Head to head comparison performance of 99mTc-EDDA/HYNIC-iPSMA SPECT/CT and 68Ga-PSMA-11 PET/CT a prospective study in biochemical recurrence prostate cancer patients (original) (raw)
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The Prostate, 2017
Background: 99m Tc-MIP-1404 (Progenics Pharmaceuticals, Inc., New York, NY) is a novel, SPECT-compatible 99m Tc-labeled PSMA inhibitor for the detection of prostate cancer. We present results of its clinical use in a cohort of 225 men with histologically confirmed prostate cancer referred for workup of biochemical relapse. Methods: From April 2013 to April 2017, 99m Tc-MIP1404-scintigraphy was performed in 225 patients for workup of PSA biochemical relapse of prostate cancer. Whole-body planar and SPECT/CT images of the lower abdomen and thorax were obtained 3-4 h p.i. of 710 ± 64 MBq 99m Tc-MIP-1404. Images were visually analyzed for presence and location of abnormal uptake. In addition, quantitative analysis of the SPECT/CT data was carried out on a subset of 125 patients. Follow-up reports of subsequent therapeutic interventions were available for 59% (139) of all patients. Results: Tracer-positive lesions were detected in 77% (174/225) of all patients. Detections occurred at the area of local recurrence in the prostate in 25% of patients (or a total of 56), with metastases in lymph nodes in 47% (105), bone in 27% (60), lung in 5% (12), and other locations in 2% (4) of patients. Detection rates were 90% at PSA levels ≥2 ng/mL and 54% below that threshold. Lesional SUVmax values were, on average, 32.2 ± 29.6 (0.8-142.2), and tumor-to-normal ratios 146.6 ± 160.5 (1.9-1482.4). The PSA level correlated significantly with total uptake of MIP-1404 in tumors (P < 0.001). Furthermore, total tumor uptake was significantly higher in patients with Gleason scores ≥8 compared to those with Gleason scores ≤7 (P < 0.05). In patients with androgen deprivation therapy, the detection rate was significantly higher compared to patients without androgen deprivation therapy (86% vs 71%, P < 0.001). Based on 99m Tc-MIP-1404-imaging and other information, an interdisciplinary tumor board review recommended changes to treatment plans in 74% (104/139) of those patients for whom the necessary documentation was available. Conclusion: SPECT/CT with 99m Tc-labeled MIP-1404 has a high probability in detecting PSMA-positive lesions in patients with elevated PSA. Statistical analysis
Direct comparison of 99mTc-PSMA SPECT/CT and 68Ga-PSMA PET/CT in patients with prostate cancer
2020
Objective(s): 99mTc-PSMA SPECT/CT is a cost effective alternative for 68Ga-PSMA PET/CT. The aim of this study was to directly compare these two techniques in patients with prostate cancer. Methods: 28 man with prostate cancer were studied using 99mTc-PSMA SPECT/CT and 68Ga-PSMA PET/CT in a short time period (<60 days). No intervention was done between the studies. Whole body PET/CT was done 60 minutes after IV injection of 2 MBq/Kg of 68Ga-PSMA. 99mTc-PSMA kit (PSMA I+S) was used for SPECT/CT and whole body imaging was performed 4 hours after IV injection of 740 MBq of 99mTc-PSMA. Images were interpreted independently and the results of each imaging were recorded. Results: The mean age of the patients was 64.7±9.6 years old and the mean time difference between two sets of images was 16.6±13.5 days. Abnormal uptake was seen in 25 (89.2%) patients by 68Ga-PSMA PET/CT and 20 (71.4%) patients with 99mTc-PSMA SPECT/CT. No patients with positive 99mTc-PSMA SPECT/CT had negative 68Ga-PS...
