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Interobserver variability, detection rate, and lesion patterns of 68Ga-PSMA-11-PET/CT in early-stage biochemical recurrence of prostate cancer after radical prostatectomy

European journal of nuclear medicine and molecular imaging, 2020-09, Vol.47 (10), p.2339-2347 [Peer Reviewed Journal]

The Author(s) 2020 ;The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;ISSN: 1619-7070 ;EISSN: 1619-7089 ;DOI: 10.1007/s00259-020-04718-w ;PMID: 32157427

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  • Title:
    Interobserver variability, detection rate, and lesion patterns of 68Ga-PSMA-11-PET/CT in early-stage biochemical recurrence of prostate cancer after radical prostatectomy
  • Author: Miksch, Jonathan ; Bottke, Dirk ; Krohn, Thomas ; Thamm, Reinhard ; Bartkowiak, Detlef ; Solbach, Christoph ; Bolenz, Christian ; Beer, Meinrad ; Wiegel, Thomas ; Beer, Ambros J. ; Prasad, Vikas
  • Subjects: Biochemistry ; Bone lesions ; Cancer surgery ; Cardiology ; Computed tomography ; Diagnostic systems ; Health services ; Imaging ; Lesions ; Lymph nodes ; Lymphatic system ; Medicine ; Medicine & Public Health ; Metastases ; Nodes ; Nuclear Medicine ; Oncology ; Oncology – Genitourinary ; Original ; Original Article ; Orthopedics ; Patients ; Physicians ; Prostate cancer ; Prostatectomy ; Radiation therapy ; Radiology ; Subgroups ; Urological surgery
  • Is Part Of: European journal of nuclear medicine and molecular imaging, 2020-09, Vol.47 (10), p.2339-2347
  • Description: Purpose 68 Ga-PSMA-11-PET/CT is increasingly used in early-stage biochemical recurrence of prostate cancer to detect potential lesions for an individualized radiotherapy concept. However, subtle findings especially concerning small local recurrences can still be challenging to interpret and are prone to variability between different readers. Thus, we analyzed interobserver variability, detection rate, and lesion patterns systematically in a homogeneous patient population with low-level biochemical recurrence. Methods We analyzed 68 Ga-PSMA-11-PET/CTs in 116 patients with status post-prostatectomy and PSA levels up to 0.6 ng/ml. None of them received ADT or radiotherapy beforehand. Images were interpreted and blinded by two nuclear medicine physicians (R1 and R2). Findings were rated using a 5-point scale concerning local recurrence, lymph nodes, bone lesions, and other findings (1: definitely benign, 2: probably benign, 3: equivocal, 4: probably malignant, 5: definitely malignant). In findings with substantial discrepancies of 2 or more categories and/or potentially leading to differences in further patient management, a consensus reading was done with a third reader (R3). Interobserver agreement was measured by Cohens Kappa analysis after sub-categorizing our classification system to benign (1 + 2), equivocal (3), and malignant (4 + 5). Time course of PSA levels after salvage treatment of patients rated as positive (4 + 5) was analyzed. Results The overall detection rate (categories 4 and 5) was 50% (R1/R2, 49%/51%) and in the PSA subgroups 0–0.2 ng/ml, 0.21–0.3 ng/ml, and 0.31–0.6 ng/ml 24%/27%, 57%/57%, and 65%/68%, respectively. Local recurrence was the most common lesion manifestation followed by lymphatic and bone metastases. The overall agreement in the Cohens Kappa analysis was 0.74 between R1 and R2. For local, lymphatic, and bone sites, the agreement was 0.76, 0.73, and 0.58, respectively. PSA levels of PSMA PET/CT-positive patients after salvage treatment decreased in 75% (27/36) and increased in 25% (9/36). A decrease of PSA, although more frequent in patients with imaging suggesting only local tumor recurrence (86%, 18/21), was also observed in 67% (10/15) of patients with findings of metastatic disease. Conclusions In a highly homogeneous group of prostate cancer patients with early-stage biochemical recurrence after radical prostatectomy, we could show that 68 Ga-PSMA-11-PET/CT has a good detection rate of 50% which is in accordance with literature, with clinically relevant findings even in patients with PSA < 0.21 ng/ml. The interobserver variability is low, particularly concerning assessment of local recurrences and lymph nodes. Therefore, PSMA-PET/CT is a robust diagnostic modality in this patient group for therapy planning.
  • Publisher: Berlin/Heidelberg: Springer Berlin Heidelberg
  • Language: English
  • Identifier: ISSN: 1619-7070
    EISSN: 1619-7089
    DOI: 10.1007/s00259-020-04718-w
    PMID: 32157427
  • Source: Springer OA刊
    ProQuest Central
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