Clinical performance of 68Ga-PSMA-11 PET/MRI for the detection of recurrent prostate cancer following radical prostatectomy
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Sensitive visualization of recurrent prostate cancer foci is a challenge in patients with early biochemical recurrence (EBR). The recently established 68Ga-PSMA-11 PET/CT has significantly improved the detection rate with published values of up to 55% for patients with a serum PSA concentration between 0.2–0.5 ng/mL. The increased soft tissue contrast in the pelvis using simultaneous 68Ga-PSMA-11 PET/MRI might further improve the detection rate in patients with EBR and low PSA values over PET/CT.
We retrospectively analyzed a cohort of 56 consecutive patients who underwent a 68Ga-PSMA-11 PET/MRI for biochemical recurrence in our institution between April and December 2016 with three readers. Median PSA level was 0.99 ng/mL (interquartile range: 3.1 ng/mL). Detection of PSMA-positive lesions within the prostate fossa, local and distant lymph nodes, bones, or visceral organs was recorded. Agreement among observers was evaluated with Fleiss’s kappa (k).
Overall, in 44 of 56 patients (78.6%) PSMA-positive lesions were detected. In four of nine patients (44.4%) with a PSA < 0.2 ng/mL, suspicious lesions were detected (two pelvic and one paraaortic lymph nodes, and two bone metastases). In eight of 11 patients (72.7%) with a PSA between 0.2 and < 0.5 ng/mL, suspicious lesions were detected (two local recurrences, six lymph nodes, and one bone metastasis). Five out of 20 patients with a PSA < 0.5 ng/mL had extrapelvic disease. In 12 of 15 patients (80.0%) with a PSA between 0.5 and < 2.0 ng/mL, suspicious lesions were detected (four local recurrences, nine lymph nodes, and four bone metastases). In 20 of 21 patients (95.2%) with a PSA >2.0 ng/mL, suspicious lesions were detected. The overall interreader agreement for cancer detection was excellent (κ = 0.796, CI 0.645–0.947).
Our data show that 68Ga-PSMA-11 PET/MRI has a high detection rate for recurrent prostate cancer even at very low PSA levels <0.5 ng/mL. Furthermore, even at those low levels extrapelvic disease can be localized in 25% of the cases and local recurrence alone is seen only in 10%.
KeywordsProstate cancer Prostate-specific antigen 68Ga-PSMA-11 Positron emission tomography PSMA antigen
The authors acknowledge Ms. Sarah Kedzia for the excellent organization of the patient database, and the technicians Marlena Hofbauer, Miguel Porto, Sofia Kaltsuni, Tobias Oblasser and Sabrina Epp for the excellent work on high quality PET/MRI.
Compliance with ethical standards
The Department of Nuclear Medicine holds an institutional Research Contract with GE Healthcare. The authors declare that no competing financial interests exist.
This retrospective study was approved by the local ethics committee (BASEC Nr. 2016–02230). All patients gave a written informed general consent for retrospective analysis of their data.
Authors IAB, MH and PAK have received research grants and speaker honorarium from GE Healthcare. Author IAB received research grants from Swiss Life and speaker honorarium from Bayer Health Care and Astellas Pharma AG. Author MG has received research grants from Varian. Authors BK, JM, ASB, PS, DE, HN, UM declare no conflict of interest.
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