Skip to main content

Advertisement

SpringerLink
Log in

The accuracy of 68Ga-PSMA PET/CT in primary lymph node staging in high-risk prostate cancer

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To assess the diagnostic accuracy of 68Ga-PSMA PET in predicting lymph node (LN) metastases in primary N staging in high-risk and very high-risk nonmetastatic prostate cancer in comparison with morphological imaging.

Methods

This was a multicentre trial of the Society of Urologic Oncology in Turkey in conjunction with the Nuclear Medicine Department of Cerrahpasa School of Medicine, Istanbul University. Patients were accrued from eight centres. Patients with high-risk and very high-risk disease scheduled to undergo surgical treatment with extended LN dissection between July 2014 and October 2015 were included. Either MRI or CT was used for morphological imaging. PSMA PET/CT was performed and evaluated at a single centre. Sensitivity, specificity and accuracy were calculated for the detection of lymphatic metastases by PSMA PET/CT and morphological imaging. Kappa values were calculated to evaluate the correlation between the numbers of LN metastases detected by PSMA PET/CT and by histopathology.

Results

Data on 51 eligible patients are presented. The sensitivity, specificity and accuracy of PSMA PET in detecting LN metastases in the primary setting were 53%, 86% and 76%, and increased to 67%, 88% and 81% in the subgroup with of patients with ≥15 LN removed. Kappa values for the correlation between imaging and pathology were 0.41 for PSMA PET and 0.18 for morphological imaging.

Conclusions

PSMA PET/CT is superior to morphological imaging for the detection of metastatic LNs in patients with primary prostate cancer. Surgical dissection remains the gold standard for precise lymphatic staging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65(2):467–79.

    Article  CAS  PubMed  Google Scholar 

  2. Heesakkers RA, Hovels AM, Jager GJ, van den Bosch HC, Witjes JA, Raat HP, et al. MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study. Lancet Oncol. 2008;9(9):850–6.

    Article  CAS  PubMed  Google Scholar 

  3. Bouchelouche K, Choyke PL, Capala J. Prostate specific membrane antigen – a target for imaging and therapy with radionuclides. Discov Med. 2010;9(44):55–61.

    PubMed  PubMed Central  Google Scholar 

  4. Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA, et al. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013;40(4):486–95.

    Article  CAS  PubMed  Google Scholar 

  5. Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG, et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2014;41(1):11–20.

    Article  CAS  PubMed  Google Scholar 

  6. Budäus L, Leyh-Bannurah SR, Salomon G, Michl U, Heinzer H, Huland H, et al. Initial experience of (68)Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol. 2016;69(3):393–6.

    Article  PubMed  Google Scholar 

  7. Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C, et al. 68Ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer. Eur Urol. 2016;70(4):553–7.

    Article  CAS  PubMed  Google Scholar 

  8. Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G, et al. Diagnostic efficacy of (68)gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol. 2016;195(5):1436–43.

    Article  PubMed  Google Scholar 

  9. van Leeuwen PJ, Emmett L, Ho B, Delprado W, Ting F, Nguyen Q, et al. Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU Int. 2017;119(2):209–15.

    Article  PubMed  Google Scholar 

  10. Comperat E, Camparo P, Srigley J, Delahunt B, Egevad L; ISUP Consensus Working Group. International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens. Ann Pathol. 2013;33(3):155–61.

    Article  PubMed  Google Scholar 

  11. Kabasakal L, Demirci E, Ocak M, Akyel R, Nematyazar J, Aygun A, et al. Evaluation of PSMA PET/CT imaging using a 68Ga-HBED-CC ligand in patients with prostate cancer and the value of early pelvic imaging. Nucl Med Commun. 2015;36(6):582–7.

    Article  CAS  PubMed  Google Scholar 

  12. Barrio M, Fendler WP, Czernin J, Herrmann K. Prostate specific membrane antigen (PSMA) ligands for diagnosis and therapy of prostate cancer. Expert Rev Mol Diagn. 2016;16(11):1177–88.

    Article  CAS  PubMed  Google Scholar 

  13. Jadvar H. PSMA PET in prostate cancer. J Nucl Med. 2015;56(8):1131–2.

    Article  CAS  PubMed  Google Scholar 

  14. Mease RC, Foss CA, Pomper MG. PET imaging in prostate cancer: focus on prostate-specific membrane antigen. Curr Top Med Chem. 2013;13(8):951–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Wright GL Jr, Haley C, Beckett ML, Schellhammer PF. Expression of prostate-specific membrane antigen in normal, benign, and malignant prostate tissues. Urol Oncol. 1995;1(1):18–28.

    Article  PubMed  Google Scholar 

  16. Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42(2):197–209.

    Article  CAS  PubMed  Google Scholar 

  17. Kabasakal L, Demirci E, Nematyazar J, Akyel R, Razavi B, Ocak M, et al. The role of PSMA PET/CT imaging in restaging of prostate cancer patients with low prostate-specific antigen levels. Nucl Med Commun. 2017;38(2):149–55.

    Article  PubMed  Google Scholar 

  18. Schmittgen TD, Zakrajsek BA, Hill RE, Liu Q, Reeves JJ, Axford PD, et al. Expression pattern of mouse homolog of prostate-specific membrane antigen (FOLH1) in the transgenic adenocarcinoma of the mouse prostate model. Prostate. 2003;55(4):308–16.

