Dynamic patterns of [68Ga]Ga-PSMA-11 uptake in recurrent prostate cancer lesions

  • Ian AlbertsEmail author
  • Christos Sachpekidis
  • Eleni Gourni
  • Silvan Boxler
  • Tobias Gross
  • George Thalmann
  • Kambiz Rahbar
  • Axel Rominger
  • Ali Afshar-Oromieh
Original Article
Part of the following topical collections:
  1. Oncology – Genitourinary



Dual-time point PET/CT scanning with [68Ga]Ga-PSMA-11 in the diagnosis of prostate cancer (PC) has been advanced as a method to increase detection of PC lesions, particularly at early stages of biochemical recurrence and as a potential means to aid the discrimination between benign and pathological prostate-specific membrane antigen (PSMA) uptake. However, the assumption that all PC lesions uniformly exhibit increasing tracer uptake at delayed imaging has not yet been investigated, which this present study aims to address.


One hundred consecutive patients with biochemically recurrent PC who received standard and late [68Ga]Ga-PSMA-11 PET/CT (by local protocol at 1.5 h “standard” and 2.5 h p.i. “late”) underwent retrospective evaluation. All lesions with a tracer uptake above local background were analysed with regard to their maximum standardised uptake values at standard and late images (SUVmax) and characterised according to their morphological characteristics.


Seventy-nine of 100 patients had PSMA-positive scans, in whom a total of 185 individual PSMA-positive lesions were identified. These were morphologically characterised as bone lesions (n = 48), solid organ lesions (n = 3), lymph node (LN) lesions (n = 78) and locally recurrent lesions in the prostatic fossa or seminal vesicles (n = 56). The relative uptake between standard and late imaging was considered; all lesions classified as local recurrence presented with increasing (86%) or stable patterns of tracer uptake (14%). In contrast, only 58% of bone lesions exhibited increasing tracer uptake, with 21% exhibiting a stable pattern and 21% exhibiting a decreasing tracer uptake at late imaging.


A heterogeneous pattern of dynamic tracer uptake was observed, with a largely increasing pattern observed for locally recurrent lesions and lymph nodes and a significant proportion of bone lesions exhibiting decreasing tracer uptake. The results are of significance not only in the imaging and identification of PC lesions, but they also have implications for PSMA-directed ligand therapy.


Prostate cancer PET/CT Positron emission tomography PSMA Prostate-specific membrane antigen Ganglion 



This thesis forms part of the doctorial thesis of I Alberts.

Compliance with ethical standards

Ethical approval

All patients published in this manuscript signed a written informed consent form for the purpose of anonymised evaluation and the publication of their data. This evaluation was approved by the ethics committee of the University of Bern (KEK-Nr. 2018-00299).

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

259_2019_4545_MOESM1_ESM.docx (13 kb)
ESM 1 (DOCX 12 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nuclear Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
  2. 2.Department of Urology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
  3. 3.Department of Nuclear MedicineUniversity Hospital MünsterMünsterGermany

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