Ga-PSMA PET/CT in the Evaluation of Bone Metastases in Prostate Cancer

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2018 Jan 25

PMID 29362859

Citations 16

Authors

Christos Sachpekidis

P Baumer

K Kopka

B A Hadaschik

M Hohenfellner

A Kopp-Schneider

U Haberkorn

A Dimitrakopoulou-Strauss

Affiliations

Soon will be listed here.

Abstract

Purpose: The aims of this retrospective analysis were to compare Ga-PSMA PET findings and low-dose CT findings (120 kV, 30 mA), and to obtain semiquantitative and quantitative Ga-PSMA PET data in patients with prostate cancer (PC) bone metastases.

Methods: In total, 152 PET/CT scans from 140 patients were evaluated. Of these patients, 30 had previously untreated primary PC, and 110 had biochemical relapse after treatment of primary PC. All patients underwent dynamic PET/CT scanning of the pelvis and lower abdomen as well as whole-body PET/CT with Ga-PSMA-11. The PET/CT scans were analysed qualitatively (visually), semiquantitatively (SUV), and quantitatively based on a two-tissue compartment model and a noncompartmental approach leading to the extraction of the fractal dimension. Differences were considered significant for p values <0.05.

Results: In total, 168 Ga-PSMA-positive and 113 CT-positive skeletal lesions were detected in 37 patients (8 with primary PC, 29 with biochemical recurrence). Of these 168 lesions, 103 were both Ga-PSMA PET-positive and CT-positive, 65 were only Ga-PSMA-positive, and 10 were only CT-positive. The Yang test showed that there were significantly more Ga-PSMA PET-positive lesions than CT-positive lesions. Association analysis showed that PSA plasma levels were significantly correlated with several Ga-PSMA-11-associated parameters in bone metastases, including the degree of tracer uptake (SUV and SUV), its transport rate from plasma to the interstitial/intracellular compartment (K), its rate of binding to the PSMA receptor and its internalization (k), its influx rate (K), and its distribution heterogeneity.

Conclusion: Ga-PSMA PET/CT is a useful diagnostic tool in the detection of bone metastases in PC. Ga-PSMA PET visualizes more bone metastases than low-dose CT. PSA plasma levels are significantly correlated with several Ga-PSMA PET parameters.

Citing Articles

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PMID: 37086333 DOI: 10.1007/s11255-023-03595-0.

Imaging Techniques in Pharmacological Precision Medicine.

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Detecting and Locating the Site of Local Relapse Using F-PSMA-1007 Imaging After Primary Treatment of 135 Prostate Cancer Patients-Potential Impact on PSMA-Guided Radiation Therapy.

Koerber S, Kroener R, Dendl K, Kratochwil C, Fink C, Ristau J Mol Imaging Biol. 2022; 25(2):375-383.

PMID: 35999425 PMC: 10006015. DOI: 10.1007/s11307-022-01766-6.

Staging Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement.

Kesler M, Kerzhner K, Druckmann I, Kuten J, Levine C, Sarid D Eur J Nucl Med Mol Imaging. 2021; 49(6):2077-2085.

PMID: 34957528 DOI: 10.1007/s00259-021-05655-y.

F-PSMA-1007 PET/CT Performance on Risk Stratification Discrimination and Distant Metastases Prediction in Newly Diagnosed Prostate Cancer.

Wang Z, Zheng A, Li Y, Dong W, Liu X, Yuan W Front Oncol. 2021; 11:759053.

PMID: 34778079 PMC: 8581554. DOI: 10.3389/fonc.2021.759053.

References

Mannweiler S, Amersdorfer P, Trajanoski S, Terrett J, King D, Mehes G . Heterogeneity of prostate-specific membrane antigen (PSMA) expression in prostate carcinoma with distant metastasis. Pathol Oncol Res. 2008; 15(2):167-72. DOI: 10.1007/s12253-008-9104-2. View

Afshar-Oromieh A, Holland-Letz T, Giesel F, Kratochwil C, Mier W, Haufe S . Diagnostic performance of Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging. 2017; 44(8):1258-1268. PMC: 5486817. DOI: 10.1007/s00259-017-3711-7. View

Fonager R, Zacho H, Langkilde N, Petersen L . (18)F-fluoride positron emission tomography/computed tomography and bone scintigraphy for diagnosis of bone metastases in newly diagnosed, high-risk prostate cancer patients: study protocol for a multicentre, diagnostic test accuracy study. BMC Cancer. 2016; 16:10. PMC: 4709935. DOI: 10.1186/s12885-016-2047-1. View

