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Pillai MRA, Nanabala R, Joy A, Sasikumar A, Russ Knapp FF. Radiolabeled enzyme inhibitors and binding agents targeting PSMA: Effective theranostic tools for imaging and therapy of prostate cancer. Nucl Med Biol 2016; 43:692-720. [PMID: 27589333 DOI: 10.1016/j.nucmedbio.2016.08.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 12/14/2022]
Abstract
Because of the broad incidence, morbidity and mortality associated with prostate-derived cancer, the development of more effective new technologies continues to be an important goal for the accurate detection and treatment of localized prostate cancer, lymphatic involvement and metastases. Prostate-specific membrane antigen (PSMA; Glycoprotein II) is expressed in high levels on prostate-derived cells and is an important target for visualization and treatment of prostate cancer. Radiolabeled peptide targeting technologies have rapidly evolved over the last decade and have focused on the successful development of radiolabeled small molecules that act as inhibitors to the binding of the N-acetyl-l-aspartyl-l-glutamate (NAAG) substrate to the PSMA molecule. A number of radiolabeled PSMA inhibitors have been described in the literature and labeled with SPECT, PET and therapeutic radionuclides. Clinical studies with these agents have demonstrated the improved potential of PSMA-targeted PET imaging agents to detect metastatic prostate cancer in comparison with conventional imaging technologies. Although many of these agents have been evaluated in humans, by far the most extensive clinical literature has described use of the 68Ga and 177Lu agents. This review describes the design and development of these agents, with a focus on the broad clinical introduction of PSMA targeting motifs labeled with 68Ga for PET-CT imaging and 177Lu for therapy. In particular, because of availability from the long-lived 68Ge (T1/2=270days)/68Ga (T1/2=68min) generator system and increasing availability of PET-CT, the 68Ga-labeled PSMA targeted agent is receiving widespread interest and is one of the fastest growing radiopharmaceuticals for PET-CT imaging.
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Affiliation(s)
| | - Raviteja Nanabala
- KIMS DDNMRC PET Scans, KIMS Hospital, Trivandrum, Kerala, India, 691601
| | - Ajith Joy
- Molecular Group of Companies, Puthuvype, Ernakulam, Kerala, 682508, India
| | - Arun Sasikumar
- KIMS DDNMRC PET Scans, KIMS Hospital, Trivandrum, Kerala, India, 691601
| | - Furn F Russ Knapp
- Emeritus, Medical Radioisotope Program, Oak Ridge National Laboratory, Oak Ridge, TN, USA, 37830
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Gupta M, Choudhury PS, Gupta G, Gandhi J. Metastasis in urothelial carcinoma mimicking prostate cancer metastasis in Ga-68 prostate-specific membrane antigen positron emission tomography-computed tomography in a case of synchronous malignancy. Indian J Nucl Med 2016; 31:222-4. [PMID: 27385897 PMCID: PMC4918490 DOI: 10.4103/0972-3919.183615] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Prostate cancer is the second most common cancer in man. It commonly presents with urinary symptoms, bone pain, or diagnosed with elevated prostate-specific antigen.(PSA) levels. Correct staging and early diagnosis of recurrence by a precise imaging tool are the keys for optimum management. Molecular imaging of prostate cancer with Ga-68 prostate-specific membrane antigen.(PSMA), positron emission tomography-computed tomography.(PET-CT) has recently received significant attention and frequently used with a signature to prostate cancer-specific remark. However, this case will highlight the more cautious use of it. A-72-year-old male treated earlier for synchronous double malignancy.(invasive papillary urothelial carcinoma right ureter and carcinoma prostate) presented with rising PSA.(0.51.ng/ml) and referred for Ga-68 PSMA PET-CT, which showed a positive enlarged left supraclavicular lymph node. Lymph node biopsy microscopic and immunohistochemistry examination revealed metastatic carcinoma favoring urothelial origin. Specificity of PSMA scan to prostate cancer has been seen to be compromised in a certain situation mostly due to neoangiogenesis, and false positives emerged in renal cell cancer, differentiated thyroid cancer, glioblastoma, breast cancer brain metastasis, and paravertebral schwannomas. Understanding the causes of false positive will further enhance the confidence of interpretating PSMA scans.
