Prospective, multisite, international comparison of 18F-fluoromethylcholine PET/CT, multiparametric MRI, and 68Ga-HBED-CC PSMA-11 PET/CT in men with high-risk features and biochemical failure after radical prostatectomy

Clinical performance and patient outcomes

Louise Emmett, Ur Metser, Glenn Bauman, Rodney J. Hicks, Andrew Weickhardt, Ian D. Davis, Shonit Punwani, Greg Pond, Sue Chua, Bao Ho, Edward Johnston, Frederic Pouliot, Andrew M. Scott

Research output: Contribution to journalReview ArticleResearchpeer-review

2 Citations (Scopus)

Abstract

A significant proportion of men with rising prostate-specific antigen (PSA) levels after radical prostatectomy (RP) fail prostate fossa (PF) salvage radiation treatment (SRT). This study was done to assess the ability of 18F-fluoromethylcholine (18F-FCH) PET/CT (hereafter referred to as 18F-FCH), 68Ga-HBED-CC PSMA-11 PET/CT (hereafter referred to as PSMA), and pelvic multiparametric MRI (hereafter referred to as pelvic MRI) to identify men who will best benefit from SRT. Methods: Prospective, multisite imaging studies were carried out in men who had rising PSA levels after RP, high-risk features, and negative/equivocal conventional imaging results and who were being considered for SRT. 18F-FCH (91/91), pelvic MRI (88/91), and PSMA (31/91) (Australia) were all performed within 2 wk. Imaging was interpreted by experienced local/central interpreters who were masked with regard to other imaging results, with consensus being reached for discordant interpretations. Expected management was documented before and after imaging, and data about all treatments and PSA levels were collected for 3 y. The treatment response to SRT was defined as a reduction in PSA levels of .50% without androgen deprivation therapy. Results: The median Gleason score, PSA level at imaging, and PSA doubling time were 8, 0.42 (interquartile range, 0.29–0.93) ng/mL, and 5.0 (interquartile range, 3.3–7.6) months. Recurrent prostate cancer was detected in 28% (25/88) by pelvic MRI, 32% (29/91) by 18F-FCH, and 42% (13/31) by PSMA. This recurrence was found within the PF in 21.5% (19/88), 13% (12/91), and 19% (6/31) and at sites outside the PF (extra-PF) in 8% (7/88), 19% (17/91), and 32% (10/31) by MRI, 18F-FCH, and PSMA, respectively (P, 0.004). A total of 94% (16/17) of extra-PF sites on 18F-FCH were within the pelvic MRI field. Intra-pelvic extra-PF disease was detected in 90% (9/10) by PSMA and in 31% (5/16) by MRI. 18F-FCH changed management in 46% (42/91), and MRI changed management in 24% (21/88). PSMA provided additional management changes over 18F-FCH in 23% (7/31). The treatment response to SRT was higher in men with negative results or disease confined to the PF than in men with extra-PF disease (18F-FCH 73% [32/44] versus 33% [3/9] [P, 0.02], pelvic MRI 70% [32/46] versus 50% [2/4] [P was not significant], and PSMA 88% [7/ 8] versus 14% [1/7] [P, 0.005]). Men with negative imaging results (MRI, 18F-FCH, or PSMA) had high (78%) SRT response rates. Conclusion: 18F-FCH and PSMA had high detection rates for extra-PF disease in men with negative/equivocal conventional imaging results and rising PSA levels after RP. These findings affected management and treatment responses, suggesting an important role for PET in triaging men being considered for curative SRT.

