The clinical efficacy of PSMA PET/MRI in biochemically recurrent prostate cancer compared with standard of care imaging modalities and confirmatory histopathology: results of a single-centre, prospective clinical trial

Published on Jan 1, 2020in Clinical & Experimental Metastasis3.027
· DOI :10.1007/S10585-020-10043-1
Andre Joshi4
Estimated H-index: 4
(QUT: Queensland University of Technology),
Matthew J. Roberts20
Estimated H-index: 20
(UQ: University of Queensland)
+ 10 AuthorsIan Vela14
Estimated H-index: 14
(QUT: Queensland University of Technology)
Prospective evidence for the clinical role and efficacy of prostate specific membrane antigen (PSMA) positron emission tomography (PET)/magnetic resonance imaging (MRI) combining MRI characterization and localization of lesions with PET avidity in comparison to conventional imaging is limited. In a prospective clinical trial, we aimed to evaluate the diagnostic yield and therapeutic impact of PSMA PET/MRI in men with biochemical recurrence (BCR) following curative therapy. A single-centre, prospective clinical trial at the Princess Alexandra Hospital recruited 30 patients with BCR. Patients underwent PSMA PET/MRI and concurrent conventional CT chest, abdomen, pelvis and whole-body bone scan. Biopsy was performed when safety possible for histological correlation of identified lesions. Clinical efficacy and impact of PSMA PET findings were evaluated. 30 patients with BCR were recruited (median PSA 0.69 ng/ml). PSMA avid lesions were present in 21 patients (70%). 23 patients were previously treated with definitive surgery, 6 patients received external beam radiotherapy and 1 patient had low dose rate brachytherapy. A total of 8 of 9 lesions biopsied were positive (88.9% histological correlation). PSMA PET/MRI detected local recurrence (p = 0.005) and pelvic lesions (p = 0.06) more accurately than conventional imaging. PSMA PET/MRI may be useful in staging men with biochemical recurrence, especially when PSA is low. Our data demonstrates a high detection rate, especially for locally recurrent disease, and highlights the role of this modality when PSA is low. This modality has the potential to significantly improve prostate cancer detection and may have implications for earlier salvage treatment, avoidance of futile local therapy and change patient management to lead to improved outcomes.
📖 Papers frequently viewed together
10 Citations
15 Authors (Andre Joshi, ..., Ian Vela)
1 Citations
51 Citations
#1Hojjat Ahmadzadehfar (University Hospital Bonn)H-Index: 36
#2Markus Essler (University Hospital Bonn)H-Index: 37
3 CitationsSource
#1Marlon Perera (UQ: University of Queensland)H-Index: 21
#2Nathan Papa (University of Melbourne)H-Index: 13
Last. Declan G. Murphy (University of Melbourne)H-Index: 107
view all 11 authors...
Abstract Context Accurate staging of high-risk localised, advanced, and metastatic prostate cancer is becoming increasingly more important in guiding local and systemic treatment. Gallium-68 prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has increasingly been utilised globally to assess the local and metastatic burden of prostate cancer, typically in biochemically recurrent or advanced disease. Following our previous meta-analysis, a high-volume series has been repo...
251 CitationsSource
#1Louisa G. Gordon (QUT: Queensland University of Technology)H-Index: 29
#2Thomas M. Elliott (QIMR: QIMR Berghofer Medical Research Institute)H-Index: 6
Last. Ian VelaH-Index: 14
view all 5 authors...
Men treated for prostate cancer with curative intent face a recurrence rate of up to 53% at 10 years. 68Ga-PSMA imaging is a new technique that can more accurately stage cancer recurrences and facilitate personalised treatment. We evaluated the cost-effectiveness of 68Ga-PSMA PET/MRI for staging men with prostate cancer biochemical recurrence. A cost-effectiveness analysis using a decision-analytic model with Markov chains was constructed. 68Ga-PSMA PET/MRI was compared with usual care in stagin...
4 CitationsSource
#1Louise Emmett (St. Vincent's Health System)H-Index: 30
#2Ur Metser (U of T: University of Toronto)H-Index: 35
Last. Andrew M. Scott (La Trobe University)H-Index: 87
view all 13 authors...
: A significant proportion of men with rising prostate-specific antigen (PSA) levels after radical prostatectomy (RP) fail prostate fossa (PF) salvage radiation treatment (SRT). This study was done to assess the ability of 18F-fluoromethylcholine (18F-FCH) PET/CT (hereafter referred to as 18F-FCH), 68Ga-HBED-CC PSMA-11 PET/CT (hereafter referred to as PSMA), and pelvic multiparametric MRI (hereafter referred to as pelvic MRI) to identify men who will best benefit from SRT. Methods: Prospective, ...
38 CitationsSource
#1Ur Metser (U of T: University of Toronto)H-Index: 35
#1Ur Metser (U of T: University of Toronto)H-Index: 8
Last. Louise Emmett (Garvan Institute of Medical Research)H-Index: 30
view all 16 authors...
593 Purpose: To assess whether the addition of data from multiparametric pelvic (mpMR) and whole body MR (wbMR) to the interpretation of 18F-fluoromethylcholine (FCH) or 68Ga-HBED-CC PSMA-11 (PSMA) PET/CT (=PET) improvesthe detection of local tumor recurrence, or nodal and distant metastases in patients following radical prostatectomy with biochemical failure. Methods: The current analysis was performed as part of a prospective, multicenter trial on FCH / PSMA PET, mpMR and wbMR. Eligible men ha...