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Affiliation(s)
- Manoj Gupta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Partha Sarathi Choudhury
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Gurudutt Gupta
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Jatin Gandhi
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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53
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Rauscher I, Maurer T, Fendler WP, Sommer WH, Schwaiger M, Eiber M. (68)Ga-PSMA ligand PET/CT in patients with prostate cancer: How we review and report. Cancer Imaging 2016; 16:14. [PMID: 27277843 PMCID: PMC4898465 DOI: 10.1186/s40644-016-0072-6] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/16/2016] [Indexed: 01/22/2023] Open
Abstract
Recently, positron emission tomography (PET) imaging using PSMA-ligands has gained high attention as a promising new radiotracer in patients with prostate cancer (PC). Several studies promise accurate staging of primary prostate cancer and restaging after biochemical recurrence with 68Ga-PSMA ligand Positron emission tomography/computed tomography (PET/CT). However, prospective trials and clinical guidelines for this new technique are still missing. Therefore, we summarized our experience with 68Ga-PSMA ligand PET/CT examinations in patients with primary PC and biochemical recurrence. It focuses on the technical and logistical aspects of 68Ga-PSMA ligand PET/CT examination as well as on the specific background for image reading discussing also potential pitfalls. Further, it includes relevant issues on free-text as well as structured reporting used in daily clinical routine.
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Affiliation(s)
- Isabel Rauscher
- Klinikum rechts der Isar, Department of Nuclear Medicine, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,Clinical Cancer Center Munich (CCM), Munich, Germany. .,German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Tobias Maurer
- Clinical Cancer Center Munich (CCM), Munich, Germany.,Klinikum rechts der Isar, Department of Urology, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Wolfgang P Fendler
- Clinical Cancer Center Munich (CCM), Munich, Germany.,Department of Nuclear Medicine, Ludwig-Maximilians University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Wieland H Sommer
- Clinical Cancer Center Munich (CCM), Munich, Germany.,Grosshadern Campus, Department of Clinical Radiology, Ludwig-Maximilians University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Markus Schwaiger
- Klinikum rechts der Isar, Department of Nuclear Medicine, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,Clinical Cancer Center Munich (CCM), Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Matthias Eiber
- Klinikum rechts der Isar, Department of Nuclear Medicine, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,Clinical Cancer Center Munich (CCM), Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
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54
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Abstract
Currently, the findings of imaging procedures used for detection or staging of prostate cancer depend on morphology of lymph nodes or bone metabolism and do not always meet diagnostic needs. Prostate-specific membrane antigen (PSMA), a transmembrane protein that has considerable overexpression on most prostate cancer cells, has gained increasing interest as a target molecule for imaging. To date, several small compounds for labelling PSMA have been developed and are currently being investigated as imaging probes for PET with the (68)Ga-labelled PSMA inhibitor Glu-NH-CO-NH-Lys(Ahx)-HBED-CC being the most widely studied agent. (68)Ga-PSMA-PET imaging in combination with multiparametric MRI (mpMRI) might provide additional molecular information on cancer localization within the prostate. In patients with primary prostate cancer of intermediate-risk to high-risk, PSMA-based imaging has been reported to improve detection of metastatic disease compared with CT or mpMRI, rendering additional cross-sectional imaging or bone scintigraphy unnecessary. Furthermore, in patients with biochemically recurrent prostate cancer, use of (68)Ga-PSMA-PET imaging has been shown to increase detection of metastatic sites, even at low serum PSA values, compared with conventional imaging or PET examination with different tracers. Thus, although current knowledge is still limited and derived mostly from retrospective series, PSMA-based imaging holds great promise to improve prostate cancer management.
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Rahbar K, Weckesser M, Huss S, Semjonow A, Breyholz HJ, Schrader AJ, Schäfers M, Bögemann M. Correlation of Intraprostatic Tumor Extent with 68Ga-PSMA Distribution in Patients with Prostate Cancer. J Nucl Med 2016; 57:563-7. [PMID: 26769858 DOI: 10.2967/jnumed.115.169243] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/04/2015] [Indexed: 02/03/2023] Open
Affiliation(s)
- Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Sebastian Huss
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Axel Semjonow
- Prostate Center, Department for Urology, University Hospital Muenster, Muenster, Germany
| | - Hans-Jörg Breyholz
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Andres J Schrader
- Prostate Center, Department for Urology, University Hospital Muenster, Muenster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany European Institute for Molecular Imaging, University of Muenster, Muenster, Germany; and Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster, Germany
| | - Martin Bögemann
- Prostate Center, Department for Urology, University Hospital Muenster, Muenster, Germany
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