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Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 5/2016

23.11.2015 | Original Article

MRI versus 68Ga-PSMA PET/CT for gross tumour volume delineation in radiation treatment planning of primary prostate cancer

verfasst von: Constantinos Zamboglou, Gesche Wieser, Steffen Hennies, Irene Rempel, Simon Kirste, Martin Soschynski, Hans Christian Rischke, Tobias Fechter, Cordula A. Jilg, Mathias Langer, Philipp T. Meyer, Michael Bock, Anca-Ligia Grosu

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 5/2016

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Abstract

Purpose

Multiparametric magnetic resonance imaging (mpMRI) is widely used in radiation treatment planning of primary prostate cancer (PCA). Focal dose escalation to the dominant intraprostatic lesions (DIPL) may lead to improved PCA control. Prostate-specific membrane antigen (PSMA) is overexpressed in most PCAs. 68Ga-labelled PSMA inhibitors have demonstrated promising results in detection of PCA with PET/CT. The aim of this study was to compare 68Ga-PSMA PET/CT with MRI for gross tumour volume (GTV) definition in primary PCA.

Methods

This retrospective study included 22 patients with primary PCA analysed after 68Ga-PSMA PET/CT and mpMRI. GTVs were delineated on MR images by two radiologists (GTV-MRIrad) and two radiation oncologists separately. Both volumes were merged leading to GTV-MRIint. GTVs based on PET/CT were delineated by two nuclear medicine physicians in consensus (GTV-PET). Laterality (left, right, and left and right prostate lobes) on mpMRI, PET/CT and pathological analysis after biopsy were assessed.

Results

Mean GTV-MRIrad, GTV-MRIint and GTV-PET were 5.92, 3.83 and 11.41 cm3, respectively. GTV-PET was significant larger then GTV-MRIint (p = 0.003). The MRI GTVs GTV-MRIrad and GTV-MRIint showed, respectively, 40 % and 57 % overlap with GTV-PET. GTV-MRIrad and GTV-MRIint included the SUVmax of GTV-PET in 12 and 11 patients (54.6 % and 50 %), respectively. In nine patients (47 %), laterality on mpMRI, PET/CT and histopathology after biopsy was similar.

