The Management Impact of 68Gallium-Tris(Hydroxypyridinone) Prostate Specific Membrane Antigen (68Ga-THP-PSMA) PET-CT Imaging for High-Risk and Biochemically Recurrent Prostate Cancer

Meghana Kulkarni; Simon Hughes; Andrew Mallia; Victoria Gibson; Jennifer Young; Ajay Aggarwal; Stephen Morris; Ben Challacombe; Rick Popert; Christian Brown; Paul Cathcart; Prokar Dasgupta; Victoria S. Warbey; Gary J.R. Cook

doi:10.1007/s00259-019-04643-7

The Management Impact of ⁶⁸Gallium-Tris(Hydroxypyridinone) Prostate Specific Membrane Antigen (68Ga-THP-PSMA) PET-CT Imaging for High-Risk and Biochemically Recurrent Prostate Cancer

Meghana Kulkarni^*, Simon Hughes, Andrew Mallia, Victoria Gibson, Jennifer Young, Ajay Aggarwal, Stephen Morris, Ben Challacombe, Rick Popert, Christian Brown, Paul Cathcart, Prokar Dasgupta, Victoria S. Warbey, Gary J.R. Cook

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Purpose: To determine the impact on clinical management of patients with high-risk (HR) prostate cancer at diagnosis and patients with biochemical recurrence (BCR) using a new kit form of ⁶⁸Ga-prostate-specific membrane antigen (PSMA), namely tris(hydroxypyridinone) (THP)-PSMA, with positron emission tomography-computed tomography (PET-CT). Methods: One hundred eighteen consecutive patients (50 HR, 68 BCR) had management plans documented at a multidisciplinary meeting before ⁶⁸Ga-THP-PSMA PET-CT. Patients underwent PET-CT scans 60-min post-injection of ⁶⁸Ga-THP-PSMA (mean 159 ± 21.2 MBq). Post-scan management plans, Gleason score, prostate-specific antigen (PSA) and PSA doubling time (PSAdt) were recorded. Results: HR group: 12/50 (24%) patients had management changed (9 inter-modality, 3 intra-modality). Patients with PSA < 20 μg/L had more frequent management changes (9/26, 34.6%) compared with PSA > 20 μg/L (3/24, 12.5%). Gleason scores > 8 were associated with detection of more nodal (4/16, 25% vs 5/31, 16.1%) and bone (2/16, 12.5% vs 2/31, 6.5%) metastases. BCR group: Clinical management changed in 23/68 (34%) patients (17 inter-modality, 6 intra-modality). Forty out of 68 (59%) scans were positive. Positivity rate increased with PSA level (PSA < 0.5 μg/L, 0%; PSA 0.5–1.0 μg/L, 35%; PSA 1.0–5.0 μg/L, 69%; PSA 5.0–10.0 μg/L, 91%), PSAdt of < 6 months (56% vs 45.7%) and Gleason score > 8 (78.9% vs 51.2%). Conclusions: ⁶⁸Ga-THP-PSMA PET-CT influences clinical management in significant numbers of patient with HR prostate cancer pre-radical treatment and is associated with PSA. Management change also occurs in patients with BCR and is associated with PSA and Gleason score, despite lower scan positivity rates at low PSA levels < 0.5 μg/L.

Original language	English
Pages (from-to)	674–686
Number of pages	13
Journal	European Journal of Nuclear Medicine and Molecular Imaging
Volume	47
Issue number	3
Early online date	23 Dec 2019
DOIs	https://doi.org/10.1007/s00259-019-04643-7
Publication status	Published - Mar 2020

Keywords

Ga-THP-PSMA
Management impact
PSMA-PET-CT
Prostate cancer
Prostate-specific membrane antigen

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Kulkarni, M., Hughes, S., Mallia, A., Gibson, V., Young, J., Aggarwal, A., Morris, S., Challacombe, B., Popert, R., Brown, C., Cathcart, P., Dasgupta, P., Warbey, V. S., & Cook, G. J. R. (2020). The Management Impact of ⁶⁸Gallium-Tris(Hydroxypyridinone) Prostate Specific Membrane Antigen (68Ga-THP-PSMA) PET-CT Imaging for High-Risk and Biochemically Recurrent Prostate Cancer. European Journal of Nuclear Medicine and Molecular Imaging, 47(3), 674–686. https://doi.org/10.1007/s00259-019-04643-7

