Detection efficacy of 18 F-PSMA-1007 PET/CT in 251 patients with biochemical recurrence of prostate cancer after radical prostatectomy

Frederik L. Giesel, Karina Knorr, Fabian Spohn, Leon Will, Tobias Maurer, Paul Flechsig, Oliver Neels, Kilian Schiller, Horacio Amaral, Wolfgang A. Weber, Uwe Haberkorn, Markus Schwaiger, Clemens Kratochwil, Peter Choyke, Vasko Kramer, Klaus Kopka, Matthias Eiber

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Abstract

Prostate-specific membrane antigen (PSMA)–targeted PET imaging recently emerged as a new method for the staging and restaging of prostate cancer. Most published studies investigated the diagnostic potential of 68 Ga-labeled PSMA agents that are excreted renally. 18 F-PSMA-1007 is a novel PSMA ligand that has excellent preclinical characteristics and that 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 18 F-PSMA-1007 for biochemical recurrence (BCR) after radical prostatectomy. Methods: From 3 academic centers, 251 patients with BCR after radical prostatectomy were evaluated in a retrospective analysis. Patients who had received second-line androgen deprivation therapy (ADT) or chemotherapy were excluded, but prior first-line ADT exposure was allowed. The median prostate-specific antigen (PSA) level was 1.2 ng/mL (range, 0.2–228 ng/mL). All patients underwent PSMA PET/CT at 92 ± 26 min after injection of 301 ± 46 MBq of 18 F-PSMA-1007. The rate of detection of presumed recurrence sites was correlated with the PSA level and original primary Gleason score. A comparison to a subset of patients treated previously with ADT was undertaken. Results: Of the 251 patients, 204 (81.3%) had evidence of recurrence on 18 F-PSMA-1007 PET/CT. The detection rates were 94.0% (79/84), 90.9% (50/55), 74.5% (35/47), and 61.5% (40/65) for PSA levels of greater than or equal to 2, 1 to less than 2, 0.5 to less than 1, and 0.2 to less than 0.5 ng/mL, respectively. 18 F-PSMA-1007 PET/CT revealed local recurrence in 24.7% of patients (n 5 62). Lymph node metastases were present in the pelvis in 40.6% of patients (n 5 102), in the retroperitoneum in 19.5% of patients (n 5 49), and in supradiaphragmatic locations in 12.0% of patients (n 5 30). Bone and visceral metastases were detected in 40.2% of patients (n 5 101) and in 3.6% of patients (n 5 9), respectively. In tumors with higher Gleason scores (#7 vs. $8), detection efficacy trended higher (76.3% vs. 86.7%) but was not statistically significant (P 5 0.32). However, detection efficacy was higher in patients who had received ADT (91.7% vs. 78.0%) within 6 mo before imaging (P 5 0.0179). Conclusion: 18 F-PSMA-1007 PET/CT offers high detection rates for BCR after radical prostatectomy that are comparable to or better than those published for 68 Ga-labeled PSMA ligands.

Original languageEnglish
Pages (from-to)362-368
Number of pages7
JournalJournal of Nuclear Medicine
Volume60
Issue number3
DOIs
StatePublished - 2019

Keywords

  • Biochemical recurrence
  • F-PSMA-1007
  • Hybrid imaging
  • PET/CT
  • Prostate cancer

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