INTRODUCTION: Accurate early staging of prostate cancer is crucial to selecting the most appropriate patient-specific management. ⁶⁸Ga-ligands targeting prostate-specific membrane antigen (PSMA) are rapidly emerging as a significant step forward in the management of prostate cancer, based on the fact that PSMA is a type II transmembrane protein with high expression in prostate carcinoma cells. The aim of the study was to evaluate the value of ⁶⁸Ga-PSMA-HEBD-CC(⁶⁸Ga-PSMA)-PET/CT in patients with prostate cancer.

METHODS: Patients with histologically confirmed prostate cancer underwent imaging with ⁶⁸Ga-PSMA-PET/CT indications included initial staging, suspected recurrence, suitability for PSMA ligand-based therapy and response to therapy.  Findings were evaluated qualitatively and semi-quantitatively (SUVmax) and compared to the results of histology, Gleason score, and bone scintigraphy.

RESULTS: 182 ⁶⁸Ga-PSMA contrast enhanced PET/CT scans were acquired on 169 prostate cancer patients (mean age 67, ranges 43-93 years) presenting with abnormal PSA (mean 223.8 ng/ml, range 0.1-3036). ⁶⁸Ga-PSMA-PET/CT was positive in 172 of the 182 scans (95 %). Bone scan (n=114) results revealed metastatic bone lesions in 32 patients, and was normal in 81 patients. ⁶⁸Ga-PSMA-PET/CT confirmed malignant disease in 8 (12%) of the normal bone scan patients. Of the100 patients (56%) who were imaged for biochemical recurrence 93 (93%) demonstrated intense prostatic/seminal vesicle tracer uptake whilst 38 (38%) demonstrated widespread nodal, skeletal or soft tissue qualifying them for PSMA ligand-based therapy as part of their management plan. PET/CT imaging resulted in a changed of management in 82% of the acquired studies.

CONCLUSION: Performance of ⁶⁸Ga-PSMA PET/CT in different clinical scenarios with its ability to detect lesions even in low PSA values significantly changes management in patients with prostate cancer.