68Ga-PSMA-11 PET/MR Detects Local Recurrence Occult on mpMRI in Prostate Cancer Patients After HIFU

Irene A Burger; Julian Müller; Olivio F Donati; Daniela A Ferraro; Michael Messerli; Benedikt Kranzbühler; Edwin E G W Ter Voert; Urs J Muehlematter; Niels J Rupp; Ashkan Mortezavi; Daniel Eberli

doi:10.2967/jnumed.118.221564

⁶⁸Ga-PSMA-11 PET/MR Detects Local Recurrence Occult on mpMRI in Prostate Cancer Patients After HIFU

J Nucl Med. 2019 Aug;60(8):1118-1123. doi: 10.2967/jnumed.118.221564. Epub 2019 Jan 25.

Authors

Affiliations

¹ Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland irene.burger@usz.ch.
² Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland.
³ Institute of Diagnostic and Interventional Radiology, University Hospital Zürich, Zürich, Switzerland.
⁴ Department of Urology, University Hospital Zürich, Zürich, Switzerland.
⁵ University of Zurich, Zürich, Switzerland; and.
⁶ Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland.

PMID: 30683764
DOI: 10.2967/jnumed.118.221564

Abstract

High-intensity focused ultrasound (HIFU) is a promising new modality for the treatment of localized prostate cancer (PCa). Follow-up of patients is recommended with biopsies and multiparametric MRI (mpMRI). However, mpMRI in the postinterventional setting is often false-negative. It was our aim to investigate if the new tracer targeting the prostate-specific membrane antigen (⁶⁸Ga-PSMA-11) could be used to localize recurrent disease with PET/MR in patients with discrepant findings between mpMRI and template biopsies. Methods: Interim analysis was performed of the first 10 patients scanned between September 2016 and May 2018 with positive template biopsy and negative mpMRI after HIFU from an ongoing clinical trial (NCT02265159). All patients underwent ⁶⁸Ga-PSMA-11 PET/MRI within 3 mo. Four prostatic quadrants were defined, and for every quadrant suspicion for recurrence was rated on a 5-point Likert scale from definitely no recurrence (1) to highly suspected of recurrence (5), with 4 used as a cutoff for suspected disease based on PET/MRI by a masked reader. ⁶⁸Ga-PSMA-11 uptake of suspected lesions and background areas was measured with the SUV_max The apparent diffusion coefficient values of lesions and background were given for each segment. PET/MRI scans were compared with the template biopsy results, including corresponding Gleason scores (GS), number of positive cores, and tumor length. Results: The quadrant-based sensitivity, specificity, and positive and negative predictive values for PET/MRI were 55%, 100%, 100%, and 85%, respectively. Patient-based PET/MRI was negative in 4 cases with GS 3 + 4 and a tumor length between 0.1 and 3 mm. All tumor lesions with GS 4 + 3 or higher were detected on PET/MRI. Conclusion: Our preliminary results indicate that ⁶⁸Ga-PSMA-11-PET/MR has the potential to localize PCa recurrence after HIFU occult on mpMRI.

Keywords: high-intensity focused ultrasound; magnetic resonance imaging; prostate-specific membrane antigen; template biopsy.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Biopsy
False Negative Reactions
Gallium Isotopes
Gallium Radioisotopes
High-Intensity Focused Ultrasound Ablation*
Humans
Male
Membrane Glycoproteins
Middle Aged
Multiparametric Magnetic Resonance Imaging*
Neoplasm Recurrence, Local
Observer Variation
Organometallic Compounds
Positron-Emission Tomography*
Prospective Studies
Prostatic Neoplasms / diagnostic imaging*
Prostatic Neoplasms / therapy*
Radiopharmaceuticals
Reproducibility of Results

Substances

Gallium Isotopes
Gallium Radioisotopes
Membrane Glycoproteins
Organometallic Compounds
Radiopharmaceuticals
gallium 68 PSMA-11