    Article  CAS  PubMed  Google Scholar 

  19. Hijazi S, Meller B, Leitsmann C, Strauss A, Meller J, Ritter CO, et al. Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68Ga-PSMA-positron emission tomography/computerized tomography. Prostate. 2015;75(16):1934–40.

    Article  CAS  PubMed  Google Scholar 

  20. Perera M, Papa N, Christidis D, Wetherell D, Hofman MS, Murphy DG, et al. Sensitivity, specificity, and predictors of positive 68Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol. 2016;70(6):926–37.

    Article  PubMed  Google Scholar 

  21. Giesel FL, Fiedler H, Stefanova M, Sterzing F, Rius M, Kopka K, et al. PSMA PET/CT with Glu-urea-Lys-(Ahx)-[68Ga(HBED-CC)] versus 3D CT volumetric lymph node assessment in recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42(12):1794–800.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Hovels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008;63(4):387–95.

    Article  CAS  PubMed  Google Scholar 

  23. Huang SS, Wang X, Zhang Y, Doke A, DiFilippo FP, Heston WD. Improving the biodistribution of PSMA-targeting tracers with a highly negatively charged linker. Prostate. 2014;74(7):702–13.

    Article  CAS  PubMed  Google Scholar 

  24. Sterzing F, Kratochwil C, Fiedler H, Katayama S, Habl G, Kopka K, et al. (68)Ga-PSMA-11 PET/CT: a new technique with high potential for the radiotherapeutic management of prostate cancer patients. Eur J Nucl Med Mol Imaging. 2016;43(1):34–41.

    Article  CAS  PubMed  Google Scholar 

  25. Bluemel C, Linke F, Herrmann K, Simunovic I, Eiber M, Kestler C, et al. Impact of 68Ga-PSMA PET/CT on salvage radiotherapy planning in patients with prostate cancer and persisting PSA values or biochemical relapse after prostatectomy. EJNMMI Res. 2016;6(1):78.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kolthammer JA, Su KH, Grover A, Narayanan M, Jordan DW, Muzic RF. Performance evaluation of the ingenuity TF PET/CT scanner with a focus on high count-rate conditions. Phys Med Biol. 2014;59(14):3843–59.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sanchez-Crespo A. Comparison of gallium-68 and fluorine-18 imaging characteristics in positron emission tomography. Appl Radiat Isot. 2013;76:55–62.

    Article  CAS  PubMed  Google Scholar 

  28. Giesel FL, Hadaschik B, Cardinale J, Radtke J, Vinsensia M, Lehnert W, et al. F-18 labelled PSMA-1007: biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. Eur J Nucl Med Mol Imaging. 2017;44(4):678–88.

    Article  CAS  PubMed  Google Scholar 

  29. Giesel FL, Kesch C, Yun M, Cardinale J, Haberkorn U, Kopka K, et al. 18F-PSMA-1007 PET/CT detects micrometastases in a patient with biochemically recurrent prostate cancer. Clin Genitourin Cancer. 2017;15(3):e497–9.

    Article  PubMed  Google Scholar 

  30. Noto B, Buther F, Auf der Springe K, Avramovic N, Heindel W, Schafers M, et al. Impact of PET acquisition durations on image quality and lesion detectability in whole-body 68Ga-PSMA PET-MRI. EJNMMI Res. 2017;7(1):12.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Suardi N, Briganti A, Gandaglia G, Fossati N, Montorsi F. Salvage lymph node dissection for node-only recurrence of prostate cancer: ready for prime time? Eur Urol. 2017;71(5):693–4.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Scientific Research Projects Coordination Unit of Istanbul University, under project number 3264.

We acknowledge the contribution of Polat Türker, Erkan Erkan, Levent Türkeri, Çağ Çal and Haluk Akpınar in providing patients for the study.

Author information

Authors and Affiliations

  1. Department of Urology, Acibadem Taksim Hospital, Inonu Mah., Nizamiye Cad. No:1, 34373 Sisli, Istanbul, Turkey

    Can Öbek & Tünkut Doğanca

  2. Department of Nuclear Medicine, Sisli Etfal Training and Research Hospital, Istanbul, Turkey

    Emre Demirci

  3. Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul University, Istanbul, Turkey

    Meltem Ocak

  4. Department of Urology, Acibadem University, Istanbul, Turkey

    Ali Rıza Kural

  5. Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey

    Asıf Yıldırım

  6. Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey

    Uğur Yücetaş

  7. Department of Urology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey

    Çetin Demirdağ

  8. Department of Public Health, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey

    Sarper M. Erdoğan

  9. Department of Nuclear Medicine, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey

    Levent Kabasakal

Authors
  1. Can Öbek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tünkut Doğanca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emre Demirci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meltem Ocak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Rıza Kural
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Asıf Yıldırım
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Uğur Yücetaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Çetin Demirdağ
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sarper M. Erdoğan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Levent Kabasakal
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Members of Urooncology Association, Turkey

Corresponding author

Correspondence to Tünkut Doğanca.

Ethics declarations

Funding

Dr. Levent Kabasakal has received a research grant from the Scientific Research Projects Coordination Unit of Istanbul University, under project number 3264.

Ethical approval

All procedures performed in this study 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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Öbek, C., Doğanca, T., Demirci, E. et al. The accuracy of 68Ga-PSMA PET/CT in primary lymph node staging in high-risk prostate cancer. Eur J Nucl Med Mol Imaging 44, 1806–1812 (2017). https://doi.org/10.1007/s00259-017-3752-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-017-3752-y

Keywords

Search

Navigation