Research Papers:

Diagnostic performance of 68Gallium-PSMA-11 PET/CT to detect significant prostate cancer and comparison with 18FEC PET/CT

Manuela A. Hoffmann _, Matthias Miederer, Helmut J. Wieler, Christian Ruf, Frank M. Jakobs and Mathias Schreckenberger

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Oncotarget. 2017; 8:111073-111083. https://doi.org/10.18632/oncotarget.22441

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Manuela A. Hoffmann1,2,3, Matthias Miederer2, Helmut J. Wieler3, Christian Ruf4, Frank M. Jakobs5 and Mathias Schreckenberger2

1Supervisory Center for Medical Radiation Protection, Bundeswehr Medical Service Headquarters, Koblenz, Germany

2Department of Nuclear Medicine, Johannes Gutenberg-University, Mainz, Germany

3Department of Nuclear Medicine, Bundeswehr Central Hospital, Koblenz, Germany

4Department of Urology, Bundeswehr Central Hospital, Koblenz, Germany

5Department of Epidemiology, German Air Force Center for Aerospace Medicine, Fürstenfeldbruck, Germany

Correspondence to:

Manuela A. Hoffmann, email: [email protected]

Keywords: prostate cancer; positron emission tomography/computed tomography; prostate-specific membrane antigen; choline; detection of significant cancer

Received: August 16, 2017     Accepted: October 27, 2017     Published: November 14, 2017


Background: Radiolabeled prostate-specific membrane antigen (PSMA) has proven to be a highly accurate method to detect recurrence and metastases of prostate cancer, but only sparse data is available about its performance in the diagnosis of clinically significant primary prostate cancer.

Methods: We compared 68Ga-PSMA-11 PET/CT in 25 patients with 18FEC PET/CT in 40 patients with suspected prostate carcinoma based on an increased PSA level.

The PET/CT results were compared with the histopathologic Gleason Score (GS) of biopsies.

Results: The 68Ga-PSMA-11 PET/CT revealed highly suspect prostatic lesions (maximum standardized uptake value/SUVmax >2.5) in 21/25 patients (84%), associated with GS≥6 (low-grade/high-grade carcinoma). Two histopathologic non-malignancy-relevant cases (GS<6) had PSMA-SUVmax ≤2.5; all histopathologic high-grade cases (GS≥7b) showed PSMA-SUVmax >12.0 which further increased with rising GS. There were 2 false positives and no false negative findings for high-grade prostate cancer using a cut off-level for SUVmax of 2.5.

In contrast, the 18FEC PET/CT showed suspected malignant lesions in 38/40 patients (95%), which included 3 lesions with GS<6. The mean SUVmax values did not differ with different GS. There were 11 false positives and 1 false negative for detection of high-grade prostate cancer (cut off 2.5).

By means of ROC analysis a SUVmax of 5.4 was found to be an optimal cut off-level to distinguish between low- and high-grade carcinoma in 68Ga-PSMA-11 PET/CT (AUC=0.9692; 95% CI 0.9086;1.0000;SD(AUC)=0.0309)). Choosing a cut off-level of SUVmax5.4, 68Ga-PSMA-11 PET/CT was able to distinguish between GS ≤7a/≥7b with a sensitivity of 84%, a specificity of 100%, a negative predictive value (NPV) of 67%, and an efficiency of 88% (p<0.001).

The ROC analysis revealed a SUVmax 6.5 as an optimal cut off-level to distinguish between low- and high-grade carcinoma in 18FEC PET/CT (AUC=0.7470; 95% CI 0.5919;0.9020;SD(AUC)=0.0791) with a sensitivity of 61% and a specificity of 92%; but the efficiency was only 70% and the NPV 50% (p=0.01).

Conclusion: 68Ga-PSMA-11 PET/CT guided biopsy of the prostate increases diagnostic precision and is likely to help to reduce overtreatment of low-grade malignant disease as well as detect the foci of the highest Gleason pattern. Both methods (68Ga-PSMA-11,18FEC) were suitable to detect primary prostate cancer, but the excellent image quality, the higher specificity and the good correlation of positive scans with GS are advantages of 68Ga-PSMA-11.

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