1
|
Lee KH, Mena E, Shih J, Lindenberg L, Wood BJ, Pinto PA, Patel KR, Citrin DE, Choyke PL, Turkbey B. Predicting 18F-DCFPyL-PET/CT Scan Positivity in Prostate Cancer Patients with Biochemical Recurrence. Acad Radiol 2024; 31:1419-1428. [PMID: 37775447 PMCID: PMC10965502 DOI: 10.1016/j.acra.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
RATIONALE AND OBJECTIVES To analyze variables that can predict the positivity of 18F-DCFPyL- positron emission tomography/computed tomography (PET/CT) and extent of disease in patients with biochemically recurrent (BCR) prostate cancer after primary local therapy with either radical prostatectomy or radiation therapy. MATERIALS AND METHODS This is a retrospective analysis of a prospective single institutional review board-approved study. We included 199 patients with biochemical recurrence and negative conventional imaging after primary local therapies (radical prostatectomy n = 127, radiation therapy n = 72). All patients underwent 18F-DCFPyL-PET/CT. Univariate and multivariate logistic regression analyses were used to determine predictors of a positive scan for both cohort of patients. Regression-based coefficients were used to develop nomograms predicting scan positivity and extra-pelvic disease. Decision curve analysis (DCA) was implemented to quantify nomogram's clinical benefit. RESULTS Of the 127 (63%) post-radical prostatectomy patients, 91 patients had positive scans - 61 of those with intrapelvic lesions and 30 with extra-pelvic lesions (i.e., retroperitoneal or distant nodes and/or bone/organ lesions). Of the 72 post-radiation therapy patients, 65 patients had positive scans - 39 of them had intrapelvic lesions and 26 extra-pelvic lesions. In the radical prostatectomy cohort, multivariate regression analysis revealed original International Society of Urological Pathology category, prostate-specific antigen (PSA), prostate-specific antigen doubling time (PSAdt), and time from BCR (mo) to scan were predictors for scan positivity and presence of extra-pelvic disease, with an area under the curve of 80% and 78%, respectively. Positive versus negative tumor margin after radical prostatectomy was not related to scan positivity or to the presence of positive extra-pelvic foci. In the radiation therapy cohort, multivariate regression analysis revealed that PSA, PSAdt, and time to BCR (mo) were predictors of extra-pelvic disease, with area under the curve of 82%. Because only seven patients in the radiation therapy cohort had negative scans, a prediction model for scan positivity could not be analyzed and only the presence of extra-pelvic disease was evaluated. CONCLUSION PSA and PSAdt are consistently significant predictors of 18F-DCFPyL PET/CT positivity and extra-pelvic disease in BCR prostate cancer patients. Stratifying the patient population into primary local treatment group enables the use of other variables as predictors, such as time since BCR. This nomogram may guide selection of the most suitable candidates for 18F-DCFPyL-PET/CT imaging.
Collapse
Affiliation(s)
- Katerina H Lee
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., B.J.W.)
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.).
| | - Joanna Shih
- Division Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.S.)
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.)
| | - Bradford J Wood
- Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., B.J.W.)
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (P.A.P.)
| | - Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.R.P., D.E.C.)
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.R.P., D.E.C.)
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.)
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.)
| |
Collapse
|
2
|
Bianchi L, Castellucci P, Farolfi A, Droghetti M, Artigas C, Leite J, Corona P, Shagera QA, Moreira R, González C, Queiroz M, de Galiza Barbosa F, Schiavina R, Deandreis D, Fanti S, Ceci F. Multicenter External Validation of a Nomogram for Predicting Positive Prostate-specific Membrane Antigen/Positron Emission Tomography Scan in Patients with Prostate Cancer Recurrence. Eur Urol Oncol 2023; 6:41-48. [PMID: 34933814 DOI: 10.1016/j.euo.2021.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/14/2021] [Accepted: 12/03/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND A nomogram has recently been developed to predict 68Ga-labeled prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET)/computed tomography (PSMA-PET) results in recurrent prostate cancer (PCa) patients. OBJECTIVE To perform external validation of the original nomogram in a multicentric setting. DESIGN, SETTING, AND PARTICIPANTS A total of 1639 patients who underwent PSMA-PET for prostate-specific antigen (PSA) relapse after radical therapy were retrospectively included from six high-volume PET centers. The external cohort was stratified according to clinical setting categories: group 1: first-time biochemical recurrence (n = 774); group 2: PSA relapse after salvage therapy (n = 499); group-3: biochemical persistence after radical prostatectomy (n = 210); and group-4: advanced-stage PCa before second-line systemic therapies (n = 124). INTERVENTION PSMA-PET in recurrent PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PSMA-PET detection rate was assessed in the overall population and in each subgroup. A multivariable logistic regression model was produced to evaluate the predictors of a positive scan. The performance characteristics of the model were assessed by quantifying the predictive accuracy (PA) according to model calibration. The Youden's index was used to find the best nomogram's cutoff. Decision curve analysis (DCA) was implemented to quantify the nomogram's clinical net benefit. RESULTS AND LIMITATIONS In the external cohort, the overall detection rate was 53.8% versus 51.2% in the original population. At multivariate analysis, International Society of Urological Pathology grade group, PSA, PSA doubling time, and clinical setting were independent predictors of a positive scan (all p ≤ 0.02). The PA of the nomogram was identical to the original model (82.0%); the model showed an optimal calibration curve. The best nomogram's cutoff was 55%. In the DCA, the nomogram revealed clinical net benefit when the threshold nomogram probabilities were ≥20%. The retrospective design is a major limitation. CONCLUSIONS The original nomogram exhibited excellent characteristics on external validation. The incidence of a false negative scan can be reduced if PSMA-PET is performed when the predicted probability is ≥20%. PATIENT SUMMARY A nomogram has been developed to predict prostate-specific membrane antigen/positron emission tomography (PSMA-PET) results for recurrent prostate cancer (PCa). The nomogram represents an easy tool in the decision-making process of recurrent PCa.