Conclusion

Ga-PSMA PET/CT and mpMRI provided concordant results for delineation of the DIPL in 47 % of patients (40 % – 54 % of lesions). GTV-PET was significantly larger than GTV-MRIint. 68Ga-PSMA PET/CT may have a role in radiation treatment planning for focal radiation to the DIPL. Exact correlation of PET and MRI images with histopathology is needed.
Literatur
4.
Zurück zum Zitat Fonteyne V, Villeirs G, Speleers B, De Neve W, De Wagter C, Lumen N, et al. Intensity-modulated radiotherapy as primary therapy for prostate cancer: report on acute toxicity after dose escalation with simultaneous integrated boost to intraprostatic lesion. Int J Radiat Oncol Biol Phys. 2008;72:799–807. doi:10.1016/j.ijrobp.2008.01.040.CrossRefPubMed Fonteyne V, Villeirs G, Speleers B, De Neve W, De Wagter C, Lumen N, et al. Intensity-modulated radiotherapy as primary therapy for prostate cancer: report on acute toxicity after dose escalation with simultaneous integrated boost to intraprostatic lesion. Int J Radiat Oncol Biol Phys. 2008;72:799–807. doi:10.​1016/​j.​ijrobp.​2008.​01.​040.CrossRefPubMed
5.
Zurück zum Zitat Pinkawa M, Piroth MD, Holy R, Klotz J, Djukic V, Corral NE, et al. Dose-escalation using intensity-modulated radiotherapy for prostate cancer – evaluation of quality of life with and without (18)F-choline PET-CT detected simultaneous integrated boost. Radiat Oncol. 2012;7:14. doi:10.1186/1748-717X-7-14.CrossRefPubMedPubMedCentral Pinkawa M, Piroth MD, Holy R, Klotz J, Djukic V, Corral NE, et al. Dose-escalation using intensity-modulated radiotherapy for prostate cancer – evaluation of quality of life with and without (18)F-choline PET-CT detected simultaneous integrated boost. Radiat Oncol. 2012;7:14. doi:10.​1186/​1748-717X-7-14.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Lips IM, van der Heide UA, Haustermans K, van Lin EN, Pos F, Franken SP, et al. Single blind randomized phase III trial to investigate the benefit of a focal lesion ablative microboost in prostate cancer (FLAME-trial): study protocol for a randomized controlled trial. Trials. 2011;12:255. doi:10.1186/1745-6215-12-255.CrossRefPubMedPubMedCentral Lips IM, van der Heide UA, Haustermans K, van Lin EN, Pos F, Franken SP, et al. Single blind randomized phase III trial to investigate the benefit of a focal lesion ablative microboost in prostate cancer (FLAME-trial): study protocol for a randomized controlled trial. Trials. 2011;12:255. doi:10.​1186/​1745-6215-12-255.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Yakar D, Debats OA, Bomers JG, Schouten MG, Vos PC, van Lin E, et al. Predictive value of MRI in the localization, staging, volume estimation, assessment of aggressiveness, and guidance of radiotherapy and biopsies in prostate cancer. J Magn Reson Imaging. 2012;35:20–31. doi:10.1002/jmri.22790.CrossRefPubMed Yakar D, Debats OA, Bomers JG, Schouten MG, Vos PC, van Lin E, et al. Predictive value of MRI in the localization, staging, volume estimation, assessment of aggressiveness, and guidance of radiotherapy and biopsies in prostate cancer. J Magn Reson Imaging. 2012;35:20–31. doi:10.​1002/​jmri.​22790.CrossRefPubMed
10.
Zurück zum Zitat Kwee SA, Wei H, Sesterhenn I, Yun D, Coel MN. Localization of primary prostate cancer with dual-phase 18F-fluorocholine PET. J Nucl Med. 2006;47:262–9.PubMed Kwee SA, Wei H, Sesterhenn I, Yun D, Coel MN. Localization of primary prostate cancer with dual-phase 18F-fluorocholine PET. J Nucl Med. 2006;47:262–9.PubMed
11.
Zurück zum Zitat Farsad M, Schiavina R, Castellucci P, Nanni C, Corti B, Martorana G, et al. Detection and localization of prostate cancer: correlation of (11)C-choline PET/CT with histopathologic step-section analysis. J Nucl Med. 2005;46:1642–9.PubMed Farsad M, Schiavina R, Castellucci P, Nanni C, Corti B, Martorana G, et al. Detection and localization of prostate cancer: correlation of (11)C-choline PET/CT with histopathologic step-section analysis. J Nucl Med. 2005;46:1642–9.PubMed
