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Chaussé G, Ben-Ezra N, Stoopler M, Levett JY, Niazi T, Anidjar M, Abikhzer G, Probst S. Diagnostic performance of 18F-DCFPyL positron emission tomography/computed tomography for biochemically recurrent prostate cancer and change-of-management analysis. Can Urol Assoc J 2020; 15:173-178. [PMID: 33212005 DOI: 10.5489/cuaj.6817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Conventional imaging (CI) performs poorly to identify sites of disease in biochemically recurrent prostate cancer. 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) is most studied but has a very short half-life. This study reports the diagnostic performance of the novel prostate-specific membrane antigen (PSMA) radiotracer 18F-DCFPyL using real-life data and tumor board simulation to estimate the impact of 18F-DCFPyL PET on patient management. METHODS Ninety-three 18F-DCFPyL PET/CT scans performed for patients previously treated for prostate cancer with a rising prostate-specific antigen (PSA) were retrospectively compared to contemporary CI and clinical imaging and PSA followups. A chart review was performed to document prior imaging, pathology results, serial serum PSA measurements, and other pertinent clinical data. Clinical utility of 18F-DCFPyL PET was measured using a simulated tumor board formed by three physicians with extensive prostate cancer experience deciding on management with and without knowledge of PET/CT results. RESULTS At median PSA 2.27 (interquartile rage [IQR] 5.27], 82% of 18F-DCFPyL PET/CT demonstrated at least one site of disease: non-regional lymph nodes (37% of scans), regional lymph node metastases (28%), local recurrence (27%), and bone metastases (20%), with higher PET positivity at higher PSA. Compared to 18F-DCFPyL PET/CT, CI showed overall poor performance, with accuracy below 20% for all extent of disease. PET/CT changed management in 44% of cases. The most frequent scenario was a radical change from initiating androgen deprivation therapy (ADT) to stereotactic body radiotherapy (SBRT) of oligo-lesional disease. In univariate and multivariate analysis, no patient characteristic could predict change of management by PET/CT results. CONCLUSIONS 18F-DCFPyL significantly outperforms CI in recurring prostate cancer and is likely to impact management.
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Affiliation(s)
- Guillaume Chaussé
- Nuclear Medicine, Medical Imaging, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Noah Ben-Ezra
- Nuclear Medicine, Medical Imaging, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Michelle Stoopler
- Nuclear Medicine, Medical Imaging, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jeremy Y Levett
- Nuclear Medicine, Medical Imaging, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Tamim Niazi
- Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Maurice Anidjar
- Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Gad Abikhzer
- Nuclear Medicine, Medical Imaging, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Stephan Probst
- Nuclear Medicine, Medical Imaging, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Inubushi M, Miura H, Kuji I, Ito K, Minamimoto R. Current status of radioligand therapy and positron-emission tomography with prostate-specific membrane antigen. Ann Nucl Med 2020; 34:879-883. [PMID: 33175360 PMCID: PMC7680309 DOI: 10.1007/s12149-020-01549-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 01/14/2023]
Abstract
Prostate-specific membrane antigen (PSMA) is a transmembrane glycoprotein highly expressed by prostate cancer cells. PSMA-based radioligand therapy (RLT) emerged as a promising therapeutic option for prostate cancer in the early 2000s, and has been clinically validated with great enthusiasm during these past two decades. Last year, the European Association of Nuclear Medicine (EANM) published the procedure guidelines for the safe clinical practice of Lutetium-177 (177Lu)-labelled PSMA RLT. In addition, PSMA RLT with alpha-ray-emitting radioisotopes has been also developed recently. Following the clinical use of 177Lu-PSMA RLT, PSMA-targeted positron-emission tomography (PET) with Gallium-68 (68Ga) has been performed inevitably for “theranostics” for the last decade; prostate cancer is going to be treated with PSMA-RLT based on the diagnosis by PSMA-PET. Furthermore, the diagnostic usefulness of 68Ga-PSMA PET has been documented in various diseases beyond prostate cancer more recently. Regrettably, Japan is behind European countries and the United States in this field, and has just made a belated start of their clinical trials. In this review article, we briefly overviewed the current status of PSMA RLT and PSMA PET. We hope that this topic will be a particular focus of attention for most ANM readers in Japan, and that our efforts will help to facilitate the early approval of PSMA RLT and PSMA PET by the Japanese government even if only slightly.
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Affiliation(s)
- Masayuki Inubushi
- Division of Nuclear Medicine, Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Hiroyuki Miura
- Department of Radiology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ichiei Kuji
- Department of Nuclear Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kimiteru Ito
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan
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Hong JJ, Liu BL, Wang ZQ, Tang K, Ji XW, Yin WW, Lin J, Zheng XW. The value of 18F-PSMA-1007 PET/CT in identifying non-metastatic high-risk prostate cancer. EJNMMI Res 2020; 10:138. [PMID: 33169183 PMCID: PMC7652971 DOI: 10.1186/s13550-020-00730-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinical management decisions on prostate cancer (PCa) are often based on a determination of risk. 68Ga-prostate-specific membrane antigen (PSMA)-11-positron emission tomography (PET)/computer tomography (CT) is an attractive modality to assess biochemical recurrence of PCa, detect metastatic disease and stage of primary PCa, making it a promising strategy for risk stratification. However, due to some limitation of 68Ga-PSMA-11 the development of alternative tracers is of high interest. In this study, we aimed to investigate the value of 18F-PSMA-1007 in identifying non-metastatic high-risk PCa. METHODS A total of 101 patients with primary non-metastatic PCa who underwent 18F-PSMA-1007 PET/CT were retrospectively analyzed. According to the European Association of Urology guidelines on PCa, patients were classified into intermediate-risk (IR) group or high-risk (HR) group. The maximum standardized uptake values (SUVmax) of the primary prostate tumor were measured on PET/CT images. The diagnostic performance of PET/CT for IR and HR PCa was calculated, and the relationship between the SUVmax of primary prostate tumor, prostate-specific antigen (PSA) level and Gleason score (GS) was analyzed. RESULTS Of all 101 patients, 49 patients were classified into IR group and 52 patients were classified into HR group. There was a significant positive correlation between PSA level/GS and SUVmax (r = 0.561, r = 0.496, P < 0.001, respectively). Tumors with GS 6 and 7a showed significantly lower 18F-PSMA-1007 uptake compared to patients with GS 8 and 9 (P < 0.01). SUVmax in patients of HR was significantly higher than those of IR (median SUVmax: 16.85 vs 7.80; P < 0.001). In receiver operating characteristic curve analysis, the optimal cutoff value of the SUVmax for identifying high-risk PCa was set as 9.05 (area under the curve: 0.829; sensitivity: 90.4%; specificity: 65.3%). CONCLUSION 18F-PSMA-1007 PET/CT showed the powerful diagnosis efficacy for high-risk PCa, which can be used as an objective imaging reference index for clinical reference.
