title: Diagnostic Efficacy of (68)Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer.
abstract: OBJECTIVE
  Current standard imaging techniques are insufficient to reliably detect lymph node metastases in prostate cancer. Recently ligands of PSMA (prostate specific membrane antigen) were introduced in PET (positron emission tomography) of prostate cancer. Thus the aims of this retrospective analysis were to 1) investigate the diagnostic efficacy of (68)Ga-PSMA-PET imaging for lymph node staging in patients with prostate cancer scheduled for radical prostatectomy and 2) compare it to morphological imaging (computerized tomography and magnetic resonance tomography) with histopathological evaluation as the standard of reference.
  
  
  METHODS
  A total of 130 patients with intermediate to high risk prostate cancer were staged with (68)Ga-PSMA-PET/magnetic resonance tomography or PET/computerized tomography from December 2012 to November 2014 before radical prostatectomy and template pelvic lymph node dissection. Histopathological findings of resected tissue were statistically correlated with the results of (68)Ga-PSMA-PET and morphological imaging in a patient and template based manner.
  
  
  RESULTS
  Lymph node metastases were found in 41 of 130 patients (31.5%). On patient based analysis the sensitivity, specificity and accuracy of (68)Ga-PSMA-PET were 65.9%, 98.9% and 88.5%, and those of morphological imaging were 43.9%, 85.4% and 72.3%, respectively. Of 734 dissected lymph node templates 117 (15.9%) showed metastases. On template based analysis the sensitivity, specificity and accuracy of (68)Ga-PSMA-PET were 68.3%, 99.1% and 95.2%, and those of morphological imaging were 27.3%, 97.1% and 87.6%, respectively. On ROC analysis (68)Ga-PSMA-PET performed significantly better than morphological imaging alone on patient and template based analyses (p = 0.002 and <0.001, respectively).
  
  
  CONCLUSIONS
  In patients with intermediate to high risk prostate cancer preoperative lymph node staging with (68)Ga-PSMA-PET proved to be superior to standard routine imaging. Thus it has the potential to replace current standard imaging for this indication if confirmed by prospective studies.
authors.affiliation: Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany. Electronic address: t.maurer@tum.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Maurer
authors.affiliation: Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Jürgen E
authors.initials: JE
authors.lastname: Gschwend
authors.affiliation: Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Rauscher
authors.affiliation: Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Souvatzoglou
authors.affiliation: Institute of Medical Statistics and Epidemiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haller
authors.affiliation: Institute of Pathology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Weirich
authors.affiliation: Department of Pharmaceutical Radiochemistry, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Wester
authors.affiliation: Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Heck
authors.affiliation: Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Kübler
authors.affiliation: Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany; Department of Nuclear Medicine, University of Ulm, Ulm, Germany.
authors.forename: Ambros J
authors.initials: AJ
authors.lastname: Beer
authors.affiliation: Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Schwaiger
authors.affiliation: Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Eiber
mesh_terms: D000368:Aged; D005029:Ethylenediamines / Q000494:pharmacology*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D009942:Organometallic Compounds / Q000494:pharmacology*; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000556:secondary; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors
chemical_list: D005029:Ethylenediamines; D009942:Organometallic Compounds; C081867:gallium bis(4,6-dimethoxy)salicylaldimine N,N'-bis(3-aminopropyl)ethylenediamine
keywords: glutamate carboxypeptidase II, human; lymph nodes; neoplasm staging; positron-emission tomography; prostatic neoplasms