Research ArticleTheranostics

68Ga-PSMA PET/CT for Primary Lymph Node and Distant Metastasis NM Staging of High-Risk Prostate Cancer

Søren Klingenberg, Mads R. Jochumsen, Benedicte P. Ulhøi, Jacob Fredsøe, Karina D. Sørensen, Michael Borre and Kirsten Bouchelouche
Journal of Nuclear Medicine February 2021, 62 (2) 214-220; DOI: https://doi.org/10.2967/jnumed.120.245605

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Study flow for 68Ga-PSMA PET/CT primary staging of high-risk PCa patients.

  • FIGURE 2.
    FIGURE 2.

    (A) Correlation between SUVmax of primary tumors and ISUP grade from transrectal ultrasound–guided or MRI-guided biopsy. Data are median. (B) Correlation between SUVmax of primary tumors and RP ISUP grade. Data are median. (C) Primary tumor SUVmax in correlation with advanced disease (N1/M1). Data are median. (D) Correlation between SUVmax of primary tumors and PSA at diagnosis. Data are line of best fit with 95% CI. *Radical prostatectomy.

  • FIGURE 3.
    FIGURE 3.

    Occurrence of advanced disease (N1/M1) (A), LNMs (N1/M1a) (B), and BMs (M1b) (C) according to PSA interval.

  • FIGURE 4.
    FIGURE 4.

    Incidence of advanced disease (N1/M1) (A), LNMs (N1/M1a) (B), and BMs (M1b) (C) according to ISUP grade.

  • FIGURE 5.
    FIGURE 5.

    Presence of advanced disease (N1/M1) according to clinical stage.

  • FIGURE 6.
    FIGURE 6.

    (A) Primary prostate tumors. From left: 68Ga-PSMA PET/CT (arrow), PSMA-positive immunohistochemical staining of primary tumor from previous image, PSMA-negative immunohistochemical staining of primary tumor, and PSMA-positive immunohistochemical staining of primary tumor. (B) LNMs from corresponding primary tumors in A. From left: LNMs on 68Ga-PSMA PET/CT (arrow), PSMA-positive immunohistochemical staining of true-positive LNMs from previous image, PSMA-negative immunohistochemical staining of undetected LNMs, and PSMA-positive immunohistochemical staining of undetected LN micrometastasis, characteristically located in the border of the LN cortex.

Tables

  • TABLE 1

    Study Group Characteristics and Odds Ratios (ORs) for Having Advanced Disease Compared with Reference

    CharacteristicStudy group (n = 691)Advanced disease on 68Ga-PSMA PET/CTUnivariate ORs of advanced diseaseMultivariate ORs of advanced disease
    Age (y)
     Median70.4
     Range45.2–87.2
    Time from biopsy to scan (mo)
     Median0.7
     Range0.1–5.1
    Prescan PSA (ng/mL)
     <10200 (28.9%)37 (18.5%)Reference = 1Reference = 1
     10–20194 (28.1%)58 (29.9%)OR1 = 1.88 (1.17, 3.01)OR1 = 1.45 (0.86, 2.47)
     >20297 (43.0%)149 (50.2%)OR2 = 4.44 (2.90, 6.77)OR2 = 4.32 (2.66, 7.12)
     Unknown0 (0.0%)
    ISUP grade in biopsies
     141 (5.9%)1 (2.4%)Reference = 1Reference = 1
     2102 (14.8%)11 (10.8%)OR1 = 4.84 (0.89, 89.87)OR1 = 3.75 (0.67, 70.51)
     389 (12.9%)33 (37.1%)OR2 = 23.57 (4.76, 427.76)OR2 = 19.67 (3.84, 361.15)
     4262 (38.0%)81 (30.9%)OR3 = 17.90 (3.79, 320.27)OR3 = 25.55 (5.21, 462.70)
     5196 (28.4%)117 (59.7%)OR4 = 59.24 (12.47, 1061.62)OR4 = 53.17 (10.79, 964.19)
     Unknown1 (0.1%)
    Clinical stage*
     cT1123 (17.8%)13 (10.6%)Reference = 1Reference = 1
     cT2246 (35.6%)60 (24.4%)OR1 = 2.73 (1.47, 5.40)OR1 = 2.18 (1.13, 4.45)
     cT3314 (45.4%)165 (52.5%)OR2 = 9.37 (5.23, 18.11)OR2 = 7.13 (3.80, 14.29)
     cT48 (1.2%)6 (75.0%)OR3 = 25.38 (5.25, 186.23)OR3 = 17.26 (2.82, 160.69)
     Unknown0 (0.0%)

    • ↵* Digital rectal examination.

    • Qualitative data are numbers followed by percentages in parentheses; continuous data are OR followed by 95% CI in parentheses.

  • TABLE 2

    Primary Tumor SUVmax with 95% CI in Relation to ISUP Grade and Advanced Disease

    ParameterSUVmax in primary tumors
    ISUP grade in biopsies
     1 (n = 41)13.07 (10.48, 16.31)
     2 (n = 102)15.36 (13.59, 17.36)
     3 (n = 89)22.86 (20.04, 26.07)
     4 (n = 262)16.58 (15.20, 18.08)
     5 (n = 196)24.31 (22.09, 26.75)
    ISUP grade in RP specimens
     1 (n = 10)9.79 (6.33, 15.15)
     2 (n = 96)10.57 (9.38, 11.92)
     3 (n = 60)17.60 (14.84, 20.87)
     4 (n = 47)16.65 (13.72, 20.20)
     5 (n = 34)19.87 (16.62, 23.75)
    Advanced disease
     No (n = 447)15.86 (14.87, 16.91)
     Yes (n = 244)25.75 (23.76, 27.91)

    • Data are median followed by 95% CI in parentheses.

  • TABLE 3

    SUVmax of Different Lesion Sites

    Lesion siteLesions measured (n)Median SUVmax
    Primary tumor69119.5 (range, 3.1–140.5)
    LNs (regional and nonregional)1,22221.1 (range, 2.2–136.3)
    BMs38617.3 (range, 1.8–137.9)
    Visceral metastases408.1 (range, 3.2–48.0)
  • TABLE 4

    Histopathologic Coherence Between PSMA-Positive or -Negative LNs and Pathologic Verification in Patients with PLND

    Histology (n = 177)
    68Ga-PSMA PET/CTPositive (n = 36)Negative (n = 141)Index
    Positive (n = 16)n = 11 (30.6%)n = 5 (3.5%)PPV 68.8%
    Negative (n = 161)n = 25 (69.4%)n = 136 (96.5%)NPV 84.5%
    IndexSensitivity 30.6%Specificity 96.5%Accuracy 83.1%

    • PPV and NPV = positive and negative predictive values, respectively.

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