Original languageEnglish
Pages (from-to)794-800
Number of pages7
JournalJournal of Nuclear Medicine
Volume60
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Keywords

  • F-fluoromethylcholine
  • Biochemical recurrence
  • Multiparametric MRI
  • PET
  • Prostate cancer
  • PSMA

Cite this

Emmett, Louise ; Metser, Ur ; Bauman, Glenn ; Hicks, Rodney J. ; Weickhardt, Andrew ; Davis, Ian D. ; Punwani, Shonit ; Pond, Greg ; Chua, Sue ; Ho, Bao ; Johnston, Edward ; Pouliot, Frederic ; Scott, Andrew M. / Prospective, multisite, international comparison of 18F-fluoromethylcholine PET/CT, multiparametric MRI, and 68Ga-HBED-CC PSMA-11 PET/CT in men with high-risk features and biochemical failure after radical prostatectomy : Clinical performance and patient outcomes. In: Journal of Nuclear Medicine. 2019 ; Vol. 60, No. 6. pp. 794-800.
@article{69c6e5fb15164489b82be21a5429f16b,
title = "Prospective, multisite, international comparison of 18F-fluoromethylcholine PET/CT, multiparametric MRI, and 68Ga-HBED-CC PSMA-11 PET/CT in men with high-risk features and biochemical failure after radical prostatectomy: Clinical performance and patient outcomes",
abstract = "A significant proportion of men with rising prostate-specific antigen (PSA) levels after radical prostatectomy (RP) fail prostate fossa (PF) salvage radiation treatment (SRT). This study was done to assess the ability of 18F-fluoromethylcholine (18F-FCH) PET/CT (hereafter referred to as 18F-FCH), 68Ga-HBED-CC PSMA-11 PET/CT (hereafter referred to as PSMA), and pelvic multiparametric MRI (hereafter referred to as pelvic MRI) to identify men who will best benefit from SRT. Methods: Prospective, multisite imaging studies were carried out in men who had rising PSA levels after RP, high-risk features, and negative/equivocal conventional imaging results and who were being considered for SRT. 18F-FCH (91/91), pelvic MRI (88/91), and PSMA (31/91) (Australia) were all performed within 2 wk. Imaging was interpreted by experienced local/central interpreters who were masked with regard to other imaging results, with consensus being reached for discordant interpretations. Expected management was documented before and after imaging, and data about all treatments and PSA levels were collected for 3 y. The treatment response to SRT was defined as a reduction in PSA levels of .50{\%} without androgen deprivation therapy. Results: The median Gleason score, PSA level at imaging, and PSA doubling time were 8, 0.42 (interquartile range, 0.29–0.93) ng/mL, and 5.0 (interquartile range, 3.3–7.6) months. Recurrent prostate cancer was detected in 28{\%} (25/88) by pelvic MRI, 32{\%} (29/91) by 18F-FCH, and 42{\%} (13/31) by PSMA. This recurrence was found within the PF in 21.5{\%} (19/88), 13{\%} (12/91), and 19{\%} (6/31) and at sites outside the PF (extra-PF) in 8{\%} (7/88), 19{\%} (17/91), and 32{\%} (10/31) by MRI, 18F-FCH, and PSMA, respectively (P, 0.004). A total of 94{\%} (16/17) of extra-PF sites on 18F-FCH were within the pelvic MRI field. Intra-pelvic extra-PF disease was detected in 90{\%} (9/10) by PSMA and in 31{\%} (5/16) by MRI. 18F-FCH changed management in 46{\%} (42/91), and MRI changed management in 24{\%} (21/88). PSMA provided additional management changes over 18F-FCH in 23{\%} (7/31). The treatment response to SRT was higher in men with negative results or disease confined to the PF than in men with extra-PF disease (18F-FCH 73{\%} [32/44] versus 33{\%} [3/9] [P, 0.02], pelvic MRI 70{\%} [32/46] versus 50{\%} [2/4] [P was not significant], and PSMA 88{\%} [7/ 8] versus 14{\%} [1/7] [P, 0.005]). Men with negative imaging results (MRI, 18F-FCH, or PSMA) had high (78{\%}) SRT response rates. Conclusion: 18F-FCH and PSMA had high detection rates for extra-PF disease in men with negative/equivocal conventional imaging results and rising PSA levels after RP. These findings affected management and treatment responses, suggesting an important role for PET in triaging men being considered for curative SRT.",
keywords = "F-fluoromethylcholine, Biochemical recurrence, Multiparametric MRI, PET, Prostate cancer, PSMA",
author = "Louise Emmett and Ur Metser and Glenn Bauman and Hicks, {Rodney J.} and Andrew Weickhardt and Davis, {Ian D.} and Shonit Punwani and Greg Pond and Sue Chua and Bao Ho and Edward Johnston and Frederic Pouliot and Scott, {Andrew M.}",
year = "2019",
month = "6",
day = "1",
doi = "10.2967/jnumed.118.220103",
language = "English",
volume = "60",
pages = "794--800",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine",
number = "6",