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Affiliation(s)
- Jun-Jie Hong
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Bo-le Liu
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Zhi-Qiang Wang
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Kun Tang
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Xiao-Wei Ji
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Wei-Wei Yin
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jie Lin
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Xiang-Wu Zheng
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Rd, Wenzhou, 325000, Zhejiang, People's Republic of China.
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Miyahira AK, Pienta KJ, Babich JW, Bander NH, Calais J, Choyke P, Hofman MS, Larson SM, Lin FI, Morris MJ, Pomper MG, Sandhu S, Scher HI, Tagawa ST, Williams S, Soule HR. Meeting report from the Prostate Cancer Foundation PSMA theranostics state of the science meeting. Prostate 2020; 80:1273-1296. [PMID: 32865839 PMCID: PMC8442561 DOI: 10.1002/pros.24056] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Prostate Cancer Foundation (PCF) convened a PCF prostate-specific membrane antigen (PSMA) Theranostics State of the Science Meeting on 18 November 2019, at Weill Cornell Medicine, New York, NY. METHODS The meeting was attended by 22 basic, translational, and clinical researchers from around the globe, with expertise in PSMA biology, development and use of PSMA theranostics agents, and clinical trials. The goal of this meeting was to discuss the current state of knowledge, the most important biological and clinical questions, and critical next steps for the clinical development of PSMA positron emission tomography (PET) imaging agents and PSMA-targeted radionuclide agents for patients with prostate cancer. RESULTS Several major topic areas were discussed including the biology of PSMA, the role of PSMA-targeted PET imaging in prostate cancer, the physics and performance of different PSMA-targeted PET imaging agents, the current state of clinical development of PSMA-targeted radionuclide therapy (RNT) agents, the role of dosimetry in PSMA RNT treatment planning, barriers and challenges in PSMA RNT clinical development, optimization of patient selection for PSMA RNT trials, and promising combination treatment approaches with PSMA RNT. DISCUSSION This article summarizes the presentations from the meeting for the purpose of globally disseminating this knowledge to advance the use of PSMA-targeted theranostic agents for imaging and treatment of patients with prostate cancer.
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Affiliation(s)
- Andrea K. Miyahira
- Science Department, Prostate Cancer Foundation, Santa Monica, California
| | - Kenneth J. Pienta
- Department of Urology, The Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John W. Babich
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Neil H. Bander
- Laboratory of Urologic Oncology, Department of Urology and Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Peter Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Michael S. Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Steven M. Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Frank I. Lin
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Michael J. Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin G. Pomper
- Department of Urology, The Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shahneen Sandhu
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Howard I. Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Scott T. Tagawa
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Scott Williams
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Howard R. Soule
- Science Department, Prostate Cancer Foundation, Santa Monica, California
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Fusion 68Ga-Prostate-Specific Membrane Antigen PET/MRI on Postoperative Surveillance of Juvenile Nasal Angiofibroma. Clin Nucl Med 2020; 45:e325-e326. [PMID: 32404701 DOI: 10.1097/rlu.0000000000003041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prostate-specific membrane antigen (PSMA) is expressed universally in juvenile nasopharyngeal angiofibroma (JNA). As contrast enhancement of postoperative scar is common with contrast-enhanced MRI (CEMRI), diagnosis of residual/recurrent JNA remains perplexing. Prostate-specific membrane antigen PET targets only the neovasculature and may aid in resolving this dilemma. Positive contrast enhancement on CEMRI was noted in a patient after 30 years of initial surgery, simulating recurrence. However, there was no abnormal uptake in PSMA scan, which was confirmed by biopsy as postoperative fibrosis. Ga-PSMA PET/MRI fusion may be an easy and novel technique to aid in differentiating residual/recurrent disease from surgical site reparative tissue.
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PSMA Expression in the Neovasculature Associated With Rectal Adenocarcinoma: A Potential Stromal Target for Nuclear Theranostics. Clin Nucl Med 2020; 45:e309-e310. [PMID: 32404709 DOI: 10.1097/rlu.0000000000003066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We report the case of a 63-year-old man who underwent MRI and Ga-PSMA-11 PET/CT for biochemical recurrence localization after radical prostatectomy (serum PSA, 0.25 ng/mL) and describe the incidental discovery of a rectal adenocarcinoma. Immunohistochemical analysis showed PSMA staining in the tumor-associated neovasculature, but not in normal vasculature, or tumor cells. After surgical removal, he was treated with salvage radiotherapy to the postoperative prostate bed. This case example has several implications: the findings confirm the expression of PSMA in the tumor-associated neovasculature of a rectal cancer, nonprostate cancers' stroma may represent a potentially relevant target for nuclear theranostics.
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PSMA expression in thyroid nodule. Rev Esp Med Nucl Imagen Mol 2020; 40:270-272. [PMID: 34218897 DOI: 10.1016/j.remnie.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/22/2022]
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Foley RW, Redman SL, Graham RN, Loughborough WW, Little D. Fluorine-18 labelled prostate-specific membrane antigen (PSMA)-1007 positron-emission tomography-computed tomography: normal patterns, pearls, and pitfalls. Clin Radiol 2020; 75:903-913. [PMID: 32782128 DOI: 10.1016/j.crad.2020.06.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/30/2020] [Indexed: 11/15/2022]
Abstract
Prostate-specific membrane antigen (PSMA)-based positron-emission tomography (PET)-computed tomography (CT) has shown great promise in prostate cancer imaging. This technique has demonstrated particular utility in the staging of high-risk primary cancer and in the localisation of recurrent disease. The use of fluorine-18 PSMA-1007 is advantageous, as it is excreted via the hepatobiliary system rather than urinary and the longer half-life of fluorine-18 compared to gallium tracers, allows for PSMA imaging in centres without a gallium generator. However, imaging with this tracer is not without flaws and areas of ambiguity remain. In this article, the biodistribution, clinical indications, and pearls of 18F-PSMA-1007 PET-CT in patients with prostate cancer will be discussed, as well as the potential pitfalls in the reporting of these studies.
