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68Ga-PSMA PET/CT for monitoring response to 177Lu-PSMA-617 radioligand therapy in patients with metastatic castration-resistant prostate cancer

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Abstract

Purpose

To evaluate the use of 68Ga-PSMA PET/CT for monitoring response to 177Lu-617 PSMA radioligand therapy in patients with metastatic castrate-resistant prostate cancer (mCRPC).

Methods

Patients from the University Hospital Bonn and the University Hospital Aachen were retrospectively reviewed for this study. We included 48 patients with mCRPC who were treated with 177Lu-PSMA-617 and whose records included 68Ga-PSMA PET/CT imaging before the first and after the third or fourth treatment cycle. A treatment response based on 68Ga-PSMA PET/CT was defined according to a modified version of the PERCIST criteria. A decline in PSA level of ≥50% was considered the reference standard. The sensitivity, specificity, positive and negative predictive values, and ROC curves were calculated, and patient survival times in relation to the PET results were also analysed.

Results

68Ga-PSMA PET/CT had a sensitivity of about 85% and a specificity of between 55% and 65%. The negative and positive predictive values ranged between 70% and 78%. The fitted ROC area was 0.70. The survival time was about 19.6 months in patients with a treatment response, while nonresponders had a survival time of about 15.9 months. However, this difference between the groups was not statistically significant.

Conclusion

Our results indicate that 68Ga-PSMA PET/CT could be a useful tool for the evaluation of response to 177Lu-PSMA-617 radioligand therapy within a theranostic framework.

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Acknowledgments

We thank Tanja Berger of The Institute of Medical Statistics of RWTH Aachen University for reviewing the data analysis.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Alexander Heinzel, Dima Boghos & Dirk von Mallek

  2. Institute for Neuroscience and Medicine (INM-4), Research Centre Jülich, Jülich, Germany

    Alexander Heinzel

  3. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

    Felix M. Mottaghy

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

    Florian Gaertner, Markus Essler & Hojjat Ahmadzadehfar

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  1. Alexander Heinzel
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Correspondence to Alexander Heinzel.

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This study was approved by the Institutional Review Board of the University Hospital Aachen. Given the type of study (a retrospective analysis), the need for written informed consent was waived. All procedures were performed in accordance with the ethical standards of the institutional and/or national research committees and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Heinzel, A., Boghos, D., Mottaghy, F.M. et al. 68Ga-PSMA PET/CT for monitoring response to 177Lu-PSMA-617 radioligand therapy in patients with metastatic castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging 46, 1054–1062 (2019). https://doi.org/10.1007/s00259-019-4258-6

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