Flourine-18 prostate-specific membrane antigen-1007 positron emission tomography imaging in staging of primary and secondary prostate cancer - a retrospective observational cohort study

Journal article

Background: 

Detection of metastatic disease is important to inform prostate cancer management.

Objectives: 

Evaluate local and distant staging by initial ¹⁸F-PSMA-1007 PET in primary and secondary prostate cancer.

Design, Setting, and Participants: 

We retrospectively identified a consecutive series of ¹⁸F-PSMA-1007 PET scans from the date of introduction of ¹⁸F-PSMA-1007 PET in September 2019 until April 2022 at a single UK tertiary referral center. Our protocol was registered in advance (OSF registration ID: KTE3R).

Results: 

We identified 1335 PSMA-PET scans, from 1220 men. Across 623 initial scans for primary staging, we observed PSMA-PET avidity in 97.6% cases positive for local disease, 29.5% for nodal disease, and 26.5% for metastatic disease. PSMA-PET identified a 13.2% absolute increase in nodal lesions compared with MRI and a 24.0% absolute increase in metastatic lesions compared with MRI marrow. The sensitivity for detection of local disease among 79 patients who had radical prostatectomy was 96.2% for PSMA-PET vs 89.4% for multiparametric MRI. Across 612 scans for secondary staging, we observed PSMA-PET positive avidity in 51.2% of cases for local recurrence, 46.6% for nodal disease, and 43.0% for metastatic disease. When evaluated by the PSA range for patients receiving secondary staging, using the PSA values of 0.2 to 0.49, 0.5 to 0.99, 1 to 1.99, and ≥ 2 ng/mL, PSMA-PET scans were positive in 57.8%, 75.0%, 83.8%, and 95.5% of cases, respectively. PSMA-PET identified a 26.2% absolute increase in metastatic lesions compared with MRI marrow or other skeletal MRI (n = 61) and a 14.7% absolute increase in metastatic lesions compared with the bone scan (n = 42).

Conclusion: 

¹⁸F-PSMA-1007 PET identifies a higher number of nodal and metastatic lesions compared with conventional cross-sectional imaging. However, the high number of indeterminate lesions and stage migration necessitates discussion of ¹⁸F-PSMA-1007 PET imaging within a multidisciplinary team and places a higher burden on these teams.

Authors: Byrne, MHV; Ranasinha, N; Sharma, A; Mercader, C; Raslan, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Neurological Association
• Journal: JU Open Plus
• Volume: 2
• Issue: 10
• Article number: e00108
• Publication date: 2024-10-08
• Acceptance date: 2024-08-06
• DOI: 10.1097/ju9.0000000000000206
• ISSN: 2771-554X
• Language: English
• Keywords: PSMA-PET; staging; prostate cancer; fluorine-18