to <1.0, 1.0 to <2.0, and ≥2.0 ng/mL, respectively. The optimal cut-off PSA value to predict a positive 18F-DCFBC scan was 0.78 ng/mL (AUC = 0.764). A change in clinical management occurred in 51.2% (21/41) of patients with a positive 18F-DCFBC result, generally characterized by starting a new treatment in 19 patients or changing the treatment plan in two patients. CONCLUSIONS 18F-DCFBC detects recurrences in 60.3% of a population of patients with biochemical recurrence, but results are dependent on PSA levels. Above a threshold PSA value of 0.78 ng/mL, 18F-DCFBC was able to identify recurrence with high reliability. Positive 18F-DCFBC PET imaging led clinicians to change treatment strategy in 51.2% of patients.
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Affiliation(s)
- Esther Mena
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA.
| | - Maria L Lindenberg
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Joanna H Shih
- Division of Cancer treatment and Diagnosis: Biometric Research Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stephen Adler
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute, Campus at Frederick, Frederick, MD, USA
| | - Stephanie Harmon
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute, Campus at Frederick, Frederick, MD, USA
| | - Ethan Bergvall
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Deborah Citrin
- Radiation Oncology Branch, Center for Cancer Research. National Cancer Institute, NIH, Bethesda, MD, USA
| | - William Dahut
- Genitourinary Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Anita T Ton
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Yolanda McKinney
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Juanita Weaver
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute, Campus at Frederick, Frederick, MD, USA
| | - Philip Eclarinal
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Alicia Forest
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute, Campus at Frederick, Frederick, MD, USA
| | - George Afari
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Frederick, MD, USA
| | - Sibaprasad Bhattacharyya
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Frederick, MD, USA
| | - Ronnie C Mease
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Paula Jacobs
- Cancer Imaging Program, National Cancer Institute, NIH, Rockville, MD, USA
| | - Martin G Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
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26
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Biochemical Recurrence After Radiation Therapy. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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27
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Farrell MB. Statistics Refresher for Molecular Imaging Technologists Part 1: Testing the Test. J Nucl Med Technol 2017; 46:jnmt.117.201467. [PMID: 29273700 DOI: 10.2967/jnmt.117.201467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/14/2017] [Indexed: 11/16/2022] Open
Abstract
Molecular imaging technologists are faced with statistics on a daily basis because they image patients who have been selected for diagnostic testing based on analysis of how well the test performs, and because technical factors can influence the performance of any diagnostic test. Choosing what test procedure to perform on which patient is a matter of understanding the patient's pretest likelihood of disease, the performance characteristics of the diagnostic test, and other clinical factors which may impact the usefulness of the results. Terms such as sensitivity, specificity, accuracy, and predictive value are used to describe how a diagnostic test performs, or how it compares to other diagnostic tests. While nuclear medicine and PET technologists study these concepts in training programs, applying this learning to daily patient care can be daunting given that new tracers and technologies are continuously moving into clinical practice. Research advances continue to challenge diagnostic paradigms with new patient populations, increasingly sophisticated technology, and the advent of large databases with which to study population outcomes. This article is part I of a two-part series. The purpose of this article is to provide a refresher about basic clinical statistics that are useful in understanding how diagnostic testing is optimally applied in the patient care setting.
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28
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New aspects of molecular imaging in prostate cancer. Methods 2017; 130:36-41. [DOI: 10.1016/j.ymeth.2017.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/12/2017] [Accepted: 07/10/2017] [Indexed: 11/22/2022] Open
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29
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Puche-Sanz I, Triviño-Ibáñez E, Vázquez-Alonso F, Llamas-Elvira JM, Cózar-Olmo JM, Rodríguez-Fernández A. Role of PET-CT with 18F-fluorocholine in biochemical recurrence after treatment of prostate cancer with curative intent. Actas Urol Esp 2017; 41:437-444. [PMID: 28389027 DOI: 10.1016/j.acuro.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To analyse the ability of the PET-CT with 18F-fluorocholine (18F-FCH) to detect disease on biochemical recurrence after treatment with curative intent. To determine the clinical variables that would be able to optimise the test's diagnostic yield. MATERIAL AND METHODS A retrospective study of PET-CTs with 18F-fluorocholine performed on 61 patients with prostate cancer who had undergone treatment with curative intent and met the criteria for biochemical recurrence. The results of the PET-CT were categorised into positive or negative and were validated using pre-established criteria. The relationship between the result of the PET-CT and the initial PSA nadir, PSA trigger, rising PSA velocity (PSAva) and PSA doubling time (PSAdt). The relationship between the metastatic sites on the PET-CT and the remaining variables was analysed. RESULTS There was a 34.4% detection rate of the disease. The initial PSA, PSA nadir, PSA trigger and PSAva showed statistically significant differences according to the result of the PET-CT. The best discriminatory cut-off point between a positive or negative PET-CT for PSA trigger and PSAva was 3.5ng/ml and 0.25ng/ml/month respectively. The PSAdt was significantly lower in patients with remote disease compared to patients with localised disease (5.1 vs 16.8 months, P=.01). The probability that the PET-CT would detect remote disease vs localised disease was 3.2 times higher if the PSAdt was under 6 months (80% vs 20%, OR: 3.2, P=.02). In the multivariate analysis, only the initial PSA and not having undergone radical prostatectomy were demonstrated as independent predictive factors of a positive PET-CT result. CONCLUSIONS The PET-CT with 18F-FCH can detect disease in a high percentage of patients with biochemical recurrence and provides information on its anatomical location. PSA kinetics and the patient's previous treatment are key variables in increasing the test's diagnostic.
