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Diagnostic Accuracy of 64Copper Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Primary Lymph Node Staging of Intermediate- to High-risk Prostate Cancer: Our Preliminary Experience

      Objective

      To assess the diagnostic accuracy of 64Copper prostate-specific membrane antigen (64Cu-PSMA) positron emission tomography/computed tomography (PET/CT) in the primary lymph node (LN) staging of a selected cohort of intermediate- to high-risk prostate cancer (PCa) patients.

      Materials and Methods

      An observational prospective study was performed in 23 patients with intermediate- to high-risk PCa, who underwent 64Cu-PSMA PET/CT for local and lymph nodal staging before laparoscopic radical prostatectomy with an extended pelvic LN dissection.
      The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for LN status of 64Cu-PSMA PET/CT were calculated using the final pathological findings as reference. Furthermore, we evaluated the correlation of intraprostatic tumor extent and grading with 64Cu-PSMA intraprostatic distribution.

      Results

      Pathological analysis of LN involvement in 413 LNs harvested from our study cohort identified a total of 22 LN metastases in 8 (5%) of the 23 (35%) PCa patients. Imaging-based LN staging in a per-patient analysis showed that 64Cu-PSMA PET/CT was positive in 7 of 8 LN-positive patients (22%) with a sensitivity of 87.5%, specificity of 100%, PPV of 100%, and NPV of 93.7%, considering the maximum standardized uptake value (SUVmax) at 4 hours as our reference. Receiver operating characteristic curve was characterized by an area under the curve of 0.938.
      A significant positive association was observed between SUVmax at 4 hours with Gleason score, index, and cumulative tumor volume.

      Conclusion

      In our intermediate- to high-risk PCa patients study cohort, we showed the high diagnostic accuracy of 64Cu-PSMA PET/CT for primary LN staging before radical prostatectomy.
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      References

