Journal
EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
Volume 47, Issue 3, Pages 674-686Publisher
SPRINGER
DOI: 10.1007/s00259-019-04643-7
Keywords
Prostate-specific membrane antigen; Prostate cancer; PSMA-PET-CT; Management impact; Ga-68-THP-PSMA
Funding
- King's College London/University College London Comprehensive Cancer Imaging Centres - Cancer Research UK
- Engineering and Physical Sciences Research Council
- Medical Research Council [C1519/A16463]
- Department of Health [C1519/A16463]
- Wellcome Trust EPSRC Centre for Medical Engineering at King's College London [WT203148/Z/16/Z]
- Theragnostics Ltd.
- MRC [MC_PC_16048] Funding Source: UKRI
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Purpose To determine the impact on clinical management of patients with high-risk (HR) prostate cancer at diagnosis and patients with biochemical recurrence (BCR) using a new kit form of Ga-68-prostate-specific membrane antigen (PSMA), namely tris(hydroxypyridinone) (THP)-PSMA, with positron emission tomography-computed tomography (PET-CT). Methods One hundred eighteen consecutive patients (50 HR, 68 BCR) had management plans documented at a multidisciplinary meeting before Ga-68-THP-PSMA PET-CT. Patients underwent PET-CT scans 60-min post-injection of Ga-68-THP-PSMA (mean 159 +/- 21.2 MBq). Post-scan management plans, Gleason score, prostate-specific antigen (PSA) and PSA doubling time (PSAdt) were recorded. Results HR group: 12/50 (24%) patients had management changed (9 inter-modality, 3 intra-modality). Patients with PSA < 20 mu g/L had more frequent management changes (9/26, 34.6%) compared with PSA > 20 mu g/L (3/24, 12.5%). Gleason scores > 8 were associated with detection of more nodal (4/16, 25% vs 5/31, 16.1%) and bone (2/16, 12.5% vs 2/31, 6.5%) metastases. BCR group: Clinical management changed in 23/68 (34%) patients (17 inter-modality, 6 intra-modality). Forty out of 68 (59%) scans were positive. Positivity rate increased with PSA level (PSA < 0.5 mu g/L, 0%; PSA 0.5-1.0 mu g/L, 35%; PSA 1.0-5.0 mu g/L, 69%; PSA 5.0-10.0 mu g/L, 91%), PSAdt of < 6 months (56% vs 45.7%) and Gleason score > 8 (78.9% vs 51.2%). Conclusions Ga-68-THP-PSMA PET-CT influences clinical management in significant numbers of patient with HR prostate cancer pre-radical treatment and is associated with PSA. Management change also occurs in patients with BCR and is associated with PSA and Gleason score, despite lower scan positivity rates at low PSA levels < 0.5 mu g/L.
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