Difference in the Spectrum of Metastatic Disease on 68Ga PSMA PET/CT after Radical Prostatectomy and after Radical Radiotherapy in Patients of Carcinoma Prostate with Biochemical Recurrence
To determine the pattern of metastatic disease with 68Ga PSMA PET/CT in patients with biochemical recurrence after definitive treatment.
METHOD AND MATERIALS
A retrospective analysis of subjects with carcinoma prostate, who had undergone definitive treatment (Radical
prostatectomy or Radiotherapy) and presented with biochemical recurrence, was done by 68Ga PSMA PET/CT. The data collected was analysed to establish temporal occurrence and patterns of regional and distant metastatic disease in both the groups and correlated with serum PSA levels.
The study included 200 subjects with history of adenocarcinoma prostate. In the post radical prostatectomy group (n=144), median serum PSA was 1.8 ng/ml, the overall metastatic detection rate was 39.3% for PSA 0.2 to < 0.5ng/ml, 47.3% for PSA 0.5 to < 1 ng/ml, 68.4% for PSA 1 to < 2 ng/ml and 93.1% for PSA >=2 ng/ml. In this group local recurrence was identified in 28.73 % and lymph nodal metastases in 65.1%, with the pelvic lymph nodal metastases being the most common site of metastasis followed by bone metastases. The mean time for serum PSA recurrence in the radical prostatectomy group was 49.77±44.44 months (range 2-184 months). In the post radiotherapy group, median serum PSA was 5.2 ng/ml, the detection rate was 88.8 % for PSA 2 to < 4 ng/ml and 100 % for PSA >= 4 ng/ ml. Local recurrence after radiotherapy was present in 79.5 % of the group and 63.6 % had lymph nodal metastases. The mean time for serum PSA recurrence following radiotherapy was 49.15± 24.32 months, (range 12-111 months).
Radical prostatectomy and Radical radiotherapy are the two standard treatment options for localized carcinoma prostate. Although the extent and patterns of recurrence differed in the two groups, the temporal occurrence of metastatic disease remained comparable.
68Ga-PSMA has been suggested as a novel tracer for detection of prostate cancer relapse and metastases with high specificity and sensitivity.