}

Prospective, multisite, international comparison of 18F-fluoromethylcholine PET/CT, multiparametric MRI, and 68Ga-HBED-CC PSMA-11 PET/CT in men with high-risk features and biochemical failure after radical prostatectomy : Clinical performance and patient outcomes. / Emmett, Louise; Metser, Ur; Bauman, Glenn; Hicks, Rodney J.; Weickhardt, Andrew; Davis, Ian D.; Punwani, Shonit; Pond, Greg; Chua, Sue; Ho, Bao; Johnston, Edward; Pouliot, Frederic; Scott, Andrew M.

In: Journal of Nuclear Medicine, Vol. 60, No. 6, 01.06.2019, p. 794-800.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Prospective, multisite, international comparison of 18F-fluoromethylcholine PET/CT, multiparametric MRI, and 68Ga-HBED-CC PSMA-11 PET/CT in men with high-risk features and biochemical failure after radical prostatectomy

T2 - Clinical performance and patient outcomes

AU - Emmett, Louise

AU - Metser, Ur

AU - Bauman, Glenn

AU - Hicks, Rodney J.

AU - Weickhardt, Andrew

AU - Davis, Ian D.

AU - Punwani, Shonit

AU - Pond, Greg

AU - Chua, Sue

AU - Ho, Bao

AU - Johnston, Edward

AU - Pouliot, Frederic

AU - Scott, Andrew M.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - A significant proportion of men with rising prostate-specific antigen (PSA) levels after radical prostatectomy (RP) fail prostate fossa (PF) salvage radiation treatment (SRT). This study was done to assess the ability of 18F-fluoromethylcholine (18F-FCH) PET/CT (hereafter referred to as 18F-FCH), 68Ga-HBED-CC PSMA-11 PET/CT (hereafter referred to as PSMA), and pelvic multiparametric MRI (hereafter referred to as pelvic MRI) to identify men who will best benefit from SRT. Methods: Prospective, multisite imaging studies were carried out in men who had rising PSA levels after RP, high-risk features, and negative/equivocal conventional imaging results and who were being considered for SRT. 18F-FCH (91/91), pelvic MRI (88/91), and PSMA (31/91) (Australia) were all performed within 2 wk. Imaging was interpreted by experienced local/central interpreters who were masked with regard to other imaging results, with consensus being reached for discordant interpretations. Expected management was documented before and after imaging, and data about all treatments and PSA levels were collected for 3 y. The treatment response to SRT was defined as a reduction in PSA levels of .50% without androgen deprivation therapy. Results: The median Gleason score, PSA level at imaging, and PSA doubling time were 8, 0.42 (interquartile range, 0.29–0.93) ng/mL, and 5.0 (interquartile range, 3.3–7.6) months. Recurrent prostate cancer was detected in 28% (25/88) by pelvic MRI, 32% (29/91) by 18F-FCH, and 42% (13/31) by PSMA. This recurrence was found within the PF in 21.5% (19/88), 13% (12/91), and 19% (6/31) and at sites outside the PF (extra-PF) in 8% (7/88), 19% (17/91), and 32% (10/31) by MRI, 18F-FCH, and PSMA, respectively (P, 0.004). A total of 94% (16/17) of extra-PF sites on 18F-FCH were within the pelvic MRI field. Intra-pelvic extra-PF disease was detected in 90% (9/10) by PSMA and in 31% (5/16) by MRI. 18F-FCH changed management in 46% (42/91), and MRI changed management in 24% (21/88). PSMA provided additional management changes over 18F-FCH in 23% (7/31). The treatment response to SRT was higher in men with negative results or disease confined to the PF than in men with extra-PF disease (18F-FCH 73% [32/44] versus 33% [3/9] [P, 0.02], pelvic MRI 70% [32/46] versus 50% [2/4] [P was not significant], and PSMA 88% [7/ 8] versus 14% [1/7] [P, 0.005]). Men with negative imaging results (MRI, 18F-FCH, or PSMA) had high (78%) SRT response rates. Conclusion: 18F-FCH and PSMA had high detection rates for extra-PF disease in men with negative/equivocal conventional imaging results and rising PSA levels after RP. These findings affected management and treatment responses, suggesting an important role for PET in triaging men being considered for curative SRT.

