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The use of 68Ga-PET/CT PSMA to determine patterns of disease for biochemically recurrent prostate cancer following primary radiotherapy

Prostate Cancer and Prostatic Diseases volume 22, pages 385–390 (2019)Cite this article

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Abstract

Background

68Ga-PET/CT PSMA scan is being increasingly used for the staging of biochemically recurrent disease. Early identification of recurrent disease after radiotherapy is important in considering suitability for early salvage therapy to improve prognosis. The aim is to identify patterns of suspected prostate cancer recurrence in relation to post-radiotherapy PSA levels, especially below the accepted Phoenix definition of PSA failure (PSA nadir + 2).

Methods

This was a retrospective single tertiary institution cohort study of consecutive men between July 2014 and June 2018 who received a 68Ga-PSMA PET/CT for elevated PSA levels following radiotherapy as primary treatment of prostate cancer. The primary outcome measure was to determine the relationship between pre-scan PSA and the probability of identifying PSMA-avid disease suggestive of recurrent prostate cancer.

Results

Two hundred and seventy-six patients met criteria for inclusion. The median PSA was 3.60 ng/mL. The overall detection rate for suspected recurrent prostate cancer was 86.3%. Local recurrence was the most common site, occurring in 56.9% (157/276) of men, with isolated local recurrence in 32.6% (90/276). A total of 75.3% (55/73) of men below Phoenix criteria had scans suggestive of recurrent disease, with 52.1% of men having salvageable disease. The regions surrounding the iliac arteries were the most common areas of nodal metastatic disease, with 55.6% of recurrence occurring in the iliac regions.

Conclusions

68Ga-PSMA PET/CT frequently identifies suspected recurrent disease prior to the accepted Phoenix definition of PSA nadir +2. Prospective outcome studies are required to determine if early identification of local recurrence improves outcomes by increasing the use of salvage local treatments and whether earlier identification of metastatic disease may improve outcomes with prompt initiation of multimodality therapies.

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References

  1. Ghosh A, Heston WDW. Tumor target prostate specific membrane antigen (PSMA) and its regulation in prostate cancer. J Cell Biochem. 2004;91:528–39.

    Article  CAS  Google Scholar 

  2. Fitzpatrick C, Lynch O, Marignol L. 68Ga-PSMA-PET/CT has a role in detecting prostate cancer lesions in patients with recurrent disease. Anticancer Res. 2017;37:2753–60.

    CAS  PubMed  Google Scholar 

  3. Perera M, Papa N, Roberts M, Williams M, Udovicich C, Vela I, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: a systematic review and meta-analysis. Eur Urol. 2019. https://doi.org/10.1016/j.eururo.2019.01.049. pii S0302-2838(19)30095-8 (1873-7560 (Electronic)).

  4. Meredith G, Wong D, Yaxley J, Coughlin G, Thompson L, Kua B, et al. The use of 68Ga-PSMA PET CT in men with biochemical recurrence after definitive treatment of acinar prostate cancer. BJU Int. 2016;118:49–55.

    Article  Google Scholar 

  5. Roach M, Hanks G. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006;65:965–74.

    Article  Google Scholar 

  6. Zumsteg ZS, Spratt DE, Romesser PB, Pei X, Zhang Z, Polkinghorn W, et al. The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy. Eur Urol. 2015;67:1009–16.

    Article  Google Scholar 

  7. Hruby G, Eade T, Kneebone A, Emmett L, Guo L, Ho B, et al. Delineating biochemical failure with 68Ga-PSMA-PET following definitive external beam radiation treatment for prostate cancer. Radiother Oncol. 2017;122:99–102.

    Article  CAS  Google Scholar 

  8. Einspieler I, Rauscher I, Duwel C, Kronke M, Rischpler C, Habl G, et al. Detection efficacy of hybrid 68Ga-PSMA Ligand PET/CT in prostate cancer patients with biochemical recurrence after primary radiation therapy defined by phoenix criteria. J Nucl Med. 2017;58:1081–7.

