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Research ArticleClinical Investigation

A Comprehensive Assessment of 68Ga-PSMA-11 PET in Biochemically Recurrent Prostate Cancer: Results from a Prospective Multicenter Study on 2,005 Patients

Monica Abghari-Gerst, Wesley R. Armstrong, Kathleen Nguyen, Jeremie Calais, Johannes Czernin, David Lin, Namasvi Jariwala, Melissa Rodnick, Thomas A. Hope, Jason Hearn, Jeffrey S. Montgomery, Ajjai Alva, Zachery R. Reichert, Daniel E. Spratt, Timothy D. Johnson, Peter J.H. Scott and Morand Piert
Journal of Nuclear Medicine April 2022, 63 (4) 567-572; DOI: https://doi.org/10.2967/jnumed.121.262412
Monica Abghari-Gerst
1Radiology Department, University of Michigan, Ann Arbor, Michigan;
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Wesley R. Armstrong
2Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;
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Kathleen Nguyen
2Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;
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Jeremie Calais
2Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;
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Johannes Czernin
2Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;
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David Lin
3Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
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Namasvi Jariwala
3Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
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Melissa Rodnick
1Radiology Department, University of Michigan, Ann Arbor, Michigan;
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Thomas A. Hope
3Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
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Jason Hearn
4Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan;
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Jeffrey S. Montgomery
5Urology Department, University of Michigan, Ann Arbor, Michigan;
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Ajjai Alva
6Internal Medicine Department, University of Michigan, Ann Arbor, Michigan; and
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Zachery R. Reichert
6Internal Medicine Department, University of Michigan, Ann Arbor, Michigan; and
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Daniel E. Spratt
4Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan;
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Timothy D. Johnson
7Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
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Peter J.H. Scott
1Radiology Department, University of Michigan, Ann Arbor, Michigan;
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Morand Piert
1Radiology Department, University of Michigan, Ann Arbor, Michigan;
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  • FIGURE 1.
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    FIGURE 1.

    Schematic of identified PSMA-positive lesion locations.

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    FIGURE 2.

    Cumulative total scan positivity rate (relative to entire population in treatment groups RP [n = 1,018], RP and PORT [n = 593], or definitive RT [n = 394]). Percentage of individual PSMA-positive disease locations as listed in Figure 1 and cumulative locoregional and distant disease positivity rates are from PSMA scans rated positive (RP, n = 678; PORT, n = 485; RT, n = 376).

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    TABLE 1.

    Patient Characteristics

    CharacteristicRP (n = 1,018 [51.2%])PORT (n = 593 [29.4%])RT (n = 394 [19.4%])
    Site (n)
     University of Michigan372 (36.5%)264 (44.5%)192 (48.7%)
     University of California San Francisco109 (10.7%)82 (13.8%)81 (20.6%)
     UCLA537 (52.8%)247 (41.7%)121 (30.7%)
    Age (y)
     Median68 (IQR, 63–73)70 (IQR, 65–74)72 (IQR, 67–77)
     No. missing000
    PSA at scan (ng/mL)
     Median0.78 (IQR, 0.4–2.3)1.58 (IQR, 0.7–3.3)5.7 (IQR, 3.4–10.9)
     No. missing000
    PSA nadir (ng/mL)
     Median0.2 (IQR, <0.1–0.3) <0.1 (IQR, <0.1–0.7)0.3 (IQR, 0.1–0.8)
     No. missing45821246
    Initial PSA at diagnosis (ng/mL)
     Median7 (IQR, 5.1–11.3)6.4 (IQR, 4.7–10.2)7.6 (IQR, 5.4–7.6)
     No. missing651336209
    T-stage (RP)
     Median8 (IQR, 6–10)7 (IQR, 6–10)NA
     No. missing230433
    Clinical T-stage
     Median3 (IQR, 3–4)3 (IQR, 3–4)3 (IQR, 3–6)
     No. missing19433126
    Gleason grade group (RP)
     Median3 (IQR, 2–5)3 (IQR, 2–5)NA
     No. missing195
    Gleason grade group at biopsy
     Median3 (IQR, 2–4)3 (IQR, 2–4)3 (IQR, 2–4)
     No. missing7274035
    PSMA injected dose (MBq)
     Median200 (IQR, 185--229)204 (IQR, 185--229)215 (IQR, 185--233)
     No. missing431
    Treatment-to-scan interval (mo)
     Median40.2 (IQR, 8.4–104.0)82.3 (IQR, 48.4–130.6)75.4 (IQR, 40.3–122.5)
     No. missing231524
    • NA = not applicable.

