Research ArticleTheranostics

Impact of 68Ga-PSMA-11 PET/CT on Staging and Management of Prostate Cancer Patients in Various Clinical Settings: A Prospective Single-Center Study

Ida Sonni, Matthias Eiber, Wolfgang P. Fendler, Rejah M. Alano, Sitaram S. Vangala, Amar U. Kishan, Nicholas Nickols, Matthew B. Rettig, Robert E. Reiter, Johannes Czernin and Jeremie Calais
Journal of Nuclear Medicine August 2020, 61 (8) 1153-1160; DOI: https://doi.org/10.2967/jnumed.119.237602

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Study design flowchart.

  • FIGURE 2.
    FIGURE 2.

    Impact of PSMA PET/CT imaging on staging of PCa. Sankey diagram showing per-patient differences in staging or restaging of disease before (left) and after (right) PSMA PET/CT. Staging of disease before PSMA PET/CT was indicated by referring physician on pre-PET questionnaire, staging after PSMA was based on PSMA PET/CT results (T+ = presence of disease in prostate/prostate bed on PSMA PET/CT; 1 = presence of disease in location on PSMA PET/CT). Sixty-two (31%) patients had no change in staging, and 135 (69%) patients had change in staging. On Sankey diagram, each color of vertical bars indicates same TNM or molecular imaging TNM staging, color of flow reflects color of destination, and darker color in each flow indicates no changes in stage.

  • FIGURE 3.
    FIGURE 3.

    Changes in stage of disease before and after PSMA PET/CT stratified by subgroup.

  • FIGURE 4.
    FIGURE 4.

    Impact of PSMA PET/CT imaging on management stratified by clinical indication. Both focal and systemic treatments are intended with or without androgen deprivation therapy (ADT). ADT as monotherapy was considered systemic treatment. AS = active surveillance.

Tables

  • TABLE 1

    Patient Characteristics

    Restaging
    CharacteristicInitial staging: treatment-naïveAfter ADTAfter surgery, PSA < 0.2After RT, PSA < nadir + 2Other primary treatmentAdvanced diseaseFull cohort
    Number of patients30 (15%)16(8%)13(7%)22(11%)13(6%)103(52%)197
    Mean age (y)69.70 ± 7.02 (51–85)64.38 ± 9.53 (49–82)68.85 ± 8.73 (47–76)69.82 ± 8.06 (56–86)63.85 ± 8.86 (49–77)69.72 ± 8.61 (46–95)68.52 ± 8.64 (46–95)
    Mean PSA at time of PET ( ng/mL)19.43 ± 27.58 (2.4–135.50)62.48 ± 100.36 (0.17–322)0.13 ± 0.05 (0.04–0.2)1.79 ± 1.31 (0.3–5.6)11.53 ± 19.65 (1.10–74.30)40.66 ± 188.04 (0.02–1,789)30.03 ± 139.95 (0.02 –1,789)
    PSA (ng/mL) at time of PSMA PET*t2 to ≤5: 60 to ≤0.2: 10 to ≤0.2: 130 to ≤0.2: 00 to ≤0.2: 00 to ≤0.2: 100 to ≤0.2: 24
    5 to ≤10: 110.2 to ≤0.5: 20.2 to ≤0.5: 00.2 to ≤0.5: 30.2 to ≤0.5: 00.2 to ≤0.5: 160.2 to ≤0.5: 21
    10 to ≤20: 50.5 to ≤2: 20.5 to ≤2: 00.5 to ≤2: 100.5 to ≤2: 10.5 to ≤2: 250.5 to ≤2: 38
    >20: 8>2: 11>2: 0>2: 9>2: 12>2: 52>2: 114
    Currently under ADT016 (100%)4 (13%)5 (20%)037 (43%)59 (30%)
    Gleason score≤: 19≤7: 4≤7: 8≤7: 12≤7: 7≤7: 41≤7: 91
    ≥8: 11≥8: 10≥8: 4≥8: 6≥8: 3≥8: 45≥8: 79
    Unknown: 0Unknown: 2Unknown: 1Unknown: 4Unknown: 3Unknown: 17Unknown: 27

    • ↵* Serum PSA ranges used for treatment-naïve group are different from other groups.

    • ADT = androgen deprivation therapy; known M1 = known metastatic disease.

    • Qualitative data are expressed as number followed by percentage in parentheses; continuous data are expressed as mean ± SD followed by range in parentheses.

  • TABLE 2

    Study Result Summary

    Restaging
    ResultInitial staging: treatment-naïveAfter ADTAfter surgery, PSA < 0.2After RT, PSA < nadir + 2Other primary treatmentAdvanced diseaseFull cohort
    Detection rate30/30 (100%)16/16 (100%)1/13 (8%)19/22 (86%)13/13 (100%)86/103 (84%)166/197 (84%)
    Number of miT1 (% by subgroup)29 (97%)15 (94%)0 (0%)13 (59%)10 (77%)27 (26%)95 (48%)
    Number of miN1 (% by subgroup)11 (38%)8 (47%)0 (0%)4 (18%)3 (23%)48 (47%)71 36%
    Number of miM1 (% by subgroup)M1a: 5 (17%)M1a: 3 (18%)M1a: 0 (0%)M1a: 4 (18%)M1a: 1 (8%)M1a: 40 (39%)M1a: 51 (26%)
    M1b: 4 (14%)M1b:6 (35%)M1b: 1 (8%)M1b: 4 (18%)M1b: 3 (23%)M1b: 57 (55%)M1b: 75 (38%)
    M1c: 0M1c: 1 (6%)M1c: 0 (0%)M1c: 0M1c: 1 (8%)M1c: 11 (11%)M1c: 13 (7%)
    Change in stageChange: 67%Change: 81%Change: 38%Change: 86%Change: 69%Change: 67%Change: 69%
    No change: 33%No change: 19%No change: 62%No change: 14%No change: 31%No change: 33%No change: 31%
    Change in management* (%)12/28 (43%)6/15 (40%)6/13 (46%)13/18 (72%)8/12 (67%)59/96 (61%)104/182 (57%)

    • ↵* Change-in-management analysis was conducted on 182 patients.

    • Molecular imaging TNM classification: T = PSMA uptake in prostate gland or prostate bed or prostatic fossa; N = PSMA uptake in pelvic lymph nodes; M = PSMA uptake in distant lymph nodes (M1a), bone (M1b), or other visceral organs (M1c).

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