13.
14.
Zurück zum Zitat Eder M, Neels O, Muller M, Bauder-Wust U, Remde Y, Schafer M, et al. Novel preclinical and radiopharmaceutical aspects of [68Ga]Ga-PSMA-HBED-CC: a new PET tracer for imaging of prostate cancer. Pharmaceuticals. 2014;7:779–96. doi:10.3390/ph7070779.CrossRefPubMedPubMedCentral Eder M, Neels O, Muller M, Bauder-Wust U, Remde Y, Schafer M, et al. Novel preclinical and radiopharmaceutical aspects of [68Ga]Ga-PSMA-HBED-CC: a new PET tracer for imaging of prostate cancer. Pharmaceuticals. 2014;7:779–96. doi:10.​3390/​ph7070779.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Mhawech-Fauceglia P, Zhang S, Terracciano L, Sauter G, Chadhuri A, Herrmann FR, et al. Prostate-specific membrane antigen (PSMA) protein expression in normal and neoplastic tissues and its sensitivity and specificity in prostate adenocarcinoma: an immunohistochemical study using multiple tumour tissue microarray technique. Histopathology. 2007;50:472–83. doi:10.1111/j.1365-2559.2007.02635.x.CrossRefPubMed Mhawech-Fauceglia P, Zhang S, Terracciano L, Sauter G, Chadhuri A, Herrmann FR, et al. Prostate-specific membrane antigen (PSMA) protein expression in normal and neoplastic tissues and its sensitivity and specificity in prostate adenocarcinoma: an immunohistochemical study using multiple tumour tissue microarray technique. Histopathology. 2007;50:472–83. doi:10.​1111/​j.​1365-2559.​2007.​02635.​x.CrossRefPubMed
16.
Zurück zum Zitat Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res. 1997;3:81–5.PubMed Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res. 1997;3:81–5.PubMed
17.
Zurück zum Zitat Eder M, Schafer M, Bauder-Wust U, Hull WE, Wangler C, Mier W, et al. 68Ga-complex lipophilicity and the targeting property of a urea-based PSMA inhibitor for PET imaging. Bioconjug Chem. 2012;23:688–97. doi:10.1021/bc200279b.CrossRefPubMed Eder M, Schafer M, Bauder-Wust U, Hull WE, Wangler C, Mier W, et al. 68Ga-complex lipophilicity and the targeting property of a urea-based PSMA inhibitor for PET imaging. Bioconjug Chem. 2012;23:688–97. doi:10.​1021/​bc200279b.CrossRefPubMed
18.
Zurück zum Zitat Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid 68Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015;56:668–74. doi:10.2967/jnumed.115.154153.CrossRefPubMed Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid 68Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015;56:668–74. doi:10.​2967/​jnumed.​115.​154153.CrossRefPubMed
19.
Zurück zum Zitat Ceci F, Uprimny C, Nilica B, Geraldo L, Kendler D, Kroiss A, et al. Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate? Eur J Nucl Med Mol Imaging. 2015;42:1284–94. doi:10.1007/s00259-015-3078-6.CrossRefPubMed Ceci F, Uprimny C, Nilica B, Geraldo L, Kendler D, Kroiss A, et al. Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate? Eur J Nucl Med Mol Imaging. 2015;42:1284–94. doi:10.​1007/​s00259-015-3078-6.CrossRefPubMed
20.
Zurück zum Zitat Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG, et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2014;41:11–20. doi:10.1007/s00259-013-2525-5.CrossRefPubMedPubMedCentral Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG, et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2014;41:11–20. doi:10.​1007/​s00259-013-2525-5.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Singh AK, Guion P, Sears-Crouse N, Ullman K, Smith S, Albert PS, et al. Simultaneous integrated boost of biopsy proven, MRI defined dominant intra-prostatic lesions to 95 Gray with IMRT: early results of a phase I NCI study. Radiat Oncol. 2007;2:36. doi:10.1186/1748-717X-2-36.CrossRefPubMedPubMedCentral Singh AK, Guion P, Sears-Crouse N, Ullman K, Smith S, Albert PS, et al. Simultaneous integrated boost of biopsy proven, MRI defined dominant intra-prostatic lesions to 95 Gray with IMRT: early results of a phase I NCI study. Radiat Oncol. 2007;2:36. doi:10.​1186/​1748-717X-2-36.CrossRefPubMedPubMedCentral
