Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with (68)Ga-PSMA-HBED-CC than with (18)F-Fluoroethylcholine PET/CT

• Published in: European journal of nuclear medicine and molecular imaging Vol. 43; no. 8; pp. 1410 - 1417
• Main Authors: Pfister, David, Porres, Daniel, Heidenreich, Axel, Heidegger, Isabel, Knuechel, Ruth, Steib, Florian, Behrendt, Florian F, Verburg, Frederik A
• Format: Journal Article
• Language: English
• Published: Germany 01.07.2016
• Subjects: Aged; Choline - analogs & derivatives; Edetic Acid - analogs & derivatives; Humans; Lymph Node Excision; Male; Middle Aged; Oligopeptides; Positron Emission Tomography Computed Tomography - methods; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - surgery; Recurrence; Retrospective Studies; Salvage Therapy; Sensitivity and Specificity; Salvage lymphadenectomy; Histology; F-18-Fluoroethycholine PET/CT; Ga-68-PSMA PET/CT; Prostate cancer
• ISSN: 1619-7089
• DOI: 10.1007/s00259-016-3366-9

[(68)Ga]PSMA-HBED-CC ((68)Ga-PSMA) is a novel and promising tracer for highly sensitive combined integrated positron emission tomography and X-ray computed tomography (PET/CT) diagnosis of recurrent prostate cancer (PCA). Our aim was to assess the sensitivity, specificity, positive and negative predictive value (PPV/NPV), and accuracy per lesion, as well as the positive predictive value per patient of (68)Ga-PSMA PET/CT using post-lymphadenectomy histology as a standard, and to compare these values to those obtained in a patient collective scanned using (18)F-Fluoroethylcholine ((18)FEC) PET/CT. Thirty eight patients had (18)FEC and 28 patients had (68)Ga-PSMA. We performed a pelvic and/or retroperitoneal lymphadenectomy, if necessary supplemented by resection of locally recurrent lesions in accordance with imaging results. In 30/38 (18)FEC and 23/28 (68)Ga-PSMA patients ≥1 focus of PCA was identified in postsurgical histology, leading to a per-patient PPV of 78.9 % for (18)FEC and 82.1 % for (68)Ga-PSMA. In (18)FEC and (68)Ga-PSMA patients, a total of 378 and 308 lymph nodes and local lesions were removed, respectively. For (18)FEC and (68)for Ga-PSMA, the respective sensitivity (95 % confidence interval) was 71.2 % (64.5-79.6 %) and 86.9 % (75.8-94.2 %), specificity was 86.9 % (82.3-90.6 % ) and 93.1 % (89.2-95.9 %), PPV was 67.3 % (57.7-75.9 %) and 75.7 % (64.0-98.5 %), NPV was 88.8 % (84.4-92.3 %) and 96.6 % (93.5-98.5 %), and accuracy was 82.5 % (78.3-86.8 %) and 91.9 % (88.7 %-95.1 %). In the present series Ga-PSMA PET/CT shows a better performance than FEC PET/CT with a significantly higher NPV and accuracy for the detection of locoregional recurrent and/or metastatic lesions prior to salvage lymphadenectomy.