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68Ga-PSMA PET/CT Imaging Predicting Intraprostatic Tumor Extent, Extracapsular Extension and Seminal Vesicle Invasion Prior to Radical Prostatectomy in Patients with Prostate Cancer

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Abstract

Purpose

68Ga-labeled prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) has shown promising results in patients with biochemical recurrence after primary therapy for prostate cancer. In this study, we evaluated the usefulness of PSMA I&T (imaging and therapy) PET/CT prior to radical prostatectomy.

Methods

The study population consisted of 21 patients with prostate cancer who underwent 68Ga-PSMA I&T PET/CT before either open or laparoscopic radical prostatectomy. Intraprostatic tumor extent, extracapsular extension (ECE) and seminal vesicle invasion (SVI) were assessed on the PET/CT scans. Tracer uptake was quantified in terms of standardized uptake values (SUVs). Imaging findings were correlated with final whole-gland histopathology.

Results

Of the 21 patients, two had T stage 2b disease, nine stage 2c, six stage 3a and four stage 3b. The median Gleason score was 7. The SUVmean of the primary tumors was 9.5 ± 8.8. SUVmean was higher in tumors with ECE than in organ-confined tumors (13.8 ± 11.0 vs. 5.6 ± 3.2, p = 0.029). Peak tracer uptake was significantly positively correlated with Gleason score (r s = 0.49, p = 0.025). Sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 94.7%, 75.0%, 97.3% and 60.0% for tumor infiltration of an individual prostate lobe, 75.0%, 100.0%, 100.0% and 97.4% for SVI, and 90.0%, 90.9%, 90.0% and 90.9% for ECE, using an angulated contour of the prostate as the criterion. Tumor volume derived from 68Ga-PSMA I&T PET/CT was significantly correlated with preoperative prostate-specific antigen value (r p = 0.75, p < 0.001) and tumor volume on histopathology (r p = 0.45, p = 0.039).

Conclusions

68Ga-PSMA I&T PET/CT prior to radical prostatectomy can contribute to presurgical local staging of prostate cancer. In this pilot study, 68Ga-PSMA I&T PET/CT showed promising results for prediction of lobe infiltration, ECE and SVI.

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Authors and Affiliations

  1. Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany

    Christoph-Alexander J. von Klot, Alena Böker & Markus A. Kuczyk

  2. Department of Urology, Campus Lübeck University Hospital Schleswig-Holstein, Lübeck, Germany

    Axel S. Merseburger

  3. Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany

    Sebastian Schmuck, Tobias L. Ross, Frank M. Bengel & Thorsten Derlin

  4. Department of Radiation Oncology, Hannover Medical School, Hannover, Germany

    Christoph Henkenberens & Hans Christiansen

  5. Radiopharmaceutical Chemistry, Technical University Munich, Garching, Germany

    Hans-Jürgen Wester

  6. Institute for Pathology, Hannover Medical School, Hannover, Germany

    Wiebke Solass & Marcel Lafos

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  1. Christoph-Alexander J. von Klot
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Correspondence to Christoph-Alexander J. von Klot.

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Conflict of Interest

Hans-Jürgen Wester is shareholder of Scintomics. Christoph-Alexander Joachim von Klot, Axel Stuard Merseburger, Sebastian Schmuck, Frank Michael Bengel, Markus Antonius Kuczyk, Christoph Henkenberens, Hans Christiansen, Wiebke Solass, Marcel Lafos and Thorsten Derlin declare no conflict of interest. No funding was received.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All patient data was anonymized prior to statistical analysis. No additional data were created nor used aside from the retrospective evaluation of our database.

Informed Consent

The institutional review board of our institution approved this retrospective study, and the requirement to obtain informed consent was waived.

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von Klot, CA.J., Merseburger, A.S., Böker, A. et al. 68Ga-PSMA PET/CT Imaging Predicting Intraprostatic Tumor Extent, Extracapsular Extension and Seminal Vesicle Invasion Prior to Radical Prostatectomy in Patients with Prostate Cancer. Nucl Med Mol Imaging 51, 314–322 (2017). https://doi.org/10.1007/s13139-017-0476-7

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  • DOI: https://doi.org/10.1007/s13139-017-0476-7

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