Highlights
- •In France, PSMA-11 is granted by the National Agency for Medicine Security (ANSM) in selected prostate cancer patients.
- •PSMA-11 PET/CT detection rate in biochemical recurrence prostate cancer and negative choline PET/CT is not well known.
- •PSMA-11 PET/CT is able to detect occult biochemical recurrence even in a selected population of patients.
- •Majority of patients with a positive PSMA-11 PET/CT initiated a treatment.
Abstract
Introduction
Prostate adenocarcinoma (CaP) is the leading cancer in men. After curative treatment,
from 27% to 53% of patients will experience biochemical recurrence (BR). With the
development of focal therapies, precise early identification of recurrence's sites
is of utmost importance in order to deliver individualized treatment on positive lesions.
The aim of this study was to assess the detection rate (DR) of 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) in selected patients
with prostate cancer BR and recent negative 18F-choline PET/CT.
Patients and Methods
We performed a retrospective analysis including all patients with CaP referred for
BR with a negative 18F-choline PET/CT, and who underwent 68Ga-PSMA-11 PET/CT between October, 2018 and December, 2019. The overall DR of 68Ga-PSMA-11 PET/CT was calculated, and described according to BR characteristics especially
PSA levels and velocity. Patients were followed up for at least 1 year. Patient management
following 68Ga-PSMA-11 PET/CT and PSA levels evolution after treatment were also recorded.
Results
One hundred fifty-nine patients comprising 164 examinations were analyzed. The overall
DR of 68Ga-PSMA-11 PET/CT for BR was 65.9% (95CI, 58.6-73.1). The DR was 52.5% (95CI, 39.9-65.0),
70.6% (95CI, 55.3-85.9), 70.4% (95CI, 53.1-87.6), and 78.6% (95CI, 66.2-91.0) for
PSA levels between 0.2 and 0.49 ng/mL, 0.5 to 0.99 ng/mL, 1 to 1.99 ng/mL and PSA
≥ 2 ng/mL, respectively. The DR was 70.7% (95CI, 59.0-82.4) with a PSA doubling time
(PSA-DT) ≤6 months and 65.2% (95CI, 55.5-74.9) with a PSA-DT >6 months. Around 3/4
of patients (75.9%) with a positive 68Ga-PSMA-11 PET/CT initiated treatment, including surgery (2.4%), stereotactic radiotherapy
± androgen deprivation therapy (ADT) (22%) or external conformational radiotherapy
± ADT (46.3%). Patient management changed in 43 cases (39.8%).
Conclusion
Our study confirmed the ability of 68Ga-PSMA-11 PET/CT to detect occult biochemical recurrence, even in a selected population
of CaP patients with negative 18F-choline PET/CT, even at low PSA levels.
Keywords
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Article info
Publication history
Published online: December 27, 2022
Accepted:
December 24,
2022
Received in revised form:
December 21,
2022
Received:
May 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