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Affiliation(s)
- I Puche-Sanz
- UGC Urología, Complejo Hospitalario Universitario de Granada, Instituto de Investigación Biosanitaria IBS Granada (IBS Granada Bio-Health Research Institute), Granada, España.
| | - E Triviño-Ibáñez
- UGC Medicina Nuclear, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - F Vázquez-Alonso
- UGC Urología, Complejo Hospitalario Universitario de Granada, Instituto de Investigación Biosanitaria IBS Granada (IBS Granada Bio-Health Research Institute), Granada, España
| | - J M Llamas-Elvira
- UGC Medicina Nuclear, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - J M Cózar-Olmo
- UGC Urología, Complejo Hospitalario Universitario de Granada, Instituto de Investigación Biosanitaria IBS Granada (IBS Granada Bio-Health Research Institute), Granada, España
| | - A Rodríguez-Fernández
- UGC Medicina Nuclear, Complejo Hospitalario Universitario de Granada, Granada, Spain
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30
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Sathianathen NJ, Geurts N, Nair R, Lawrentschuk N, Murphy DG, Lamb AD. The phytological future of prostate cancer staging: PSMA-PET and the dandelion theory. Future Oncol 2017; 13:1801-1807. [DOI: 10.2217/fon-2017-0074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PSMA-PET is changing how we stage prostate cancer, both in the primary setting and with relapse after treatment. It allows us to identify lesions in the bones and lymph nodes that were not previously visible on conventional imaging with bone scan and CT/MRI. In this Special Report we review the ‘state of the art’ for PSMA imaging and discuss the implications for treatment decisions in prostate cancer. We liken early high risk or metastatic prostate to a common phytological problem: the dandelion. In this analogous situation, we consider the additional evidence needed for us to start plucking out the original dandelion and for us to focus attention on killing the seeded weeds that are identifiable elsewhere in the lawn.
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Affiliation(s)
- Niranjan J Sathianathen
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Nicolas Geurts
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Rajesh Nair
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Victoria, Australia
| | - Declan G Murphy
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
- Australian Prostate Cancer Research Centre, Epworth Healthcare, Richmond, Australia
| | - Alastair D Lamb
- Department of Genitourinary Oncology & Division of Cancer Surgery, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
- Academic Urology Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Nuffield Department of Surgical Sciences, University of Oxford, UK
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31
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Ceci F, Herrmann K, Hadaschik B, Castellucci P, Fanti S. Therapy assessment in prostate cancer using choline and PSMA PET/CT. Eur J Nucl Med Mol Imaging 2017; 44:78-83. [PMID: 28540419 DOI: 10.1007/s00259-017-3723-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 01/15/2023]
Abstract
While PET with non-FDG tracers (mainly choline and Ga-PSMA) has commonly been used for restaging in men with biochemically recurrent prostate cancer, as well as for primary staging, it is only recently that a few preliminary studies have addressed the possible use of PET for monitoring the response to systemic therapy of metastatic disease, especially innovative treatments such as abiraterone and enzalutamide. This article aims to evaluate the role of PET imaging with different non-FDG radiotracers for assessment of therapy in advanced prostate cancer patients.
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Affiliation(s)
- Francesco Ceci
- Nuclear Medicine Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Paolo Castellucci
- Nuclear Medicine Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy
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32
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Development of standardized image interpretation for 68Ga-PSMA PET/CT to detect prostate cancer recurrent lesions. Eur J Nucl Med Mol Imaging 2017; 44:1622-1635. [DOI: 10.1007/s00259-017-3725-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/09/2017] [Indexed: 12/31/2022]
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33
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Ceci F, Castellucci P, Mapelli P, Incerti E, Picchio M, Fanti S. Evaluation of Prostate Cancer with 11C-Choline PET/CT for Treatment Planning, Response Assessment, and Prognosis. J Nucl Med 2017; 57:49S-54S. [PMID: 27694172 DOI: 10.2967/jnumed.115.170126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/05/2016] [Indexed: 01/29/2023] Open
Abstract
The aim of this review is to report on the value of 11C-choline PET imaging as a diagnostic procedure for metastasis-directed therapies. Furthermore, the role of 11C-choline PET/CT as a diagnostic tool for monitoring castration-resistant prostate cancer patients treated with systematic therapy is assessed. Finally, the role of 11C-choline PET/CT in the prediction of survival in both castration-resistant prostate cancer patients and hormone-naïve patients is investigated.
