This article was originally published here<\/p>\n
Eur J Nucl Med Mol Imaging. 2021 Jan 8. doi: 10.1007\/s00259-020-05086-1. Online ahead of print.<\/p>\n
ABSTRACT<\/p>\n
INTRODUCTION: Despite growing evidence of a superior diagnostic performance of 68Ga-PSMA-11 over 18F-fluorocholine (FCH) PET\/CT, the number of PET\/CT centres able to label on site with gallium-68 is still currently limited. Therefore, patients with biochemical recurrence (BCR) of prostate cancer frequently undergo FCH as the 1st-line PET\/CT. Actually, the positivity rate (PR) of a second-line PSMA-11 PET\/CT in case of negative FCH PET\/CT has only been reported in few short series, in a total of 185 patients. Our aims were to check (1) whether the excellent PR reported with PSMA-11 is also obtained in BCR patients whose recent FCH PET\/CT was negative or equivocal; (2) in which biochemical and clinical context a high PSMA-11 PET\/CT PR may be expected in those patients, in particular revealing an oligometastatic pattern; (3) whether among the various imaging protocols for PSMA-11 PET\/CT used in France, one yields a significantly highest PR; (4) the tolerance of PSMA-11.<\/p>\n
PATIENTS AND METHODS: Six centres performed 68Ga-PSMA-11 PET\/CTs during the first 3 years of its use in France. Prior to each PET\/CT, the patients data were submitted prospectively for authorisation to ANSM, the French Medicine Agency. The on-site readings of 1084 PSMA-11 PET\/CTs in BCR patients whose recent FCH PET\/CTs resulted negative or equivocal were pooled and analysed.<\/p>\n
RESULTS: (1) The overall PR was 68%; for a median serum PSA level (sPSA) of 1.7 ng\/mL, an oligometastatic pattern (1-3 foci) was observed in 31% of the cases overall; (2) PR was significantly related to sPSA (from 41% if < 0.2 ng\/mL to 81% if 2 ng\/mL), to patients age, to initial therapy (64% if prostatectomy vs. 85% without prostatectomy due to frequent foci in the prostate fossa), to whether FCH PET\/CT was negative or equivocal (PR = 62% vs. 82%), and to previous BCR (PR = 63% for 1st BCR vs. 72% in case of previous BCR); (3) no significant difference in PR was found according to the imaging protocol: injected activity, administration of a contrast agent and\/or of furosemide, dose length product, one single or multiple time points of image acquisition; (4) no adverse event was reported after PSMA-11 injection, even associated with a contrast agent and\/or furosemide.<\/p>\n
CONCLUSION: Compared with the performance of PSMA-11 PET\/CT in BCR reported independently of FCH PET\/CT in 6 large published series (n > 200), the selection based on FCH PET\/CT resulted in no difference of PSMA-11 PR for sPSA < 1 ng\/mL but in a slightly lower PR for sPSA 1 ng\/mL, probably because FCH performs rather well at this sPSA and very occult BCR was over-represented in our cohort. An oligometastatic pattern paving the way to targeted therapy was observed in one fourth to one third of the cases, according to the clinico-biochemical context of the BCR. Systematic dual or triple acquisition time points or administration of a contrast agent and\/or furosemide did not bring a significant added value for PSMA-11 PET\/CT positivity and should be decided on individual bases.<\/p>\n
PMID:33416958 | DOI:10.1007\/s00259-020-05086-1<\/p>\n
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\nSurvey by the French Medicine Agency (ANSM) of the imaging protocol, detection rate, and safety of (68)Ga-PSMA-11 PET\/CT in the biochemical recurrence...<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"