title: Extent of disease in recurrent prostate cancer determined by [(68)Ga]PSMA-HBED-CC PET/CT in relation to PSA levels, PSA doubling time and Gleason score.
abstract: OBJECTIVE
  To examine the relationship between the extent of disease determined by [(68)Ga]PSMA-HBED-CC-PET/CT and the important clinical measures prostate-specific antigen (PSA), PSA doubling time (PSAdt) and Gleason score.
  
  
  METHODS
  We retrospectively studied the first 155 patients with recurrent prostate cancer (PCA) referred to our university hospital for [(68)Ga]PSMA-HBED-CC PET/CT.
  
  
  RESULTS
  PET/CT was positive in 44%, 79% and 89% of patients with PSA levels of ≤1, 1-2 and ≥2 ng/ml, respectively. Patients with high PSA levels showed higher rates of local prostate tumours (p < 0.001), and extrapelvic lymph node (p = 0.037) and bone metastases (p = 0.013). A shorter PSAdt was significantly associated with pelvic lymph node (p = 0.026), extrapelvic lymph node (p = 0.001), bone (p < 0.001) and visceral (p = 0.041) metastases. A high Gleason score was associated with more frequent pelvic lymph node metastases (p = 0.039). In multivariate analysis, both PSA and PSAdt were independent determinants of scan positivity and of extrapelvic lymph node metastases. PSAdt was the only independent marker of bone metastases (p = 0.001). Of 20 patients with a PSAdt <6 months and a PSA ≥2 ng/ml, 19 (95%) had a positive scan and 12 (60%) had M1a disease. Of 14 patients with PSA <1 ng/ml and PSAdt >6 months, only 5 (36%) had a positive scan and 1 (7%) had M1a disease.
  
  
  CONCLUSIONS
  [(68)Ga]PSMA-HBED-CC PET/CT will identify PCA lesions even in patients with very low PSA levels. Higher PSA levels and shorter PSAdt are independently associated with scan positivity and extrapelvic metastases, and can be used for patient selection for [(68)Ga]PSMA-HBED-CC PET/CT.
authors.affiliation: Department of Nuclear Medicine, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. fverburg@ukaachen.de.|Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. fverburg@ukaachen.de.
authors.forename: Frederik A
authors.initials: FA
authors.lastname: Verburg
authors.affiliation: Department of Urology, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Pfister
authors.affiliation: Department of Urology, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.affiliation: Department of Nuclear Medicine, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Vogg
authors.affiliation: Department of Nuclear Medicine, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: Natascha I
authors.initials: NI
authors.lastname: Drude
authors.affiliation: Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Vöö
authors.affiliation: Department of Nuclear Medicine, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.|Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.affiliation: Department of Nuclear Medicine, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: Florian F
authors.initials: FF
authors.lastname: Behrendt
mesh_terms: D000328:Adult; D000368:Aged; D000954:Antigens, Surface / Q000737:chemistry*; D004492:Edetic Acid / Q000031:analogs & derivatives / Q000737:chemistry; D005710:Gallium Radioisotopes / Q000737:chemistry*; D043425:Glutamate Carboxypeptidase II / Q000737:chemistry*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000954:Antigens, Surface; D005710:Gallium Radioisotopes; C075313:N,N'-bis(2-hydroxy-5-(ethylene-beta-carboxy)benzyl)ethylenediamine N,N'-diacetic acid; D004492:Edetic Acid; C473848:FOLH1 protein, human; D043425:Glutamate Carboxypeptidase II; D017430:Prostate-Specific Antigen
keywords: Gleason score; PSA; PSA doubling time; Prostate cancer; [68Ga]PSMA-HBED-CC PET/CT