23.
24.
Zurück zum Zitat van Lin EN, Futterer JJ, Heijmink SW, van der Vight LP, Hoffmann AL, van Kollenburg P, et al. IMRT boost dose planning on dominant intraprostatic lesions: gold marker-based three-dimensional fusion of CT with dynamic contrast-enhanced and 1H-spectroscopic MRI. Int J Radiat Oncol Biol Phys. 2006;65:291–303. doi:10.1016/j.ijrobp.2005.12.046.CrossRefPubMed van Lin EN, Futterer JJ, Heijmink SW, van der Vight LP, Hoffmann AL, van Kollenburg P, et al. IMRT boost dose planning on dominant intraprostatic lesions: gold marker-based three-dimensional fusion of CT with dynamic contrast-enhanced and 1H-spectroscopic MRI. Int J Radiat Oncol Biol Phys. 2006;65:291–303. doi:10.​1016/​j.​ijrobp.​2005.​12.​046.CrossRefPubMed
26.
Zurück zum Zitat Milker-Zabel S, Zabel-du Bois A, Henze M, Huber P, Schulz-Ertner D, Hoess A, et al. Improved target volume definition for fractionated stereotactic radiotherapy in patients with intracranial meningiomas by correlation of CT, MRI, and [68Ga]-DOTATOC-PET. Int J Radiat Oncol Biol Phys. 2006;65:222–7. doi:10.1016/j.ijrobp.2005.12.006.CrossRefPubMed Milker-Zabel S, Zabel-du Bois A, Henze M, Huber P, Schulz-Ertner D, Hoess A, et al. Improved target volume definition for fractionated stereotactic radiotherapy in patients with intracranial meningiomas by correlation of CT, MRI, and [68Ga]-DOTATOC-PET. Int J Radiat Oncol Biol Phys. 2006;65:222–7. doi:10.​1016/​j.​ijrobp.​2005.​12.​006.CrossRefPubMed
27.
Zurück zum Zitat Shepherd T, Teras M, Beichel RR, Boellaard R, Bruynooghe M, Dicken V, et al. Comparative study with new accuracy metrics for target volume contouring in PET image guided radiation therapy. IEEE Trans Med Imaging. 2012;31:2006–24. doi:10.1109/TMI.2012.2202322.CrossRefPubMed Shepherd T, Teras M, Beichel RR, Boellaard R, Bruynooghe M, Dicken V, et al. Comparative study with new accuracy metrics for target volume contouring in PET image guided radiation therapy. IEEE Trans Med Imaging. 2012;31:2006–24. doi:10.​1109/​TMI.​2012.​2202322.CrossRefPubMed
28.
Zurück zum Zitat Nestle U, Kremp S, Schaefer-Schuler A, Sebastian-Welsch C, Hellwig D, Rube C, et al. Comparison of different methods for delineation of 18F-FDG PET-positive tissue for target volume definition in radiotherapy of patients with non-small cell lung cancer. J Nucl Med. 2005;46:1342–8.PubMed Nestle U, Kremp S, Schaefer-Schuler A, Sebastian-Welsch C, Hellwig D, Rube C, et al. Comparison of different methods for delineation of 18F-FDG PET-positive tissue for target volume definition in radiotherapy of patients with non-small cell lung cancer. J Nucl Med. 2005;46:1342–8.PubMed
29.
Zurück zum Zitat Rischke HC, Beck T, Vach W, Wieser G, Grosu AL, Schultze-Seemann W, et al. Furosemide diminishes (18)F-fluoroethylcholine uptake in prostate cancer in vivo. Eur J Nucl Med Mol Imaging. 2014;41:2074–82. doi:10.1007/s00259-014-2829-0.CrossRefPubMed Rischke HC, Beck T, Vach W, Wieser G, Grosu AL, Schultze-Seemann W, et al. Furosemide diminishes (18)F-fluoroethylcholine uptake in prostate cancer in vivo. Eur J Nucl Med Mol Imaging. 2014;41:2074–82. doi:10.​1007/​s00259-014-2829-0.CrossRefPubMed
31.
Zurück zum Zitat Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42:197–209. doi:10.1007/s00259-014-2949-6.CrossRefPubMedPubMedCentral Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42:197–209. doi:10.​1007/​s00259-014-2949-6.CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Herrmann K, Bluemel C, Weineisen M, Schottelius M, Wester HJ, Czernin J, et al. Biodistribution and radiation dosimetry for a probe targeting prostate-specific membrane antigen for imaging and therapy. J Nucl Med. 2015;56:855–61. doi:10.2967/jnumed.115.156133.CrossRefPubMed Herrmann K, Bluemel C, Weineisen M, Schottelius M, Wester HJ, Czernin J, et al. Biodistribution and radiation dosimetry for a probe targeting prostate-specific membrane antigen for imaging and therapy. J Nucl Med. 2015;56:855–61. doi:10.​2967/​jnumed.​115.​156133.CrossRefPubMed
