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Vol. 45. Issue 5.
Pages 353-358 (June 2021)
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Vol. 45. Issue 5.
Pages 353-358 (June 2021)
Original article
68Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use
68Ga-PSMA-11 PET/TC en la recidiva bioquímica oculta del carcinoma de próstata, con 18F-Colina PET/TC negativa. Valoración preliminar de su uso clínico
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P.J. Plaza Lópeza,
Corresponding author
pedro.plaza@quironsalud.es

Corresponding author.
, E. Puertasb, J.J. Aguilóc, M. Suarez-Piñerad, B. Domenecha, A. Mestre-Fuscod, J. Casalsb, J.R. Chicharo de Fleitase
a Servicio de Medicina Nuclear, Hospital Quironsalud Barcelona, Barcelona, Spain
b Servicio de Radioterapia, Hospital Quironsalud Barcelona, Barcelona, Spain
c Servicio de Urología, Hospital Quironsalud Barcelona, Barcelona, Spain
d Servicio de Medicina Nuclear, Hospital del Mar, Barcelona, Spain
e Unidad de Imagen Molecular, CIMES-FGUMA, Málaga, Spain
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Table 1. Patient characteristics and 18F-Choline PET/CT and 68Ga-PSMA-11 results.
Abstract
Objective

To assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18 F-Choline PET/CT imaging studies.

Material and methods

Retrospective descriptive study. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (<3 ng/mL) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT.

All patients were referred to 68 Ga-PSMA-11 PET/CT. Protocol: Dose 2.2 M Bq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 h if needed.

Results

The 68 Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them.

Four patients (28.5%) obtained a negative or inconclusive 68 Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/mL).

One of the 68 Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy.

Conclusion

68 Ga-PSMA-11 PET/CT allows an early diagnosis, with low PSA values, of occult biochemical recurrence of prostate carcinoma, even in patients with negative 18 F-Choline PET/CT.

Keywords:
PSMA
PET/CT
Prostate cancer
Resumen
Objetivo

Valorar la utilidad de los estudios PET/TC 68Ga-PSMA en la práctica clínica de los pacientes con recidiva bioquímica oculta de carcinoma de próstata, con estudios de imagen radiológicos y PET/TC 18F-Colina negativos o no concluyentes.

Material y métodos

Estudio descriptivo retrospectivo. Se seleccionaron los primeros 14 pacientes con antecedentes de carcinoma de próstata, tratados con intención curativa y que presentaban sospecha de recidiva bioquímica con valores bajos de PSA (<3 ng/mL). Los estudios de imagen, ecografía prostática, TC y/o RM pélvica eran negativos, y todos ellos tenían un PET/TC 18F-Colina negativo o no concluyente. Se derivó a todos los pacientes para realizarse un 68 Ga-PSMA-11PET/TC. Protocolo: Dosis 2.2 M Bq/Kg. 20 mg de furosemida en el minuto 0. Imágenes PET/TC desde calota craneal hasta tercio proximal de muslos a los 60 min, e imágenes tardías a las 3 horas si precisara.

Resultados

: En 9 de los 14 pacientes (64.2%) el 68 Ga-PSMA-11PET/TC consiguió localizar la recidiva bioquímica oculta, y en todos ellos hubo cambios en la actitud terapéutica. En 4 de los 14 pacientes (28.5%) el 68 Ga-PSMA-11PET/TC resultó negativo o no concluyente, se prosiguió con la actitud vigilante con controles de PSA y estudios de imagen según los protocolos habituales. Estos pacientes presentaban los valores más bajos de PSA (inferiores a 1 ng/mL). Uno de los estudios 68 Ga-PSMA-11PET/TC fue no concluyente, informándose la presencia de una dudosa adenopatía iliaca derecha.

Conclusión

El 68 Ga-PSMA-11PET/TC permite un diagnóstico precoz, con valores bajos de PSA, de la recidiva bioquímica oculta del carcinoma de próstata, incluso en pacientes con 18F-Colina PET/TC negativos.

Palabras clave:
PSMA
PET/TC
Prostate cancer

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