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Affiliation(s)
- R W Foley
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, BA1 3NG, UK
| | - S L Redman
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, BA1 3NG, UK
| | - R N Graham
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, BA1 3NG, UK
| | - W W Loughborough
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, BA1 3NG, UK
| | - D Little
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, BA1 3NG, UK.
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Ancira-Cortez A, Ferro-Flores G, Jiménez-Mancilla N, Morales-Avila E, Trujillo-Benítez D, Ocampo-García B, Santos-Cuevas C, Escudero-Castellanos A, Luna-Gutiérrez M. Synthesis, chemical and biochemical characterization of Lu 2O 3-iPSMA nanoparticles activated by neutron irradiation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 117:111335. [PMID: 32919684 DOI: 10.1016/j.msec.2020.111335] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/16/2022]
Abstract
Among the nanomaterials, rare sesquioxides (lanthanide oxides such as Lu2O3) are of interest due to their adequate thermal conductivity, excellent chemical stability, and high light output. The prostate-specific membrane antigen (PSMA) is an integral multifunctional protein overexpressed in various types of cancer cells. The radiolabeled PSMA inhibitor peptides (iPSMA) have demonstrated their usefulness as specific probes in the treatment and detection of a wide variety of neoplasms, mainly due to their high in vivo recognition by the PSMA protein. The objective of this research was to synthesize Lu2O3-iPSMA nanoparticles (NPs) and characterize their physicochemical properties before and after neutron activation, as well as to assess their biodistribution profile and in vitro potential to target cells overexpressing PSMA. The Lu2O3 NPs were synthesized by the precipitation-calcination method and conjugated to the iPSMA peptide using DOTA (1,4,7,10-tetraazocyclodecane-N,N',N″,N‴-tetraacetic acid) as a linking agent. Results of the physicochemical characterization by FT-IR and UV-Vis spectroscopies, SEM, TEM, DLS, HRTEM, SAED, DSC-TGA, and X-ray diffraction indicated the formation of Lu2O3-iPSMA NPs (diameter of 29.98 ± 9.07 nm), which were not affected in their physicochemical properties after neutron activation. 177Lu2O3-iPSMA NPs showed high affinity (Kd = 5.7 ± 1.9 nM) for the PSMA protein, evaluated by the saturation assay on HepG2 hepatocellular carcinoma cells (PSMA-positive). The biodistribution profile of the nanosystem in healthy mice showed the main uptake in the liver. After irradiation, radioactive Lu2O3-iPSMA NPs exhibited radioluminescent properties, making the in vivo acquisition of their biodistribution, via optical imaging, possible. The results obtained from this research validate the execution of additional preclinical studies with the objective of evaluating the potential of the 177Lu2O3-iPSMA NPs for the targeted radiotherapy and in vivo imaging of tumors overexpressing the PSMA protein.
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Affiliation(s)
- A Ancira-Cortez
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Estado de México 52750, Mexico; Facultad de Química, Universidad Autónoma del Estado de México, Estado de México 50180, Mexico
| | - G Ferro-Flores
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Estado de México 52750, Mexico.
| | - N Jiménez-Mancilla
- Cátedras CONACyT, Instituto Nacional de Investigaciones Nucleares, Estado de México 52750, Mexico.
| | - E Morales-Avila
- Facultad de Química, Universidad Autónoma del Estado de México, Estado de México 50180, Mexico
| | - D Trujillo-Benítez
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Estado de México 52750, Mexico; Facultad de Química, Universidad Autónoma del Estado de México, Estado de México 50180, Mexico
| | - B Ocampo-García
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Estado de México 52750, Mexico
| | - C Santos-Cuevas
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Estado de México 52750, Mexico
| | - A Escudero-Castellanos
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Estado de México 52750, Mexico
| | - M Luna-Gutiérrez
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Estado de México 52750, Mexico
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Braga Ribeiro AM, Nascimento TMD, Lima ENP. Extrapleural solitary fibrous tumor evidenced by 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography study in the staging of a high-risk prostate cancer patient. World J Nucl Med 2020; 19:425-427. [PMID: 33623515 PMCID: PMC7875026 DOI: 10.4103/wjnm.wjnm_18_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/06/2020] [Accepted: 03/31/2020] [Indexed: 12/24/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) using 68Ga-labeled prostate-specific membrane antigen (68Ga-PSMA) became an important tool in the prostate cancer (PC) diagnosis. Despite its high sensitivity and specificity, this method may produce false-positive findings, as indicated by previous studies. This case report aims to warn nuclear medicine physicians, oncologists, and urologists about the possibility of false-positive findings using this imaging modality, especially in patients who have already been diagnosed with other malignancies. A 69-year-old man, previously treated for an extrapleural solitary fibrous tumor (ESFT), underwent staging tests after a new diagnosis of high-risk PC. 68Ga-PSMA PET/CT imaging revealed an abnormal uptake in the prostate and in the right humerus. A biopsy was performed, and the pathology showed a lesion consisting of an ESFT metastasis. Diagnostic issues related to 68Ga-PSMA PET/CT imaging should be disseminated to help physicians make appropriate treatment choices for each patient and avoid unnecessary procedures.
