Clinical impact of PSMA PET/CT in primary prostate cancer compared to conventional nodal and distant staging: a retrospective single center study

• Published in: BMC cancer Vol. 20; no. 1; pp. 723 - 10
• Main Authors: Donswijk, Maarten L., van Leeuwen, Pim J., Vegt, Erik, Cheung, Zing, Heijmink, Stijn W. T. P. J., van der Poel, Henk G., Stokkel, Marcel P. M.
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.08.2020; BioMed Central; BMC
• Subjects: Abdomen; Aged; Aged, 80 and over; Androgens; Antigens, Surface; Biopsy; Bisphosphonates; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; Cancer metastasis; Cancer research; Cancer surgery; Cancer therapies; CAT scans; Comparative analysis; Computed tomography; Drug dosages; Femoral Neoplasms - diagnostic imaging; Femoral Neoplasms - secondary; Gallium; Gallium Radioisotopes; Glutamate Carboxypeptidase II; Humans; Impact; Lymphatic Metastasis - diagnostic imaging; Lymphatic system; Magnetic resonance imaging; Male; Management; Metastases; Metastasis; Middle Aged; Neoplasm Grading; Neoplasm Staging - methods; Nuclear medicine; Palliative Care; Patients; Physicians; Positron emission tomography; Positron Emission Tomography Computed Tomography - methods; Prostate; Prostate cancer; Prostatectomy; Prostatectomy - methods; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; PSMA; Recurrence (Disease); Retrospective Studies; Robotic Surgical Procedures - methods; Robots; Scintigraphy; Staging; Tumors; United States > US; Impact; PSMA; Management; Staging; Prostate
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-020-07192-7

To evaluate the impact of Gallium-68 [ Ga] labeled prostate specific membrane antigen (PSMA) positron emission tomography (PET)/X-ray computed tomography (CT) compared with conventional imaging on staging and clinical management of men evaluated for primary prostate cancer (PCa). Men with newly diagnosed biopsy-proven PCa who had been staged with a conventional staging protocol including bone scintigraphy (BS) and additionally underwent [ Ga]PSMA PET/CT, were evaluated retrospectively. Imaging findings from BS, magnetic resonance imaging (MRI) and/or CT were categorized regarding locoregional nodal (N) and distant metastasis (M) status as negative, positive or equivocal before and after addition of the information of PET/CT. Also, the imaging-based level of confidence (LoC) in correct assessment of N and M status was scored. Impact of PET/CT on clinical management was evaluated by the percentage of treatment category changes after PET/CT as determined in the multidisciplinary tumour board. Sixty-four men with intermediate and high-risk PCa were evaluated. With additional information of PET/CT, N status was upstaged in 23%, and downstaged in 9%. M status was upstaged in 13%, and downstaged in 23%. A net increase in LoC of 20% was noted, mainly regarding M status. Treatment category changed from palliative to curative in 9%, and from curative to palliative in 3%. An undecided treatment plan changed to curative in 14%, as well as to palliative in another 9%. In total, a 36% treatment category change was noted. High negative predictive value of PET/CT for M status was indicated by 27 patients that underwent robot-assisted radical prostatectomy and reached postoperative biochemical disease-free status or had a likely other site of disease recurrence. PSMA PET/CT can cause considerable changes in N and M staging, as well as in management compared to conventional staging. Findings of this study support the replacement of BS and CT by PSMA PET/CT in staging primary PCa.