34.
Zurück zum Zitat Padhani AR, Gapinski CJ, Macvicar DA, Parker GJ, Suckling J, Revell PB, et al. Dynamic contrast enhanced MRI of prostate cancer: correlation with morphology and tumour stage, histological grade and PSA. Clin Radiol. 2000;55:99–109. doi:10.1053/crad.1999.0327.CrossRefPubMed Padhani AR, Gapinski CJ, Macvicar DA, Parker GJ, Suckling J, Revell PB, et al. Dynamic contrast enhanced MRI of prostate cancer: correlation with morphology and tumour stage, histological grade and PSA. Clin Radiol. 2000;55:99–109. doi:10.​1053/​crad.​1999.​0327.CrossRefPubMed
35.
Zurück zum Zitat Oto A, Yang C, Kayhan A, Tretiakova M, Antic T, Schmid-Tannwald C, et al. Diffusion-weighted and dynamic contrast-enhanced MRI of prostate cancer: correlation of quantitative MR parameters with Gleason score and tumor angiogenesis. AJR Am J Roentgenol. 2011;197:1382–90. doi:10.2214/AJR.11.6861.CrossRefPubMed Oto A, Yang C, Kayhan A, Tretiakova M, Antic T, Schmid-Tannwald C, et al. Diffusion-weighted and dynamic contrast-enhanced MRI of prostate cancer: correlation of quantitative MR parameters with Gleason score and tumor angiogenesis. AJR Am J Roentgenol. 2011;197:1382–90. doi:10.​2214/​AJR.​11.​6861.CrossRefPubMed
36.
Zurück zum Zitat Tamada T, Sone T, Higashi H, Jo Y, Yamamoto A, Kanki A, et al. Prostate cancer detection in patients with total serum prostate-specific antigen levels of 4–10 ng/mL: diagnostic efficacy of diffusion-weighted imaging, dynamic contrast-enhanced MRI, and T2-weighted imaging. AJR Am J Roentgenol. 2011;197:664–70. doi:10.2214/AJR.10.5923.CrossRefPubMed Tamada T, Sone T, Higashi H, Jo Y, Yamamoto A, Kanki A, et al. Prostate cancer detection in patients with total serum prostate-specific antigen levels of 4–10 ng/mL: diagnostic efficacy of diffusion-weighted imaging, dynamic contrast-enhanced MRI, and T2-weighted imaging. AJR Am J Roentgenol. 2011;197:664–70. doi:10.​2214/​AJR.​10.​5923.CrossRefPubMed
37.
Zurück zum Zitat Mannweiler S, Amersdorfer P, Trajanoski S, Terrett JA, King D, Mehes G. Heterogeneity of prostate-specific membrane antigen (PSMA) expression in prostate carcinoma with distant metastasis. Pathol Oncol Res. 2009;15:167–72. doi:10.1007/s12253-008-9104-2.CrossRefPubMed Mannweiler S, Amersdorfer P, Trajanoski S, Terrett JA, King D, Mehes G. Heterogeneity of prostate-specific membrane antigen (PSMA) expression in prostate carcinoma with distant metastasis. Pathol Oncol Res. 2009;15:167–72. doi:10.​1007/​s12253-008-9104-2.CrossRefPubMed
39.
Zurück zum Zitat Rischke HC, Nestle U, Fechter T, Doll C, Volegova-Neher N, Henne K, et al. 3 Tesla multiparametric MRI for GTV-definition of dominant intraprostatic lesions in patients with prostate cancer – an interobserver variability study. Radiat Oncol. 2013;8:183. doi:10.1186/1748-717X-8-183.CrossRefPubMedPubMedCentral Rischke HC, Nestle U, Fechter T, Doll C, Volegova-Neher N, Henne K, et al. 3 Tesla multiparametric MRI for GTV-definition of dominant intraprostatic lesions in patients with prostate cancer – an interobserver variability study. Radiat Oncol. 2013;8:183. doi:10.​1186/​1748-717X-8-183.CrossRefPubMedPubMedCentral
Metadaten
Titel
MRI versus 68Ga-PSMA PET/CT for gross tumour volume delineation in radiation treatment planning of primary prostate cancer
verfasst von
Constantinos Zamboglou
Gesche Wieser
Steffen Hennies
Irene Rempel
Simon Kirste
Martin Soschynski
Hans Christian Rischke
Tobias Fechter
Cordula A. Jilg
Mathias Langer
Philipp T. Meyer
Michael Bock
Anca-Ligia Grosu
Publikationsdatum
23.11.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 5/2016
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-015-3257-5

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