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Affiliation(s)
- Francesco Ceci
- Service of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; and
| | - Paolo Castellucci
- Service of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; and
| | - Paola Mapelli
- Service of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Incerti
- Service of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Service of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Fanti
- Service of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; and
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34
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Einspieler I, Rauscher I, Düwel C, Krönke M, Rischpler C, Habl G, Dewes S, Ott A, Wester HJ, Schwaiger M, Maurer T, Eiber M. Detection Efficacy of Hybrid 68Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria. J Nucl Med 2017; 58:1081-1087. [PMID: 28209912 DOI: 10.2967/jnumed.116.184457] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/24/2017] [Indexed: 01/04/2023] Open
Abstract
The aim of this retrospective study was to evaluate the detection rate of Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] (68Ga-PSMA ligand; PSMA is prostate-specific membrane antigen) PET/CT in patients with biochemical recurrent prostate cancer defined by Phoenix criteria after external-beam radiotherapy or brachytherapy as primary treatment. Methods: One hundred eighteen patients with a median prostate-specific antigen (PSA) of 6.4 ng/mL (range, 2.2-158.4 ng/mL; interquartile range, 4.2-10.2 ng/mL) were finally eligible for this retrospective analysis. Seventy-seven and 41 patients had been treated by external-beam radiotherapy or brachytherapy, respectively. Of the 118 patients, 45 were receiving androgen-deprivation therapy (ADT) within at least 6 mo before the PET/CT. The detection rates were stratified by PSA. The influence of primary Gleason score and ADT was assessed. Relationships between SUV and clinical as well as pathologic features in patients with positive findings were analyzed using univariate and multivariable linear regression models. Results: One hundred seven of 118 patients (90.7%) showed pathologic findings indicative for tumor recurrence in 68Ga-PSMA ligand PET/CT. The detection rates were 81.8% (36/44), 95.3% (41/43), and 96.8% (30/31) for PSA of 2 to <5, 5 to <10, and ≥10 ng/mL, respectively (P = 0.0377). 68Ga-PSMA ligand PET/CT indicated local recurrence in 68 of 107 patients (63.5%), distant lesions in 64 of 107 patients (59.8%), and local recurrence as well as distant lesions in 25 of 107 patients (23.4%). The detection rate was significantly higher in patients with ADT (97.7%) versus without ADT (86.3%, P = 0.0381), but independent from primary Gleason score ≥ 8 (92.0%) versus ≤ 7 (90.2%, P = 0.6346). SUVmax and SUVmean were significantly associated with PSA and ADT (P = 0.018 and 0.004 for SUVmax, respectively; P = 0.025 and 0.007 for SUVmean, respectively). Conclusion:68Ga-PSMA ligand PET/CT demonstrates high detection rates in patients with biochemical recurrence of prostate cancer after primary radiation therapy. The detection rate was positively associated to increasing PSA as well as concomitant ADT. 68Ga-PSMA ligand PET/CT enables discrimination of local versus metastatic disease and thus might have a crucial impact on further clinical management. A major limitation of this study is the lack of histopathologic proof in most patients.
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Affiliation(s)
- Ingo Einspieler
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany .,Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Charlotte Düwel
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus Krönke
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gregor Habl
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabrina Dewes
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Armin Ott
- Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany; and
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Matti A, Lima GM, Zanoni L, Pultrone C, Schiavina R, Lodi F, Fanti S, Nanni C. Interpretation of 11C-choline PET/CT for the diagnosis of local relapse in radically treated prostate cancer. Eur J Hybrid Imaging 2017; 1:5. [PMID: 29782589 PMCID: PMC5954670 DOI: 10.1186/s41824-017-0007-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 09/01/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose 11C–choline PET/CT is a widely-used tool for the diagnostic of prostate cancer (PCa). In literature, a great variability of local relapse (LR) detection rate is reported. The aim of this study is to provide positivity criteria for 11C–choline PET/CT detection of LR in patients who had surgery for PCa and presented prostate specific antigen (PSA) failure. Methods Sixty patients radically treated for PCa and presenting PSA failure were retrospectively analysed. Two Nuclear Medicine Physicians revised the 11C–choline PET/CT scans and defined by consensus if even mild focal uptake was present in the prostate bed (PB) and bladder-urethral junction (BUJ) along midline, regardless the previous report results. The results were subsequently correlated with a clinical and radiological follow up (FU) of 1 to 2 year and with TNM staging, Gleason score (GS), PSA level at relapse, radiotherapy (RT) and hormone therapy (HT) after surgery. Results There was focal uptake in 22/60 patients; 11 of them were true positive and 11 false positive. The PSA level showed a tight connection with the true positivity/negativity of Choline scan. Most of true positive cases (10/11 patients) presented a PSA ≥ 1 ng/ml, while approximately half of the false positive cases (5/11 patients) presented PSA below 1 ng/ml. The other variables were not correlated to Choline detection rate for LR. Conclusions This study shows that an even mild focal uptake of Choline in the PB and BUJ along midline must be considered suspicious for LR in patients radically treated for PCa, especially if they are presenting with PSA level > 1 ng/ml.
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Affiliation(s)
- A Matti
- 1Nuclear Medicine Department, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - G M Lima
- 1Nuclear Medicine Department, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - L Zanoni
- 1Nuclear Medicine Department, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - C Pultrone
- 2Urology Department, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - R Schiavina
- 2Urology Department, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - F Lodi
- 1Nuclear Medicine Department, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - S Fanti
- 1Nuclear Medicine Department, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - C Nanni
- 1Nuclear Medicine Department, S.Orsola-Malpighi Hospital, Bologna, Italy
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Sathianathen NJ, Lamb A, Nair R, Geurts N, Mitchell C, Lawrentschuk NL, Moon DA, Murphy DG. Updates of prostate cancer staging: Prostate-specific membrane antigen. Investig Clin Urol 2016; 57:S147-S154. [PMID: 27995218 PMCID: PMC5161015 DOI: 10.4111/icu.2016.57.s2.s147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/08/2016] [Indexed: 11/23/2022] Open
Abstract
The ability to accurately stage prostate cancer in both the primary and secondary staging setting can have a major impact on management. Until recently radiological staging has relied on computer tomography, magnetic resonance imaging, and nuclear bone scans to evaluate the extent of disease. However, the utility of these imaging technologies has been limited by their sensitivity and specificity especially in detecting early recurrence. Functional imaging using positron-emission tomography with a radiolabeled ligand targeted to prostate-specific membrane antigen has transformed the prostate cancer imaging landscape. Initial results suggest that it is a substantial improvement over conventional imaging in the setting of recurrence following primary therapy by having a superior ability to detect disease and to do so at an earlier stage. Additionally, it appears that the benefits seen in the secondary staging setting may also exist in the primary staging setting.
