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DOI: 10.1055/a-2344-6825
Determination of the optimal imaging protocol for [18F]PSMA-PET-CT for the detection of bone metastases in prostate cancer patients
Bestimmung des optimalen Bildgebungsprotokolls für das [18F]PSMA-PET/CT zur Detektion von Knochenmetastasen bei Patienten mit ProstatakarzinomAbstract
Aim Prostate-specific membrane antigen-positron emission tomography (PSMA-PET) is a widely used diagnostic tool in patients with prostate cancer (PC). However, due to the limited availability of PET scanners and relevant acquisition costs, it is important to consider the indications and acquisition time. The aim of this investigation was to determine whether a PET scan from the skull base to the proximal thigh is sufficient to detect the presence of bone metastases.
Methods A retrospective analysis was conducted on 1050 consecutive [18F]PSMA-1007-PET-CT scans from the head to the proximal lower leg. The PET scans were categorised according to the presence and amount of bone metastases: (1) 1–5, (2) 6–19 and (3) ≥20. Additionally, the PET scans were evaluated for the presence of bone metastases below the proximal thigh as well as bone metastases above the skull base. Imaging results were compared to patients PSA values.
Results Of the 391 patients with bone metastases, 146 (37.3%) exhibited metastases located below the proximal thigh and 104 (26.6%) above the skull base. The majority of bone metastases located below the proximal thigh (145, 99.3%) and above the skull base (94, 90.4%) were identified in patients with more than five bone metastases. No solitary distal metastasis was detected. The PSA value correlated significantly with number of bone metastases (e. g., 1–5 vs. ≥20 bone metastases, P < 0.001) and was significantly higher in patients with distal bone metastases (P < 0.001). ROC analysis showed that a PSA value of 11.15 ng/mL is the optimal cut-off for detecting bone metastases located below the proximal thigh, with an AUC of 0.919 (95% CI: 0.892–0.945, sensitivity 87%, specificity 86%). Similarly, the PSA value of 12.86 ng/mL is the optimal cut-off for detecting bone metastases above the skull base with an AUC of 0.904 (95% CI: 0.874–0.935, sensitivity 87%, specificity 83%).
Conclusion PSMA-PET acquisition protocols from the skull base to the proximal femur may be sufficient to accurately detect bone metastatic disease in PC. PSA values can provide decision support for individual PET acquisition protocols.
Publication History
Received: 29 March 2024
Accepted after revision: 12 June 2024
Article published online:
12 July 2024
© 2024. Thieme. All rights reserved.
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References
- 1 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209-249 DOI: 10.3322/CAAC.21660. (PMID: 33538338)
- 2 Riihimäki M, Thomsen H, Sundquist K. et al. Clinical landscape of cancer metastases. Cancer Med 2018; 7: 5534-5542 DOI: 10.1002/CAM4.1697. (PMID: 30328287)
- 3 Gandaglia G, Abdollah F, Schiffmann J. et al. Distribution of metastatic sites in patients with prostate cancer: A population-based analysis. Prostate 2014; 74: 210-216 DOI: 10.1002/PROS.22742.
- 4 Parker C, Castro E, Fizazi K. et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Annals of Oncology 2020; 31: 1119-1134 DOI: 10.1016/J.ANNONC.2020.06.011. (PMID: 32593798)
- 5 Ross JS, Sheehan CE, Fisher HAG. et al. Correlation of primary tumor prostate-specific membrane antigen expression with disease recurrence in prostate cancer. Clin Cancer Res 2003; 9: 6357-6362
- 6 Backhaus P, Noto B, Avramovic N. et al. Targeting PSMA by radioligands in non-prostate disease—current status and future perspectives. EJNMMI 2018; 45: 860-877 DOI: 10.1007/S00259-017-3922-Y. (PMID: 29335762)
- 7 Giesel FL, Will L, Lawal I. et al. Intraindividual Comparison of 18F-PSMA-1007 and 18F-DCFPyL PET/CT in the Prospective Evaluation of Patients with Newly Diagnosed Prostate Carcinoma: A Pilot Study. JNM 2018; 59: 1076-1080 DOI: 10.2967/JNUMED.117.204669.