    • T-stage nomenclature: T1 = 1, T1a = 2, T1b = 3, T1c = 4, T2 = 5, T2a = 6, T2b = 7, T2c = 8, T3 = 9, T3a = 10, T3b = 11, T4 = 12.

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    TABLE 2.

    68Ga-PSMA-11 Per-Patient Detection Rate Stratified by PSA Level and Prior Therapy

    TotalRPPORTRT
    PSA range (ng/mL)No. Neg.No. Pos.% Pos.No. Neg.No. Pos.% Pos.No. Neg.No. Pos.% Pos.No. Neg.No. Pos.% Pos.
    <0.25645244.8614441.93872.7
    0.25–<0.516016350.513812046.5224366.2
    0.5–<1.010423469.27013666.0349874.2
    1.0–<2.06623578.14012876.22610780.5
    2.0–<5.04641490.01812087.01913187.3916394.8
    5.0–<10.01823893.0107488.135594.8510995.6
    ≥10820396.235694.914397.7410496.3
    Total466153976.834067866.610848581.81837695.4
    • Neg. = negative; Pos. = positive.

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    TABLE 3.

    68Ga-PSMA-11 Accuracy Confirmed by Histopathology per Region

    All groups combinedRPPORTRT
    SitenTPFPPPVnTPFPPPVnTPFPPPVnTPFPPPV
    Prostate and prostate bed7764130.8310820.807610.866050100.83
    Pelvic lymph nodes4734130.72251690.64191630.843210.67
    Soft tissue433850.887520.71262510.9610820.80
    Bone121020.832201.004310.756510.83
    Total179146330.824431130.80565060.897965140.82

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Journal of Nuclear Medicine: 63 (4)
Journal of Nuclear Medicine
Vol. 63, Issue 4
April 1, 2022
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A Comprehensive Assessment of 68Ga-PSMA-11 PET in Biochemically Recurrent Prostate Cancer: Results from a Prospective Multicenter Study on 2,005 Patients
Monica Abghari-Gerst, Wesley R. Armstrong, Kathleen Nguyen, Jeremie Calais, Johannes Czernin, David Lin, Namasvi Jariwala, Melissa Rodnick, Thomas A. Hope, Jason Hearn, Jeffrey S. Montgomery, Ajjai Alva, Zachery R. Reichert, Daniel E. Spratt, Timothy D. Johnson, Peter J.H. Scott, Morand Piert
Journal of Nuclear Medicine Apr 2022, 63 (4) 567-572; DOI: 10.2967/jnumed.121.262412

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A Comprehensive Assessment of 68Ga-PSMA-11 PET in Biochemically Recurrent Prostate Cancer: Results from a Prospective Multicenter Study on 2,005 Patients
Monica Abghari-Gerst, Wesley R. Armstrong, Kathleen Nguyen, Jeremie Calais, Johannes Czernin, David Lin, Namasvi Jariwala, Melissa Rodnick, Thomas A. Hope, Jason Hearn, Jeffrey S. Montgomery, Ajjai Alva, Zachery R. Reichert, Daniel E. Spratt, Timothy D. Johnson, Peter J.H. Scott, Morand Piert
Journal of Nuclear Medicine Apr 2022, 63 (4) 567-572; DOI: 10.2967/jnumed.121.262412
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