Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with 68Ga-PSMA-HBED-CC than with 18F-Fluoroethylcholine PET/CT

Abstract

In the present series Ga-PSMA PET/CT shows a better performance than FEC PET/CT with a significantly higher NPV and accuracy for the detection of locoregional recurrent and/or metastatic lesions prior to salvage lymphadenectomy.

Sensitivity, Specificity, and Predictors of Positive 68 Ga–Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer: A Systematic Review and Meta-analysis

“…On evaluation of predictive values for positive 68 Ga-PSMA PET, two studies included only patients with positive 68 Ga-PSMA PET findings and predictive data were not available for analysis [34,35]. On evaluation of sensitivity and specificity, 11 articles reported histopathologic correlation, but only five of these were suitable for analysis according to our inclusion criteria [29,36,38,41,43].…”

“…One additional study was excluded as patients were enrolled following negative choline-based PET, and thus provided a skewed patient population [28]. This left 18 articles were suitable for assessment [14,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]; a summary of the search strategy is shown in Figure 1. On evaluation of predictive values for positive 68 Ga-PSMA PET, two studies included only patients with positive 68 Ga-PSMA PET findings and predictive data were not available for analysis [34,35].…”

PSMA Ligands for PET Imaging of Prostate Cancer

“…The excellent specificity of PSMA ligands, especially for lymph node metastases, was demonstrated in several studies (21,39,46,(83)(84)(85). Therefore, any focal uptake of the PSMA ligand higher than the surrounding background uptake in morphologically visible lesions and not associated with physiologic uptake should be considered suggestive.…”

Radium-223: Insight and Perspectives in Bone-metastatic Castration-resistant Prostate Cancer

“…In a meta-analysis with 11 C-choline PET, the detection rate for nodal involvement from pooled data was only 36% (95% CI=22-50%) (79), while others reported an overall accuracy of 83% with 18 Fcholine, a significantly higher sensitivity and a similar specificity in comparison to dedicated computed tomography (80). 68 Ga-PSMA, being the gold standard for histopathology, has a better performance than 18 F-choline for the detection of nodal involvement (81). In other words, we are far from being able to validate a diagnostic method able to stage nodal involvement correctly and therefore identify potentially full responders to 223 Ra therapy.…”