PT  - JOURNAL ARTICLE
AU  - Abghari-Gerst, Monica
AU  - Armstrong, Wesley R.
AU  - Nguyen, Kathleen
AU  - Calais, Jeremie
AU  - Czernin, Johannes
AU  - Lin, David
AU  - Jariwala, Namasvi
AU  - Rodnick, Melissa
AU  - Hope, Thomas A.
AU  - Hearn, Jason
AU  - Montgomery, Jeffrey S.
AU  - Alva, Ajjai
AU  - Reichert, Zachery R.
AU  - Spratt, Daniel E.
AU  - Johnson, Timothy D.
AU  - Scott, Peter J.H.
AU  - Piert, Morand
TI  - A Comprehensive Assessment of <sup>68</sup>Ga-PSMA-11 PET in Biochemically Recurrent Prostate Cancer: Results from a Prospective Multicenter Study on 2,005 Patients
AID  - 10.2967/jnumed.121.262412
DP  - 2022 Apr 01
TA  - Journal of Nuclear Medicine
PG  - 567--572
VI  - 63
IP  - 4
4099  - http://jnm.snmjournals.org/content/63/4/567.short
4100  - http://jnm.snmjournals.org/content/63/4/567.full
SO  - J Nucl Med2022 Apr 01; 63
AB  - We prospectively investigated the performance of the prostate-specific membrane antigen (PSMA) ligand 68Ga-PSMA-11 for detecting prostate adenocarcinoma in patients with elevated levels of prostate-specific antigen (PSA) after initial therapy. Methods: 68Ga-PSMA-11 hybrid PET was performed on 2,005 patients at the time of biochemically recurrent prostate cancer after radical prostatectomy (RP) (50.8%), definitive radiation therapy (RT) (19.7%), or RP with postoperative RT (PORT) (29.6%). The presence of prostate cancer was assessed qualitatively (detection rate = positivity rate) and quantitatively on a per-patient and per-region basis, creating a disease burden estimate from the presence or absence of local (prostate/prostate bed), nodal (N1: pelvis), and distant metastatic (M1: distant soft tissue and bone) disease. The primary study endpoint was the positive predictive value (PPV) of 68Ga-PSMA-11 PET/CT confirmed by histopathology. Results: After RP, the scan detection rate increased significantly with rising PSA level (44.8% at PSA < 0.25%–96.2% at PSA > 10 ng/mL; P < 0.001). The detection rate significantly increased with rising PSA level in each individual region, overall disease burden, prior androgen deprivation, clinical T-stage, and Gleason grading from the RP specimen (P < 0.001). After RT, the detection rate for in-gland prostate recurrence was 64.0%, compared with 20.6% prostate bed recurrence after RP and 13.3% after PORT. PSMA-positive pelvic nodal disease was detected in 42.7% after RP, 40.8% after PORT, and 38.8% after RT. In patients with histopathologic validation, the PPV per patient was 0.82 (146/179). The SUVmax of histologically proven true-positive lesions was significantly higher than that of false-positive lesions (median, 11.0 [interquartile range, 6.3–22.2] vs. 5.1 [interquartile range, 2.2–7.4]; P < 0.001). Conclusion: We confirmed a high PPV for 68Ga-PSMA-11 PET in biochemical recurrence and the PSA level as the main predictor of scan positivity.