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Affiliation(s)
| | - Alastair Lamb
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
| | - Rajesh Nair
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
| | - Nicolas Geurts
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
| | | | | | - Daniel A Moon
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
| | - Declan G Murphy
- Peter MacCallum Cancer Centre, Parkville, Melbourne, Australia
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Bach-Gansmo T, Nanni C, Nieh PT, Zanoni L, Bogsrud TV, Sletten H, Korsan KA, Kieboom J, Tade FI, Odewole O, Chau A, Ward P, Goodman MM, Fanti S, Schuster DM, Willoch F. Multisite Experience of the Safety, Detection Rate and Diagnostic Performance of Fluciclovine ( 18F) Positron Emission Tomography/Computerized Tomography Imaging in the Staging of Biochemically Recurrent Prostate Cancer. J Urol 2016; 197:676-683. [PMID: 27746282 DOI: 10.1016/j.juro.2016.09.117] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE Sensitive detection of cancer foci in men experiencing biochemical recurrence following initial treatment of prostate cancer is of great clinical significance with a possible impact on subsequent treatment choice. We describe a multisite experience of the efficacy and safety of the positron emission tomography/computerized tomography agent fluciclovine (18F) after biochemical recurrence. MATERIALS AND METHODS A total of 596 patients underwent fluciclovine (18F) positron emission tomography/computerized tomography at 4 clinical sites. Detection rate determinations were stratified by the baseline prostate specific antigen value. Diagnostic performance was assessed against a histological reference standard in 143 scans. RESULTS The subject level fluciclovine (18F) positron emission tomography/computer tomography detection rate was 67.7% (403 of 595 scans). Positive findings were detected in the prostate/bed and pelvic lymph node regions in 38.7% (232 of 599) and 32.6% of scans (194 of 596), respectively. Metastatic involvement outside the pelvis was detected in 26.2% of scans (155 of 591). The subject level detection rate in patients in the lowest quartile for baseline prostate specific antigen (0.79 ng/ml or less) was 41.4% (53 of 128). Of these patients 13 had involvement in the prostate/bed only, 16 had pelvic lymph node involvement without distant disease and 24 had distant metastases. The positive predictive value of fluciclovine (18F) positron emission tomography/computerized tomography scanning for all sampled lesions was 62.2%, and it was 92.3% and 71.8% for extraprostatic and prostate/bed involvement, respectively. Fluciclovine (18F) was well tolerated and the safety profile was not altered following repeat administration. CONCLUSIONS Fluciclovine (18F) is well tolerated and able to detect local and distant prostate cancer recurrence across a wide range of prostate specific antigen values.
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Affiliation(s)
- Tore Bach-Gansmo
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
| | - Cristina Nanni
- Nuclear Medicine, Azienda ospedaliero-universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Peter T Nieh
- Department of Urology, Emory University, Atlanta, Georgia
| | - Lucia Zanoni
- Nuclear Medicine, Azienda ospedaliero-universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Tronde Velde Bogsrud
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Heidi Sletten
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | - J Kieboom
- Department of Nuclear Medicine and Radiology, Aleris Healthcare, Oslo, Norway
| | - Funmilayo I Tade
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Oluwaseun Odewole
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Albert Chau
- Blue Earth Diagnostics, Oxford, United Kingdom
| | | | - Mark M Goodman
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Stefano Fanti
- Nuclear Medicine, Azienda ospedaliero-universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - David M Schuster
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Frode Willoch
- Department of Nuclear Medicine and Radiology, Aleris Healthcare, Oslo, Norway; Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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Graziani T, Ceci F, Castellucci P, Polverari G, Lima GM, Lodi F, Morganti AG, Ardizzoni A, Schiavina R, Fanti S. (11)C-Choline PET/CT for restaging prostate cancer. Results from 4,426 scans in a single-centre patient series. Eur J Nucl Med Mol Imaging 2016; 43:1971-9. [PMID: 27277279 DOI: 10.1007/s00259-016-3428-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/19/2016] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate (11)C-choline PET/CT as a diagnostic tool for restaging prostate cancer (PCa), in a large, homogeneous and clinically relevant population of patients with biochemical recurrence (BCR) of PCa after primary therapy. The secondary aim was to assess the best timing for performing (11)C-choline PET/CT during BCR. METHODS We retrospectively analysed 9,632 (11)C-choline PET/CT scans performed in our institution for restaging PCa from January 2007 to June 2015. The inclusion criteria were: (1) proven PCa radically treated with radical prostatectomy (RP) or with primary external beam radiotherapy (EBRT); (2) PSA serum values available; (3) proven BCR (PSA >0.2 ng/mL after RP or PSA >2 ng/mL above the nadir after primary EBRT with rising PSA levels). Finally, 3,203 patients with recurrent PCa matching all the inclusion criteria were retrospectively enrolled and 4,426 scans were analysed. RESULTS Overall, 52.8 % of the (11)C-choline PET/CT scans (2,337/4,426) and 54.8 % of the patients (1,755/3,203) were positive. In 29.4 % of the scans, at least one distant finding was observed. The mean and median PSA values were, respectively, 4.9 and 2.1 ng/mL at the time of the scan (range 0.2 - 50 ng/mL). In our series, 995 scans were performed in patients with PSA levels between 1 and 2 ng/mL. In this subpopulation the positivity rate in the 995 scans was 44.7 %, with an incidence of distant findings of 19.2 % and an incidence of oligometastatic disease (one to three lesions) of 37.7 %. The absolute PSA value at the time of the scan and ongoing androgen deprivation therapy were associated with an increased probability of a positive (11)C-choline PET/CT scan (p < 0.0001). In the ROC analysis, a PSA value of 1.16 ng/mL was the optimal cut-off value. In patients with a PSA value <1.16 ng/mL, 26.8 % of 1,426 (11)C-choline PET/CT scans were positive, with oligometastatic disease in 84.7 % of positive scans. CONCLUSION In a large cohort of patients, the feasibility of (11)C-choline PET/CT for detecting the sites of metastatic disease in PCa patients with BCR was confirmed. The PSA level was the main predictor of a positive scan with 1.16 ng/mL as the optimal cut-off value. In the majority of positive scans oligometastatic disease, potentially treatable with salvage therapies, was observed.
