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

  • Martin T. Freitag
  • Jan P. Radtke
  • Ali Afshar-Oromieh
  • Matthias C. Roethke
  • Boris A. Hadaschik
  • Martin Gleave
  • David Bonekamp
  • Klaus Kopka
  • Matthias Eder
  • Thorsten Heusser
  • Marc Kachelriess
  • Kathrin Wieczorek
  • Christos Sachpekidis
  • Paul Flechsig
  • Frederik Giesel
  • Markus Hohenfellner
  • Uwe Haberkorn
  • Heinz-Peter Schlemmer
  • A. Dimitrakopoulou-Strauss
Original Article

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.

Keywords

68Ga-PSMA-11 Local relapse Local recurrence PET/MRI PET/CT Prostate specific membrane antigen 

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Martin T. Freitag
    • 1
    • 2
  • Jan P. Radtke
    • 1
    • 3
  • Ali Afshar-Oromieh
    • 4
  • Matthias C. Roethke
    • 1
  • Boris A. Hadaschik
    • 3
  • Martin Gleave
    • 5
  • David Bonekamp
    • 1
  • Klaus Kopka
    • 6
  • Matthias Eder
    • 6
  • Thorsten Heusser
    • 7
  • Marc Kachelriess
    • 7
  • Kathrin Wieczorek
    • 8
  • Christos Sachpekidis
    • 2
  • Paul Flechsig
    • 4
  • Frederik Giesel
    • 4
  • Markus Hohenfellner
    • 3
  • Uwe Haberkorn
    • 4
  • Heinz-Peter Schlemmer
    • 1
  • A. Dimitrakopoulou-Strauss
    • 2
  1. 1.Department of Radiology, German Cancer Research CenterHeidelbergGermany
  2. 2.Clinical Cooperation Unit Nuclear Medicine, German Cancer Research CenterHeidelbergGermany
  3. 3.Department of UrologyUniversity Hospital HeidelbergHeidelbergGermany
  4. 4.Department of Nuclear MedicineUniversity Hospital HeidelbergHeidelbergGermany
  5. 5.The Vancouver Prostate CentreUniversity of British ColumbiaVancouverCanada
  6. 6.Division of Radiopharmaceutical Chemistry, German Cancer Research CenterHeidelbergGermany
  7. 7.Department of Medical Physics in Radiology, German Cancer Research CenterHeidelbergGermany
  8. 8.Institute of PathologyUniversity Hospital HeidelbergHeidelbergGermany

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