- 8 Roll W, Schindler P, Masthoff M. et al. Evaluation of 68Ga-PSMA-11 PET-MRI in Patients with Advanced Prostate Cancer Receiving 177Lu-PSMA-617 Therapy: A Radiomics Analysis. Cancers (Basel) 2021; 13: 3849 DOI: 10.3390/CANCERS13153849.
- 9 Relt E, Roll W, Claesener M. et al. Time after Synthesis and Time after Injection Do Not Affect Diagnostic Quality of [18F]F-PSMA 1007 PET. Cancers (Basel) 2022; 14 DOI: 10.3390/CANCERS14205141. (PMID: 36291925)
- 10 Giesel FL, Hadaschik B, Cardinale J. et al. F-18 labelled PSMA-1007: biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. EJNMMI 2017; 44: 678-688 DOI: 10.1007/S00259-016-3573-4. (PMID: 27889802)
- 11 Hofman MS, Lawrentschuk N, Francis RJ. et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. The Lancet 2020; 395: 1208-1216 DOI: 10.1016/S0140-6736(20)30314-7.
- 12 Fendler WP, Eiber M, Beheshti M. et al. PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0. EJNMMI 2023; 50: 1466-1486 DOI: 10.1007/S00259-022-06089-W. (PMID: 36604326)
- 13 Rassek P, Schäfers M, Rahbar K. et al. [18F]-PSMA-1007-PET for evaluation of kidney function. Nucl Med (Stuttg) 2023; 62: 244-251 DOI: 10.1055/a-2127-7880. (PMID: 37595624)
- 14 Afshar-Oromieh A, Eiber M, Fendler W. et al. DGN-Handlungsempfehlung (S1-Leitlinie) PSMA-Liganden-PET/CT in der Diagnostik des Prostatakarzinoms. DGN 2019; 14: 16
- 15 Löffler M, Weckesser M, Franzius C. et al. Malignant melanoma and 18F-FDG-PET: Should the whole body scan include the legs?. Nuklearmedizin 2003; 42: 167-172 DOI: 10.1055/S-0038-1625186.
- 16 Vrachimis A, Dirksen U, Weßling J. et al. PET surveillance of patients with Ewing sarcomas of the trunk: Must the lower legs be included?. Nuklearmedizin 2010; 49: 183-186 DOI: 10.3413/NUKMED-03131004.
- 17 Briganti A, Suardi N, Gallina A. et al. Predicting the risk of bone metastasis in prostate cancer. Cancer Treat Rev 2014; 40: 3-11 DOI: 10.1016/j.ctrv.2013.07.001. (PMID: 23896177)
- 18 Li S, Chen C, Zhu H. et al. Risk Evaluation of Bone Metastases and a Simple Tool for Detecting Bone Metastases in Prostate Cancer: A Population-Based Study. Comput Math Methods Med 2023; 2023 DOI: 10.1155/2023/9161763. (PMID: 36824150)
- 19 Manohar P, Rather T, Khan S. Determination of the optimal cut-off value of serum prostate-specific antigen in the prediction of skeletal metastases on technetium-99m whole-body bone scan by receiver operating characteristic curve analysis. World J Nucl Med 2020; 19: 255-259 DOI: 10.4103/WJNM.WJNM_77_19. (PMID: 33354181)
- 20 Pepe P, Pennisi M. Should 68Ga-PSMA PET/CT Replace CT and Bone Scan in Clinical Staging of High-risk Prostate Cancer?. Anticancer Res 2022; 42: 1495-1498 DOI: 10.21873/ANTICANRES.15621. (PMID: 35220244)
- 21 Ventura D, Schindler P, Masthoff M. et al. Radiomics of Tumor Heterogeneity in 18F-FDG-PET-CT for Predicting Response to Immune Checkpoint Inhibition in Therapy-Naïve Patients with Advanced Non-Small-Cell Lung Cancer. Cancers (Basel) 2023; 15 DOI: 10.3390/CANCERS15082297.
- 22 Liu Y, Li L, Qin Y. et al. Total-body PET/CT with half-dose [68 Ga]Ga-PSMA-11 for biochemical recurrent prostate cancer: comparable diagnostic value to short axial field-of-view PET/CT with full-dose [68 Ga]Ga-PSMA-11. EJNMMI 2024; 51: 581-589 DOI: 10.1007/S00259-023-06466-Z.