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Gao J, Xu Q, Fu Y, He K, Zhang C, Zhang Q, Shi J, Zhao X, Wang F, Guo H. Comprehensive evaluation of 68Ga-PSMA-11 PET/CT parameters for discriminating pathological characteristics in primary clear-cell renal cell carcinoma. Eur J Nucl Med Mol Imaging 2020; 48:561-569. [PMID: 32623502 DOI: 10.1007/s00259-020-04916-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/07/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate parameters derived from 68Ga-PSMA-11 PET/CT images for discriminating pathological characteristics in primary clear-cell renal cell carcinoma (ccRCC). METHODS The study retrospectively examined data for 36 ccRCC patients with preoperative 68Ga-PSMA-11 PET/CT scan and surgical specimens. Radiological parameters including maximal tumor diameter, mean CT value, and maximal standard uptake value (SUVmax) were derived from PET/CT images. Pathological characteristics included WHO/ISUP grade and adverse pathology (tumor necrosis or sarcomatoid or rhabdoid feature). Values of radiological parameters were compared within subgroups of pathological characteristics. Receiver operating characteristic (ROC) curve analysis was used for the effectiveness of radiological parameters in differentiating pathological characteristics, estimating area under the ROC curve (AUC) and 95% confidence intervals (CIs). RESULTS The WHO/ISUP grade distribution for 36 tumors was grade 1, 9 (25.0%); grade 2, 12 (33.3%); grade 3, 9 (25.0%); and grade 4, 6 (16.7%). Adverse pathology was positive for 15 (41.7%). Radiological tumor diameter and SUVmax significantly differed by WHO/ISUP grade, pT stage, and adverse pathology (all P < 0.05), with no difference by CT value. Tumor diameter demonstrated sensitivity 86% and specificity 88% for pT stage, with cutoff 6.70 and AUC 0.91 (95% CI, 0.79-1.00, P < 0.001). SUVmax could effectively differentiate WHO/ISUP grade (3-4 vs. 1-2) and adverse pathology (positive vs. negative), with AUC 0.89 (95% CI, 0.81-0.98, P < 0.001), cutoff 16.4, sensitivity 100%, and specificity 71% and AUC 0.92 (95% CI, 0.85-0.99, P < 0.001), cutoff 18.5, sensitivity 94%, and specificity 87%, respectively. CONCLUSION 68Ga-PSMA-11 PET/CT could effectively identify aggressive pathological features of ccRCC.
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Affiliation(s)
- Jie Gao
- Department of Urology, Nanjing Drum Tower Hospital, Institute of Urology Nanjing University, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Qinfeng Xu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yao Fu
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Kuiqiang He
- Department of Urology, Nanjing Drum Tower Hospital, Institute of Urology Nanjing University, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Chengwei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, Institute of Urology Nanjing University, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Qing Zhang
- Department of Urology, Nanjing Drum Tower Hospital, Institute of Urology Nanjing University, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Jiong Shi
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaozhi Zhao
- Department of Urology, Nanjing Drum Tower Hospital, Institute of Urology Nanjing University, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, Institute of Urology Nanjing University, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
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Jafari E, Ahmadzadehfar H, Dadgar H, Assadi M. An overview on prostate-specific membrane antigen uptake in malignancies other than prostate cancer: A pictorial essay. World J Nucl Med 2020; 19:260-265. [PMID: 33354182 PMCID: PMC7745855 DOI: 10.4103/wjnm.wjnm_78_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/28/2019] [Indexed: 01/10/2023] Open
Abstract
Prostate-specific membrane antigen (PSMA) is a Type II transmembrane glycoprotein which is extremely overexpressed in prostate cancer epithelial cells. Recently, PSMA-targeted small molecule labeled with 68Ga and 99mTc allowed precise molecular imaging of prostate cancer and PSMA-targeted small molecule labeled with 177Lu leads to the development of radionuclide-targeted therapy of prostate cancer. Despite its name, it has been shown that PSMA has been expressed in several malignancies which can be due to significant neovascularization. Present pictorial assay reports the nonspecific tracer uptake in some malignancies during 68Ga-PSMA positron-emission tomography/computed tomography imaging and 99mTc-PSMA scintigraphy.
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Affiliation(s)
- Esmail Jafari
- Department of Molecular Imaging and Radionuclide Therapy, The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Habibollah Dadgar
- Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran
| | - Majid Assadi
- Department of Molecular Imaging and Radionuclide Therapy, The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
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63
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Prostate-Specific Membrane Antigen Expression in Primary Juvenile Nasal Angiofibroma-A Pilot Study. Clin Nucl Med 2020; 45:195-199. [PMID: 31977481 DOI: 10.1097/rlu.0000000000002928] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Prostate-specific membrane antigen (PSMA) is highly expressed in prostate cancer cells and is exploited for imaging and treatment of patients with prostate cancer. Prostate-specific membrane antigen expression is also demonstrated in the tumor-associated neovasculature endothelium. Juvenile nasal angiofibroma (JNA), being a similar highly vascular tumor, may also demonstrate significant PSMA expression, which may be utilized for its imaging and treatment. METHODS In this prospective study, 25 clinicoradiologically diagnosed primary JNA patients underwent PSMA PET/CT scan. The scan was performed after 45 to 60 minutes of intravenous injection of 2 to 3 mCi (74-111 MBq) of Ga-PSMA-HBED-CC on a dedicated PET/CT scanner. Low-dose CT scan was acquired from vertex to sternoclavicular joint (100 mA, 20 kVp, 3-mm slice thickness, 0.8 pitch). Images were reconstructed with iterative reconstruction technique (4 iterations, 24 subsets). The objective was to assess the intensity and pattern of PSMA uptake in primary JNA patients. RESULTS All cases (n = 25) of primary JNA showed PSMA expression in the tumor (100%). The median PSMA SUVmax ratio of tumor to background was 4.57 (range, 2.08-7.27). Intracranial extension in 14 of 25 patients was prominently visualized because of absence of background uptake in the brain. Advanced stage tumors demonstrated greater uptake than early tumors (P = 0.011). A statistically nonsignificant trend was noted for decreasing uptake with increasing age after normalizing for stage (Spearman correlation coefficient r = -0.08). CONCLUSIONS Assessment of PSMA expression in JNA by PSMA PET/CT opens up a new window of opportunity with respect to its radiological staging, vascularity assessment, and molecular characterization. A potential role in identification of the difficult residual-recurrent disease is anticipated and perhaps also in radioligand therapy for residual/recurrent JNA.Clinical Trials Registry of India (CTRI/2018/08/015479).