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Affiliation(s)
- Tiziano Graziani
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Ceci
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Castellucci
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. .,UO Medicina Nucleare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, PAD. 30, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Giulia Polverari
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Maria Lima
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Filippo Lodi
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Andrea Ardizzoni
- Department of Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Tan H, Joseph D, Loh NK, McCarthy M, Leong E, Siew T, Segard T, Morandeau L, Trevenen M, Francis RJ. A pilot study of the utility of choline PET-CT in prostate cancer biochemical relapse following radical prostatectomy. J Med Imaging Radiat Oncol 2016; 60:374-81. [PMID: 27094471 DOI: 10.1111/1754-9485.12455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To evaluate the detection rate of positive choline PET-CT and its clinical role in assisting with management decisions and the correlation between positive choline PET-CT and clinical/pathological parameters in prostate cancer patients with biochemical relapse following radical prostatectomy. METHODS This was a longitudinal observational pilot study of 34 patients who received choline PET-CT scans with biochemical relapse after radical prostatectomy. Variables including peak PSA, PSA doubling time (DT), Gleason score, age, initial PSA at diagnosis, use of ADT prior to PET and initial clinical staging were statistically analysed to assess for independent predictive factors for positive PET findings. RESULTS Choline PET-CT was positive in 38.2% of patients (13/34). The only statistically significant predictor for positive PET-CT was the use of ADT prior to PET-CT, with OR 18.7 (95% CI, 2.87-122.45), P < 0.01. Mean peak PSA for patients with positive PET-CT was 5.5 ± 4.8 ng/mL. Patients with positive PET-CT had a mean PSA DT of 5.1 ± 3.8 months and mean total Gleason of 7.6 ± 0.8. Although these variables were not statistically significant, they showed a tendency towards significance. At Receiver Operator Characteristics (ROC) analysis, a peak PSA value of 1.65 ng/mL and PSA DT of 4.4 months were determined to be the optimal cut-off values predicting positive PET-CT. CONCLUSION Choline PET-CT has its potential as a diagnostic modality enabling the detection of occult prostate cancer recurrence and to differentiate localised disease from systemic disease thus guiding management. Use of ADT prior to PET-CT is a significant predictor of positive PET-CT. Patients with a short PSA DT, high-peak PSA and high Gleason score should also be considered for choline PET-CT.
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Affiliation(s)
- Hendrick Tan
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Department of Radiation Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - David Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Nelson K Loh
- Department of Nuclear Medicine/WA PET Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Michael McCarthy
- Department of Nuclear Medicine/WA PET Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Eugene Leong
- Department of Radiation Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Teck Siew
- Department of Nuclear Medicine/WA PET Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Tatiana Segard
- Department of Nuclear Medicine/WA PET Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Laurence Morandeau
- Radiopharmaceutical Production & Development (RAPID) PET Labs, Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Michelle Trevenen
- Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia.,Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Roslyn J Francis
- Department of Nuclear Medicine/WA PET Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
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Odewole OA, Tade FI, Nieh PT, Savir-Baruch B, Jani AB, Master VA, Rossi PJ, Halkar RK, Osunkoya AO, Akin-Akintayo O, Zhang C, Chen Z, Goodman MM, Schuster DM. Recurrent prostate cancer detection with anti-3-[(18)F]FACBC PET/CT: comparison with CT. Eur J Nucl Med Mol Imaging 2016; 43:1773-83. [PMID: 27091135 DOI: 10.1007/s00259-016-3383-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/29/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare the diagnostic performance of the synthetic amino acid analogue PET radiotracer anti-3-[(18)F]FACBC (fluciclovine) with that of CT in the detection of recurrent prostate carcinoma. METHODS This was a retrospective analysis of 53 bone scan-negative patients with suspected recurrent prostate carcinoma who underwent fluciclovine PET/CT and routine clinical CT within 90 days of each other. The correlation between imaging findings and histology and clinical follow-up was evaluated. Positivity rates and diagnostic performance were calculated for fluciclovine PET/CT and CT. RESULTS Of 53 fluciclovine PET/CT and 53 CT examinations, 41 (77.4 %) and 10 (18.9 %), respectively, had positive findings for recurrent disease. Positivity rates were higher with fluciclovine PET/CT than with CT at all prostate-specific antigen (PSA) levels, PSA doubling times and original Gleason scores. In the prostate/bed, fluciclovine PET/CT was true-positive in 31 and CT was true-positive in 4 of 51 patients who met the reference standard. In extraprostatic regions, fluciclovine PET/CT was true-positive in 12 and CT was true-positive in 3 of 41 patients who met the reference standard. Of the 43 index lesions used to prove positivity, 42 (97.7 %) had histological proof. In 51 patients with sufficient follow-up to calculate diagnostic performance in the prostate/bed, fluciclovine PET/CT demonstrated a sensitivity of 88.6 %, a specificity of 56.3 %, an accuracy of 78.4 %, a positive predictive value (PPV) of 81.6 %, and a negative predictive value (NPV) of 69.2 %; the respective values for CT were 11.4 %, 87.5 %, 35.3 %, 66.7 % and 31.1 %. In 41 patients with sufficient follow-up to calculate diagnostic performance in extraprostatic regions, fluciclovine PET/CT demonstrated a sensitivity of 46.2 %, a specificity of 100 %, an accuracy of 65.9 %, a PPV of 100 %, and an NPV of 51.7 %; the respective values for CT were 11.5 %, 100 %, 43.9 %, 100 % and 39.5 %. CONCLUSION The diagnostic performance of fluciclovine PET/CT in recurrent prostate cancer is superior to that of CT and fluciclovine PET/CT provides better delineation of prostatic from extraprostatic recurrence.