@article{4ffee528fa734ebeaf71e59b06949402,

title = "The Management Impact of 68Gallium-Tris(Hydroxypyridinone) Prostate Specific Membrane Antigen (68Ga-THP-PSMA) PET-CT Imaging for High-Risk and Biochemically Recurrent Prostate Cancer",

abstract = "Purpose: To determine the impact on clinical management of patients with high-risk (HR) prostate cancer at diagnosis and patients with biochemical recurrence (BCR) using a new kit form of 68Ga-prostate-specific membrane antigen (PSMA), namely tris(hydroxypyridinone) (THP)-PSMA, with positron emission tomography-computed tomography (PET-CT). Methods: One hundred eighteen consecutive patients (50 HR, 68 BCR) had management plans documented at a multidisciplinary meeting before 68Ga-THP-PSMA PET-CT. Patients underwent PET-CT scans 60-min post-injection of 68Ga-THP-PSMA (mean 159 ± 21.2 MBq). Post-scan management plans, Gleason score, prostate-specific antigen (PSA) and PSA doubling time (PSAdt) were recorded. Results: HR group: 12/50 (24%) patients had management changed (9 inter-modality, 3 intra-modality). Patients with PSA < 20 μg/L had more frequent management changes (9/26, 34.6%) compared with PSA > 20 μg/L (3/24, 12.5%). Gleason scores > 8 were associated with detection of more nodal (4/16, 25% vs 5/31, 16.1%) and bone (2/16, 12.5% vs 2/31, 6.5%) metastases. BCR group: Clinical management changed in 23/68 (34%) patients (17 inter-modality, 6 intra-modality). Forty out of 68 (59%) scans were positive. Positivity rate increased with PSA level (PSA < 0.5 μg/L, 0%; PSA 0.5–1.0 μg/L, 35%; PSA 1.0–5.0 μg/L, 69%; PSA 5.0–10.0 μg/L, 91%), PSAdt of < 6 months (56% vs 45.7%) and Gleason score > 8 (78.9% vs 51.2%). Conclusions: 68Ga-THP-PSMA PET-CT influences clinical management in significant numbers of patient with HR prostate cancer pre-radical treatment and is associated with PSA. Management change also occurs in patients with BCR and is associated with PSA and Gleason score, despite lower scan positivity rates at low PSA levels < 0.5 μg/L. ",

keywords = "Ga-THP-PSMA, Management impact, PSMA-PET-CT, Prostate cancer, Prostate-specific membrane antigen",

author = "Meghana Kulkarni and Simon Hughes and Andrew Mallia and Victoria Gibson and Jennifer Young and Ajay Aggarwal and Stephen Morris and Ben Challacombe and Rick Popert and Christian Brown and Paul Cathcart and Prokar Dasgupta and Warbey, {Victoria S.} and Cook, {Gary J.R.}",

year = "2020",

month = mar,

doi = "10.1007/s00259-019-04643-7",

language = "English",

volume = "47",

pages = "674–686",

journal = "European Journal of Nuclear Medicine and Molecular Imaging",

issn = "1619-7070",

publisher = "SPRINGER",

number = "3",

}

Kulkarni, M, Hughes, S, Mallia, A, Gibson, V, Young, J, Aggarwal, A, Morris, S, Challacombe, B, Popert, R, Brown, C, Cathcart, P, Dasgupta, P , Warbey, VS & Cook, GJR 2020, 'The Management Impact of ⁶⁸Gallium-Tris(Hydroxypyridinone) Prostate Specific Membrane Antigen (68Ga-THP-PSMA) PET-CT Imaging for High-Risk and Biochemically Recurrent Prostate Cancer', European Journal of Nuclear Medicine and Molecular Imaging, vol. 47, no. 3, pp. 674–686. https://doi.org/10.1007/s00259-019-04643-7

The Management Impact of ⁶⁸Gallium-Tris(Hydroxypyridinone) Prostate Specific Membrane Antigen (68Ga-THP-PSMA) PET-CT Imaging for High-Risk and Biochemically Recurrent Prostate Cancer. / Kulkarni, Meghana; Hughes, Simon; Mallia, Andrew et al.
In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 47, No. 3, 03.2020, p. 674–686.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The Management Impact of 68Gallium-Tris(Hydroxypyridinone) Prostate Specific Membrane Antigen (68Ga-THP-PSMA) PET-CT Imaging for High-Risk and Biochemically Recurrent Prostate Cancer

AU - Kulkarni, Meghana

AU - Hughes, Simon

AU - Mallia, Andrew

AU - Gibson, Victoria

AU - Young, Jennifer

AU - Aggarwal, Ajay

AU - Morris, Stephen

AU - Challacombe, Ben

AU - Popert, Rick

AU - Brown, Christian

AU - Cathcart, Paul

AU - Dasgupta, Prokar

AU - Warbey, Victoria S.

AU - Cook, Gary J.R.