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64
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Impact of PSMA PET/CT in prostate cancer patient’s clinical management: a pictorial essay of interesting cases with histologic confirmation. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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65
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Current K, Meyer C, Magyar CE, Mona CE, Almajano J, Slavik R, Stuparu AD, Cheng C, Dawson DW, Radu CG, Czernin J, Lueckerath K. Investigating PSMA-Targeted Radioligand Therapy Efficacy as a Function of Cellular PSMA Levels and Intratumoral PSMA Heterogeneity. Clin Cancer Res 2020; 26:2946-2955. [PMID: 31932492 PMCID: PMC7299755 DOI: 10.1158/1078-0432.ccr-19-1485] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/26/2019] [Accepted: 01/08/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Prostate-specific membrane antigen (PSMA) targeting radioligands deliver radiation to PSMA-expressing cells. However, the relationship between PSMA levels and intralesion heterogeneity of PSMA expression, and cytotoxic radiation by radioligand therapy (RLT) is unknown. Here we investigate RLT efficacy as function of PSMA levels/cell, and the fraction of PSMA+ cells in a tumor. EXPERIMENTAL DESIGN RM1 cells expressing different levels of PSMA (PSMA-, PSMA+, PSMA++, PSMA+++; study 1) or a mix of PSMA+ and PSMA- RM1 (study 2, 4) or PC-3/PC-3-PIP (study 3) cells at various ratios were injected into mice. Mice received 177Lu- (studies 1-3) or 225Ac- (study 4) PSMA617. Tumor growth was monitored. Two days post-RLT, tumors were resected in a subset of mice. Radioligand uptake and DNA damage were quantified. RESULTS 177Lu-PSMA617 efficacy increased with increasing PSMA levels (study 1) and fractions of PSMA positive cells (studies 2, 3) in both, the RM1 and PC-3-PIP models. In tumors resected 2 days post-RLT, PSMA expression correlated with 177Lu-PSMA617 uptake and the degree of DNA damage. Compared with 177Lu-PSMA617, 225Ac-PSMA617 improved overall antitumor effectiveness and tended to enhance the differences in therapeutic efficacy between experimental groups. CONCLUSIONS In the current models, both the degree of PSMA expression and the fraction of PSMA+ cells correlate with 177Lu-/225Ac-PSMA617 tumor uptake and DNA damage, and thus, RLT efficacy. Low or heterogeneous PSMA expression represents a resistance mechanism to RLT.See related commentary by Ravi Kumar and Hofman, p. 2774.
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Affiliation(s)
- Kyle Current
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Catherine Meyer
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Clara E Magyar
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Christine E Mona
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Joel Almajano
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Roger Slavik
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Andreea D Stuparu
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Chloe Cheng
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - David W Dawson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Caius G Radu
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California
| | - Katharina Lueckerath
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), California.
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66
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Klein Nulent TJW, Valstar MH, Smit LA, Smeele LE, Zuithoff NPA, de Keizer B, de Bree R, van Es RJJ, Willems SM. Prostate-specific membrane antigen (PSMA) expression in adenoid cystic carcinoma of the head and neck. BMC Cancer 2020; 20:519. [PMID: 32503460 PMCID: PMC7275445 DOI: 10.1186/s12885-020-06847-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Treatment options for advanced head and neck adenoid cystic carcinoma (AdCC) are limited. Prostate-Specific Membrane Antigen (PSMA), a transmembrane protein that is known for its use in diagnostics and targeted therapy in prostate cancer, is also expressed by AdCC. This study aimed to analyse PSMA expression in a large cohort of primary, recurrent and metastasized AdCC of the head and neck. METHODS One hundred ten consecutive patients with histologically confirmed AdCC in the period 1990-2017 were included. An analysis was made of clinical details, revised pathology and semiquantitative immunohistochemical expression of PSMA on tissue microarray and whole slides. Associations of PSMA expression with clinicopathological parameters were explored and survival was analysed by multivariate Cox-proportional Hazard analysis. RESULTS PSMA expression was present in 94% of the 110 primary tumours, with a median of 31% positive cells (IQR 15-60%). Primary tumours (n = 18) that recurred (n = 15) and/or had metastases (n = 10) demonstrated 40, 60 and 23% expression respectively. Expression was not independently related to increased pathological stage, tumour grade, and the occurrence of locoregional recurrence or metastasis. After dichotomization, only primary tumour PSMA expression ≤10% appeared to be associated with reduced 10-years recurrence-free survival (HR 3.0, 95% CI 1.1-8.5, p = .04). CONCLUSIONS PSMA is highly expressed in primary, recurrent and metastatic AdCC of the salivary and seromucous glands. PSMA expression has no value in predicting clinical behaviour of AdCC although low expression may indicate a reduced recurrence-free survival. This study provides supporting results to consider using PSMA as target for imaging and therapy when other diagnostic and palliative treatment options fail.
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Affiliation(s)
- Thomas J W Klein Nulent
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht, 3508, GA, The Netherlands.
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Matthijs H Valstar
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laura A Smit
- Department of Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Ludwig E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht, 3508, GA, The Netherlands
| | - Robert J J van Es
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht, 3508, GA, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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Vaz SC, Oliveira F, Herrmann K, Veit-Haibach P. Nuclear medicine and molecular imaging advances in the 21st century. Br J Radiol 2020; 93:20200095. [PMID: 32401541 PMCID: PMC10993229 DOI: 10.1259/bjr.20200095] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Currently, Nuclear Medicine has a clearly defined role in clinical practice due to its usefulness in many medical disciplines. It provides relevant diagnostic and therapeutic options leading to patients' healthcare and quality of life improvement. During the first two decades of the 21stt century, the number of Nuclear Medicine procedures increased considerably.Clinical and research advances in Nuclear Medicine and Molecular Imaging have been based on developments in radiopharmaceuticals and equipment, namely, the introduction of multimodality imaging. In addition, new therapeutic applications of radiopharmaceuticals, mainly in oncology, are underway.This review will focus on radiopharmaceuticals for positron emission tomography (PET), in particular, those labeled with Fluorine-18 and Gallium-68. Multimodality as a key player in clinical practice led to the development of new detector technology and combined efforts to improve resolution. The concept of dual probe (a single molecule labeled with a radionuclide for single photon emission computed tomography)/positron emission tomography and a light emitter for optical imaging) is gaining increasing acceptance, especially in minimally invasive radioguided surgery. The expansion of theranostics, using the same molecule for diagnosis (γ or positron emitter) and therapy (β minus or α emitter) is reshaping personalized medicine.Upcoming research and development efforts will lead to an even wider array of indications for Nuclear Medicine both in diagnosis and treatment.