AB - A significant proportion of men with rising prostate-specific antigen (PSA) levels after radical prostatectomy (RP) fail prostate fossa (PF) salvage radiation treatment (SRT). This study was done to assess the ability of 18F-fluoromethylcholine (18F-FCH) PET/CT (hereafter referred to as 18F-FCH), 68Ga-HBED-CC PSMA-11 PET/CT (hereafter referred to as PSMA), and pelvic multiparametric MRI (hereafter referred to as pelvic MRI) to identify men who will best benefit from SRT. Methods: Prospective, multisite imaging studies were carried out in men who had rising PSA levels after RP, high-risk features, and negative/equivocal conventional imaging results and who were being considered for SRT. 18F-FCH (91/91), pelvic MRI (88/91), and PSMA (31/91) (Australia) were all performed within 2 wk. Imaging was interpreted by experienced local/central interpreters who were masked with regard to other imaging results, with consensus being reached for discordant interpretations. Expected management was documented before and after imaging, and data about all treatments and PSA levels were collected for 3 y. The treatment response to SRT was defined as a reduction in PSA levels of .50% without androgen deprivation therapy. Results: The median Gleason score, PSA level at imaging, and PSA doubling time were 8, 0.42 (interquartile range, 0.29–0.93) ng/mL, and 5.0 (interquartile range, 3.3–7.6) months. Recurrent prostate cancer was detected in 28% (25/88) by pelvic MRI, 32% (29/91) by 18F-FCH, and 42% (13/31) by PSMA. This recurrence was found within the PF in 21.5% (19/88), 13% (12/91), and 19% (6/31) and at sites outside the PF (extra-PF) in 8% (7/88), 19% (17/91), and 32% (10/31) by MRI, 18F-FCH, and PSMA, respectively (P, 0.004). A total of 94% (16/17) of extra-PF sites on 18F-FCH were within the pelvic MRI field. Intra-pelvic extra-PF disease was detected in 90% (9/10) by PSMA and in 31% (5/16) by MRI. 18F-FCH changed management in 46% (42/91), and MRI changed management in 24% (21/88). PSMA provided additional management changes over 18F-FCH in 23% (7/31). The treatment response to SRT was higher in men with negative results or disease confined to the PF than in men with extra-PF disease (18F-FCH 73% [32/44] versus 33% [3/9] [P, 0.02], pelvic MRI 70% [32/46] versus 50% [2/4] [P was not significant], and PSMA 88% [7/ 8] versus 14% [1/7] [P, 0.005]). Men with negative imaging results (MRI, 18F-FCH, or PSMA) had high (78%) SRT response rates. Conclusion: 18F-FCH and PSMA had high detection rates for extra-PF disease in men with negative/equivocal conventional imaging results and rising PSA levels after RP. These findings affected management and treatment responses, suggesting an important role for PET in triaging men being considered for curative SRT.

KW - F-fluoromethylcholine

KW - Biochemical recurrence

KW - Multiparametric MRI

KW - PET

KW - Prostate cancer

KW - PSMA

UR - http://www.scopus.com/inward/record.url?scp=85066993432&partnerID=8YFLogxK

U2 - 10.2967/jnumed.118.220103

DO - 10.2967/jnumed.118.220103

M3 - Review Article

VL - 60

SP - 794

EP - 800

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 6

ER -