68Ga-PSMA has high detection rate of prostate cancer recurrence outside the prostatic fossa in patients being considered for salvage radiation treatment.

To examine the detection rates of (68) Ga-PSMA-PET/CT in patients with biochemical recurrence (BCR) after radical prostatectomy (RP), and also the impact on their management.

300 consecutive PC patients who underwent (68) Ga-PSMA-PET/CT between February and July 2015 were prospectively included in the ProCan-I Database.

For this analysis, men were included with BCR (PSA ≥0. 05ng/ml) after RP, PSA <1. 0ng/ml, being considered for salvage radiation treatment (RT) according to FROGG guidelines. Two readers assessed each (68) Ga-PSMA-PET/CT, and all positive lesions were assigned to an anatomical location. For each patient, the clinical and pathological features were recorded, their association with pathological (68) Ga-PSMA uptake was investigated, and detection rates were determined according to PSA level.

70 patients were included, 53 positive (68) Ga-PSMA lesions were detected in 38 (54%) positive patients. For PSA (ng/ml) 0. 05-0. 09, 8% were definitely positive; for 0. 1-0. 19, 23%; for 0. 2-0. 29, 58%; for 0. 3-0. 49, 36%; and for 0. 5-0. 99, 57%, respectively. Eighteen of 70 patients (27%) had pathological (68) Ga-PSMA uptake in the prostatic fossa, 11 (14. 3%) in the pelvic nodes, and 5 (4. 3%) in both the fossa and pelvic lymph nodes. Finally, there was uptake outside the pelvis with or without a lesion in the fossa or pelvic lymph nodes in 4 cases (8. 6%). There was a major management impact in 20 (28. 6%) men, all were attributable to the (68) Ga-PSMA findings.

(68) Ga-PSMA appears useful for re-staging of PC in patients with rising PSA being considered for salvage RT even at PSA levels below 0. 5 ng/ml. These results underline the need for further prospective trials to evaluate the changes in RT volume or management attributable to (68) Ga-PSMA findings. This article is protected by copyright. All rights reserved.

BJU international. 2015 Dec 18 [Epub ahead of print]

Pim J van Leeuwen, Phillip Stricker, George Hruby, Andrew Kneebone, Francis Ting, Ben Thompson, Quoc Nguyen, Bao Ho, Louise Emmett

St Vincent's Prostate Cancer Centre, St Vincent's Clinic, Sydney, Australia. , St Vincent's Prostate Cancer Centre, St Vincent's Clinic, Sydney, Australia. , Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia. , Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia. , St Vincent's Prostate Cancer Centre, St Vincent's Clinic, Sydney, Australia. , Australian Prostate Cancer Research Centre - New South Wales, The Garvan Institute of Medical Research / The Kinghorn Cancer Centre, Sydney, Australia. , Australian Prostate Cancer Research Centre - New South Wales, The Garvan Institute of Medical Research / The Kinghorn Cancer Centre, Sydney, Australia. , Department of Diagnostic Imaging, St Vincent's Public Hospital, Sydney, Australia. , Department of Diagnostic Imaging, St Vincent's Public Hospital, Sydney, Australia.

PubMed

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