Comparison of PET imaging with a 68Ga-labelled PSMA ligand and 18F-choline-based PET/CT for the diagnosis of recurrent prostate cancer

Afshar‐Oromieh, Ali; Zechmann, Christian M.; Malcher, A.; Eder, Matthias; Eisenhut, Michael; Linhart, Heinz; Holland‐Letz, Tim; Hadaschik, Boris; Giesel, Frederik L.; Debus, Jürgen; Haberkorn, Uwe

doi:10.1007/s00259-013-2525-5

Cited by 826 publications

(617 citation statements)

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“…Our data, based on a large and highly selected patient cohort, are in line with preliminary reports by Afshar-Oromieh (17,23). Compared with reports in the literature stating detection rates between 34% and 88% for 11 C-choline, 43%-79% for 18 F-choline, and 59%-80% for 11 C-acetate (7,(24)(25)(26)(27)(28)(29)(30)(31), 68 Ga-PSMA ligand PET/ CT offers a substantially higher detection efficacy.…”

Section: Discussionsupporting

confidence: 77%

“…The recent development of 68 Ga-PSMA (Glu-NH-CO-NH-Lys-(Ahx)-[ 68 Ga(HBED-CC)]) as an extracellular PSMA inhibitor for PET imaging demonstrated a high specificity for PSMA tumor-expressing cells as well a high and specific uptake in a mouse model (16). A first preliminary study in PC patients revealed a higher image contrast and detection rate for 68 Ga-PSMA than 18 F-choline (17). In addition, further preliminary data in primary PC back the high specificity of 68 Ga-PSMA ligand PET imaging, ranging more than 95% at both patient-and fieldbased analysis for lymph node staging validated by extended pelvic lymph node dissection (18).…”

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confidence: 99%

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Evaluation of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

et al. 2015

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The expression of prostate-specific membrane antigen (PSMA) is increased in prostate cancer. Recently, 68 Ga-PSMA (Glu-NH-CO-NH-Lys-(Ahx)-[ 68 Ga(HBED-CC)]) was developed as a PSMA ligand. The aim of this study was to investigate the detection rate of 68 Ga-PSMA PET/CT in patients with biochemical recurrence after radical prostatectomy. Methods: Two hundred forty-eight of 393 patients were evaluable for a retrospective analysis. Median prostate-specific antigen (PSA) level was 1.99 ng/mL (range, 0.2-59.4 ng/mL). All patients underwent contrast-enhanced PET/CT after injection of 155 ± 27 MBq of 68 Ga-PSMA ligand. The detection rates were correlated with PSA level and PSA kinetics. The influence of antihormonal treatment, primary Gleason score, and contribution of PET and morphologic imaging to the final diagnosis were assessed. Results: Two hundred twenty-two (89.5%) patients showed pathologic findings in 68 Ga-PSMA ligand PET/CT. The detection rates were 96.8%, 93.0%, 72.7%, and 57.9% for PSA levels of $2, 1 to ,2, 0.5 to ,1, and 0.2 to ,0.5 ng/mL, respectively. Whereas detection rates increased with a higher PSA velocity (81.8%, 82.4%, 92.1%, and 100% in ,1, 1 to ,2, 2 to ,5, and $5 ng/mL/y, respectively), no significant association could be found for PSA doubling time (82.7%, 96.2%, and 90.7% in .6, 4-6, and ,4 mo, respectively). 68 Ga-PSMA ligand PET (as compared with CT) exclusively provided pathologic findings in 81 (32.7%) patients. In 61 (24.6%) patients, it exclusively identified additional involved regions. In higher Gleason score (#7 vs. $8), detection efficacy was significantly increased (P 5 0.0190). No significant difference in detection efficacy was present regarding antiandrogen therapy (P 5 0.0783). Conclusion: Hybrid 68 Ga-PSMA ligand PET/CT shows substantially higher detection rates than reported for other imaging modalities. Most importantly, it reveals a high number of positive findings in the clinically important range of low PSA values (,0.5 ng/mL), which in many cases can substantially influence the further clinical management.

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Evaluation of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

et al. 2015

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“…125,126 In a subsequent, small clinical trial, 68 Ga-PSMA detected more lesions than 18 F-choline. 127 Somatostatin receptors are overexpressed on neuroendocrine tumor cells. Imaging of this biomarker is currently accomplished using SPECT with 111 Indiethylenetriaminepentaacetic acid (DTPA)-octreotide; however, several new radiotracers have been developed that can be imaged using PET.…”

Section: Imaging Protein and Cell Membrane Metabolismmentioning

confidence: 99%

PET/CT imaging in cancer: Current applications and future directions

Farwell

Pryma

Mankoff

2014

Cancer

196

120

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Positron emission tomography (PET) is a radiotracer imaging method that yields quantitative images of regional in vivo biology and biochemistry. PET, now used in conjunction with computed tomography (CT) in PET/CT devices, has had its greatest impact to date on cancer and is now an important part of oncologic clinical practice and translational cancer research. In this review of current applications and future directions for PET/CT in cancer, the authors first highlight the basic principles of PET followed by a discussion of the biochemistry and current clinical applications of the most commonly used PET imaging agent, 18 F-fluorodeoxyglucose (FDG). Then, emerging methods for PET imaging of other biologic processes relevant to cancer are reviewed, including cellular proliferation, tumor hypoxia, apoptosis, amino acid and cell membrane metabolism, and imaging of tumor receptors and other tumor-specific gene products. The focus of the review is on methods in current clinical practice as well as those that have been translated to patients and are currently in clinical trials. Cancer 2014;120:3433-45.

