68Ga-PSMA ligand PET/CT in patients with prostate cancer: How we review and report

Cancer Imaging

Table 1 Potential indications for ⁶⁸Ga-PSMA ligand PET/CT

Benefit using ⁶⁸Ga-PSMA ligand PET/CT	Patient group
High estimated benefit/diagnostic gain	• Primary staging in high-risk disease according to D’Amico classification • Biochemical recurrence with low PSA-values (0.2 ng/ml to 10 ng/ml)^a
Low estimated benefit/diagnostic gain	• Primary staging in low-risk (and intermediate-risk) disease according to D’Amico classification
Potential application with promising preliminary data	• Biopsy targeting after previous negative biopsy, but high suspicion of PC (esp. in combination with multiparametric MRI using PET/MRI)
Potential application with current lack of published data	• Monitoring of systemic treatment in metastatic CRPC^b • Monitoring of systemic treatment in metastatic castration-sensitive PC^b • Active surveillance (esp. in combination with multiparametric MRI using PET/MRI) • Treatment monitoring in metastatic castration-resistant PC undergoing radioligand therapy targeting PSMA (e.g. ¹⁷⁷Lu-PSMA-ligand)

^ain biochemical recurrence with PSA-values over 10 ng/ml conventional imaging (e.g. CT, MRI, bone scan) is also able to demonstrate distribution of disease. Furthermore, at PSA-values > 10 ng/ml salvage options facilitated by ⁶⁸Ga-PSMA ligand PET/CT are unlikely
^bMonitoring of treatment in metastasized PC patients might be enhanced due to often limited applicability of RECIST 1.1 criteria (e.g. non-target lymph node/bone metastases without extra-osseous extension) and the ineffectiveness of bone scan to reliably proving therapy response (e.g. flare phenomenon) compared to preclinical data suggesting PSMA-expression as indicator for response assessment

ISSN: 1470-7330