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Affiliation(s)
| | - Funmilayo I Tade
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | | | | | - Ashesh B Jani
- Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | - Peter J Rossi
- Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | - Adeboye O Osunkoya
- Urology, Emory University, Atlanta, GA, USA
- Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | | | - Chao Zhang
- Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zhengjia Chen
- Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mark M Goodman
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - David M Schuster
- Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road, Atlanta, GA, 30322, USA.
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Nanni C, Zanoni L, Pultrone C, Schiavina R, Brunocilla E, Lodi F, Malizia C, Ferrari M, Rigatti P, Fonti C, Martorana G, Fanti S. 18F-FACBC (anti1-amino-3-18F-fluorocyclobutane-1-carboxylic acid) versus 11C-choline PET/CT in prostate cancer relapse: results of a prospective trial. Eur J Nucl Med Mol Imaging 2016; 43:1601-10. [DOI: 10.1007/s00259-016-3329-1] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/07/2016] [Indexed: 11/30/2022]
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Imaging yield from 133 consecutive patients with prostate cancer and low trigger PSA from a single institution. Clin Radiol 2016; 71:e143-9. [DOI: 10.1016/j.crad.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/19/2015] [Accepted: 12/11/2015] [Indexed: 01/22/2023]
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18F-Fluciclovine PET/CT for the Detection of Prostate Cancer Relapse: A Comparison to 11C-Choline PET/CT. Clin Nucl Med 2016; 40:e386-91. [PMID: 26053708 DOI: 10.1097/rlu.0000000000000849] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE In recent years, a new PET compound (anti-3-(18)F-FACBC or (18)F-fluciclovine) was tested for the detection of prostate cancer relapse. Despite very promising results, only preliminary data were available with regard to the comparison to (11)C-choline. The aim of this study was to compare the detection rate of (18)F-FACBC and (11)C-choline in patients presenting a biochemical relapse. PATIENTS AND METHODS Fifty patients radically treated for prostate cancer and presenting with rising prostate-specific antigen (PSA) levels were consecutively and prospectively enrolled. All the patients were out of hormonal therapy and underwent both (11)C-choline PET/CT and (18)F-fluciclovine PET/CT within 1 week. The results were compared in terms of detection rate on a patient and lesion basis. Furthermore, a more detailed analysis regarding local, lymph node, and bone relapse was performed. RESULTS On a patient-based analysis, (18)F-fluciclovine detection turned out to be significantly superior to (11)C-choline (P < 0.000001). This result was also true on lesion, lymph node, bone lesion, and local relapse analysis (P < 0.0001 in all the cases). There was no significant difference in terms of target to background of positive lesions between (11)C-choline and (18)F-fluciclovine. When the patients were divided into groups with different PSA levels, (18)F-fluciclovine had a superior detection rate for low, intermediate, and high PSA levels. CONCLUSIONS In our experimental conditions, (18)F-fluciclovine provided a statistically significant better performance in terms of lesion detection rate as compared with (11)C-choline. However, more studies are required to evaluate the clinical significance of these results in terms of sensitivity, specificity, and accuracy.
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11C-choline PET/CT identifies osteoblastic and osteolytic lesions in patients with metastatic prostate cancer. Clin Nucl Med 2015; 40:e265-70. [PMID: 25783519 DOI: 10.1097/rlu.0000000000000783] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to compare C-choline PET/CT, prostate-specific antigen (PSA), PSA kinetics, and C-choline uptake in recurrent metastatic prostate cancer patients with osteoblastic and osteolytic bone metastases. PATIENTS AND METHODS We retrospectively analyzed 140 patients with the following criteria: (a) positive bone lesions identified with C-choline PET/CT and validated as true positive by histology (14.2%), correlative imaging (33.4%), or clinical follow-up (52.4%); (b) after radical prostatectomy (67.9%) or primary radiotherapy (22.1%); (c) proven biochemical relapse with rising PSA levels; (d) no chemotherapy, zoledronic acid, or palliative bone external beam radiation therapy previously administrated during biochemical relapse; and (f) asymptomatic for bone pain. Lesions were categorized as osteoblastic, osteolytic, or bone marrow lesions. Patients were divided into osteoblastic and osteolytic patient groups. RESULTS C-Choline PET/CT detected oligometastatic bone disease (1-3 lesions) in 98 (70%) of the 140 patients and multiple bone lesions in 42 (30%) of the 140 patients. By per-lesion analysis of 304 lesions, there were 184 osteoblastic, 99 osteolytic, and 21 bone marrow lesions.By per-patient analysis, 97 (69.3%) of the 140 patients were in the osteoblastic group, whereas 43 (30.7%) of the 140 patients were in the osteolytic group. Statistically significant differences in SUVmax (P < 0.001), fast PSA doubling time (P = 0.01), and PSA velocity (P = 0.01) were observed between osteoblastic (lower values) and osteolytic (higher values) groups. By multivariate analysis, fast PSA doubling time was a significant predictor for osteolytic lesions. CONCLUSIONS We demonstrated differences in PSA kinetics and SUVmax between osteolytic and osteoblastic lesions. C-Choline PET/CT may identify patients that could benefit from early targeted therapies, depending on the type of bone lesions expressed.
