Clinical impact of 68Ga-PSMA-11 PET on patient management and outcome, including all patients referred for an increase in PSA level during the first year after its clinical introduction

Müller, Julian; Ferraro, Daniela A.; Muehlematter, Urs J.; Schüler, Helena Garcia; Kedzia, Sarah; Eberli, Daniel; Gückenberger, Matthias; Kroeze, S.G.C.; Sulser, Tullio; Schmid, Daniel; Omlin, Aurelius; Müller, Alexander; Zilli, Thomas; John, Hubert; Kranzbuehler, Helmut; Kaufmann, Philipp A.; Schulthess, Gustav K. von; Burger, Irene A.

doi:10.1007/s00259-018-4203-0

Cited by 49 publications

(46 citation statements)

References 52 publications

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“…Furthermore, elective fields were not included in this trial, and most of the patients included had already received adjuvant SRT or had experienced secondary recurrence after SRT. Since our study involves real-life data and it remains unclear whether elective irradiation of the prostate bed and/or the pelvic lymphatics should be performed as part of MDT [25][26][27], many of our cohort had also received elective radiotherapy, which could possibly also influence bRFS. In line with the first small retrospective studies that performed PSMA PET-based MDT [26,27], our study included patients with lower PSA levels.…”

Section: Discussionmentioning

confidence: 99%

Prostate-specific Membrane Antigen Positron Emission Tomography–detected Oligorecurrent Prostate Cancer Treated with Metastases-directed Radiotherapy: Role of Addition and Duration of Androgen Deprivation

Kroeze

Henkenberens

Schmidt-Hegemann

et al. 2021

European Urology Focus

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Section: Discussionmentioning

confidence: 99%

Prostate-specific Membrane Antigen Positron Emission Tomography–detected Oligorecurrent Prostate Cancer Treated with Metastases-directed Radiotherapy: Role of Addition and Duration of Androgen Deprivation

Kroeze

Henkenberens

Schmidt-Hegemann

et al. 2021

European Urology Focus

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“…Scatter was corrected using the extended single-scatter simulation algorithm, which distinguished the scattered annihilation radiation according to its TOF [8]. In addition, a prompt gamma coincidence correction method is by default implemented in the PET reconstruction algorithm for radionuclides emitting prompt gammas such as 68 Ga (branching ratio of 89% and prompt gamma fraction of 1.2%) [12]. For both acquisition protocols, 4 image sets were reconstructed: TOF and TOF+PSF, each with 2 iterations (5 subsets) or 4 iterations (5 subsets).…”

Section: Image Reconstructionmentioning

confidence: 99%

“…The high sensitivity and speci city of 68 Ga-labeled prostate-speci c membrane antigen-ligand positronemission tomography ([ 68 Ga]Ga-PSMA-11 PET) for prostate cancer lesions has led to an increasing use over the past years [1]. Advantages over other modalities, such as computed tomography (CT) and magnetic resonance imaging as well as bone scan scintigraphy with regards to lesion detection, are particularly marked in patients with low tumor burden, in uencing management in a substantial fraction of patients [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…To ensure optimal image quality the joint EANM/SNMMI procedure guidelines for 68 Ga-PSMA PET recommend intravenous administration of 1.8-2.2 MBq [ 68 Ga]Ga-PSMA-11 per kilogram body weight and an emission time of 2-4 min per bed position in step-and-shoot mode [4]. However, availability of [ 68 Ga]Ga-PSMA-11 PET is limited fundamentally by 68 Ge/ 68 Ga-generator yield and, to a lesser degree, positron-emission tomography (PET) scan duration time [5]. Current strategies to expand PSMA PET operation include distribution of 18 F-labeled probes with longer half-life.…”

Section: Introductionmentioning

confidence: 99%

“…A recent study has shown that the administration of a reduced [ 68 Ga]Ga-PSMA-11 activity was not feasible without sacri cing tumor detectability and image quality on a "conventional" Siemens Biograph mCT PET/CT system [5]. These limitations might potentially be overcome with the advent of a new generation of "digital" PET/CT systems using digital detector technology (of note, the frequently used term "digital" PET is in a way misleading and can be more aptly replaced by silicon photomultiplier-based PET; however, we adopt the term used in current literature).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of [68Ga]Ga-PSMA PET/CT Images Acquired with a Reduced Scan Time Duration in Prostate Cancer Patients using the Digital Biograph Vision