1 Citations
Purpose To assess whole-body magnetic resonance imaging (wb-MRI) for detection of biochemical recurrence in comparison to 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) in prostate cancer (Pca) patients after radical prostatectomy.
27 CitationsSource
#1Pieter De Visschere (Ghent University Hospital)H-Index: 15
#2Chloë Standaert (Ghent University Hospital)H-Index: 4
Last. Stefano Fanti (UNIBO: University of Bologna)H-Index: 83
view all 11 authors...
Abstract Context In patients treated for prostate cancer, a rising serum prostate-specific antigen (PSA) level is a first sign of relapse, but imaging is needed to determine the localization of the recurrence, which may be local, in lymph nodes, and/or metastatic. With the increasing success rate of earlier salvage therapy, the diagnosis has become pertinent when the recurrent PSA level is still very low. Objective To systematically review the literature on the role of the existing imaging techn...
64 CitationsSource
#1Peter Donato (Royal Brisbane and Women's Hospital)H-Index: 2
#2Matthew J. Roberts (UQ: University of Queensland)H-Index: 20
Last. John Yaxley (UQ: University of Queensland)H-Index: 22
view all 9 authors...
Purpose Positron emission tomography (PET) for prostate-specific membrane antigen (PSMA) represents a promising method for prostate cancer diagnosis and staging. Comparisons of PSMA-based tumour characterisation to multiparametric MRI (mpMRI) are limited, hence this study sought to compare the diagnostic accuracy of 68Ga-PSMA PET/CT to mpMRI against radical prostatectomy (RP) whole gland histopathology.
29 CitationsSource
#1Mark Thalgott (TUM: Technische Universität München)H-Index: 18
#2Charlotte Düwel (TUM: Technische Universität München)H-Index: 4
Last. Matthias Eiber (TUM: Technische Universität München)H-Index: 22
view all 10 authors...
: Our aim was to assess the diagnostic potential of 1-stop-shop prostate-specific membrane antigen ligand (68Ga-PSMA-11) PET/MRI compared with preoperative staging nomograms in patients with high-risk prostate cancer. Methods: A total of 102 patients underwent 68Ga-PSMA-11 PET/MRI before intended radical prostatectomy with lymph node dissection. Preoperative variables determined the probabilities for lymph node metastases (LNM), extracapsular extension (ECE), and seminal vesical involvement (SVI...
29 CitationsSource
#1Helle D Zacho (AAU: Aalborg University)H-Index: 14
#2Julie B. Nielsen (AAU: Aalborg University)H-Index: 7
Last. Lars Jelstrup Petersen (AAU: Aalborg University)H-Index: 28
view all 5 authors...
BACKGROUND: 68 Ga-labelled prostate-specific membrane antigen (PSMA) is a promising PET ligand for the detection of prostate cancer. Little attention has been given to the ability of 68 Ga-PSMA PET/CT to detect malignant bone lesions and whether this approach is superior to existing bone imaging modalities. AIM: To review the existing data of 68 Ga-PSMA PET/CT for the diagnosis of bone metastases in prostate cancer. METHODS: Systematic review of the peer-reviewed literature. RESULTS: Among 1858 ...
43 CitationsSource
Cited By5
#1Brennan TimmH-Index: 4
#2Matthew FaragH-Index: 4
Last. Damien M BoltonH-Index: 51
view all 6 authors...
OBJECTIVE To review the utility of vesicourethral anastomosis (VUA)-directed biopsy in the setting of biochemical recurrence (BCR) after radical prostatectomy (RP) for prostate cancer (PCa) in patients who have undergone evaluation by gallium-68 prostate-specific membrane antigen positron emission tomography with computed tomography (68 Ga-PSMA PET/CT). METHODS We completed a retrospective review of a prospectively maintained dataset from January 2015 to August 2020. Patient demographics were re...
#2Cigdem Soydal (Ankara University)H-Index: 14
Last. Rie von Eyben (Stanford University)H-Index: 23
view all 3 authors...
The study aimed to summarize clinical characteristics associated with Gallium-68-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (68Ga-PSMA PET/CT) scans as patients were restaged for prostate-specific antigen (PSA) relapse after radical prostatectomy (RP) or external beam radiotherapy (EBRT). Our analyses included multiple cox regression analyses. The study evaluated 95 patients with rising values of PSAs after RP and after EBRT. Sixty 63% of patients ...
#1Nathan Papa (Monash University)H-Index: 13
#2Marlon Perera (University of Melbourne)H-Index: 21
Last. Damien M Bolton (University of Melbourne)H-Index: 51
view all 7 authors...
INTRODUCTION There has been a growing body of evidence highlighting the improved sensitivity and specificity for prostate specific membrane antigen (PSMA) positron emission tomography (PET) in advanced prostate cancer imaging. We aimed to assess prostate cancer staging practice patterns in Australia using population-based data. SUBJECT AND METHODS We extracted data on men diagnosed with prostate cancer between October 2016 and December 2018 from the Prostate Cancer Outcomes Registry-Victoria (PC...
#1Niamh M Keegan (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 2
#2Lisa Bodei (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 25
Last. Michael J. Morris (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 66
view all 3 authors...
CONTEXT Men with biochemically relapsed prostate cancer face a clinical conundrum. Depending on the detected distribution of disease, treatment goals may range from cure with focal therapy to palliative with systemic therapy to expectant observation. Retrospective studies of prostate-specific membrane antigen (PSMA)-based imaging demonstrate higher disease detection rates than conventional imaging. OBJECTIVE This review focuses on available prospective evidence for diagnostic use of PSMA-based i...
2 CitationsSource