Article Figures & Data
Figures
- FIGURE 1.
Study methodology. (A) Experienced radiation oncologist masked to PET findings contoured RTOG CTVs onto CT dataset of PET/CT scan for all 270 patients (prostate bed CTV in orange and pelvic LN CTV in green). (B) All 68Ga-PSMA-11 PET/CT images were analyzed by an experienced nuclear medicine physician. (C) PSMA-11–positive lesions were contoured in yellow on CT images. (D) Consensus CTVs were coregistered with 68Ga-PSMA-11 PET/CT images and PSMA-11–positive lesion contours (yellow) to assess, for each patient, whether PSMA-11–positive lesions were localized inside or outside consensus CTVs.
- FIGURE 2.
A 3-dimensional map of the PSMA-11–positive lesions (yellow) of all 52 patients with recurrence outside consensus CTVs (23 patients with recurrence outside only and 29 patients with recurrence outside and inside consensus CTVs), created by rigid registration of each patient’s CT image to template patient’s CT image, followed by transfer of each PSMA-11–positive lesion contour to template patient CT image (MIM, version 6.7.5; MIM Software Inc.). On right side, 3-dimensional prostate bed consensus CTV is shown in orange and 3-dimensional pelvic LN consensus CTV in green.
- FIGURE 3.
PSMA-11–positive lesions (yellow contours) inside prostate bed CTV (gold contours) and nodal CTV (green contours).
- FIGURE 4.
Examples of PSMA-11–positive lesions outside consensus CTVs: perirectal LN (A), inguinal LN (B), lumboaortic LN (C), bone (D), and lung (E).
Tables
Characteristic Data Age at PET/CT, median (y) 68 (range, 43–90) Initial PSA level before surgery, median (ng/mL) 8.3 (range, 0.4–200) 10 130 (48%) ≥10 < 20 46 (17%) ≥20 38 (14%) Unknown 56 (21%) Gleason score ≤6 33 (12%) 7 135 (50%) ≥8 86 (32%) Unknown 16 (6%) Pathologic primary tumor stage pT2 99 (36.5%) pT3 142 (52.5%) pT4 2 (0.7%) Unknown 27 (10%) Pathologic regional LN stage pN0 166 (61.5%) pN1 54 (20%) pNx 50 (18.5%) Positive margin R0 152 (56.5%) R1 67 (25%) Unknown 51 (19%) National Comprehensive Cancer Network risk group Low 4 (1.5%) Intermediate 36 (13.5%) High 163 (60.5%) N1 54 (20%) Unknown 13 (5%) Androgen deprivation therapy within 6 mo before imaging 33 (12.5%) Time between surgery and PET/CT, median (mo) 25 (range, 2–272) Last PSA value before PET/CT, median (ng/mL) 0.44 (range, 0.03–1) Pattern Number of patients PSMA-11 PET/CT+ 132 (49%) Prostate bed (T+) 47 (17.5%) Pelvic LN (N1) 83 (30.5%) Extrapelvic LN (M1a) 9 (3.5%) Bone (M1b) 23 (8.5%) Visceral (M1c) 3 (1%) PSMA-11 T+ N0 M0 32 (12%) PSMA-11 T0 N1 M0 59 (22%) PSMA-11 T+ N1 M0 8 (3%) PSMA-11 T+ N0 M1 2 (0.7%) PSMA-11 T0 N0 M1 15 (5.5%) PSMA-11 T0 N1 M1 11 (4%) PSMA-11 T+ N1 M1 5 (2%) Total population = 270. Percentages do not add up to 100 because multiple disease localizations per patient were possible.
- TABLE 3
Anatomic Repartition of 68Ga-PSMA-11–Positive Findings and Outside Planning Volumes Based on RTOG Consensus CTVs
Site PSMA-11–positive patients (n) Outside CTV patients (n) PSMA-11–positive lesions (n) Outside CTV lesions (n) Median size (mm)* Median SUVmax* Overall 132 (49%) 52 (19.5%) 304 119 6.0 (3.0–23.0) 5.7 (0.5–86.9) Prostate bed (T+) 47 (17.5%) 1 (0.003%) 52 1 7.0 (4.0–23.0) 6.4 (2.2–86.9) Pelvic LN (N+) 83 (30.5%) 30 (11%) 174 39 6.0 (3.0–17.0) 5.8 (1.5–69.7) Internal iliac 27 (10%) 2 (0.7%) 32 2 6.0 (3.0–10.0) 7.3 (2.3–55.0) External Iliac 38 (14%) 9 (3.5%) 45 9 7.0 (3.5–15.0) 5.9 (1.5–69.7) Obturator 19 (7%) 2 (0.7%) 24 2 6.0 (4.0–17.0) 3.5 (2.1–17.4) Perirectal 18 (6.5%) 16 (6%) 25 19 5.0 (4.0–10.0) 5.2 (1.50–57.7) Presacral 13 (5%) 3 (1%) 22 4 6.0 (4.0–10.0) 7.5 (1.5–45.7) Common iliac 16 (6%) 2 (0.7%) 26 3 6.0 (3.0–15.0) 5.9 (2.0–33.3) Extrapelvic LN (M1a) 9 (3.5%) 9 (3.5%) 28 28 8.0 (3.0–12.0) 13.6 (2.7–38.9) Inguinal 2 (0.7%) 2 (0.7%) 7 7 — — Retroperitoneal 6 (2%) 6 (2.2%) 15 15 — — Upper diaphragm 2 (0.7%) 2 (0.7%) 6 6 — — Bone (M1b) 23 (8.5%) 23 (8.5%) 39 39 — 5.3 (2.7–28.8) Lung (M1c) 3 (1%) 3 (1%) 11 11 5.0 (4.0–7.0) 1.0 (0.5–2.6) ↵* Data in parentheses are range.
Percentages do not add up to 100 because multiple disease localizations per patient were possible.
- TABLE 4
Potential Impact of 68Ga-PSMA-11 PET/CT Imaging on SRT Planning for Early BCR After Primary Prostatectomy
Impact Data Major impact on SRT planning—outside RTOG CTV recurrence 52 (19%) Extension of pelvic consensus CTVs 19 (7%) Superior extension to cover paraaortic LNs 5 (2%) Oligometastasis-directed stereotactic body radiation therapy (≤5 M1a or M1b) 22 (9.5%) Radiotherapy futile because of polymetastatic or visceral disease (>5 M1a, M1b, or M1c) 6 (2.5%) Minor impact on SRT planning—covered by planning based on consensus CTVs; dose escalation to gross disease (68Ga-PSMA-11–positive disease) 80 (29.5%) No impact on SRT planning—negative 68Ga-PSMA-11 PET/CT results 138 (51%) Total population = 270.
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