Clinical Impact of 68Ga-PSMA PET/CT in a Patient With Biochemical Recurrence of Prostate Cancer
Clinical nuclear medicine, 2016
A 64-year-old man with history of prostate adenocarcinoma underwent radical prostatectomy in 2003. He remained with undetectable prostate-specific antigen (PSA) levels until 2014, when he then presented rising serum PSA levels and performed a Tc-MDP bone scan that was negative for metastases. In August 2015, his PSA was 4.89 ng/dL, and restaging images with pelvic MR and F-FDG PET/CT were both negative. Therefore, the patient underwent a Ga-PSMA PET/CT that showed marked tracer uptake in a single mediastinal lymph node. Histopathology demonstrated metastatic adenocarcinoma secondary to prostate cancer, altering patient management to hormone therapy instead of pelvic radiotherapy.
Journal of Nuclear Medicine, 2019
18 F-PSMA-1007 is a novel prostate-specific membrane antigen (PSMA)-based radiopharmaceutical for imaging prostate cancer (PCa). The aim of this study was to compare the diagnostic accuracy of 18 F-PSMA-1007 with 68 Ga-PSMA-11 PET/CT in the same patients presenting with newly diagnosed intermediate-or high-risk PCa. Methods: Sixteen patients with intermediate-or high-risk PCa underwent 18 F-PSMA-1007 and 68 Ga-PSMA-11 PET/CT within 15 d. PET findings were compared between the 2 radiotracers and with reference-standard pathologic specimens obtained from radical prostatectomy. The Cohen κ-coefficient was used to assess the concordance between 18 F-PSMA-1007 and 68 Ga-PSMA-11 for detection of intraprostatic lesions. The McNemar test was used to assess agreement between intraprostatic PET/CT findings and histopathologic findings. Sensitivity, specificity, positive predictive value, and negative predictive value were reported for each radiotracer. SUV max was measured for all lesions, and tumor-to-background activity was calculated. Areas under receiver-operating-characteristic curves were calculated for discriminating diseased from nondiseased prostate segments, and optimal SUV cutoffs were calculated using the Youden index for each radiotracer. Results: PSMA-avid lesions in the prostate were identified in all 16 patients with an almost perfect concordance between the 2 tracers (κ ranged from 0.871 to 1). Aside from the dominant intraprostatic lesion, similarly detected by both radiotracers, a second less intense positive focus was detected in 4 patients only with 18 F-PSMA-1007. Three of these secondary foci were confirmed as Gleason grade 3 lesions, whereas the fourth was shown on pathologic examination to represent chronic prostatitis. Conclusion: This pilot study showed that both 18 F-PSMA-1007 and 68 Ga-PSMA-11 identify all dominant prostatic lesions in patients with intermediateor high-risk PCa at staging. 18 F-PSMA-1007, however, may detect additional low-grade lesions of limited clinical relevance.
Journal of Nuclear Medicine Technology, 2021
The use of prostate-specific membrane antigen (PSMA)-based PET/CT has grown rapidly in recent years. This study estimated lesional uptake, normal physiologic concentrations, and temporal variation on delayed PET/CT of 68 Ga-PSMA-11 across different molecular imaging PSMA (miPSMA) expression scores in patients with metastatic castration-resistant prostatic carcinoma. Methods: We retrospectively studied 50 patients who were evaluated for 177 Lu-PSMA-targeted radioligand therapy and underwent 68 Ga-PSMA-11 PET/CT to determine disease status. Their mean age was 67.5 6 8 y (52-84 y), and their average serum prostatespecific antigen level was 401 6 1,353 ng/mL (0.098-9,235.13 ng/mL) at the time of scanning. They underwent standard 68 Ga-PSMA-11 PET/CT an average of 65 min after injection (60-90 min). Tumors (n 5 50) were correlated with miPSMA expression score and uptake. Physiologic tracer distribution was estimated by placing a volume of interest 1 cm in diameter for smaller organs (submandibular, parotid, lacrimal, and tubarial glands; renal cortices; blood pool; and bowel) and 3 cm for larger organs (liver and spleen). SUV max and SUV mean were estimated for each region.
