Initial Experience of (68)Ga-PSMA PET/CT Imaging in High-risk Prostate Cancer Patients Prior to Radical Prostatectomy

Eur Urol. 2016 Mar;69(3):393-6. doi: 10.1016/j.eururo.2015.06.010. Epub 2015 Jun 25.


Prostate-specific membrane antigen (PSMA) overexpression theoretically enables targeting of prostate cancer (PCa) metastases using gallium Ga 68 ((68)Ga)-labeled PSMA ligands for positron emission tomography/computed tomography (PET/CT) imaging. Promising detection rates have been reported when using this approach for functional imaging of recurrent PCa; however, until now, the diagnostic accuracy of (68)Ga-PSMA PET/CT for preoperatively identifying lymph node metastases (LNMs) had not been assessed. We retrospectively compared preoperative (68)Ga-PSMA PET/CT lymph node (LN) findings with histologic work-up after radical prostatectomy (RP). Overall, 608 LNs containing 53 LNMs were detected during RP. LNMs were present in 12 of 30 patients (40%). The (68)Ga-PSMA PET/CT scans identified 4 patients (33.3%) as LN true positive and 8 patients (66.7%) as false negative. Median size of (68)Ga-PSMA-PET/CT-detected versus undetected LNMs was 13.6 versus 4.3 mm (p<0.05). Overall sensitivity, specificity, positive predictive value, and negative predictive value of (68)Ga-PSMA PET/CT for LNM detection were 33.3%, 100%, 100%, and 69.2%, respectively. Per-side analyses revealed corresponding values of 27.3%, 100%, 100%, and 52.9%. Conversely, (68)Ga-PSMA PET/CT enabled tumor visualization in the prostate. In 92.9% of patients, the intraprostatic tumor foci were correctly predicted. Overall, (68)Ga-PSMA PET/CT is a promising tool for functional imaging; however, our initial experience revealed substantial influence of LNM size on the diagnostic accuracy of (68)Ga-PSMA PET/CT.

Patient summary: We assessed the diagnostic accuracy of (68)Ga-PSMA PET/CT in high-risk prostate cancer patients prior to radical prostatectomy. We found that lymph node metastasis detection rates were substantially influenced by lymph node metastasis size.

Keywords: Imaging; Lymph node metastasis; Positron-emission tomography; Prostate cancer; Prostate-specific membrane antigen.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Edetic Acid / administration & dosage
  • Edetic Acid / analogs & derivatives*
  • Edetic Acid / metabolism
  • Gallium Isotopes
  • Gallium Radioisotopes
  • Humans
  • Kallikreins / metabolism
  • Lymph Node Excision
  • Lymph Nodes* / diagnostic imaging
  • Lymph Nodes* / metabolism
  • Lymph Nodes* / surgery
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Multimodal Imaging / methods*
  • Oligopeptides / administration & dosage*
  • Oligopeptides / metabolism
  • Positron-Emission Tomography*
  • Predictive Value of Tests
  • Preoperative Care / methods*
  • Prostate-Specific Antigen / metabolism
  • Prostatectomy*
  • Prostatic Neoplasms* / diagnostic imaging
  • Prostatic Neoplasms* / metabolism
  • Prostatic Neoplasms* / surgery
  • Radiopharmaceuticals / administration & dosage*
  • Radiopharmaceuticals / metabolism
  • Retrospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed*
  • Treatment Outcome


  • Gallium Isotopes
  • Gallium Radioisotopes
  • Oligopeptides
  • Radiopharmaceuticals
  • gallium 68 PSMA-11
  • Edetic Acid
  • KLK3 protein, human
  • Kallikreins
  • Prostate-Specific Antigen