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The impact of [68Ga]PSMA I&T PET/CT on radiotherapy planning in patients with prostate cancer

Der Einfluss von [68Ga]-PSMA-I&T-PET/CT auf die Radiotherapieplanung bei Patienten mit Prostatakarzinom

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Abstract

Purpose

To determine the impact of Gallium-68-labled prostate-specific membrane antigen positron-emission tomography/computed tomography ([68Ga]PSMA PET/CT) on radiotherapy planning for primary disease, biochemical cancer relapse, and advanced disease of prostate cancer.

Methods

A total of 106 patients with prostate cancer scheduled for radiation therapy underwent 120 [68Ga]PSMA PET/CT scans prior to radiotherapy treatment. In 20 cases, patients underwent [68Ga]PSMA PET/CT for primary therapy (PT), 75 cases were referred for biochemical relapse after surgery (RL), and 25 cases were intended for palliative treatment of localized metastases (MD). We retrospectively compared the impact of [68Ga]PSMA PET/CT on lesion detection and treatment decision to CT alone.

Results

[68Ga]PSMA PET/CT revealed a total of 271 positive lesions, whereas CT detected 86 lesions (32%). Overall, the radiotherapy regime was changed in 55 of 120 cases (46%) based on the higher detection rate of [68Ga]PSMA PET/CT: in 15% of cases with PT, in 43% of cases with RL, and in 44% of cases with MD.

Conclusion

[68Ga]PSMA PET/CT is superior to CT alone for lesion detection in prostate cancer, thereby significantly impacting on radiotherapy planning for primary disease, biochemical cancer relapse, and advanced disease of prostate cancer.

Zusammenfassung

Zielsetzung

Es sollte der Einfluss eines Gallium-68-markierten-prostataspezifischen-Membranantigen-Positronenemissionstomogamms/Röntgencomputertomogramms ([68Ga]-PSMA-PET/CT) auf die strahlentherapeutische Therapieentscheidung für Patienten mit Primärtherapie, auf die Therapie eines biochemischen Rezidivs und auf die Behandlung eines fortgeschrittenen Prostatakarzinoms untersucht werden.

Methoden

Insgesamt 106 Patienten mit einem Prostatakarzinom erhielten insgesamt 120 [68Ga]-PSMA-PET/CT-Untersuchungen vor ihrer Strahlenbehandlung. Hiervon erhielten 20 Patienten ein [68Ga]-PSMA-PET/CT im Rahmen ihrer Primärtherapie (PT), 75 Patienten wurde nach Prostatektomie bei biochemischem Rezidiv (RL) und 25 Patienten zur Palliativtherapie lokalisierter Metastasen (MD) zugewiesen. Retrospektiv wurde der Einfluss des [68Ga]-PSMA-PET/CT auf die Erkennung von Läsionen und die Therapieentscheidung im Vergleich zu einem alleinigen CT untersucht.

Ergebnisse

Die [68Ga]-PSMA-PET/CT zeigten insgesamt 271 positive Läsionen, das CT allein entdeckte nur 86 (32 %). Aufgrund der höheren Detektionsrate des [68Ga]-PSMA-PET/CT wurde das Therapiekonzept in 55 von 120 Fällen (46 %) geändert: in 15 % der Fälle mit PT, 43 % der Fälle mit RL und in 44 % der Fälle mit MD.

Schlussfolgerung

[68Ga]-PSMA-PET/CT ist einer alleinigen CT-Untersuchung bei der Detektion von Läsionen überlegen und hat damit einen signifikanten Einfluss auf die strahlentherapeutische Therapieentscheidung bei der Primärtherapie, der Therapie eines biochemischen Rezidivs und der Therapie von Patienten mit einem metastasierten Prostatakarzinom.

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Acknowledgements

We thank Heike Woicke for her assistance in the preparation of the ethics committee application.

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Authors and Affiliations

  1. Ambulatory Center, Department for Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Thorsten Frenzel MD,PhD, Rudolf Schwarz MD & Andreas Krüll MD

  2. Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Milena Tienken MD, Merve Abel MD, Christoph Berliner MD, Susanne Klutmann MD, Dirk Beyersdorff MD & Peter Bannas MD

  3. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Dirk Beyersdorff MD

Authors
  1. Thorsten Frenzel MD,PhD
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  2. Milena Tienken MD
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  3. Merve Abel MD
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  4. Christoph Berliner MD
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  5. Susanne Klutmann MD
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  8. Andreas Krüll MD
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  9. Peter Bannas MD
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Corresponding author

Correspondence to Thorsten Frenzel MD,PhD.

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Conflict of interest

T. Frenzel, M. Tienken, M. Abel, C. Berliner, S. Klutmann, D. Beyersdorff, R. Schwarz, A. Krüll, and P. Bannas declare that they have no competing interests.

Additional information

Both authors contributed equally: T. Frenzel and M. Tienken; shared last authorship: A. Krüll and P. Bannas.

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Frenzel, T., Tienken, M., Abel, M. et al. The impact of [68Ga]PSMA I&T PET/CT on radiotherapy planning in patients with prostate cancer. Strahlenther Onkol 194, 646–654 (2018). https://doi.org/10.1007/s00066-018-1291-5

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