Article Figures & Data
Figures
- FIGURE 1.
Impact of 68Ga-PSMA-11 PET/CT imaging on radiotherapeutic management. RT = radiation therapy.
- FIGURE 2.
68Ga-PSMA-11 PET/CT (C and D) guided radiotherapy (E and F) with simultaneous integrated boost of 2 lymph node metastases for a high-risk prostate cancer patient with negative CT scan (A and B).
- FIGURE 3.
68Ga-PSMA-11 PET/CT–guided radiotherapy de-escalated after 68Ga-PSMA-11 PET/CT. Whereas MRI and CT demonstrated suspicious nodes (A and B), 68Ga-PSMA-11 PET/CT showed no increased activity in nodes (C). Thus, treatment could be planned for prostate itself with reduced doses to pelvic side walls.
Tables
Characteristic All patients Initial diagnosis PSA persistence after surgery PSA recurrence No. of patients 121 50 11 60 Median age (y) 71 (50–84) 72 (50–84) 67 (53–75) 69 (50–84) Gleason score (n) ≤6 6 (5.0%) 4 (8.0%) — 2 (3.3%) 7 59 (48.8%) 18 (36.0%) 2 (18.2%) 39 (65.0%) ≥8 55 (45.5%) 28 (56.0%) 9 (81.8%) 18 (30.0%) Unknown 1 (0.8%) — — 1 (1.7%) Median iPSA (ng/mL) 9.95 (1.40–520.00) 11.9 (3.50–313.13) 18.58 (5.20–87.55) 9.14 (1.40–520.00) Nadir PSA (ng/mL) 0.09 (<0.01–9.70) — 1.36 (0.53–9.70) 0.07 (<0.01–3.00) PSA at PET (ng/mL) 3.06 (0.03–41.24) 9.76 (0.06–37.10) 1.27 (0.03–9.70) 1.10 (0.10–41–24) Risk group according to D’Amico (n) Low 3 (2.5%) 3 (6.0%) — — Intermediate 12 (9.9%) 9 (18.0%) — 3 (5.0%) High 106 (87.6%) 38 (76.0%) 11 (100.0%) 57 (95.0%) Ongoing ADT (n) Yes 26 (21.5%) 12 (24.0%) 5 (45.5%) 9 (15.0%) No 95 (78.5%) 38 (76.0%) 6 (54.5%) 51 (85.0%) Prior RP only 34 (28.1%) — 11 (100.0%) 23 (38.3%) Prior RT only 5 (4.1%) — — 5 (8.3%) Prior RP and RT 32 (26.4%) — — 32 (53.3%) Surgery margin R0 40 (33.1%) — 2 (18.2%) 38 (69.1%) R1 24 (19.8%) — 9 (81.8%) 15 (27.3%) Rx 2 (1.7%) — — 2 (3.6%) iPSA = initial prostate-specific antigen serum level; ADT = androgen deprivation therapy; RP = radical prostatectomy; RT = radiotherapy.
Data in parentheses are ranges unless otherwise indicated.
Characteristic Conventional imaging 68Ga-PSMA-11 PET/CT Change P Local relapse (n) PSA recurrence/persistence 30/71 (42.3%) <0.001 Total rcTx 33/71 (46.5%) 8/71 (11.3%) rcT0 33/71 (46.5%) 53/71 (74.6%) rcT+ 5/71 (7.0%) 10/71 (14.1%) Lymph node spread (n) All patients 15/121 (12.4%) 39/121 (32.2%) 25/121 (20.7%)* <0.001 Initial diagnosis 5/50 (10.0%) 8/50 (16.0%) 5/50 (10.0%) Intern iliac vessels — 2/50 (4.0%)† Extern iliac vessels 5/50 (10.0%)† 5/50 (10.0%)† Presacral 1/50 (2.0%)† 2/50 (4.0%)† Obturatoric vessels — 2/50 (4.0%)† Other — 1/50 (2.0%)† PSA recurrence/persistence 10/71 (14.1%) 31/71 (43.7%) 20/71 (28.2%) Intern iliac vessels 3/71 (4.2%)† 10/71 (14.1%)† Extern iliac vessels 3/71 (4.2%)† 13/71 (18.3%)† Presacral 3/71 (4.2%)† 12/71 (16.9%)† Obturatoric vessels — 2/71 (2.8%)* Other 2/71 (2.8%)† 8/71 (11.3%)† Distant metastases (n) All patients 26/121 (21.5%) 41/121 (33.9%) 23/121 (19.0%)* <0.001 Initial diagnosis 3/50 (6.0%) 5/50 (10.0%) 7/50 (14.0%) Lymph nodes 2/50 (4.0%) 3/50 (6.0%)† Bone 1/50 (2.0%) 3/50 (6.0%)† Other — — PSA recurrence/persistence 23/71 (32.4%) 36/71 (50.7%) 16/71 (22.5%) Lymph nodes 2/71 (2.8%) 8/71 (11.3%)† Bone 18/71 (25.4%) 27/71 (38.0%)† Other 3/71 (4.2%) 3/71 (4.2%)† - TABLE 3
Overview of Changes in Radiotherapeutic Management According to 68Ga-PSMA-11 PET/CT
Characteristic All patients Initial diagnosis PSA persistence/recurrence Individual RT concept (n) 5/22 (22.7%) 37/40 (92.5%) SIB lymph node 26/62 (41.9%) 4/22 (18.2%) 22/40 (55.0%) SBRT lymph node 5/62 (8.1%) 1/22 (4.6%) 4/40 (10.0%) SBRT bone lesion 6/62 (9.7%) — 6/40 (15.0%) Other 5/62 (8.1%) — 5/40 (12.5%) RT de-escalation (n) 16/62 (25.8%) 15/22 (68.2%) 1/40 (2.5%) Palliative treatment (n) 4/62 (6.5%) 2/22 (9.1%) 2/40 (5.0%) RT = radiotherapy; SIB = simultaneous integrated boost; SBRT = stereotactic body irradiation.
- TABLE 4
Changes in Radiotherapeutic Management After Additional 68Ga-PSMA-11 PET/CT Imaging in Detail [n, (%)]
RT after 68Ga-PSMA-11 PET/CT imaging Planned RT before 68Ga-PSMA-11 PET/CT imaging RT prostate only RT prostate and pLN RT prostate, pLN and SIB SBRT only ADT Other, individual RT concept RT pLN and SIB Systemic chemotherapy RT prostate only X — 4/62 (6.5%) 2/62 (3.2%) 1/62 (1.6%) 1/62 (1.6%) — — RT prostate and pLN 15/62 (24.2%) X 8/62 (12.9%) — — 1/62 (1.6%) — — RT prostate, pLN, and SIB — 1/62 (1.6%) X 1/62 (1.6%) 2/62 (3.2%) 3/62 (4.8%) — — SBRT only — — — X — 3/62 (4.8%) 1/62 (1.6%) 1/62 (1.6%) ADT — — — 5/62 (8.1%) X 4/62 (6.5%) 6/62 (9.7%) — Individual RT concept — — — — — X 2/62 (3.2%) — BSC — — — 1/62 (1.6%) — — — — RT = radiotherapy; pLN = pelvic lymph nodes; SIB = simultaneous integrated boost; SBRT = stereotactic body radiotherapy, ADT = androgen deprivation therapy; BSC = best supportive care.