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Affiliation(s)
- Sofia C. Vaz
- Nuclear Medicine - Radiopharmacology, Champalimaud Centre for
the Unknown, Champalimaud Foundation,
Lisbon, Portugal
| | - Francisco Oliveira
- Nuclear Medicine - Radiopharmacology, Champalimaud Centre for
the Unknown, Champalimaud Foundation,
Lisbon, Portugal
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen,
University of Duisburg-Essen,
Essen, Germany
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68
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Ahn T, Roberts MJ, Abduljabar A, Joshi A, Perera M, Rhee H, Wood S, Vela I. A Review of Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET) in Renal Cell Carcinoma (RCC). Mol Imaging Biol 2020; 21:799-807. [PMID: 30617728 DOI: 10.1007/s11307-018-01307-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Metastatic renal cell carcinoma (mRCC) is a disease that portends poor prognosis despite an increasing number of novel systemic treatment options including new targeted therapies and immunotherapy. Ablative intervention directed at oligometastatic RCC has demonstrated survival benefit. Consequently, developing techniques for improved staging of mRCC on contemporary imaging modalities including X-ray computed tomography (CT), magnetic resonance imaging (MRI) and/or bone scan (BS) is a clinical priority. This is relevant for metastatic deposits too small to characterize or lymph nodes within physiological normality. Prostate-specific membrane antigen (PSMA) is a type II transmembrane glycoprotein highly expressed on prostate cancer epithelial cells. Recently, small molecules targeting the PSMA receptor, linked to radioactive isotopes have been developed for use with positron emission tomography (PET). Despite its nomenclature, PSMA has also been found to be expressed in the neovasculature of non-prostate cancers such as renal cell carcinoma (RCC) and hence PSMA PET/CT imaging has been proposed as an alternative staging modality. Preliminary small studies involving the use of PSMA PET/CT imaging in mRCC have been encouraging with evidence of improved staging sensitivity which has directly led to change in management in some cases. Given these early encouraging reports, we performed a comprehensive narrative review on the available evidence, including the scientific basis for PSMA expression in RCC, the role of PSMA PET/CT imaging with potential clinical implications in mRCC, its limitations and future opportunities.
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Affiliation(s)
- Thomas Ahn
- Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Matthew J Roberts
- Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aous Abduljabar
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andre Joshi
- Department of Urology, Townsville Hospital, Brisbane, Queensland, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Marlon Perera
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Handoo Rhee
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Simon Wood
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Ian Vela
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australian Prostate Cancer Research Center Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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69
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Quicker, deeper and stronger imaging: A review of tumor-targeted, near-infrared fluorescent dyes for fluorescence guided surgery in the preclinical and clinical stages. Eur J Pharm Biopharm 2020; 152:123-143. [PMID: 32437752 DOI: 10.1016/j.ejpb.2020.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
Cancer is a public health problem and the main cause of human mortality and morbidity worldwide. Complete removal of tumors and metastatic lymph nodes in surgery is significantly beneficial for the prognosis of patients. Tumor-targeted, near-infrared fluorescent (NIRF) imaging is an emerging field of real-time intraoperative cancer imaging based on tumor-targeted NIRF dyes. Targeted NIRF dyes contain NIRF fluorophores and specific binding ligands such as antibodies, peptides and small molecules. The present article reviews recently updated tumor-targeted NIRF dyes for the molecular imaging of malignant tumors in the preclinical stage and clinical trials. The strengths and challenges of NIRF agents with tumor-targeting ability are also summarized. Smaller ligands, near infrared II dyes, dual-modality dyes and activatable dyes may contribute to quicker, deeper, stronger imaging in the nearest future. In this review, we highlighted tumor-targeted NIRF dyes for fluorescence-guided surgery and their potential clinical translation.
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70
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Seifert R, Herrmann K, Kleesiek J, Schäfers M, Shah V, Xu Z, Chabin G, Grbic S, Spottiswoode B, Rahbar K. Semiautomatically Quantified Tumor Volume Using 68Ga-PSMA-11 PET as a Biomarker for Survival in Patients with Advanced Prostate Cancer. J Nucl Med 2020; 61:1786-1792. [PMID: 32332147 DOI: 10.2967/jnumed.120.242057] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA)-targeting PET imaging is becoming the reference standard for prostate cancer staging, especially in advanced disease. Yet, the implications of PSMA PET-derived whole-body tumor volume for overall survival are poorly elucidated to date. This might be because semiautomated quantification of whole-body tumor volume as a PSMA PET biomarker is an unmet clinical challenge. Therefore, in the present study we propose and evaluate a software that enables the semiautomated quantification of PSMA PET biomarkers such as whole-body tumor volume. Methods: The proposed quantification is implemented as a research prototype. PSMA-accumulating foci were automatically segmented by a percental threshold (50% of local SUVmax). Neural networks were trained to segment organs in PET/CT acquisitions (training CTs: 8,632, validation CTs: 53). Thereby, PSMA foci within organs of physiologic PSMA uptake were semiautomatically excluded from the analysis. Pretherapeutic PSMA PET/CTs of 40 consecutive patients treated with 177Lu-PSMA-617 were evaluated in this analysis. The whole-body tumor volume (PSMATV50), SUVmax, SUVmean, and other whole-body imaging biomarkers were calculated for each patient. Semiautomatically derived results were compared with manual readings in a subcohort (by 1 nuclear medicine physician). Additionally, an interobserver evaluation of the semiautomated approach was performed in a subcohort (by 2 nuclear medicine physicians). Results: Manually and semiautomatically derived PSMA metrics were highly correlated (PSMATV50: R 2 = 1.000, P < 0.001; SUVmax: R 2 = 0.988, P < 0.001). The interobserver agreement of the semiautomated workflow was also high (PSMATV50: R 2 = 1.000, P < 0.001, interclass correlation coefficient = 1.000; SUVmax: R 2 = 0.988, P < 0.001, interclass correlation coefficient = 0.997). PSMATV50 (ml) was a significant predictor of overall survival (hazard ratio: 1.004; 95% confidence interval: 1.001-1.006, P = 0.002) and remained so in a multivariate regression including other biomarkers (hazard ratio: 1.004; 95% confidence interval: 1.001-1.006 P = 0.004). Conclusion: PSMATV50 is a promising PSMA PET biomarker that is reproducible and easily quantified by the proposed semiautomated software. Moreover, PSMATV50 is a significant predictor of overall survival in patients with advanced prostate cancer who receive 177Lu-PSMA-617 therapy.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany.,West German Cancer Center, Muenster and Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany.,West German Cancer Center, Muenster and Essen, Germany
