68Ga-PSMA PET/CT and volumetric morphology of PET-positive lymph nodes stratified by tumor differentiation of prostate cancer

• Verfasst von: Vinsensia, Maria [VerfasserIn]
• Verfasst von: Hadaschik, Boris [VerfasserIn]
• Verfasst von: Holland-Letz, Tim [VerfasserIn]
• Verfasst von: Mier, Walter [VerfasserIn]
• Verfasst von: Haberkorn, Uwe [VerfasserIn]
• Verfasst von: Kratochwil, Clemens [VerfasserIn]
• Verfasst von: Giesel, Frederik L. [VerfasserIn]
• Titel: 68Ga-PSMA PET/CT and volumetric morphology of PET-positive lymph nodes stratified by tumor differentiation of prostate cancer
• Verf.angabe: Maria Vinsensia, Peter L. Chyoke, Boris Hadaschik, Tim Holland-Letz, Jan Moltz, Klaus Kopka, Isabel Rauscher, Walter Mier, Markus Schwaiger, Uwe Haberkorn, Tobias Mauer, Clemens Kratochwil, Matthias Eiber, Frederik L. Giesel
• E-Jahr: 2017
• Jahr: Jun. 21, 2017
• Umfang: 7 S.
• Illustrationen: Illustrationen
• Fussnoten: Im Titel ist "68" hochgestellt ; Published online Jun. 21, 2017 ; Gesehen am 10.09.2018
• Titel Quelle: Enthalten in: Journal of nuclear medicine
• Ort Quelle: New York, NY : Soc., 1964
• Jahr Quelle: 2017
• Band/Heft Quelle: 58(2017), 12, Seite 1949-1955
• ISSN Quelle: 2159-662X
• ISSN Quelle: 1535-5667
• DOI: doi:10.2967/jnumed.116.185033
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: lymph node
• Sach-SW: morphology
• Sach-SW: N-staging
• Sach-SW: prostate cancer
• Sach-SW: PSMA PET/CT
• K10plus-PPN: 1580827276

Abstract

68Ga-prostate-specific membrane antigen (PSMA) PET/CT is a new method to detect early nodal metastases in patients with biochemical relapse of prostate cancer. In this retrospective investigation, the dimensions, volume, localization, and SUVmax of nodes identified by 68Ga-PSMA were correlated to their Gleason score (GS) at diagnosis. Methods: All PET/CT images were acquired 60 ± 10 min after intravenous injection of 68Ga-PSMA (mean dose, 176 MBq). In 147 prostate cancer patients (mean age, 68 y; range, 44-87 y) with prostate-specific antigen relapse (mean prostate-specific antigen level, 5 ng/mL; range, 0.25-294 ng/mL), 362 68Ga-PSMA PET-positive lymph nodes (LNs) were identified. These patients were classified on the basis of their histopathology at primary diagnosis into either low- (GS ≤ 6, well differentiated), intermediate- (GS = 7, moderately differentiated), or high-GS cohorts (GS ≥ 8, poorly differentiated prostate cancer). Using semiautomated LN segmentation software (Fraunhofer MEVIS), we measured node volume and short-axis dimensions (SADs) and long-axis dimensions based on CT and compared with the SUVmax. Nodes demonstrating uptake of 68Ga-PSMA with an SUVmax of 2.0 or more were considered PSMA-positive, and nodes with an SAD of 8 mm or more were considered positive by morphologic criteria. Results: Mean SUVmax was 13.5 (95% confidence interval [CI], 10.9-16.1), 12.4 (95% CI, 9.9-14.9), and 17.8 (95% CI, 15.4-20.3) within the low-, intermediate-, and high-GS groups, respectively. The morphologic assessment of the 68Ga-PSMA-positive LN demonstrated that the low-GS cohort presented with smaller 68Ga-PSMA-positive LNs (mean SAD, 7.7 mm; n = 113), followed by intermediate- (mean SAD, 9.4 mm; n = 122) and high-GS cohorts (mean SAD, 9.5 mm; n = 127). On the basis of the CT morphology criteria, only 34% of low-GS patients, 56% of intermediate-GS patients, and 53% of high-GS patients were considered CT positive. Overall, 68Ga-PSMA imaging led to a reclassification of stage in 90 patients (61%) from cN0 to cN1 over CT. Conclusion: 68Ga-PSMA PET is a promising modality in biochemical recurrent prostate cancer patients for N staging. Conventional imaging underestimates LN involvement compared with PSMA molecular staging score in each GS cohort. The sensitivity of 68Ga-PSMA PET/CT enables earlier detection of subcentimeter LN metastases in the biochemical recurrence setting.