Weber

Jentzen

Hofferber

et al. 2020

Preprint

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Aim: [68Ga]Ga-PSMA-11 PET/CT allows for a superior detection of prostate cancer tissue, especially in the context of a low tumor burden. Digital PET/CT bears the potential of reducing scan time duration / administered tracer activity due to, for instance, its higher sensitivity and improved time coincidence resolution. It might thereby expand [68Ga]Ga-PSMA-11 PET/CT that is currently limited by 68Ge/68Ga-generator yield. Our aim was to clinically evaluate the influence of a reduced scan time duration in combination with different image reconstruction algorithms on the diagnostic performance.Methods: Twenty prostate cancer patients (11 for biochemical recurrence, 5 for initial staging, 4 for metastatic disease) sequentially underwent [68Ga]Ga-PSMA-11 PET/CT on a digital Siemens Biograph Vision. PET data were collected in continuous-bed-motion mode with a mean scan time duration of 16.7 min (reference acquisition protocol) and 4.6 min (reduced acquisition protocol). 4 iterative reconstruction algorithms were applied using a time-of-flight (TOF) approach alone or combined with point-spread-function (PSF) correction, each with 2 or 4 iterations. To evaluate the diagnostic performance, the following metrics were chosen: (a) per-region detectability, (b) the tumor maximum and peak standardized uptake values (SUVmax and SUVpeak) and (c) image noise using the liver’s activity distribution.Results: Overall, 98% of regions (91% of affected regions) were correctly classified in the reduced acquisition protocol independent of the image reconstruction algorithm. Two nodal lesions (each ≤4 mm) were not identified (leading to downstaging in 1/20 cases). Mean absolute percentage deviation of SUVmax (SUVpeak) was approximately 9% (6%) for each reconstruction algorithm. The mean image noise increased from 13% to 21% (4 iterations) and from 10% to 15% (2 iterations) for PSF+TOF and TOF images.Conclusions: High agreement at 3.5-fold reduction of scan time in terms of per-region detection (98 % of regions) and image quantification (mean deviation ≤ 10 %) was demonstrated; however, small lesions can be missed in about 10% of patients leading to downstaging (T1N0M0 instead of T1N1M0) in 5 % of patients. Our results suggest that a reduction of scan time duration or administered [68Ga]Ga-PSMA-11 activities can be considered in metastatic patients, where missing small lesions would not impact patient management. Limitations include the small and heterogeneous sample size and the lack of follow-up.

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Added Value of [18F]PSMA‐1007 PET/CT and PET/MRI in Patients With Biochemically Recurrent Prostate Cancer: Impact on Detection Rates and Clinical Management

Abrahamsen,

Tandstad,

Aksnessæther

et al. 2024

Magnetic Resonance Imaging

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BackgroundProstate‐specific membrane antigen (PSMA) positron emission tomography (PET) can change management in a large fraction of patients with biochemically recurrent prostate cancer (BCR).PurposeTo investigate the added value of PET to MRI and CT for this patient group, and to explore whether the choice of the PET paired modality (PET/MRI vs. PET/CT) impacts detection rates and clinical management.Study TypeRetrospective.Subjects41 patients with BCR (median age [range]: 68 [55–78]).Field Strength/Sequence3T, including T1‐weighted gradient echo (GRE), T2‐weighted turbo spin echo (TSE) and dynamic contrast‐enhanced GRE sequences, diffusion‐weighted echo‐planar imaging, and a T1‐weighted TSE spine sequence. In addition to MRI, [18F]PSMA‐1007 PET and low‐dose CT were acquired on the same day.AssessmentImages were reported using a five‐point Likert scale by two teams each consisting of a radiologist and a nuclear medicine physician. The radiologist performed a reading using CT and MRI data and a joint reading between radiologist and nuclear medicine physician was performed using MRI, CT, and PET from either PET/MRI or PET/CT.Findings were presented to an oncologist to create intended treatment plans. Intrareader and interreader agreement analysis was performed.Statistical TestsMcNemar test, Cohen's κ, and intraclass correlation coefficients. A P‐value <0.05 was considered significant.Results7 patients had positive findings on MRI and CT, 22 patients on joint reading with PET/CT, and 18 patients joint reading with PET/MRI. For overall positivity, interreader agreement was poor for MR and CT (κ = 0.36) and almost perfect with addition of PET (PET/CT κ = 0.85, PET/MRI κ = 0.85). The addition of PET from PET/CT and PET/MRI changed intended treatment in 20 and 18 patients, respectively. Between joint readings, intended treatment was different for eight patients.Data ConclusionThe addition of [18F]PSMA‐1007 PET/MRI or PET/CT to MRI and CT may increase detection rates, could reduce interreader variability, and may change intended treatment in half of patients with BCR.Level of Evidence3Technical EfficacyStage 3

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Clinical impact of 68Ga-PSMA-11 PET on patient management and outcome, including all patients referred for an increase in PSA level during the first year after its clinical introduction

Cited by 49 publications

References 52 publications

Prostate-specific Membrane Antigen Positron Emission Tomography–detected Oligorecurrent Prostate Cancer Treated with Metastases-directed Radiotherapy: Role of Addition and Duration of Androgen Deprivation

Prostate-specific Membrane Antigen Positron Emission Tomography–detected Oligorecurrent Prostate Cancer Treated with Metastases-directed Radiotherapy: Role of Addition and Duration of Androgen Deprivation

Evaluation of [68Ga]Ga-PSMA PET/CT Images Acquired with a Reduced Scan Time Duration in Prostate Cancer Patients using the Digital Biograph Vision

Added Value of [18F]PSMA‐1007 PET/CT and PET/MRI in Patients With Biochemically Recurrent Prostate Cancer: Impact on Detection Rates and Clinical Management

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