| | - Jens Kleesiek
- German Cancer Consortium (DKTK), Essen, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,West German Cancer Center, Muenster and Essen, Germany
| | - Vijay Shah
- Siemens Medical Solutions USA, Inc., Knoxville, Tennessee; and
| | - Zhoubing Xu
- Siemens Medical Solutions USA, Inc., Princeton, New Jersey
| | | | - Sasa Grbic
- Siemens Medical Solutions USA, Inc., Princeton, New Jersey
| | | | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany .,West German Cancer Center, Muenster and Essen, Germany
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de Galiza Barbosa F, Queiroz MA, Nunes RF, Costa LB, Zaniboni EC, Marin JFG, Cerri GG, Buchpiguel CA. Nonprostatic diseases on PSMA PET imaging: a spectrum of benign and malignant findings. Cancer Imaging 2020; 20:23. [PMID: 32169115 PMCID: PMC7071711 DOI: 10.1186/s40644-020-00300-7] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
PSMA PET imaging was originally used to assess biochemical recurrence of prostate cancer (PCa), but its clinical use was promptly extended to detection, staging and therapy response assessment. The expanding use of PSMA PET worldwide has also revealed PSMA ligand uptake in diverse nonprostatic diseases, which raised questions about the specificity of this imaging modality. Although not very common initially, a growing number of pathologies presenting PSMA uptake on PET have been reported in the last few years, and a proper interpretation of PSMA PET imaging findings suddenly became challenging and, to some extent, confusing. Compared to cytoplasmic PSMA expression in nonprostatic cells, the molecular features of apical PSMA expression in PCa cells can help to distinguish these various conditions. Correlations of imaging findings to patient history, to the expected pattern of disease spread and mainly to computed tomography (CT) and/or magnetic resonance imaging (MRI) characteristics will reinforce the distinction of lesions that are more likely related to PCa from those that could lead to an incorrect diagnosis. The overall benefits of endothelial PSMA expression, which is associated with the neovasculature of malignant neoplasms, will be highlighted, stating the potential use of PSMA ligand uptake as a theranostic tool. This review aims to cover the collection of nonprostatic diseases, including benign and malignant tumors, in a didactic approach according to disease etiology, with discussion of bone-related conditions and inflammatory and infectious processes.
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Affiliation(s)
- Felipe de Galiza Barbosa
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Marcelo Araujo Queiroz
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil.
| | - Rafael Fernandes Nunes
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Larissa Bastos Costa
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Elaine Caroline Zaniboni
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - José Flavio Gomes Marin
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Giovanni Guido Cerri
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Carlos Alberto Buchpiguel
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
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Clinical Utility of 68Ga-Prostate-Specific Membrane Antigen PET/CT Scan on Postoperative Assessment of Juvenile Nasal Angiofibroma. Clin Nucl Med 2020; 45:e83-e84. [PMID: 31348086 DOI: 10.1097/rlu.0000000000002745] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prostate-specific membrane antigen (PSMA) is expressed on the endothelial cells of tumor-associated neovasculature of various nonprostatic benign and malignant neoplasms. Positive uptake on PET/CT imaging with Ga-labeled PSMA is noted in a patient with juvenile nasal angiofibroma, and the same is noted to be absent following complete surgical excision. Ga-PSMA PET/CT may be a useful tool for juvenile nasal angiofibroma recurrence identification and in differentiating recurrence from surgical site reparative tissue.
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73
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Abstract
We present a 60-year-old man with known prostate cancer treated with robot-assisted radical prostatectomy. Prostate-specific antigen levels did not decline accordingly, and a second Ga-PSMA PET/CT demonstrated a new focus with high Ga-PSMA uptake in the pancreatic tail. A subsequent CT scan did not display the lesion as a typical pancreatic tumor, and a spleen scintigraphy was also negative excluding an ectopic intrapancreatic accessory spleen. Ga-DOTATOC PET/CT showed uptake in the same area of the pancreatic tail consistent with a neuroendocrine tumor. This case illustrates that neuroendocrine tumors can be important pitfalls in Ga-PSMA PET/CT performed in prostate cancer patients.
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74
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Comparison of 68Ga-PSMA PET/CT and Contrast-Enhanced MRI on Residual Disease Assessment of Juvenile Nasal Angiofibroma. Clin Nucl Med 2020; 45:308-309. [DOI: 10.1097/rlu.0000000000002951] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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75
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Sakthivel P, Thakar A, Prashanth A, Angamuthu M, Sharma SC, Kumar R. Clinical Applications of 68Ga-PSMA PET/CT on Residual Disease Assessment of Juvenile Nasopharyngeal Angiofibroma (JNA). Nucl Med Mol Imaging 2019; 54:63-64. [PMID: 32206135 DOI: 10.1007/s13139-019-00628-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022] Open
Abstract
We present a case of a 16-year-old boy who underwent 68Ga-PSMA PET/CT for residual disease assessment of juvenile nasal angiofibroma. Positive uptake was noted in residual tumor on PET/CT imaging. However, there was no abnormal uptake in surrounding scar tissues as compared with contrast-enhanced magnetic resonance imaging. These findings were confirmed by biopsy from the scar tissue on posterior ethmoids. 68Ga-PSMA PET/CT may be a potentially valuable tool especially in distinguishing recurrences from surgical site reparative tissue and in planning and delivering stereotactic radiotherapy.
