Research ArticleTheranostics

3-Year Freedom from Progression After 68Ga-PSMA PET/CT–Triaged Management in Men with Biochemical Recurrence After Radical Prostatectomy: Results of a Prospective Multicenter Trial

Louise Emmett, Reuben Tang, Rohan Nandurkar, George Hruby, Paul Roach, Jo Anne Watts, Thomas Cusick, Andrew Kneebone, Bao Ho, Lyn Chan, Pim J. van Leeuwen, Matthijs J. Scheltema, Andrew Nguyen, Charlotte Yin, Andrew Scott, Colin Tang, Michael McCarthy, Karen Fullard, Matthew Roberts, Roslyn Francis and Phillip Stricker
Journal of Nuclear Medicine June 2020, 61 (6) 866-872; DOI: https://doi.org/10.2967/jnumed.119.235028

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    (A) PSMA PET images of man with Gleason score 9 prostate cancer and PSA of 0.23 ng/mL, treated with initial RP 12 mo beforehand, demonstrate PSMA PET–positive left obturator node (arrows). Patient subsequently underwent sRT to prostatic fossa and pelvic nodes. However, PSA did not respond. (B) Repeat PSMA PET images 10 mo later demonstrate treatment response in left obturator lymph node, but multiple new PSMA-avid lymph nodes (arrows) are seen immediately above sRT treatment field, extending superiorly to paraaortic region.

  • FIGURE 2.
    FIGURE 2.

    Kaplan–Meier curves for FFP based on PSMA PET (A), PSA (ng/mL) at PSMA PET (B), PSMA PET (negative/fossa-confined vs. outside fossa) stratified for both PSA and PSMA PET (C), and PSMA PET (negative/fossa-confined vs. outside fossa) (D).

  • FIGURE 3.
    FIGURE 3.

    FFP in men with negative scan results who underwent sRT vs. men who were observed over 3 y (P < 0.0001).

Tables

  • TABLE 1

    Patient Characteristics

    CharacteristicData
    Median age (y)68 (IQR, 63–72)
    Median PSA at PSMA PET (ng/mL)0.26 (IQR, 0.15–0.59)
    Tumor stage (n)
     T258/260 (22.4%)
     T3a111/260 (42.7%)
     T3b41/260 (15.7%)
     Missing50/260 (19.2%)
    Positive surgical margins55/219 (25%)
    Gleason score (n)
     6−7161/260 (58%)
     8−1072/260 (42%)
     Missing27/260 (10%)
    Time to BCR from RP (mo)37.8 (IQR, 8.6–87.0)
    Duration of follow-up since sRT (mo)38 (IQR, 31–43)
  • TABLE 2

    Sites of Disease Recurrence on PSMA PET

    SiteData
    None90/260 (34.6%)
    Fossa56/260 (21.5%)
    Pelvic lymph nodes68/260 (26.2%)
    Distant lymph nodes16/260 (6.2%)
    Bone metastases25/260 (9.6%)
    Visceral metastases5/260 (1.9%)
  • TABLE 3

    PSMA PET Result Stratified by Increasing PSA Level

    PSA (ng/mL)PSMA PET-negativePSMA PET-positiveOverall
    <0.241 (49.4%)42 (50.6%)83
    0.2–0.536 (34.9%)67 (65.1%)103
    0.51–0.999 (27.3%)24 (72.7%)33
    1.0−5.04 (9.8%))37 (90.2%)41
    Total90 (34.6%)170 (65.4%)260
  • TABLE 4

    Treatment Administered on the Basis of PSMA PET Results

    PSMA result
    TreatmentNegativeFossa-positivePelvic node–positiveDistant disease
    sRT to fossa only35/90 (39%)19/56 (43%)12/68 (21%)5/46 (11%)
    sRT to fossa plus pelvic nodes21/90 (23%)23/56 (41%)38/68 (64%)10/46 (22%)
    SBRT to pelvic nodes only0/90 (0%)0/56 (0%)9/68 (13%)14/46 (30%)
    Adjuvant ADT plus sRT6/56 (11%)8/42 (19%)20/59 (34%)12/28 (43%)
    ADT alone5/90 (5%)2/56 (4%)5/68 (7%)13/46 (28%)
    No treatment over 3 y29/90 (32%)12/56 (26%)4/68 (6%)5/46 (11%)

    • SBRT = stereotactic body radiation therapy.

  • TABLE 5

    Incidence of FFP or Progressive Disease Based on PSMA PET Findings in Men Treated with sRT

    PSMA PET resultFFP at 3 yProgressive diseaseOverall
    Negative47 (82.5%)10 (17.5%)57/186 (31%)
    Fossa-positive34 (79%)9 (21%)43/186 (23%)
    Pelvic LN–positive33 (55%)26 (45%)59/186 (32%)
    Distant LN–positive2 (25%)6 (75%)8/186 (4%)
    Bone or viscera4 (21%)15 (79%)19/186 (10%)
    Total120 (64.5%)66 (35.4%)186 (100%)
  • TABLE 6

    Cox Logistic Regression Analysis of Clinical and Imaging Variables for Prediction of FFP in Men Who Underwent sRT

    95.0% CI for exp(B)
    ParameterHazard ratioLowerHigherSignificance
    Extracapsular extension0.730.252.130.57
    RP surgical margin1.10.196.180.94
    T stage at RP0.710.114.450.71
    Lymph node stage at RP0.540.112.690.45
    Gleason score0.690.232.060.50
    PSA at PSMA1.170.821.680.38
    PSMA-negative/fossa vs. outside fossa2.731.455.140.002

    • CI = confidence interval; exp(B) = odd ratio.

Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Bookmark this article

Jump to section

Related Articles

Cited By...

More in this TOC Section

Similar Articles

Keywords