Evaluating the role of a 99mTc-HYNIC-PSMA SPECT scan following a negative bone scan in men with prostate cancer: a single-centre, retrospective cohort study

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dc.contributor.advisorLazarus, John
dc.contributor.authorOppel, Cleve
dc.date.accessioned2024-05-31T11:08:19Z
dc.date.available2024-05-31T11:08:19Z
dc.date.issued2023
dc.date.updated2024-05-31T11:00:58Z
dc.description.abstractPurpose: This study aimed to review the management of patients with high-risk and unfavourable intermediate-risk prostate cancer, who had a 99mTc-HYNIC-PSMA SPECT (technetium-99m hydrazine nicotinamide prostate-specific membrane antigen singlephoton emission computerised tomography) scan following a negative 99mTc-MDP (technetium-99m methylene diphosphonate) bone scan. Materials and methods: This study is a retrospective review of patients with high-risk and unfavourable intermediate-risk prostate cancer, who underwent a 99mTc-PSMA SPECT scan after a negative/equivocal bone scan between January 2018 and December 2020. Patients with a life expectancy of less than 10 years were excluded. Results: A total of 64 patients were investigated. The mean age was 63 years and the mean prostate-specific antigen (PSA) level was 40 ng/mL. The International Society of Urological Pathology (ISUP) scores were as follows: ISUP 1 in six patients, ISUP 2 in eight patients, ISUP 3 in 13 patients, and ISUP > 4 in 37 patients. A positive 99mTc-PSMA SPECT scan for disease metastases occurred in 20% of the patients who had a negative bone scan. Seven of the patients with a positive 99mTc-PSMA SPECT scan received a bilateral orchiectomy, while four patients received treatment with radical intent. Management of patients with both scans negative included external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT) (n = 47), and radical prostatectomy with or without lymph node (LN) dissection (n = 4). A limiting factor was that not every patient underwent conventional cross-sectional imaging of the pelvis and prostate prior to intervention. Conclusion: A 99mTc-PSMA SPECT scan is a valuable diagnostic tool and was able to identify one in five men (20%) who are understaged by bone scan, allowing for their management plan to be tailored and sparing them morbid intervention.
dc.identifier.apacitationOppel, C. (2023). <i>Evaluating the role of a 99mTc-HYNIC-PSMA SPECT scan following a negative bone scan in men with prostate cancer: a single-centre, retrospective cohort study</i>. (). ,Faculty of Health Sciences ,Division of General Surgery. Retrieved from http://hdl.handle.net/11427/39798en_ZA
dc.identifier.chicagocitationOppel, Cleve. <i>"Evaluating the role of a 99mTc-HYNIC-PSMA SPECT scan following a negative bone scan in men with prostate cancer: a single-centre, retrospective cohort study."</i> ., ,Faculty of Health Sciences ,Division of General Surgery, 2023. http://hdl.handle.net/11427/39798en_ZA
dc.identifier.citationOppel, C. 2023. Evaluating the role of a 99mTc-HYNIC-PSMA SPECT scan following a negative bone scan in men with prostate cancer: a single-centre, retrospective cohort study. . ,Faculty of Health Sciences ,Division of General Surgery. http://hdl.handle.net/11427/39798en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Oppel, Cleve AB - Purpose: This study aimed to review the management of patients with high-risk and unfavourable intermediate-risk prostate cancer, who had a 99mTc-HYNIC-PSMA SPECT (technetium-99m hydrazine nicotinamide prostate-specific membrane antigen singlephoton emission computerised tomography) scan following a negative 99mTc-MDP (technetium-99m methylene diphosphonate) bone scan. Materials and methods: This study is a retrospective review of patients with high-risk and unfavourable intermediate-risk prostate cancer, who underwent a 99mTc-PSMA SPECT scan after a negative/equivocal bone scan between January 2018 and December 2020. Patients with a life expectancy of less than 10 years were excluded. Results: A total of 64 patients were investigated. The mean age was 63 years and the mean prostate-specific antigen (PSA) level was 40 ng/mL. The International Society of Urological Pathology (ISUP) scores were as follows: ISUP 1 in six patients, ISUP 2 in eight patients, ISUP 3 in 13 patients, and ISUP > 4 in 37 patients. A positive 99mTc-PSMA SPECT scan for disease metastases occurred in 20% of the patients who had a negative bone scan. Seven of the patients with a positive 99mTc-PSMA SPECT scan received a bilateral orchiectomy, while four patients received treatment with radical intent. Management of patients with both scans negative included external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT) (n = 47), and radical prostatectomy with or without lymph node (LN) dissection (n = 4). A limiting factor was that not every patient underwent conventional cross-sectional imaging of the pelvis and prostate prior to intervention. Conclusion: A 99mTc-PSMA SPECT scan is a valuable diagnostic tool and was able to identify one in five men (20%) who are understaged by bone scan, allowing for their management plan to be tailored and sparing them morbid intervention. DA - 2023 DB - OpenUCT DP - University of Cape Town KW - General Surgery LK - https://open.uct.ac.za PY - 2023 T1 - Evaluating the role of a 99mTc-HYNIC-PSMA SPECT scan following a negative bone scan in men with prostate cancer: a single-centre, retrospective cohort study TI - Evaluating the role of a 99mTc-HYNIC-PSMA SPECT scan following a negative bone scan in men with prostate cancer: a single-centre, retrospective cohort study UR - http://hdl.handle.net/11427/39798 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/39798
dc.identifier.vancouvercitationOppel C. Evaluating the role of a 99mTc-HYNIC-PSMA SPECT scan following a negative bone scan in men with prostate cancer: a single-centre, retrospective cohort study. []. ,Faculty of Health Sciences ,Division of General Surgery, 2023 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/39798en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDivision of General Surgery
dc.publisher.facultyFaculty of Health Sciences
dc.subjectGeneral Surgery
dc.titleEvaluating the role of a 99mTc-HYNIC-PSMA SPECT scan following a negative bone scan in men with prostate cancer: a single-centre, retrospective cohort study
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
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