    Article  CAS  Google Scholar 

  9. Yaxley J, Raveenthiran S, Nouhaud F, Samartunga H, Yaxley A, Coughlin G, et al. Outcomes of primary lymph node staging of prostate cancer with 68Ga-PET/CT PSMA scanning in intermediate and high risk prostate cancer, compared to histological correlation of pelvic lymph node pathology. Can a pre-operative 68Ga-PET/CT PSMA scan replace a PLND for prostate cancer staging? J Urol. 2019;201:815–20.

    Article  Google Scholar 

  10. Siriwardana A, Thompson J, van Leeuwen PJ, Doig S, Kalsbeek A, Emmett L, et al. Initial multicentre experience of 68gallium-PSMA PET/CT guided robot-assisted salvage lymphadenectomy: acceptable safety profile but oncological benefit appears limited. BJU Int. 2017;120:673–81.

    Article  CAS  Google Scholar 

  11. James LM, Emmanuel SA, Andrew JA, Anthony VDA, Brian JD, Tanya D, et al. Prostate Cancer, Version 2. 2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2019;17:479–505.

  12. Tran H, Kwok J, Pickles T, Tyldesley S, Black PC. Underutilization of local salvage therapy after radiation therapy for prostate cancer. Semin Urol Oncol. 2014;32:701–6.

  13. Gardiner RA, Green H, Yaxley J, Nicol D, Pakenham K, Mactaggart P, et al. Cognition and hormonal manipulation in prostate cancer. Br J Urol Int. 2000;86(Supplement 3):218.

    Google Scholar 

  14. Cellini N, Morganti AG, Mattiucci GC, Valentini V, Leone M, Luzi S, et al. Analysis of intraprostatic failures in patients treated with hormonal therapy and radiotherapy: implications for conformal therapy planning. Int J Radiat Oncol Biol Phys. 2002;53:595–9.

    Article  Google Scholar 

  15. Pucar D, Hricak H, Shukla-Dave A, Kuroiwa K, Drobnjak M, Eastham J, et al. Clinically significant prostate cancer local recurrence after radiation therapy occurs at the site of primary tumor: magnetic resonance imaging and step-section pathology evidence. Int J Radiat Oncol Biol Phys. 2007;69:62–9.

    Article  Google Scholar 

  16. Chade DC, Shariat SF, Cronin AM, Savage CJ, Karnes RJ, Blute ML, et al. Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. Eur Urol. 2011;60:205–10.

  17. Chade DC, Shariat SF, Cronin AM, Savage CJ, Karnes RJ, Blute ML, et al. Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. Eur Urol. 2011;60:205–10.

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Acknowledgements

We would like to thank Ricardo Maldonado from PowerStats Pty. Ltd for his assistance in completing the statistical analysis for this manuscript.

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Authors and Affiliations

  1. Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Sheliyan Raveenthiran & John Yaxley

  2. Wesley Urology Clinic, Brisbane, QLD, Australia

    John Yaxley & Boon Kua

  3. Department of Medicine, University of Queensland, Brisbane, QLD, Australia

    John Yaxley

  4. Brisbane Prostate Clinic, Brisbane, QLD, Australia

    Troy Gianduzzo

  5. Wesley Medical Imaging, Brisbane, QLD, Australia

    Louise McEwan & David Wong

  6. Genesis Cancer Care, Brisbane, QLD, Australia

    Gail Tsang & James MacKean

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  1. Sheliyan Raveenthiran
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Correspondence to Sheliyan Raveenthiran.

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Raveenthiran, S., Yaxley, J., Gianduzzo, T. et al. The use of 68Ga-PET/CT PSMA to determine patterns of disease for biochemically recurrent prostate cancer following primary radiotherapy. Prostate Cancer Prostatic Dis 22, 385–390 (2019). https://doi.org/10.1038/s41391-019-0163-0

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