The Journal of Urology, 2018
, we selected those who performed an early scan for the detection of prostate fossae recurrences and had a PSA levels <2 ng/mL at PET time. 75 subjects met the inclusion criteria. All these patients underwent an early static (after 2 minutes from the FCH injection; 1 bed; 5 minutes/bed) and late whole-body (after 60 minutes from FCH injection; 7 beds; 3 minutes/ bed) PET/CT acquisition. A correlation among terapeutic factors, Gleason Score, PSA levels, PSA doubling time (PSAdt), PSA velocity (PSA vel) and early PET/CT findings were assessed by using the chisquare test and Mann-Whitney test. The agreement between early and late PET/CT acquisitions was studied by K-statistic. ROC analysis was used to evaluate the optimal cutoff point for PSA able to distinguish positive and negative PET/CT finding. A p<0.05 was considered statistically significant. RESULTS: PET/CT showed a pathological tracer uptake in 25 patients (33.3%); in 15 cases confined to the prostatic bed, in 4 to lymph nodes, in 4 to the bone, in 2 to both prostatic fossae and lymph nodes and in 3 to both bone and lymph nodes. Therefore, the detection rate of PET/CT was higher for local recurrences (18/25; 72%). PSA values increased in patients with a positive PET/CT finding compared to subjects with a negative scan. Similarly, PSAdt and PSAvel values were different between patients with a positive and a negative PET/CT scan (6.9 versus 10.2 mo and 0.6 versus 0.4 ng/mL/year, respectively). 15 patients had positive early scans and only 4/15 were positive for both early and late PET/CT acquisition (Kappa value ¼ 0.368; p< 0.001). No correlation was found between the PSAdt or PSAvel and positive or negative early PET/CT images. At ROC analysis a PSA value of 0.67 ng/mL showed a sensitivity and specificity of 69% and 64%, respectively, to distinguish patients with positive or negative PET findings. Using this cutoff value, FCH PET/CT was positive in 23% of patients with PSA < 0.67 ng/mL; 12% of patients had a positive early PET/CT and therefore 88% had negative early scans. CONCLUSIONS: From this study emerges that, in patients with PSA < 2 ng/mL, local recurrence is more often detect by FCH PET/CT finding. An early PET acquisition is able to improve the detection rate, expecially in prostatic fossae, and we reported in this study that local findings were increased to 70%. Our results suggest that the selection of patients ungergoing a "dual phase" PET/CT should be based not only on PSA value but also on PSA kinetic.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2017
The introduction ofF-labelled prostate-specific membrane antigen (PSMA) targeted positron emission tomography/computed-tomography (PET/CT) tracers, firstlyF-DCFPyL and more recentlyF-PSMA-1007, have demonstrated promising results for the diagnostic workup of prostate cancer (PCa). This clinical study presents an intra-individual comparison to evaluate tracer-specific characteristics ofF-DCFPyL versusF-PSMA-1007.Twelve prostate cancer patients, drug naive or prior to surgery, received similar activities of about 250 MBqF-DCFPyL andF-PSMA-1007 48 h apart and were imaged 2 h p.i. in the same PET/CT-scanner using the same reconstruction-algorithm. Normal organ biodistribution and tumor uptakes were quantified using SUVPSMA-positive lesions were detected in twelve out of twelve PCa patients. Both tracers,F-DCFPyL andF-PSMA-1007, detected the identical lesions. No statistical significance could be observed when comparing the SUVofF-DCFPyL andF-PSMA-1007 for local tumor, lymph node metasta...