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“…[4][5][6] Here, based on our first clinical results, we describe 68Ga-PSMA-L PET/MRI as a novel imaging technique for patients with PCa at different disease stages, and discuss potential future applications.Briefly, PET/MRI was carried out on a fully integrated whole-body hybrid PET/MRI system (Siemens Biograph mMR; Siemens Healthcare, Erlangen, Germany). After intravenous injection of 122 ± 17 MBq 68 Ga-PSMA-L, a diagnostic PET-examination of the trunk (from base of skull to the proximal femur) with simultaneous acquisition of coronal T1-weighted and fat saturated axial T2-weighted images was carried out followed by a diagnostic multiparametric MR examination of the pelvis including a 15-min PET scan (mean time from injection to imaging: 51 min, range 45-63 min).…”

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“…3 Together with the novel development of combined PET/MRI, the combination of excellent morphological detail, multiparametric functional information, and molecular PET data might lead to a significant improvement in detection and staging of PCa, and thus could help to optimize oncological treatment. [4][5][6] Here, based on our first clinical results, we describe 68 Ga-PSMA-L PET/MRI as a novel imaging technique for patients with PCa at different disease stages, and discuss potential future applications.…”

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Positron emission tomography/magnetic resonance imaging with ⁶⁸Gallium‐labeled ligand of prostate‐specific membrane antigen: Promising novel option in prostate cancer imaging?

et al. 2014

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68Galliumlabeled ligand of prostate-specific membrane antigen ADC = apparent diffusion coefficient BS = bone scintigraphy CT = computed tomography DCE = dynamic contrast-enhanced Gs = Gleason score iAUC60 = initial area under the time-intensive curve (within 60 s) LN = lymph node(s) MBq = megabequerel MRI = magnetic resonance imaging PCa = prostate cancer PET = positron emission tomography PSMA = prostate-specific membrane antigen Ga-PSMA-L has been introduced in PET imaging of PCa with first promising results.2 As a result of relatively exclusive expression of PSMA in prostatic tissue, as well as increased expression in PCa, 68 Ga-PSMA-L was reported to show a favorable lesion-to-background ratio compared with the presently used choline-based PET examinations.3 Together with the novel development of combined PET/MRI, the combination of excellent morphological detail, multiparametric functional information, and molecular PET data might lead to a significant improvement in detection and staging of PCa, and thus could help to optimize oncological treatment. [4][5][6] Here, based on our first clinical results, we describe 68Ga-PSMA-L PET/MRI as a novel imaging technique for patients with PCa at different disease stages, and discuss potential future applications.Briefly, PET/MRI was carried out on a fully integrated whole-body hybrid PET/MRI system (Siemens Biograph mMR; Siemens Healthcare, Erlangen, Germany). After intravenous injection of 122 ± 17 MBq 68 Ga-PSMA-L, a diagnostic PET-examination of the trunk (from base of skull to the proximal femur) with simultaneous acquisition of coronal T1-weighted and fat saturated axial T2-weighted images was carried out followed by a diagnostic multiparametric MR examination of the pelvis including a 15-min PET scan (mean time from injection to imaging: 51 min, range 45-63 min). To prevent extinction artifacts as a result of urinary excretion of the tracer, furosemide was applied and the bladder was emptied before the start of the examination.Case 1: A 72-year-old patient without evidence of malignancy in two prior biopsies, but highly suspected PCa (PSA 13.9 ng/mL, free-to-total ratio 6.9%, digital rectal examination normal) underwent 68 Ga-PSMA-L PET/MRI and confirmation of a Gs 7b (4 + 3) PCa within the suspicious area on target biopsies without malignancy in the remaining biopsy cores (Fig. 1a-d).Case 2: A 72-year-old patient with biopsy-proven high-risk PCa was subjected to 68 Ga-PSMA-L PET/MRI showing local tumor, but no evidence of metastatic disease (Fig. 1e,f). Postoperative histological analysis after radical prostatectomy showed a poorly differentiated PCa Gs 8 (4 + 4) of the left prostatic lobe with extracapsular extension without evidence of metastatic LN (pT3a pN0 [0/29] cM0 L0 V0 Pn1 G3 R0).Case 3: A 74-year-old patient with locally advanced high-risk PCa (PSA 12.9 ng/mL; Gs 9 [4 + 5]; cT3) and suspicion of pelvine LN metastases on CT, but negative results in bone scintigraphy (Fig. 1g) underwent further staging with 68

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Comparison of PET imaging with a 68Ga-labelled PSMA ligand and 18F-choline-based PET/CT for the diagnosis of recurrent prostate cancer

Cited by 826 publications

References 29 publications

Evaluation of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

Evaluation of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

PET/CT imaging in cancer: Current applications and future directions

Positron emission tomography/magnetic resonance imaging with ⁶⁸Gallium‐labeled ligand of prostate‐specific membrane antigen: Promising novel option in prostate cancer imaging?

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Comparison of PET imaging with a 68Ga-labelled PSMA ligand and 18F-choline-based PET/CT for the diagnosis of recurrent prostate cancer

Cited by 826 publications

References 29 publications

Evaluation of Hybrid 68Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

Evaluation of Hybrid 68Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

PET/CT imaging in cancer: Current applications and future directions

Positron emission tomography/magnetic resonance imaging with 68Gallium‐labeled ligand of prostate‐specific membrane antigen: Promising novel option in prostate cancer imaging?

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Evaluation of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

Evaluation of Hybrid ⁶⁸Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

Positron emission tomography/magnetic resonance imaging with ⁶⁸Gallium‐labeled ligand of prostate‐specific membrane antigen: Promising novel option in prostate cancer imaging?