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Initial Experience of 68Ga-PSMA PET/CT Imaging in High-risk Prostate Cancer Patients Prior to Radical Prostatectomy

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Budäus L., Leyh-Bannurah S.-R., Salomon G., Michl U., Heinzer H., Huland H., Graefen M., Steuber T., Rosenbaum C.

European Urology 2015

Prostate-specific membrane antigen (PSMA) overexpression theoretically enables targeting of prostate cancer (PCa) metastases using gallium Ga 68 (<sup>68</sup>Ga)-labeled PSMA ligands for positron emission tomography/computed tomography (PET/CT) imaging. Promising detection rates have been reported when using this approach for functional imaging of recurrent PCa; however, until now, the diagnostic accuracy of <sup>68</sup>Ga-PSMA PET/CT for preoperatively identifying lymph node metastases (LNMs) had not been assessed. We retrospectively compared preoperative <sup>68</sup>Ga-PSMA PET/CT lymph node (LN) findings with histologic work-up after radical prostatectomy (RP). Overall, 608 LNs containing 53 LNMs were detected during RP. LNMs were present in 12 of 30 patients (40%). The <sup>68</sup>Ga-PSMA PET/CT scans identified 4 patients (33.3%) as LN true positive and 8 patients (66.7%) as false negative. Median size of <sup>68</sup>Ga-PSMA-PET/CT-detected versus undetected LNMs was 13.6 versus 4.3mm (p <0.05). Overall sensitivity, specificity, positive predictive value, and negative predictive value of <sup>68</sup>Ga-PSMA PET/CT for LNM detection were 33.3%, 100%, 100%, and 69.2%, respectively. Per-side analyses revealed corresponding values of 27.3%, 100%, 100%, and 52.9%. Conversely, <sup>68</sup>Ga-PSMA PET/CT enabled tumor visualization in the prostate. In 92.9% of patients, the intraprostatic tumor foci were correctly predicted. Overall, <sup>68</sup>Ga-PSMA PET/CT is a promising tool for functional imaging; however, our initial experience revealed substantial influence of LNM size on the diagnostic accuracy of <sup>68</sup>Ga-PSMA PET/CT. Patient summary: We assessed the diagnostic accuracy of <sup>68</sup>Ga-PSMA PET/CT in high-risk prostate cancer patients prior to radical prostatectomy. We found that lymph node metastasis detection rates were substantially influenced by lymph node metastasis size. Prostate-specific membrane antigen (PSMA) overexpression enables targeting of prostate cancer (PCa) metastases using gallium Ga 68 (68Ga)-labeled PSMA ligands for positron emission tomography/computed tomography (PET/CT) imaging. In the setting of intial PCa staging, diagnostic accuracy of <sup>68</sup>Ga-PSMA PET/CT is substantially influenced by lymph node metastasis size.

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