Mikolajczyk K, Szabatin M, Rudnicki P, Grodzki M, Burger C . A JAVA environment for medical image data analysis: initial application for brain PET quantitation. Med Inform (Lond). 1998; 23(3):207-14. DOI: 10.3109/14639239809001400. View

Uprimny C, Kroiss A, Decristoforo C, Fritz J, von Guggenberg E, Kendler D . Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Med Mol Imaging. 2017; 44(6):941-949. DOI: 10.1007/s00259-017-3631-6. View

Langsteger W, Rezaee A, Pirich C, Beheshti M . F-NaF-PET/CT and Tc-MDP Bone Scintigraphy in the Detection of Bone Metastases in Prostate Cancer. Semin Nucl Med. 2016; 46(6):491-501. DOI: 10.1053/j.semnuclmed.2016.07.003. View

Ibrahim T, Flamini E, Mercatali L, Sacanna E, Serra P, Amadori D . Pathogenesis of osteoblastic bone metastases from prostate cancer. Cancer. 2010; 116(6):1406-18. DOI: 10.1002/cncr.24896. View

Cook G, Azad G, Padhani A . Bone imaging in prostate cancer: the evolving roles of nuclear medicine and radiology. Clin Transl Imaging. 2016; 4(6):439-447. PMC: 5118401. DOI: 10.1007/s40336-016-0196-5. View

Burger C, Buck A . Requirements and implementation of a flexible kinetic modeling tool. J Nucl Med. 1997; 38(11):1818-23. View

10.

Kratochwil C, Bruchertseifer F, Rathke H, Bronzel M, Apostolidis C, Weichert W . Targeted α-Therapy of Metastatic Castration-Resistant Prostate Cancer with Ac-PSMA-617: Dosimetry Estimate and Empiric Dose Finding. J Nucl Med. 2017; 58(10):1624-1631. DOI: 10.2967/jnumed.117.191395. View

11.

Yang Z, Sun X, Hardin J . A note on the tests for clustered matched-pair binary data. Biom J. 2010; 52(5):638-52. DOI: 10.1002/bimj.201000035. View

12.

Kratochwil C, Bruchertseifer F, Giesel F, Weis M, Verburg F, Mottaghy F . 225Ac-PSMA-617 for PSMA-Targeted α-Radiation Therapy of Metastatic Castration-Resistant Prostate Cancer. J Nucl Med. 2016; 57(12):1941-1944. DOI: 10.2967/jnumed.116.178673. View

13.

Mohler J, Kantoff P, Armstrong A, Bahnson R, Cohen M, DAmico A . Prostate cancer, version 2.2014. J Natl Compr Canc Netw. 2014; 12(5):686-718. DOI: 10.6004/jnccn.2014.0072. View

14.

Rahbar K, Ahmadzadehfar H, Kratochwil C, Haberkorn U, Schafers M, Essler M . German Multicenter Study Investigating 177Lu-PSMA-617 Radioligand Therapy in Advanced Prostate Cancer Patients. J Nucl Med. 2016; 58(1):85-90. DOI: 10.2967/jnumed.116.183194. View

15.

Sachpekidis C, Kopka K, Eder M, Hadaschik B, Freitag M, Pan L . 68Ga-PSMA-11 Dynamic PET/CT Imaging in Primary Prostate Cancer. Clin Nucl Med. 2016; 41(11):e473-e479. DOI: 10.1097/RLU.0000000000001349. View

16.

Maurer T, Gschwend J, Rauscher I, Souvatzoglou M, Haller B, Weirich G . Diagnostic Efficacy of (68)Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer. J Urol. 2015; 195(5):1436-1443. DOI: 10.1016/j.juro.2015.12.025. View

17.

Dey P . Basic principles and applications of fractal geometry in pathology: a review. Anal Quant Cytol Histol. 2006; 27(5):284-90. View

18.

Strauss L, Conti P . The applications of PET in clinical oncology. J Nucl Med. 1991; 32(4):623-48; discussion 649-50. View

19.

Baum R, Kulkarni H, Schuchardt C, Singh A, Wirtz M, Wiessalla S . 177Lu-Labeled Prostate-Specific Membrane Antigen Radioligand Therapy of Metastatic Castration-Resistant Prostate Cancer: Safety and Efficacy. J Nucl Med. 2016; 57(7):1006-13. DOI: 10.2967/jnumed.115.168443. View

20.

Schafer M, Bauder-Wust U, Leotta K, Zoller F, Mier W, Haberkorn U . A dimerized urea-based inhibitor of the prostate-specific membrane antigen for 68Ga-PET imaging of prostate cancer. EJNMMI Res. 2012; 2(1):23. PMC: 3502552. DOI: 10.1186/2191-219X-2-23. View