        • Perera M.
        • Papa N.
        • Christidis D.
        • et al.
        Sensitivity, specificity, and predictors of positive 68Ga–prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis.
        Eur Urol. 2016; 70: 926-937
        • Briganti A.
        • Larcher A.
        • Abdollah F.
        • et al.
        Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores.
        Eur Urol. 2012; 6: 480-487
        • Rowe S.P.
        • Gorin M.A.
        • Allaf M.E.
        • et al.
        PET imaging of prostate-specific membrane antigen in prostate cancer: current state of the art and future challenges.
        Prostate Cancer Prostatic Dis. 2016; 19: 223-230
        • Evangelista L.
        • Briganti A.
        • Fanti S.
        • et al.
        New clinical indications for 18F/11C-choline, new tracers for positron emission tomography and a promising hybrid device for prostate cancer staging: a systematic review of the literature.
        Eur Urol. 2016; 70: 161-175
        • Rai B.P.
        • Baum R.P.
        • Patel A.
        • et al.
        The role of positron emission tomography with 68Gallium (Ga)-labeled prostate-specific membrane antigen (PSMA) in the management of patients with organ-confined and locally advanced prostate cancer prior to radical treatment and after radical prostatectomy.
        Urology. 2016; 95: 11-15
        • Afshar-Oromieh A.
        • Malcher A.
        • Eder M.
        • et al.
        PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions.
        Eur J Nucl Med Mol Imaging. 2013; 40: 486-495
        • Afshar-Oromieh A.
        • Zechmann C.M.
        • Malcher A.
        • et al.
        Comparison of PET imaging with a 68Ga-labelled PSMA ligand and 18F-choline-based PET/CT for the diagnosis of recurrent prostate cancer.
        Eur J Nucl Med Mol Imaging. 2014; 41: 11-20
        • Morigi J.J.
        • Stricker P.D.
        • Van Leeuwen P.J.
        • et al.
        Prospective comparison of fluoromethylcholine versus Ga-PSMA PET/CT in prostate cancer patients who have rising PSA after curative treatment and are being considered for targeted therapy.
        J Nucl Med. 2015; 56: 1185-1190
        • Sweat S.D.
        • Pacelli A.
        • Murphy G.P.
        • Bostwick D.G.
        Prostate-specific membrane antigen expression is greatest in prostate adenocarcinoma and lymph node metastases.
        Urology. 1998; 52: 637-640
        • Budäus L.
        • Leyh-Bannurah S.
        • Salomon G.
        • et al.
        Initial experience of 68Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy.
        Eur Urol. 2016; 69: 393-396
        • Lütje S.
        • Heskamp S.
        • Cornelissen A.S.
        • et al.
        PSMA ligands for radionuclide imaging and therapy of prostate cancer: clinical status.
        Theranostics. 2015; 5: 1388-1401
        • Nedrow J.R.
        • Latoche J.D.
        • Day K.E.
        • et al.
        Targeting PSMA with a Cu-64 labeled phosphoramidate inhibitor for PET/CT imaging of variant PSMA-expressing xenografts in mouse models of prostate cancer.
        Mol Imaging Biol. 2016; 18: 402-410
        • Evangelista L.
        • Luigi M.
        • Cascini G.L.
        New issues for copper-64: from precursor to innovative PET tracers in clinical oncology.
        Curr Radiopharm. 2013; 6: 117-123
        • Niccoli Asabella A.
        • Cascini G.L.
        • Altini C.
        • Paparella D.
        • Notaristefano A.
        • Rubini G.
        The copper radioisotopes: a systematic review with special interest to 64Cu.
        Biomed Res Int. 2014; 2014: 786463
        • Capasso E.
        • Durzu S.
        • Piras S.
        • et al.
        Role of CuCl2 PET/CT in staging of prostate cancer.
        Ann Nucl Med. 2015; 29: 482-488
        • D'Amico A.V.
        • Whittington R.
        • Bruce Malkowicz S.
        • et al.
        Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer.
        J Am Med Assoc. 1998; 280: 969-974
        • Grubmüller B.
        • Baum R.P.
        • Capasso E.
        • et al.
        64Cu-PSMA-617 PET/CT imaging of prostate adenocarcinoma: first in-human studies.
        Cancer Biother Radiopharm. 2016; 31: 277-286
        • Van Der Kwast T.H.
        • Amin M.B.
        • Billis A.
        • et al.
        International society of urological pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens. Working group 2: T2 substaging and prostate cancer volume.
        Mod Pathol. 2011; 24: 16-25
        • Epstein J.I.
        • Allsbrook Jr, W.C.
        • Amin M.B.
        • et al.
        The 2005 international society of urological pathology (ISUP) consensus conference on GS grading of prostatic carcinoma.
        Am J Surg Pathol. 2005; 29: 1228-1242
        • Chen M.E.
        • Johnston D.
        • Reyes A.O.
        • Soto C.P.
        • Babaian R.J.
        • Troncoso P.
        A streamlined three-dimensional volume estimation method accurately classifies prostate tumors by volume.
        Am J Surg Pathol. 2003; 27: 1291-1301
        • Abdollah F.
        • Sun M.
        • Suardi N.
        • et al.
        National Comprehensive Cancer Network practice guidelines 2011: need for more accurate recommendations for pelvic lymph node dissection in prostate cancer.
        J Urol. 2012; 188: 423-428
        • Joniau S.
        • Van Den Bergh L.
        • Lerut E.
        • et al.
        Mapping of pelvic lymph node metastases in prostate cancer.
        Eur Urol. 2013; 63: 450-458
        • Hövels A.M.
        • Heesakkers R.A.M.
        • Adang E.M.
        • et al.
        The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis.
        Clin Radiol. 2008; 63: 387-395
        • Umbehr M.H.
        • Müntener M.
        • Hany T.
        • Sulser T.
        • Bachmann L.M.
        The role of 11C-choline and 18F-fluorocholine positron emission tomography (PET) and PET/CT in prostate cancer: a systematic review and meta-analysis.
        Eur Urol. 2013; 64: 106-117
        • Evangelista L.
        • Guttilla A.
        • Zattoni F.
        • Muzzio P.C.
        • Zattoni F.
        Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: a systematic literature review and meta-analysis.
        Eur Urol. 2013; 63: 1040-1048
        • European Association of Urology
        Guidelines on prostate cancer.
        2016
        • Maurer T.
        • Gschwend J.E.
        • Rauscher I.
        • et al.
        Diagnostic efficacy of 68Gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer.
        J Urol. 2016; 195: 1436-1442
        • Herlemann A.
        • Wenter V.
        • Kretschmer A.
        • et al.
        68Ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer.
        Eur Urol. 2016; 70: 553-557
        • Harisinghani M.G.
        • Barentsz J.
        • Hahn P.F.
        • et al.
        Noninvasive detection of clinically occult lymph-node metastases in prostate cancer.
        N Engl J Med. 2003; 348: 2491-2499
        • Rahbar K.
        • Weckesser M.
        • Huss S.
        • et al.
        Correlation of intraprostatic tumor extent with 68Ga-PSMA distribution in patients with prostate cancer.
        J Nucl Med. 2016; 57: 563-567