Collapse
Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Farolfi
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlos Artigas
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jose Leite
- PET/CT Center, DASA - Diagnósticos da Améric, Rio de Janeiro, Brazil
| | - Paola Corona
- Fundación Centro Diagnóstico Nuclear (FCDN), Buenos Aires, Argentina
| | - Qaid Ahmed Shagera
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Renata Moreira
- PET/CT Center, DASA - Diagnósticos da Améric, Rio de Janeiro, Brazil
| | | | - Marcelo Queiroz
- Department of Radiology, Hospital Sírio-Libanês, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Desiree Deandreis
- Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefano Fanti
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Ceci
- Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
3
|
Cerci JJ, Fanti S, Lobato EE, Kunikowska J, Alonso O, Medina S, Novruzov F, Lengana T, Granados C, Kumar R, Rangarajan V, Al-Ibraheem A, Hourani M, Ali NS, Ahmad A, Keidar Z, Kucuk O, Elboga U, Bogoni M, Paez D. Diagnostic performance and clinical impact of 68Ga-PSMA-11 imaging in early relapsed prostate cancer after radical therapy: a prospective multicenter study (IAEA-PSMA study). J Nucl Med 2021; 63:240-247. [PMID: 34215674 PMCID: PMC8805782 DOI: 10.2967/jnumed.120.261886] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Biochemical recurrence (BCR) is a clinical challenge in prostate cancer (PCa) patients, as recurrence localization guides subsequent therapies. The use of PET with prostate-specific membrane antigen (PSMA) provides better accuracy than conventional imaging practice. This prospective, multicenter, international study was performed to evaluate the diagnostic performance and clinical impact of PSMA PET/CT for evaluating BCR in PCa patients in a worldwide scenario. Methods: Patients were recruited from 17 centers in 15 countries. Inclusion criteria were histopathologically proven prostate adenocarcinoma, previous primary treatment, clinically established BCR, and negative conventional imaging (CT plus bone scintigraphy) and MRI results for patients with PSA levels of 4–10 ng/mL. All patients underwent PET/CT scanning with 68Ga-PSMA-11. Images and data were centrally reviewed. Multivariate logistic regression analysis was applied to identify the independent predictors of PSMA-positive results. Variables were selected for this regression model on the basis of significant associations in the univariate analysis and previous clinical knowledge: Gleason score, the PSA level at the time of the PET scan, PSA doubling time, and primary treatment strategy. All patients were monitored for a minimum of 6 mo. Results: From a total of 1,004 patients, 77.7% were treated initially with radical prostatectomy and 22.3% were treated with radiotherapy. Overall, 65.1% had positive PSMA PET/CT results. PSMA PET/CT positivity was correlated with the Gleason score, PSA level at the time of the PET scan, PSA doubling time, and radiotherapy as the primary treatment (P < 0.001). Treatment was modified on the basis of PSMA PET/CT results in 56.8% of patients. PSMA PET/CT positivity rates were consistent and not statistically different among countries with different incomes. Conclusion: This multicenter, international, prospective trial of PSMA PET/CT confirmed its capability for detecting local and metastatic recurrence in most PCa patients in the setting of BCR. PSMA PET/CT positivity was correlated with the Gleason score, PSA level at the time of the PET scan, PSA doubling time, and radiotherapy as the primary treatment. PSMA PET/CT results led to changes in therapeutic management in more than half of the cohort. The study demonstrated the reliability and worldwide feasibility of PSMA PET/CT in the workup of PCa patients with BCR.
