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Detection Accuracy of [ 68 Ga] PSMA PET/CT with Rising PSA in Prostate Cancer.

Parul Mohan1, Palak Wadhwa2, Harsh Mahajan1

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Gallium-68 [68Ga] PSMA PET/CT effectively detects prostate cancer, even with rising prostate-specific antigen (PSA) levels. This imaging technique shows high sensitivity for identifying tumors and metastases, aiding early diagnosis and treatment prediction.

Keywords:
PSAPSMA PET/CTbiomarkersdigital PET/CT scannermolecular imagingprostate cancerprostate-specific antigen

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Area of Science:

  • Nuclear Medicine
  • Oncology
  • Radiopharmaceuticals

Background:

  • Prostate-specific membrane antigen (PSMA) is a validated target for prostate cancer imaging.
  • Gallium-68 [68Ga] PSMA positron emission tomography/computed tomography (PET/CT) offers high sensitivity and specificity for prostate cancer detection.
  • Evaluating the clinical utility of [68Ga] PSMA PET/CT in relation to prostate-specific antigen (PSA) levels is crucial for optimizing diagnostic strategies.

Purpose of the Study:

  • To assess the diagnostic performance of [68Ga] PSMA PET/CT in prostate cancer patients with varying PSA levels.
  • To determine the correlation between PSA levels, Gleason score, and [68Ga] PSMA PET/CT findings.
  • To evaluate the capability of [68Ga] PSMA PET/CT in detecting local recurrence and distant metastases.

Main Methods:

  • Retrospective, single-center observational study of 50 prostate adenocarcinoma patients.
  • Patients underwent [68Ga] PSMA PET/CT scans with PSA levels ranging from ≤0.2 to >10 ng/mL.
  • Analysis included detection rates, lesion localization (prostate bed, lymph nodes, liver, skeleton, thorax), and correlation with SUVmax.

Main Results:

  • Overall detection rate of PSMA-avid lesions was 78.9% (41 out of 50 scans).
  • Detection rates increased with PSA levels, ranging from 75.0% (PSA ≤ 0.2) to 89.3% (PSA > 10).
  • Significant correlation found between maximal standardized uptake value (SUVmax) and PSA in the prostate bed (p=0.03).

Conclusions:

  • [68Ga] PSMA PET/CT is a highly effective diagnostic tool for prostate cancer, demonstrating high sensitivity even at low PSA levels.
  • The imaging modality accurately identifies primary tumors, local recurrences, and distant metastases in lymph nodes, skeleton, and liver.
  • Findings support the integration of [68Ga] PSMA PET/CT into clinical practice for early prostate cancer detection and treatment outcome prediction.