False positive PSMA PET for tumor remnants in the irradiated prostate and other interpretation pitfalls in a prospective multi-center trial

Fendler, Wolfgang P.; Calais, Jeremie; Eiber, Matthias; Simko, Jeffrey P.; Kurhanewicz, John; Santos, Romelyn Delos; Feng, Felix Y.; Reiter, Robert E.; Rettig, Matthew B.; Nickols, Nicholas G.; Kishan, Amar U.; Shozo, Okamoto; Emmett, Louise; Zacho, Helle D.; Ilhan, Harun; Rischpler, Christoph; Wetter, Axel; Schoder, Heiko; Burger, Irene A.; Slavik, Roger; Carroll, Peter R.; Lawhn-Heath, Courtney; Herrmann, Ken; Czernin, Johannes; Hope, Thomas A.

doi:10.1007/s00259-020-04945-1

False positive PSMA PET for tumor remnants in the irradiated prostate and other interpretation pitfalls in a prospective multi-center trial

Journal Article · Mon Aug 17 04:00:00 EDT 2020 · European Journal of Nuclear Medicine and Molecular Imaging

DOI:https://doi.org/10.1007/s00259-020-04945-1· OSTI ID:1851611

Fendler, Wolfgang P. ^[1]; Calais, Jeremie; Eiber, Matthias; Simko, Jeffrey P.; Kurhanewicz, John; Santos, Romelyn Delos; Feng, Felix Y.; Reiter, Robert E.; Rettig, Matthew B.; Nickols, Nicholas G.; Kishan, Amar U.; Shozo, Okamoto; Emmett, Louise; Zacho, Helle D.; Ilhan, Harun; Rischpler, Christoph; Wetter, Axel; Schoder, Heiko; Burger, Irene A.; Slavik, Roger more »

OSTI

Readers need to be informed about potential pitfalls of [⁶⁸Ga]Ga-PSMA-11 PET interpretation. Here we report [⁶⁸Ga]Ga-PSMA-11 PET findings discordant with the histopathology/composite reference standard in a recently published prospective trial on 635 patients with biochemically recurrent prostate cancer. Consensus reads were false positive in 20 regions of 17/217 (8%) patients with lesion validation. Majority of the false positive interpretations (13 of 20, 65%) occurred in the context of suspected prostate (bed) relapse (T) after radiotherapy (n = 11); other false positive findings were noted for prostate bed post prostatectomy (T,n = 2), pelvic nodes (N,n = 2), or extra pelvic lesions (M,n = 5). Major sources of false positive findings were PSMA-expressing residual adenocarcinoma with marked post-radiotherapy treatment effect. False negative interpretation occurred in 8 regions of 6/79 (8%) patients with histopathology validation, including prostate (bed) (n = 5), pelvic nodes (n = 1), and extra pelvic lesions (n = 2). Lesions were missed mostly due to small metastases or adjacent bladder/urine uptake.[⁶⁸Ga]Ga-PSMA-11 PET at biochemical recurrence resulted in less than 10% false positive interpretations. Post-radiotherapy prostate uptake was a major source of [⁶⁸Ga]Ga-PSMA-11 PET false positivity. In few cases, PET correctly detects residual PSMA expression post-radiotherapy, originating however from treated, benign tissue or potentially indolent tumor remnants.

Research Organization:: Univ. of California, Los Angeles, CA (United States)

Sponsoring Organization:: USDOE Office of Science (SC)

Contributing Organization:: PSMA PET Reader Group

DOE Contract Number:: SC0012353

OSTI ID:: 1851611

Journal Information:: European Journal of Nuclear Medicine and Molecular Imaging, Journal Name: European Journal of Nuclear Medicine and Molecular Imaging Journal Issue: 2 Vol. 48; ISSN 1619-7070

Publisher:: Springer Nature

Country of Publication:: United States

Language:: English

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