Restaging the Biochemical Recurrence of Prostate Cancer with [68Ga]Ga-PSMA-11 PET/CT: Diagnostic Performance and Impact on Patient Disease Management

Abstract

Background: Detection rates of [68Ga]Ga-PSMA-11 PET/CT on the restaging of prostate cancer (PCa) patients presenting with biochemical recurrence (BCR) have been well documented, but its performance and impact on patient management have not been evaluated as extensively. Methods: Retrospective analysis of PCa patients presenting with BCR and referred for [68Ga]Ga-PSMA-11 PET/CT. Pathological foci were classified according to six anatomical sites and evaluated with a three-point scale according to the uptake intensity. The impact of [68Ga]Ga-PSMA-11 PET/CT was defined as any change in management that was triggered by [68Ga]Ga-PSMA-11 PET/CT. The existence of a PCa lesion was established according to a composite standard of truth based on all clinical data available collected during the follow-up period. Results: We included 294 patients. The detection rate was 69%. Per-patient sensitivity and specificity were both 70%. Patient disease management was changed in 68% of patients, and [68Ga]Ga-PSMA-11 PET/CT impacted this change in 86% of patients. The treatment carried out on patient was considered effective in 89% of patients when guided by [68Ga]Ga-PSMA-11 PET/CT versus 61% of patients when not guided by [68Ga]Ga-PSMA-11 PET/CT (p < 0.001). Conclusions: [68Ga]Ga-PSMA-11 PET/CT demonstrated high performance in locating PCa recurrence sites and impacted therapeutic management in nearly two out of three patients.

A Risk Model for Patients with PSA-Only Recurrence (Biochemical Recurrence) Based on PSA and PSMA PET/CT: An Individual Patient Data Meta-Analysis

“…The Hacettepe center [ 6 ] gave ADT to 48 (50%) of 96 patients as part of the initial treatment. Four centers restaged all patients with PSMA PET/CT, whereas the Paris center [ 10 ] carried out the initial restaging with [ 18 F]-fluorocholine or [ 18 F]-fluciclovine PET/CT and used PSMA PET/CT as a secondary restaging of only the [ 18 F]-PET-negative patients.…”

“…Our investigation is a retrospective IDP meta-analysis of all patients with PSA-only recurrence in the cohorts registered at centers in Austria, France, Germany, and Turkey [ 4 , 6 , 7 , 8 , 9 , 10 ]. The patients had been followed for more than two years and none of the patients should be lost at follow-up.…”

PSMA PET in Imaging Prostate Cancer

“…In this study 68Ga-PSMA PET/CT achieved excellent performance detecting secondary deposits of PC and impelled treatment planification change in 2/3 of cases. The performance rate of the imaging was higher with PSA>1ng/ml, particularly for abdominopelvic LN spread (31).…”

Urological Cancer Panorama in the Second Year of the COVID-19 Pandemic

“…Three out of 10 papers in this section deal with advanced prostate cancer. Fourquet et al [8] evaluate the role of [68Ga]Ga-PSMA-11 PET/CT in predicting therapy efficacy, diagnostic usefulness, and patient management in 294 patients with biochemical recurrence. The authors conclude that this technique shows a high performance in locating prostate cancer recurrence sites.…”