Systemic therapy response evaluation in prostate carcinoma with [68Ga]Ga-PSMA-11 PET/CT
Egyptian Journal of Radiology and Nuclear Medicine
Background Consensus statements was published by EAU and EANM to clarify some uncertainties on PSMA PET/CT response assessment in 2020. We aimed to investigate the response criteria for PSMA PET/CT according to published criteria by comparing with serum PSA changes and determine the factors affecting therapy response evaluation. Results A high concordance was found between [68Ga]Ga-PSMA-11 PET/CT and serum PSA responses and 0.84 of Gamma coefficient was obtained. Between concordant and discordant group, statistically significant difference was not found in terms of received therapies and castration resistance status. Statistically significant but low correlation was found between serum PSA and SUV values of prostate, moderate correlation was found serum PSA and SUVmax values of metastatic lymph nodes and bones. Conclusions The response evaluation of PSMA PET/CT according to the published criteria shows high concordance with serum PSA values without being affected by received therapi...
Scientific Reports, 2020
We aimed to evaluate the impact of prostate-specific membrane antigen ligand labelled with gallium-68 (PSMA-11) PET/CT in restaging patients with castration-resistant nonmetastatic prostate cancer (PCa). Thirty patients were included. At least one malignant focus was found in 27/30 patients (90%). The PSMA-11 PET/CT positivity rate in patients whose prostate-specific antigen serum level (PSA) was greater than 2 ng/ml was 100% (20/20), significantly superior to that of patients whose PSA was less than 2 ng/ml (7/10 = 70%). Six patients (20%) were categorized as oligometastatic (≤3 metastatic foci). Based on the 17 patients for whom a standard of truth was feasible, the overall sensitivity and specificity of PSMA-11 PET/CT in detecting residual disease in castration-resistant PCa patients were 87% and 100% respectively. PSMA-11 PET/CT impacted patients’ disease management in 70% of cases, 60% of case when PSA was less than 2 ng/ml. This management was considered as adequate in 91% of ...
Therapy response assessment is a critical step in cancer management, leading clinicians to optimize the use of therapeutic options during the course of the disease. Imaging is a pivotal biomarker for therapy response evaluation in oncology and has gained wider use through the development of reproducible data-based guidelines, of which the Response Evaluation Criteria in Solid Tumors is the most successful example. Disease-specific criteria have also been proposed, and the Prostate Cancer Working Group 3 criteria are the mainstay for prostate cancer (PC). However, conventional imaging evaluation in metastatic prostate cancer has several limitations, including (a) the inability to detect small-volume disease, (b) the high prevalence of bone (nonmeasurable) lesions at imaging, and (c) the established role of serum prostate-specific antigen (PSA) levels as the biomarker of choice for response assessment and disease progression. In addition, there are an increasing number of newer treatment options with various effects on imaging features. Prostate-specific membrane antigen (PSMA) PET has improved patient selection for newer treatments, such as metastasis-directed therapy (MDT) or radionuclide therapy. The role of PSMA PET in response assessment for many metastatic PC therapeutic options (MDT, androgen deprivation therapy, chemotherapy, radionuclide therapy, and immunotherapy) is an evolving issue, with emerging data showing good correlation with PSA levels and clinical outcome. However, there are specific implications of each therapy (especially androgen deprivation therapy and immunotherapy) on PSMA expression by PC cells, leading to potential pitfalls and inaccuracies that must be known by radiologists. Despite some limitations, PSMA PET is addressing gaps left by conventional imaging methods (eg, CT and bone scanning) and nonimaging biomarkers (PSA levels) in metastatic PC therapy response assessment, a role that can be improved with advances like refinement of interpretation criteria and whole-body tumor burden quantification. © RSNA, 2020 • Abbreviations: ADT = androgen deprivation therapy, CRPC = castration-resistant PC, FDG = fluorine 18 fluorodeoxyglucose, ISUP = International Society of Urological Pathology, MDT = metastasis-directed therapy, PC = prostate cancer, PCWG3 = Prostate Cancer Working Group 3, PSA = prostate-specific antigen, PSMA = prostate-specific membrane antigen, RECIST = Response Evaluation Criteria in Solid Tumors, SBRT = stereotactic body radiation therapy, SUV max = maximum standardized uptake value RadioGraphics 2020; 40:0000-0000 https://doi.