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Brief Correspondence

68Ga-PSMA Positron Emission Tomography/Computed Tomography Provides Accurate Staging of Lymph Node Regions Prior to Lymph Node Dissection in Patients with Prostate Cancer

By: Annika Herlemanna, Vera Wenterb, Alexander Kretschmera, Kolja M. Thierfelderc, Peter Bartensteinb d, Claudius Fabere, Franz-Josef Gildehausb, Christian G. Stiefa d, Christian Gratzkea d and Wolfgang P. Fendlerb

European Urology, Volume 70 Issue 4, October 2016, Pages 553-557

Published online: 01 October 2016

Keywords: Prostate cancer, PSMA, PET/CT, Positron emission tomography, Lymph node dissection

Abstract Full Text Full Text PDF (896 KB) Patient Summary

Abstract

We evaluated the accuracy of 68Ga-prostate-specific membrane antigen-HBED-CC (68Ga-PSMA) positron emission tomography/computed tomography (PET/CT) for nodal staging prior to lymph node dissection (LND) in patients with prostate cancer (PCa). Thirty-four patients with histologically proven PCa underwent 68Ga-PSMA-HBED-CC PET/CT prior to radical prostatectomy with primary LND (pLND; n = 20) and PET/CT prior to secondary LND (sLND; n = 14). Accuracy of PET and CT were analysed separately for staging of the following 71 lymph node (LN) regions: pelvic left (n = 30), pelvic right (n = 31), presacral (n = 3), and para-aortic (n = 7). Postoperative histopathology was taken as a reference standard. Thirty-seven of 71 (52%) regions showed LN metastases on histopathology. Sensitivity, specificity, positive predictive value, and negative predictive value for detection of LN metastases were 84%, 82%, 84%, and 82% for PET criteria and 65%, 76%, 75%, and 67% for CT criteria. PET was more accurate for nodal staging compared with CT both at pLND (88% vs 75%) and sLND (77% vs 65%). Overall, 68Ga-PSMA PET/CT provides accurate nodal staging prior to pLND and sLND for PCa.

Patient summary

68Ga-PSMA positron emission tomography/computed tomography is accurate in detecting tumour spread to lymph nodes before patients undergo surgery for prostate cancer.

Take Home Message

68Ga-PSMA positron emission tomography/computed tomography accurately detects lymph node metastases prior to primary or secondary lymph node dissection for prostate cancer.

Keywords: Prostate cancer, PSMA, PET/CT, Positron emission tomography, Lymph node dissection.

Footnotes

a Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany

b Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany

c Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany

d Comprehensive Cancer Centre, Ludwig-Maximilians-University of Munich, Munich, Germany

e Institute of Pathology, Ludwig-Maximilians-University of Munich, Munich, Germany

Corresponding author. Department of Nuclear Medicine, Marchioninistrasse 15, 81377 Munich, Germany. Tel. +49 89 4400 7 4646; Fax: +49 89 4400 7 7646.

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