Abstract
Purpose
To assess the association between PSA levels, PSA kinetics and other factors and a pathological 68Ga-PSMA PET/CT scan in patients with recurrent prostate cancer (rPCa) with biochemical relapse (BR) after radical therapy.
Methods
Seventy consecutive rPCA patients referred for 68Ga-PSMA PET/CT, matching all the following criteria, were retrospectively evaluated: (a) previous radical prostatectomy or primary radiotherapy with curative intent; (b) BR or persisting high PSA levels after primary treatment; and (c) complete clinical and imaging information. The mean ± SD PSA level was 3.5 ± 5.3 ng/mL (median 1.7, range 0.2 – 32.2 ng/mL), the mean ± SD PSA doubling time (PSAdt) was 6.5 ± 5.5 months (median 5.5, range 1.3 – 31.6 months), and the mean ± SD PSA velocity was 7.9 ± 20.5 (median 2.1, range 0.2 – 147.5 ng/mL/year). Statistical analysis was performed to assess which factors were associated with the detection of rPCa on 68Ga-PSMA PET/CT.
Results
68Ga-PSMA PET/CT was positive in 52 of 70 patients (74.2 %). In 30 patients (42.8 %) lesions limited to the pelvis were detected. Distant lesions were observed in 8 of patients (11.4 %). Local plus systemic lesions were detected in 14 patients (20 %). PSA level (p = 0.017) and PSAdt (p = 0.0001) were significantly different between PET-positive patients (higher PSA level, shorter PSAdt) and PET-negative patients (lower PSA, longer PSAdt). ROC analysis showed that PSAdt 6.5 months and PSA 0.83 ng/mL were optimal cut-off values. In multivariate analysis PSAdt was associated with 68Ga-PSMA PET/CT positivity. 68Ga-PSMA PET/CT was positive in 17 of 20 patients (85 %) with PSA <2 ng/mL and PSAdt <6.5 months, and in 3 of 16 patients (18.7 %) with PSA <2 ng/mL and PSAdt ≥6.5 months.
Conclusion
The great potential of 68Ga-PSMA PET/CT in patients with rPCa and BR was confirmed. PSA and PSAdt were valuable predictors of pathological 68Ga-PSMA PET/CT findings.
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Acknowledgments
The authors thank Dr. Cristina Fonti (Nuclear Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna) for supervision of the statistical analysis, and Dr. Joshua James Morigi (Nuclear Medicine, University of Bologna) for linguistic supervision.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Considering the retrospective design of the study, formal consent was not required.
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Francesco Ceci and Christian Uprimny contributed equally to this work.
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Supplemental Data 1
Univariate and Multivariate Binary Logistic Regression Analysis (DOCX 21 kb)
Supplemental Data 2
Treatment strategies performed according to 68Ga-PSMA-PET/CT results (DOCX 18 kb)
Supplemental Data 3
PET/CT readers (DOCX 17 kb)
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Ceci, F., Uprimny, C., Nilica, B. et al. 68Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate?. Eur J Nucl Med Mol Imaging 42, 1284–1294 (2015). https://doi.org/10.1007/s00259-015-3078-6
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DOI: https://doi.org/10.1007/s00259-015-3078-6