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Title: | A Prospective, Multi-site, International Comparison of F-18 fluoro-methyl-choline, multi-parametric magnetic resonance and Ga-68 HBED-CC (PSMA-11) in men with High-Risk Features and Biochemical Failure after Radical Prostatectomy: Clinical Performance and Patient Outcomes. | Austin Authors: | Emmett, Louise;Metser, Ur;Bauman, Glenn;Hicks, Rodney J;Weickhardt, Andrew;Davis, Ian D;Punwani, Shonit;Pond, Gregory R;Chua, Sue Siew-Chen;Ho, Bao;Johnston, Edward;Pouliot, Frederic;Scott, Andrew M | Affiliation: | Université Laval, Canada University College London, United Kingdom Eastern Health, Australia Monash University and Eastern Health, Australia St Vincent's Hospital, Australia Austin Health, Heidelberg, Victoria, Australia University of Toronto, Canada McMaster University, Canada St Vincent's Hospital, Sydney, Australia Peter MacCallum Cancer Institute, Australia London Health Sciences Center, United Kingdom The Royal Marsden Hospital NHS Foundation Trust, United Kingdom University College, United Kingdom |
Issue Date: | 2019 | Date: | 2018-11-15 | Publication information: | Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2019; 60(6): 794-800 | Abstract: | Background: A significant proportion of men with rising PSA following radical prostatectomy (RP) fail prostate fossa salvage radiotherapy (SRT). This study assessed the ability of F18 fluoro-methyl-choline PET/CT(FCH), Ga-68 HBED-CC PSMA-11 PET/CT (PSMA) and pelvic multi-parametric magnetic resonance imaging (pelvic MRI) to identify men who will best benefit from SRT. Methods: Prospective, multisite, imaging study in men with rising PSA post RP, high-risk features (PSA > 0.2ng/mL and either Gleason Score (GS) > 7 or PSA doubling time <10 months, or PSA >1.0ng/mL) and negative /equivocal conventional imaging (CT and bone scan) being considered for SRT. FCH (91/91), Pelvic MRI (88/91) and PSMA (31/91) (Australia only) were performed within two weeks. Imaging was interpreted by experienced local and central reads blinded to other imaging results with consensus for discordance. Imaging results were validated using a composite reference standard. Expected management was documented pre and post- imaging, and all treatments, biopsies and PSA collected for 3 years. Treatment response to SRT was defined as > 50% PSA reduction without androgen deprivation therapy. Results: Median GS, PSA at imaging and PSA doubling time were 8, 0.42(IQR 0.29-0.93) ng/mL, and 5.0 (IQR 3.3-7.6) months, respectively. Overall recurrent PCa was detected in 28% (25/88) with pelvic MRI, 32% (29/91) FCH and 42% (13/31) PSMA. This was within the prostate fossa (PF) in 21.5% (19/88), 13% (12/91) and 19% (6/31), with extra PF sites in 8% (7/88), 19% (17/91), and 32% (10/31) for MRI, FCH and PSMA (< 0.004). 94% (16/17) extra- PF sites on FCH were within the field of view of pelvic MRI. The detection rate for intrapelvic extra-PF disease was 90% (9/10) for PSMA and 31% (5/16) for MRI compared to FCH. Imaging changed expected management in 46% (42/91) FCH, and 23% (21/88) MRI. PSMA provided additive management change over FCH in a further 23% (7/31). Treatment response to SRT was higher in men with negative or PF confined vs. extra PF disease. FCH 73% (32/44) vs. 33% (3/9) (p< 0.02), pelvic MRI 70% (32/46) vs 50% (2/4), P = ns) and PSMA 88% (7/8) vs. 14% (1/7) (p<0.005). Men with negative imging (MRI, FCH +/- PSMA) had high (78%) response rates to SRT. Conclusion: FCH and PSMA had high detection rates for extra PF disease in men with negative/equivocal conventional imaging and BCR post RP. This impacted management and treatment responses to SRT, suggesting an important role for PET in triaging men being considered for curative SRT. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/19812 | DOI: | 10.2967/jnumed.118.220103 | ORCID: | 0000-0002-6656-295X | Journal: | Journal of nuclear medicine : official publication, Society of Nuclear Medicine | PubMed URL: | 30442757 | Type: | Journal Article | Subjects: | Fluoromethyl-choline MRI Molecular Imaging Oncology: GU PET PSMA Prostate cancer biochemical recurrence |
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