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Oncology Imaging Update Ronan McDermott Study Day March 30 th - - PowerPoint PPT Presentation
Oncology Imaging Update Ronan McDermott Study Day March 30 th - - PowerPoint PPT Presentation
Oncology Imaging Update Ronan McDermott Study Day March 30 th Brexit Day + 1 Prostate Cancer Prostate Cancer Prostate Cancer Prostate Cancer: Staging CT TAP Bone Scintigraphy CT: sens. 42%, spec. 82% Bone scan: PSA > 10
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Prostate Cancer
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Prostate Cancer
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Prostate Cancer: Staging
- CT TAP
- CT: sens. 42%, spec. 82%
- Bone Scintigraphy
- Bone scan: PSA > 10 ng/ml
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Ga 68PSMA PET
- Prostate Specific Membrane Antigen (PSMA)
- Trans-membrane Glycoprotein
- Over-expressed in Prostate Cancer x 15
- Particularly
– high grade tumours – under androgen deprivation – In hormone refractory metastatic disease
- First Ga68 PSMA PET scan in Ireland performed
Feb 20th 2019 in St James’s
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Ga 68PSMA PET
- Almost all prostate cancer cells express PSMA
– ~15 times higher expression of PSMA in prostate cancer than normal tissue
- PSMA expression correlates with Gleason score
– Higher expression of PSMA correlates with worse
- utcomes
- Higher diagnostic efficacy compared to
conventional imaging including PET with choline tracers
- Radionuclide therapy (Lu-177 PSMA)
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Ga 68PSMA PET
- Ga68
- Positron emitter
- 68 minute half life
- Germanium source
- Generator shelf life of 6-12 months
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FDG PET
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Ga68 PSMA PET
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Primary Staging
- Superior to conventional imaging in staging
high risk primary disease (D’Amico classification)
- Nodal and Distant Metastases
- May downstage patients who are considered
metastatic on conventional disease
Maurer T et al. J Urol 2016;195(5):1436–1443.
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70yo Gleason 4+5
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Gleason 4+5
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Localisation Intraprostatic Disease
- Sensitivity
- MRI
43%
- Ga68PSMA PET
64%
- Ga68PSMA PETMR 76%
Mottet at al. Eur Urol 2011;59(4):572–583.
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Biochemical Recurrence
- Increased detection of metastatic sites vs.
conventional imaging1
- Advantage most evident in patients with low
PSA levels2:
– Overall detection rate 89.5% – PSA > 2ng/ml 96.8% – PSA 1 - 2 ng/ml 93.0% – PSA 0.5 - <1.0 ng/ml 72.7% – PSA 0.2 - <0.5 ng/mL 57.9%
- 1. Afshar-Oromieh A et al. Eur J Nucl Med Mol Imaging.
2014;41(1):11–20. doi: 10.1007/s00259-013-2525-5.
- 2. Eiber M et al.. J Nucl Med. 2015;56(5):668–674. doi:
10.2967/jnumed.115.1
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Intensity of PSMA uptake varies with PSA level
Courtesy K. Zukotynski MD
PSA 0.4ng/ml 1.5 6.3
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Improved Detection of Recurrent Disease at low PSA levels
Afshar-Oromieh A et al. Eur J Nucl Med Mol Imaging 2015;42(2):197–209
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65yo 9 yrs post Sx. PSA 0.76ng/ml
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81yo 3yrs post RT PSA 4.0 ng/ml
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Krohn T et al. Eur J Nucl Med Mol Imaging. 2015;42(2):210–214. doi: 10.1007/s00259-014-2915-3
Pitfalls
- Coeliac ganglion uptake
– Up to 89%1
- Bladder/ Renal excretion
– Rewindow/ post mict.
- Benign lesion uptake
– Thyroid/ adrenal adenoma, schwannoma
- Other cancer uptake
– Adenocystic ca, HCC, glioblastoma – Neovasculature lung, colon, clear cell renal cell
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False Negative PSMA PET 5-8%
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Krohn T et al. Eur J Nucl Med Mol Imaging. 2015;42(2):210–214. doi: 10.1007/s00259-014-2915-3
Conclusion
- Ga68 PSMA PET CT is a new reference standard
for imaging prostate cancer
- Superior Sensitivity and Specificity compared
to conventional imaging
- Minimize false positive findings with
knowledge of the physiological distribution
- May have role in other tumours (RCC)
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