Collapse
Affiliation(s)
| | | | | | | | - Omar Alonso
- Clinical Hospital of the University of Uruguay
| | | | - Fuad Novruzov
- Nuclear Medicine Department, National Centre of Oncology, Azerbaijan
| | | | | | | | | | | | | | | | - Azra Ahmad
- Pakistan Atomic Energy Commission, Pakistan
| | | | | | | | | | - Diana Paez
- International Atomic Energy Agency, Austria
| |
Collapse
|
4
|
Chevalme YM, Boudali L, Gauthé M, Rousseau C, Skanjeti A, Merlin C, Robin P, Giraudet AL, Janier M, Talbot JN. Survey by the French Medicine Agency (ANSM) of the imaging protocol, detection rate, and safety of 68Ga-PSMA-11 PET/CT in the biochemical recurrence of prostate cancer in case of negative or equivocal 18F-fluorocholine PET/CT: 1084 examinations. Eur J Nucl Med Mol Imaging 2021; 48:2935-2950. [PMID: 33416958 PMCID: PMC8263442 DOI: 10.1007/s00259-020-05086-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/20/2020] [Indexed: 01/03/2023]
Abstract
Introduction Despite growing evidence of a superior diagnostic performance of 68Ga-PSMA-11 over 18F-fluorocholine (FCH) PET/CT, the number of PET/CT centres able to label on site with gallium-68 is still currently limited. Therefore, patients with biochemical recurrence (BCR) of prostate cancer frequently undergo FCH as the 1st-line PET/CT. Actually, the positivity rate (PR) of a second-line PSMA-11 PET/CT in case of negative FCH PET/CT has only been reported in few short series, in a total of 185 patients. Our aims were to check (1) whether the excellent PR reported with PSMA-11 is also obtained in BCR patients whose recent FCH PET/CT was negative or equivocal; (2) in which biochemical and clinical context a high PSMA-11 PET/CT PR may be expected in those patients, in particular revealing an oligometastatic pattern; (3) whether among the various imaging protocols for PSMA-11 PET/CT used in France, one yields a significantly highest PR; (4) the tolerance of PSMA-11. Patients and methods Six centres performed 68Ga-PSMA-11 PET/CTs during the first 3 years of its use in France. Prior to each PET/CT, the patient’s data were submitted prospectively for authorisation to ANSM, the French Medicine Agency. The on-site readings of 1084 PSMA-11 PET/CTs in BCR patients whose recent FCH PET/CTs resulted negative or equivocal were pooled and analysed. Results (1) The overall PR was 68%; for a median serum PSA level (sPSA) of 1.7 ng/mL, an oligometastatic pattern (1–3 foci) was observed in 31% of the cases overall; (2) PR was significantly related to sPSA (from 41% if < 0.2 ng/mL to 81% if ≥ 2 ng/mL), to patients’ age, to initial therapy (64% if prostatectomy vs. 85% without prostatectomy due to frequent foci in the prostate fossa), to whether FCH PET/CT was negative or equivocal (PR = 62% vs. 82%), and to previous BCR (PR = 63% for 1st BCR vs. 72% in case of previous BCR); (3) no significant difference in PR was found according to the imaging protocol: injected activity, administration of a contrast agent and/or of furosemide, dose length product, one single or multiple time points of image acquisition; (4) no adverse event was reported after PSMA-11 injection, even associated with a contrast agent and/or furosemide. Conclusion Compared with the performance of PSMA-11 PET/CT in BCR reported independently of FCH PET/CT in 6 large published series (n > 200), the selection based on FCH PET/CT resulted in no difference of PSMA-11 PR for sPSA < 1 ng/mL but in a slightly lower PR for sPSA ≥ 1 ng/mL, probably because FCH performs rather well at this sPSA and very occult BCR was over-represented in our cohort. An oligometastatic pattern paving the way to targeted therapy was observed in one fourth to one third of the cases, according to the clinico-biochemical context of the BCR. Systematic dual or triple acquisition time points or administration of a contrast agent and/or furosemide did not bring a significant added value for PSMA-11 PET/CT positivity and should be decided on individual bases.
