Abstract
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Objectives 68Gallium- Prostatic Specific Membrane Antigen (PSMA) PET/CT has been recently introduced for the assessment of patients with prostate cancer and few studies have reported its value in disease management. We report our initial experience with PSMA PET/CT imaging.
Methods Seventy patients, mean age 71 years (range 54-90), who were referred for PSMA PET/CT for staging (n=6), biochemical failure (n=44) or evaluation of known metastatic disease (n=20) were included. Mean Gleason score: 7.6 (range 6-10) and mean PSA: 11.2ng/ml (range 0.04-129). The initial pre-scan therapy plan and revised post-scan recommendations were documented according to National Comprehensive Cancer Network (NCCN) guidelines.
Results PSMA-PET/CT was positive in 54/70 pts. (77.1%; SUV max 10.7+8.8). Abnormal findings were in the: prostate (n=16; 29.6%), prostate fossa (n=5, 9.3%), lymph nodes (n=29; 54%), bone (n= 25; 46%), and liver or lung (n=3; 6%). Positivity was dependent on PSA level: PSA 5ng/ml: 31/31(100%). PSMA PET/CT changed clinical management in 4/6 (67%) patients at initial staging, in 29/44 (66%) patients with biochemical failure and in 1/20 (5 %) patients with known metastatic disease. Changes included: Androgen Deprivation Therapy (ADT) to local therapy (n=13), ADT to observation (n=8), local therapy to ADT (n=6), change in radiation therapy plan (n=5), local therapy to observation (n=1), and observation to ADT (n=1).
Conclusions PSMA PET/CT had an impact on clinical management in 66% of prostate cancer patients referred for staging or initial biochemical failure but had little benefit when used for management of known metastatic disease .