Recently, prostate-specific membrane antigen (PSMA) targeted PET-imaging has emerged as new method of staging and restaging of prostate cancer. Most published studies have investigated the diagnostic potential of 68Ga-labeled PSMA-agents which are excreted renally. [18F]PSMA-1007 is a novel PSMA-ligand with excellent preclinical characteristics which is only minimally excreted by the urinary tract, a potential advantage for pelvic imaging. The aim of this study was to investigate the diagnostic efficacy of [18F]PSMA-1007 in biochemical recurrence (BCR) after radical prostatectomy (RP). Methods: 251 patients from three academic centers with BCR after radical prostatectomy were evaluated in a retrospective analysis. Patients who had received second line androgen deprivation therapy and/or chemotherapy were excluded, however prior first line ADT exposure was allowed. The median PSA-level was 1.2 ng/ml (range: 0.2-228 ng/mL). All patients underwent a PSMA-PET/CT after injection of 301±46 MBq [18F]PSMA-1007 at 92±26 min post injection. The detection rate of presumed recurrence sites was correlated with PSA-level and original primary Gleason score. A comparison to a subset of patients treated previously with androgen deprivation therapy (ADT) was undertaken. Results: 204 of 251 patients (81.3%) patients had evidence of recurrence on [18F]PSMA-1007 PET/CT. The detection rates were 94.1% (79/84), 90.1% (50/55), 74.5% (35/47) and 61.5% (40/65) for PSA-levels of ≥2, 1-<2, 0.5-<1 and 0.2-<0.5ng/mL, respectively. [18F]PSMA-1007 PET/CT revealed local recurrence in 43.7% (62) of patients. Lymph node metastases were present in the pelvis in 40.6% (102), in the retroperitoneum in 19.5% (49) and in supradiaphragmatic locations in 12.0% (30) of patients. Bone and visceral metastases were detected in 40.2% (101) and 3.6% (9) patients. In higher Gleason score tumors (≤7vs.≥8) detection efficacy trended higher (76.3% vs. 86.7%) but was not statistically significant (P = 0.32). However, detection efficacy was higher in patients who had previously been on ADT (91.7% vs. 78.0%) within 6 months prior to imaging (P = 0.0179). Conclusion: [18F]PSMA-1007 PET/CT offers high detection rates in BCR after radical prostatectomy which is comparable to or better than that published for 68Ga-labelled PSMA-ligands.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2018 Jul 24 [Epub ahead of print]
Frederik L Giesel, Karina Knorr, Fabian Spohn, Leon Will, Tobias Maurer, Paul Flechsig, Oliver Neels, Kilian Schiller, Horacio Amaral, Wolfgang Weber, Markus Schwaiger, Markus Hohenfellner, Clemens Kratochwil, Juergen Debus, Uwe Haberkorn, Peter Choyke, Vasko Kramer, Klaus Kopka, Matthias Eiber
University Hospital Heidelberg, Germany., Technical University Munich, Germany., German Cancer Research Center (DKFZ), Germany., FALP, Chile., National Cancer Institute, United States.