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Eur J Nucl Med Mol Imaging. 2018 Nov;45(12):2045-2054. doi: 10.1007/s00259-018-4079-z. Epub 2018 Jul 7.

Impact of long-term androgen deprivation therapy on PSMA ligand PET/CT in patients with castration-sensitive prostate cancer.

Author information

1
Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany. a.afshar@gmx.de.
2
Department of Nuclear Medicine, Bern University Hospital, Freiburgstrasse 18, 3010, Bern, Switzerland. a.afshar@gmx.de.
3
Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.
4
Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
5
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.
6
Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California, USA.
7
Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany.
8
Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany.
9
German Cancer Consortium (DKTK), Heidelberg, Germany.
10
Department of Urology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany.
11
Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Centre, Heidelberg, Germany.

Abstract

PURPOSE:

Since the introduction of PSMA PET/CT with 68Ga-PSMA-11, this modality for imaging prostate cancer (PC) has spread worldwide. Preclinical studies have demonstrated that short-term androgen deprivation therapy (ADT) can significantly increase PSMA expression on PC cells. Additionally, retrospective clinical data in large patient cohorts suggest a positive association between ongoing ADT and a pathological PSMA PET/CT scan. The present evaluation was conducted to further analyse the influence of long-term ADT on PSMA PET/CT findings.

METHODS:

A retrospective analysis was performed of all 1,704 patients who underwent a 68Ga-PSMA-11 PET/CT scan at our institution from 2011 to 2017 to detect PC. Of 306 patients scanned at least twice, 10 had started and continued ADT with a continuous clinical response between the two PSMA PET/CT scans. These ten patients were included in the current analysis which compared the tracer uptake intensity and volume of PC lesions on PSMA PET/CT before and during ongoing ADT.

RESULTS:

Overall, 31 PC lesions were visible in all ten patients before initiation of ADT. However, during ongoing ADT (duration 42-369 days, median 230 days), only 14 lesions were visible in eight of the ten patients. The average tracer uptake values decreased in 71% and increased in 12.9% of the PC lesions. Of all lesions, 33.3% were still visible in six patients with a complete PSA response (≤0.1 ng/ml).

CONCLUSION:

Continuous long-term ADT significantly reduces the visibility of castration-sensitive PC on PSMA PET/CT. If the objective is visualization of the maximum possible extent of disease, we recommend referring patients for PSMA PET/CT before starting ADT.

KEYWORDS:

68Ga-PSMA-11; Androgen deprivation therapy; PET/CT; PSMA; Prostate cancer; Prostate-specific membrane antigen

PMID:
29980832
PMCID:
PMC6182397
DOI:
10.1007/s00259-018-4079-z
[Indexed for MEDLINE]
Free PMC Article

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