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Preece P, Yao HHI, Chew S, Liew D, McMullin R. PSA doubling time as a screening test to predict bone scan positivity. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415815581097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: The aim of this article is to compare the effectiveness of PSADT and tPSA as predictors of bony metastases in patients’ with prostate cancer pre-definitive treatment, and help guide clinicians with the selective ordering of bone scans (BS). Materials and methods: PSA measurements were retrospectively analysed for 330 men with prostate cancer, investigated with BS between 2009 and 2012. Exclusion criteria included previous positive BS, other malignancy, prostatectomy/radiotherapy and any prostate-specific condition or treatment initiated between the PSA levels used to calculate doubling time. PSADT (months) = log2 × dT/(log(PSA1)–log(PSA2)). Results: A total of 273 men had negative BS and 57 had positive findings of metastases. Those with positive BS had significantly ( p < 0.05) faster median PSADT (4.5 vs 15.2 months) and higher median tPSA (94 vs 24.5 ng/ml). On ROC curve analysis, PSADT outperformed tPSA as a predictor of bone scan result, with area-under-the-curve of 0.85 vs 0.76 ( p = 0.02). A ratio (R) of tPSA/PSADT was no better than PSADT alone ( p = 0.65). Conclusions: In the absence of clinical reasons to suspect metastatic disease, it is appropriate to withhold ordering a BS for non-prostatectomy/radiotherapy patients with rising PSA levels, until the PSADT is less than 18 months. This has a sensitivity of 100.0% and a specificity of 41.0%.
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Affiliation(s)
- Patrick Preece
- Department of Urology, Ballarat Base Hospital, Australia
| | - Henry HI Yao
- Department of Urology, Ballarat Base Hospital, Australia
| | - Sky Chew
- Department of Urology, Ballarat Base Hospital, Australia
| | - Danny Liew
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Australia
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Ceci F, Castellucci P, Graziani T, Schiavina R, Fanti S. PET/Computed Tomography in the Individualization of Treatment of Prostate Cancer. PET Clin 2015; 10:487-94. [PMID: 26384595 DOI: 10.1016/j.cpet.2015.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Choline PET/computed tomographic (CT) imaging represents the most diffused PET imaging techniques to investigate patients with prostate cancer (PCa). It may show the site of tumor recurrence in a single step examination, earlier than other conventional imaging techniques. In this context, the availability of a diagnostic test capable of differentiating between potentially curable local recurrence and metastatic disease implying palliative approaches may play an important role in those patients in whom targeted therapies could be performed according to choline PET/CT results. This review analyzes the value of choline PET/CT imaging in the evaluation of treatment of patients with PCa.
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Affiliation(s)
- Francesco Ceci
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Paolo Castellucci
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Tiziano Graziani
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Stefano Fanti
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
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Ceci F, Uprimny C, Nilica B, Geraldo L, Kendler D, Kroiss A, Bektic J, Horninger W, Lukas P, Decristoforo C, Castellucci P, Fanti S, Virgolini IJ. (68)Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate? Eur J Nucl Med Mol Imaging 2015; 42:1284-94. [PMID: 25975367 DOI: 10.1007/s00259-015-3078-6] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the association between PSA levels, PSA kinetics and other factors and a pathological (68)Ga-PSMA PET/CT scan in patients with recurrent prostate cancer (rPCa) with biochemical relapse (BR) after radical therapy. METHODS Seventy consecutive rPCA patients referred for (68)Ga-PSMA PET/CT, matching all the following criteria, were retrospectively evaluated: (a) previous radical prostatectomy or primary radiotherapy with curative intent; (b) BR or persisting high PSA levels after primary treatment; and (c) complete clinical and imaging information. The mean ± SD PSA level was 3.5 ± 5.3 ng/mL (median 1.7, range 0.2 - 32.2 ng/mL), the mean ± SD PSA doubling time (PSAdt) was 6.5 ± 5.5 months (median 5.5, range 1.3 - 31.6 months), and the mean ± SD PSA velocity was 7.9 ± 20.5 (median 2.1, range 0.2 - 147.5 ng/mL/year). Statistical analysis was performed to assess which factors were associated with the detection of rPCa on (68)Ga-PSMA PET/CT. RESULTS (68)Ga-PSMA PET/CT was positive in 52 of 70 patients (74.2%). In 30 patients (42.8%) lesions limited to the pelvis were detected. Distant lesions were observed in 8 of patients (11.4%). Local plus systemic lesions were detected in 14 patients (20%). PSA level (p = 0.017) and PSAdt (p = 0.0001) were significantly different between PET-positive patients (higher PSA level, shorter PSAdt) and PET-negative patients (lower PSA, longer PSAdt). ROC analysis showed that PSAdt 6.5 months and PSA 0.83 ng/mL were optimal cut-off values. In multivariate analysis PSAdt was associated with (68)Ga-PSMA PET/CT positivity. (68)Ga-PSMA PET/CT was positive in 17 of 20 patients (85%) with PSA <2 ng/mL and PSAdt <6.5 months, and in 3 of 16 patients (18.7%) with PSA <2 ng/mL and PSAdt ≥6.5 months. CONCLUSION The great potential of (68)Ga-PSMA PET/CT in patients with rPCa and BR was confirmed. PSA and PSAdt were valuable predictors of pathological (68)Ga-PSMA PET/CT findings.
