PSMA Ligand PET/MRI for Primary Prostate Cancer: Staging Performance and Clinical Impact.

Abstract

PURPOSE:

Primary staging of prostate cancer relies on modalities, which are limited. We evaluate simultaneous [68Ga]Ga-PSMA-11 PET (PSMA-PET)/MRI as a new diagnostic method for primary tumor-node-metastasis staging compared with histology and its impact on therapeutic decisions.

EXPERIMENTAL DESIGN:

We investigated 122 patients with PSMA-PET/MRI prior to planned radical prostatectomy (RP). Primary endpoint was the accuracy of PSMA-PET/MRI in tumor staging as compared with staging-relevant histology. In addition, a multidisciplinary team reassessed the initial therapeutic approach to evaluate its impact on the therapeutic management.

RESULTS:

PSMA-PET/MRI correctly identified prostate cancer in 119 of 122 patients (97.5%). Eighty-one patients were treated with RP and pelvic lymphadenectomy. The accuracy for T staging was 82.5% [95% confidence interval (CI), 73-90; P < 0.001], for T2 stage was 85% (95% CI, 71-94; P < 0.001), for T3a stage was 79% (95% CI, 43-85; P < 0.001), for T3b stage was 94% (95% CI, 73-100; P < 0.001), and for N1 stage was 93% (95% CI, 84-98; P < 0.001). PSMA-PET/MRI changed the therapeutic strategy in 28.7% of the patients with either the onset of systemic therapy/radiotherapy (n = 16) or active surveillance (n = 19).

CONCLUSIONS:

PSMA-PET/MRI can provide an accurate staging of newly diagnosed prostate cancer. In addition, treatment strategies were changed in almost a third of the patients due to the information of this hybrid imaging technique.

• Authors: Bernhard Grubmüller, Pascal Baltzer, Sabrina Hartenbach, David D'Andrea, Thomas H Helbich, Alexander R Haug, Gregor M Goldner, Wolfgang Wadsak, Sarah Pfaff, Markus Mitterhauser, Theresa Balber, Neydher Berroteran-Infante, Marko Grahovac, John Babich, Christian Seitz, Gero Kramer, Martin Susani, Peter Mazal, Lukas Kenner, Shahrokh F Shariat, Marcus Hacker, Markus Hartenbach
• Journal: Clinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 24 Issue 24 Pg. 6300-6307 (12 15 2018) ISSN: 1557-3265 [Electronic] United States
• PMID: 30139879 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: ©2018 American Association for Cancer Research.

Chemical References

• Biomarkers, Tumor
• Gallium Isotopes
• Gallium Radioisotopes
• Ligands
• Membrane Glycoproteins
• Organometallic Compounds
• Pyrrolidines
• Radiopharmaceuticals
• gallium 68 PSMA-11
• pyrrolidin-3-yl-methanesulfonic acid

Topics

• Aged
• Biomarkers, Tumor
• Biopsy
• Gallium Isotopes
• Gallium Radioisotopes
• Humans
• Immunohistochemistry
• Ligands
• Lymph Nodes
• Lymphatic Metastasis
• Magnetic Resonance Imaging (methods, standards)
• Male
• Membrane Glycoproteins
• Middle Aged
• Neoplasm Staging
• Organometallic Compounds
• Positron-Emission Tomography (methods, standards)
• Prostatic Neoplasms (diagnosis, metabolism, therapy)
• Pyrrolidines
• Radiopharmaceuticals