PY - 2020/3

Y1 - 2020/3

N2 - Purpose: To determine the impact on clinical management of patients with high-risk (HR) prostate cancer at diagnosis and patients with biochemical recurrence (BCR) using a new kit form of 68Ga-prostate-specific membrane antigen (PSMA), namely tris(hydroxypyridinone) (THP)-PSMA, with positron emission tomography-computed tomography (PET-CT). Methods: One hundred eighteen consecutive patients (50 HR, 68 BCR) had management plans documented at a multidisciplinary meeting before 68Ga-THP-PSMA PET-CT. Patients underwent PET-CT scans 60-min post-injection of 68Ga-THP-PSMA (mean 159 ± 21.2 MBq). Post-scan management plans, Gleason score, prostate-specific antigen (PSA) and PSA doubling time (PSAdt) were recorded. Results: HR group: 12/50 (24%) patients had management changed (9 inter-modality, 3 intra-modality). Patients with PSA < 20 μg/L had more frequent management changes (9/26, 34.6%) compared with PSA > 20 μg/L (3/24, 12.5%). Gleason scores > 8 were associated with detection of more nodal (4/16, 25% vs 5/31, 16.1%) and bone (2/16, 12.5% vs 2/31, 6.5%) metastases. BCR group: Clinical management changed in 23/68 (34%) patients (17 inter-modality, 6 intra-modality). Forty out of 68 (59%) scans were positive. Positivity rate increased with PSA level (PSA < 0.5 μg/L, 0%; PSA 0.5–1.0 μg/L, 35%; PSA 1.0–5.0 μg/L, 69%; PSA 5.0–10.0 μg/L, 91%), PSAdt of < 6 months (56% vs 45.7%) and Gleason score > 8 (78.9% vs 51.2%). Conclusions: 68Ga-THP-PSMA PET-CT influences clinical management in significant numbers of patient with HR prostate cancer pre-radical treatment and is associated with PSA. Management change also occurs in patients with BCR and is associated with PSA and Gleason score, despite lower scan positivity rates at low PSA levels < 0.5 μg/L.

AB - Purpose: To determine the impact on clinical management of patients with high-risk (HR) prostate cancer at diagnosis and patients with biochemical recurrence (BCR) using a new kit form of 68Ga-prostate-specific membrane antigen (PSMA), namely tris(hydroxypyridinone) (THP)-PSMA, with positron emission tomography-computed tomography (PET-CT). Methods: One hundred eighteen consecutive patients (50 HR, 68 BCR) had management plans documented at a multidisciplinary meeting before 68Ga-THP-PSMA PET-CT. Patients underwent PET-CT scans 60-min post-injection of 68Ga-THP-PSMA (mean 159 ± 21.2 MBq). Post-scan management plans, Gleason score, prostate-specific antigen (PSA) and PSA doubling time (PSAdt) were recorded. Results: HR group: 12/50 (24%) patients had management changed (9 inter-modality, 3 intra-modality). Patients with PSA < 20 μg/L had more frequent management changes (9/26, 34.6%) compared with PSA > 20 μg/L (3/24, 12.5%). Gleason scores > 8 were associated with detection of more nodal (4/16, 25% vs 5/31, 16.1%) and bone (2/16, 12.5% vs 2/31, 6.5%) metastases. BCR group: Clinical management changed in 23/68 (34%) patients (17 inter-modality, 6 intra-modality). Forty out of 68 (59%) scans were positive. Positivity rate increased with PSA level (PSA < 0.5 μg/L, 0%; PSA 0.5–1.0 μg/L, 35%; PSA 1.0–5.0 μg/L, 69%; PSA 5.0–10.0 μg/L, 91%), PSAdt of < 6 months (56% vs 45.7%) and Gleason score > 8 (78.9% vs 51.2%). Conclusions: 68Ga-THP-PSMA PET-CT influences clinical management in significant numbers of patient with HR prostate cancer pre-radical treatment and is associated with PSA. Management change also occurs in patients with BCR and is associated with PSA and Gleason score, despite lower scan positivity rates at low PSA levels < 0.5 μg/L.

KW - Ga-THP-PSMA

KW - Management impact

KW - PSMA-PET-CT

KW - Prostate cancer

KW - Prostate-specific membrane antigen

U2 - 10.1007/s00259-019-04643-7

DO - 10.1007/s00259-019-04643-7

M3 - Article

AN - SCOPUS:85077171365

SN - 1619-7070

VL - 47

SP - 674

EP - 686

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

IS - 3

ER -

Kulkarni M, Hughes S, Mallia A, Gibson V, Young J, Aggarwal A et al. The Management Impact of ⁶⁸Gallium-Tris(Hydroxypyridinone) Prostate Specific Membrane Antigen (68Ga-THP-PSMA) PET-CT Imaging for High-Risk and Biochemically Recurrent Prostate Cancer. European Journal of Nuclear Medicine and Molecular Imaging. 2020 Mar;47(3):674–686. Epub 2019 Dec 23. doi: 10.1007/s00259-019-04643-7