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Local recurrence of prostate cancer after radical prostatectomy is at risk to be missed in 68Ga-PSMA-11-PET of PET/CT and PET/MRI: comparison with mpMRI integrated in simultaneous PET/MRI

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The positron emission tomography (PET) tracer 68Ga-PSMA-11, targeting the prostate-specific membrane antigen (PSMA), is rapidly excreted into the urinary tract. This leads to significant radioactivity in the bladder, which may limit the PET-detection of local recurrence (LR) of prostate cancer (PC) after radical prostatectomy (RP), developing in close proximity to the bladder. Here, we analyze if there is additional value of multi-parametric magnetic resonance imaging (mpMRI) compared to the 68Ga-PSMA-11-PET-component of PET/CT or PET/MRI to detect LR.

Methods

One hundred and nineteen patients with biochemical recurrence after prior RP underwent both hybrid 68Ga-PSMA-11-PET/CTlow-dose (1 h p.i.) and -PET/MRI (2-3 h p.i.) including a mpMRI protocol of the prostatic bed. The comparison of both methods was restricted to the abdomen with focus on LR (McNemar). Bladder-LR distance and recurrence size were measured in axial T2w-TSE. A logistic regression was performed to determine the influence of these variables on detectability in 68Ga-PSMA-11-PET. Standardized-uptake-value (SUVmean) quantification of LR was performed.

Results

There were 93/119 patients that had at least one pathologic finding. In addition, 18/119 Patients (15.1%) were diagnosed with a LR in mpMRI of PET/MRI but only nine were PET-positive in PET/CT and PET/MRI. This mismatch was statistically significant (p = 0.004). Detection of LR using the PET-component was significantly influenced by proximity to the bladder (p = 0.028). The PET-pattern of LR-uptake was classified into three types (1): separated from bladder; (2): fuses with bladder, and (3): obliterated by bladder). The size of LRs did not affect PET-detectability (p = 0.84), mean size was 1.7 ± 0.69 cm long axis, 1.2 ± 0.46 cm short-axis. SUVmean in nine men was 8.7 ± 3.7 (PET/CT) and 7.0 ± 4.2 (PET/MRI) but could not be quantified in the remaining nine cases (obliterated by bladder).

Conclusion

The present study demonstrates additional value of hybrid 68Ga-PSMA-11-PET/MRI by gaining complementary diagnostic information compared to the 68Ga-PSMA-11-PET/CTlow-dose for patients with LR of PC.

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Abbreviations

ADT:

Androgen deprivation therapy

BCR:

Biochemical recurrence

CT:

Computed tomography

DCE:

Dynamic contrast-enhanced imaging

DWI:

Diffusion-weighted imaging

GS:

Gleason score

LR:

Local recurrence

MRI:

Magnetic resonance imaging

mpMRI:

Multiparametric MRI

PC:

Prostate cancer

PET:

Positron emission tomography

RP:

Radical prostatectomy

RT:

Radiotherapy

SUV:

Standard uptake value

68Ga:

Gallium-68

PSMA:

Prostate-specific membrane antigen

18F-FECH:

Fluorethylcholine

18F-FDG:

2 − 18F-fluoro-2-deoxy-D-glucose

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Acknowledgements

We would like to express our gratitude to Dr. Stefan Kegel and the support of our technicians Regula Gnirs, Heike Streib-Retzbach, Julia Schliebus, Cora Weyrich, and Rene Hertel for their excellent support.

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    Authors and Affiliations

    1. Department of Radiology, German Cancer Research Center, Heidelberg, Germany

      Martin T. Freitag, Jan P. Radtke, Matthias C. Roethke, David Bonekamp & Heinz-Peter Schlemmer

    2. Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany

      Martin T. Freitag, Christos Sachpekidis & A. Dimitrakopoulou-Strauss

    3. Department of Urology, University Hospital Heidelberg, Heidelberg, Germany

      Jan P. Radtke, Boris A. Hadaschik & Markus Hohenfellner

    4. Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany

      Ali Afshar-Oromieh, Paul Flechsig, Frederik Giesel & Uwe Haberkorn

    5. The Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada

      Martin Gleave

    6. Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany

      Klaus Kopka & Matthias Eder

    7. Department of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany

      Thorsten Heusser & Marc Kachelriess

    8. Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany

      Kathrin Wieczorek

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    Correspondence to Martin T. Freitag.

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    There was no funding for this study.

    Conflicts of interest

    Heinz-Peter Schlemmer, Ali Afshar-Oromieh and Matthias C. Roethke have received honoraria from Siemens Healthcare for educational sessions. The other authors report no conflict of interest.

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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 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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    Martin T. Freitag and Jan P. Radtke contributed equally to this work.

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    Freitag, M.T., Radtke, J.P., Afshar-Oromieh, A. et al. Local recurrence of prostate cancer after radical prostatectomy is at risk to be missed in 68Ga-PSMA-11-PET of PET/CT and PET/MRI: comparison with mpMRI integrated in simultaneous PET/MRI. Eur J Nucl Med Mol Imaging 44, 776–787 (2017). https://doi.org/10.1007/s00259-016-3594-z

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