Collapse
Affiliation(s)
- Yanna-Marina Chevalme
- Direction des médicaments en oncologie, hématologie, transplantation, néphrologie, thérapie cellulaire, produits sanguins, et radiopharmaceutiques, Agence Nationale de Sécurité du Médicament et des produits de santé (ANSM), 143 Bd Anatole, F93200, St Denis, France.
| | - Lotfi Boudali
- Direction des médicaments en oncologie, hématologie, transplantation, néphrologie, thérapie cellulaire, produits sanguins, et radiopharmaceutiques, Agence Nationale de Sécurité du Médicament et des produits de santé (ANSM), 143 Bd Anatole, F93200, St Denis, France
| | - Mathieu Gauthé
- Service de médecine nucléaire, Hôpital Tenon, AP-HP Sorbonne Université, Paris, France
| | - Caroline Rousseau
- Nuclear Medicine Unit, ICO René Gauducheau, CNRS, Inserm, CRCINA, Nantes University, F-44000, Nantes, France
| | - Andrea Skanjeti
- Nuclear Medicine Department, Hospices Civils de Lyon, EA 3738, Université Claude Bernard Lyon 1, Lyon, France
| | - Charles Merlin
- Nuclear Medicine Department, Cancer Center Jean PERRIN, Clermont-Ferrand, France
| | - Philippe Robin
- Service de Médecine Nucléaire, EA 3878 (GETBO), Centre Hospitalier Régional et Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | | | - Marc Janier
- Nuclear Medicine Department, Hospices Civils de Lyon, EA 3738, Université Claude Bernard Lyon 1, Lyon, France.,Comité permanent de l'ANSM, Médicaments de diagnostic et de médecine nucléaire, St Denis, France
| | - Jean-Noël Talbot
- Service de médecine nucléaire, Hôpital Tenon, AP-HP Sorbonne Université, Paris, France.,Comité permanent de l'ANSM, Médicaments de diagnostic et de médecine nucléaire, St Denis, France
| |
Collapse
|
5
|
Huits TH, Luiting HB, van der Poel HG, Nandurkar R, Donswijk M, Schaake E, Vogel W, Roobol MJ, Wit E, Stricker P, Emmett L, van Leeuwen PJ. Distribution of prostate cancer recurrences on gallium-68 prostate-specific membrane antigen ( 68 Ga-PSMA) positron-emission/computed tomography after radical prostatectomy with pathological node-positive extended lymph node dissection. BJU Int 2020; 125:876-883. [PMID: 32181951 PMCID: PMC7317723 DOI: 10.1111/bju.15052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objectives To examine the anatomical distribution of prostate cancer (PCa) recurrence on gallium‐68 prostate‐specific membrane antigen (68Ga‐PSMA) positron‐emission tomography (PET)/computed tomography (CT) in patients with biochemical recurrence (BCR) after undergoing radical prostatectomy (RP) with pathological lymph node metastasis (pN1) in their extended pelvic lymph node dissection (ePLND), and to compare the location of PCa recurrence with the location of the initial lymph node metastasis at ePLND. Materials and Methods We retrospectively reviewed 100 patients with BCR (PSA 0.05–5.00 ng/mL) after RP with pN1 ePLND who underwent 68Ga‐PSMA PET/CT to guide salvage therapy. Clinical and pathological features and anatomical locations of PCa recurrence on 68Ga‐PSMA PET/CT were obtained, and management impact was recorded. Results In all, 68 patients (68%) had a positive and 32 patients (32%) had a negative 68Ga‐PSMA PET/CT result. Of the 68 patients with a positive 68Ga‐PSMA PET/CT, 44 (65%) showed abnormal uptake only in the pelvic area, seven (10%) only outside the pelvic area, and 17 (25%) both within and outside the pelvic area. 68Ga‐PSMA PET/CT‐positive pelvic lymph nodes were often (84%) detected on the same side as the lymph node metastasis diagnosed at ePLND. Based on the outcomes of the 68Ga‐PSMA PET/CT, change of management was noted in 68% of the patients. Conclusion Recurrence of PCa on 68Ga‐PSMA PET/CT was limited to the pelvis in the majority of patients with BCR after RP with pN1 ePLND. Moreover, recurrence was often detected on the same side as the lymph node metastasis at ePLND. The results confirm the diagnostic value of 68Ga‐PSMA PET/CT in patients with BCR after RP with pN1 ePLND. Prospective studies are needed to support the long‐term benefit of 68Ga‐PSMA PET/CT‐dictated management changes.
Collapse
Affiliation(s)
- Thijs H Huits
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk B Luiting
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rohan Nandurkar
- St Vincent's Hospital Nuclear Medicine and PET Department, Darlinghurst, NSW, Australia
| | - Maarten Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eva Schaake
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wouter Vogel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Esther Wit
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Phillip Stricker
- St. Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Louise Emmett
- St Vincent's Hospital Nuclear Medicine and PET Department, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Pim J van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|