Low detection rate of conventional imaging and unspecific fluctuations of PSA can hamper early diagnosis of castration-resistant prostate cancer (CRPC). We thus assessed the value of PSMA-PET/CT in the detection of early CRPC (PSA ≤3 ng/mL). Methods: We identified 55 patients with early CRPC (PSA≤3 ng/mL) from our institutional database. PSMA-PET/CT and its CT component were interpreted independently by three blinded readers. Primary endpoint was the per-patient detection rate, secondary endpoints were interobserver agreement, and predictors of PET-positivity. Results: PSMA-PET/CT was positive in 41/55 (75%) patients. 16/55 (29%) patients had local disease only, 25/55 (45%) had M1-disease. Overall PSMA-PET/CT interobserver agreement was substantial by Landis and Koch criteria (Fleiss' kappa 0.77). Conclusion: PSMA-PET/CT localized prostate cancer in 75% of patients. Detection of early CRPC facilitates disease-delaying therapies for local/oligometastatic disease. PSMA-PET/CT is of value in early CRPC and should be included in EAU/PCWG3 CRPC entry criteria.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2020 May 22 [Epub ahead of print]
Manuel Weber, Claudia Ewa Kurek, Francesco Barbato, Matthias Eiber, Tobias Maurer, Michael Nader, Boris Hadaschik, Viktor Grünwald, Ken Herrmann, Axel Wetter, Wolfgang Peter Fendler
Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany, Germany., Department of Nuclear Medicine, Technical University Munich, Munich, Germany., Department of Urology and Martini-Klinik, University of Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany., Interdisciplinary Genitourinary Oncology, West-German Cancer Center, University Hospital Essen., Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.