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Affiliation(s)
- Francesco Ceci
- Department of Nuclear Medicine, Medizinische Universität Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria,
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Poncet D, Arnoux V, Descotes JL, Rambeaud JJ, Verry C, Terrier N, Boillot B, Dubreuil J, Lanchon C, Carnicelli D, Fiard G, Long JA. Récidive biochimique après traitement curatif d’un adénocarcinome prostatique localisé : intérêt de la TEP à la choline dans l’évaluation de la récidive locale. Prog Urol 2015; 25:325-30. [DOI: 10.1016/j.purol.2015.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/11/2015] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
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Rodado-Marina S, Coronado-Poggio M, García-Vicente AM, García-Garzón JR, Alonso-Farto JC, de la Jara AC, Maldonado-Suárez A, Rodríguez-Fernández A. Clinical utility of (18)F-fluorocholine positron-emission tomography/computed tomography (PET/CT) in biochemical relapse of prostate cancer after radical treatment: results of a multicentre study. BJU Int 2015; 115:874-83. [PMID: 25307619 DOI: 10.1111/bju.12953] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate (18)F-fluorocholine positron-emission tomography (PET)/computed tomography (CT) in restaging patients with a history of prostate adenocarcinoma who have biochemical relapse after early radical treatment, and to correlate the technique's disease detection rate with a set of variables and clinical and pathological parameters. PATIENTS AND METHODS This was a retrospective multicentre study that included 374 patients referred for choline-PET/CT who had biochemical relapse. In all, 233 patients who met the following inclusion criteria were analysed: diagnosis of prostate cancer; early radical treatment; biochemical relapse; main clinical and pathological variables; and clinical, pathological and imaging data needed to validate the results. Criteria used to validate the PET/CT: findings from other imaging techniques, clinical follow-up, treatment response and histological analysis. Different statistical tests were used depending on the distribution of the data to correlate the results of the choline-PET/CT with qualitative [T stage, N stage, early radical prostatectomy (RP) vs other treatments, hormone therapy concomitant to choline-PET/CT] and quantitative [age, Gleason score, prostate-specific antigen (PSA) levels at diagnosis, PSA nadir, PSA level on the day of the choline-PET/CT (Trigger PSA) and PSA doubling time (PSADT)] variables. We analysed whether there were independent predictive factors associated with positive PET/CT results. RESULTS Choline-PET/CT was positive in 111 of 233 patients (detection rate 47.6%) and negative in 122 (52.4%). Disease locations: prostate or prostate bed in 26 patients (23.4%); regional and/or distant lymph nodes in 52 (46.8%); and metastatic bone disease in 33 (29.7%). Positive findings were validated by: results from other imaging techniques in 35 patients (15.0%); at least 6 months of clinical follow-up in 136 (58.4%); treatment response in 24 (10.3%); histological analysis of lesions in 17 (7.3%); and follow-up plus imaging results in 21 (9.0%). The statistical analysis of qualitative variables, corresponding to patients' clinical characteristics, and the positive/negative final PET/CT results revealed that only whether or not early treatment with RP was done was statistically significant (P < 0.001), with the number of positive results higher in patients who did not undergo a RP. Among the quantitative variables, Gleason score, Trigger PSA and PSADT clearly differentiated the two patient groups (positive and negative choline-PET/CT: P = 0.010, P = 0.001 and P = 0.025, respectively). A Gleason score of <5 or ≥ 8 clearly differentiated positive from negative PET. Trigger PSA: mean of 8 ng/mL for positive PET/CT vs 2.8 ng/mL for negative PET/CT; PSADT: mean of 8 months for positive vs 12.6 months for negative. The optimal threshold values were: 3 ng/mL for Trigger PSA level and 6 months for PSADT (Youden index/receiver operating characteristic curve). Analysing these two variables together showed that PSADT was more conclusive in patients with lower Trigger PSA levels. Analysing variables by location showed that only PSADT was able to differentiate between those with disease confined to the prostate compared with the other two locations (lymph nodes and bone), with shorter PSADT in these two, which was statistically significant (P < 0.002). In the patient group with a PSA level of <1.5 ng/mL, 30.8% had the disease, 7% of whom had metastatic bone disease. In the multivariate logistic regression, the risks factors that were clearly independent for those with positive PET/CT were: PSA level of >3 ng/mL, no early RP, and Gleason score of ≥ 8. CONCLUSION Our results support the usefulness of (18)F-fluorocholine PET/CT in biochemical relapse of prostate cancer after radical treatment, with an overall disease detection rate close to 50%, and it can be recommended as first-line treatment. As mentioned above, besides Trigger PSA levels, there are other clinical and pathological variables that need to be considered so as to screen patients properly and thus minimise the number of nodular lesions and increase the diagnostic accuracy of the examination.
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