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Affiliation(s)
- Pirabu Sakthivel
- 1Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- 1Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Prashanth
- 2Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Meivel Angamuthu
- 2Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh Chandra Sharma
- 1Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- 2Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Vornov JJ, Peters D, Nedelcovych M, Hollinger K, Rais R, Slusher BS. Looking for Drugs in All the Wrong Places: Use of GCPII Inhibitors Outside the Brain. Neurochem Res 2019; 45:1256-1267. [PMID: 31749072 DOI: 10.1007/s11064-019-02909-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022]
Abstract
In tribute to our friend and colleague Michael Robinson, we review his involvement in the identification, characterization and localization of the metallopeptidase glutamate carboxypeptidase II (GCPII), originally called NAALADase. While Mike was characterizing NAALADase in the brain, the protein was independently identified by other laboratories in human prostate where it was termed prostate specific membrane antigen (PSMA) and in the intestines where it was named Folate Hydrolase 1 (FOLH1). It was almost a decade to establish that NAALADase, PSMA, and FOLH1 are encoded by the same gene. The enzyme has emerged as a therapeutic target outside of the brain, with the most notable progress made in the treatment of prostate cancer and inflammatory bowel disease (IBD). PSMA-PET imaging with high affinity ligands is proving useful for the clinical diagnosis and staging of prostate cancer. A molecular radiotherapy based on similar ligands is in trials for metastatic castration-resistant prostate cancer. New PSMA inhibitor prodrugs that preferentially block kidney and salivary gland versus prostate tumor enzyme may improve the clinical safety of this radiotherapy. The wide clinical use of PSMA-PET imaging in prostate cancer has coincidentally led to clinical documentation of GCPII upregulation in a wide variety of tumors and inflammatory diseases, likely associated with angiogenesis. In IBD, expression of the FOLH1 gene that codes for GCPII is strongly upregulated, as is the enzymatic activity in diseased patient biopsies. In animal models of IBD, GCPII inhibitors show substantial efficacy, suggesting potential theranostic use of GCPII ligands for IBD.
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Affiliation(s)
- James J Vornov
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Medpace, Cincinnati, OH, USA
| | - Diane Peters
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Department of Molecular and Comparative Pathobiology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Mike Nedelcovych
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Kristen Hollinger
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Rana Rais
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Barbara S Slusher
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
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Neale JH, Yamamoto T. N-acetylaspartylglutamate (NAAG) and glutamate carboxypeptidase II: An abundant peptide neurotransmitter-enzyme system with multiple clinical applications. Prog Neurobiol 2019; 184:101722. [PMID: 31730793 DOI: 10.1016/j.pneurobio.2019.101722] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/24/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
N-Acetylaspartylglutamate (NAAG) is the third most prevalent neurotransmitter in the mammalian nervous system, yet its therapeutic potential is only now being fully recognized. Drugs that inhibit the inactivation of NAAG by glutamate carboxypeptidase II (GCPII) increase its extracellular concentration and its activation of its receptor, mGluR3. These drugs warrant attention, as they are effective in animal models of several clinical disorders including stroke, traumatic brain injury and schizophrenia. In inflammatory and neuropathic pain studies, GCPII inhibitors moderated both the primary and secondary pain responses when given systemically, locally or in brain regions associated with the pain perception pathway. The finding that GCPII inhibition also moderated the motor and cognitive effects of ethanol intoxication led to the discovery of their procognitive efficacy in long-term memory tests in control mice and in short-term memory in a mouse model of Alzheimer's disease. NAAG and GCPII inhibitors respectively reduce cocaine self-administration and the rewarding effects of a synthetic stimulant. Most recently, GCPII inhibition also has been reported to be efficacious in a model of inflammatory bowel disease. GCPII was first discovered as a protein expressed by and released from metastatic prostate cells where it is known as prostate specific membrane antigen (PSMA). GCPII inhibitors with high affinity for this protein have been developed as prostate imaging and radiochemical therapies for prostate cancer. Taken together, these data militate in favor of the development and application of GCPII inhibitors in more advanced preclinical research as a prelude to clinical trials.
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Affiliation(s)
- Joseph H Neale
- Department of Biology, Georgetown University, 37(th) and O Sts., NW, Washington, DC, 20057, USA.
| | - Tatsuo Yamamoto
- Dept. of Anesthesiology, Kumamoto University., Kumamoto, Japan
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Kumar R, Mittal BR, Bhattacharya A, Vadi SK, Singh H, Bal A, Shukla J, Singh H, Sharma V, Sood A, Singh SK. Positron emission tomography/computed tomography guided percutaneous biopsies of Ga-68 avid lesions using an automated robotic arm. Diagn Interv Imaging 2019; 101:157-167. [PMID: 31722844 DOI: 10.1016/j.diii.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this prospective study was to evaluate the feasibility of positron emission tomography/computed tomography (PET/CT)-guided biopsy of Ga-68 avid lesions using an automated robotic arm and determine the diagnostic yield of this technique. MATERIAL AND METHODS Patients who underwent Ga-68 labelled tracers imaging followed by PET/CT-guided biopsies of tracer-avid lesions were prospectively included. Biopsies were performed using a dedicated automated-robotic-arm assisted PET/CT-guided biopsy device on the same-day of diagnostic PET/CT-imaging. The tissue samples were retrieved after confirming the position of needle-tip in the target lesion. Procedure-related complications and radiation exposure of the interventionist were recorded. Histopathological reports were reviewed for diagnostic yield. RESULTS A total of 25 patients (19 men, six women) with a mean age of 50.8±17.3 (SD) years (range: 17-83 years) were included. The biopsies were performed after PET/CT using Ga-68 DOTANOC (n=16) or Ga-68 PSMA (n=8) and Ga-68 chemokine-analogue (n=1). The biopsy samples were obtained from the liver (n=9), bone (n=8), lymph-nodes (n=3), lung (n=1), pancreas (n=1), anterior mediastinal lesion (n=1), peritoneal-deposit (n=1) and thigh-lesion (n=1). No immediate or delayed procedure-related complications were documented in any patient. PET/CT-guided molecular sampling was technically successful in all the patients. Histopathology revealed malignancies in all the biopsied specimens without the need for repeat sampling or further invasive-diagnostic workup, with a diagnostic yield of 100%. The estimated absorbed-radiation dose was 566.7μSv/year for the interventionist. CONCLUSION PET/CT-guided molecular biopsy using Ga-68 labelled radiotracers is feasible and can be performed safely and accurately with a high-diagnostic yield. It is helpful in accurately staging the disease when tracer-avid isolated distant lesion evident on imaging and highly practical in patients with previous inconclusive sampling.
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Affiliation(s)
- R Kumar
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India
| | - B R Mittal
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India.
| | - A Bhattacharya
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India
| | - S K Vadi
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India
| | - H Singh
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India
| | - A Bal
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J Shukla
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India
| | - H Singh
- Department of Surgery, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India
| | - V Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India
| | - A Sood
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India
| | - S K Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, 160012 Chandigarh, India
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Moreau A, Febvey O, Mognetti T, Frappaz D, Kryza D. Contribution of Different Positron Emission Tomography Tracers in Glioma Management: Focus on Glioblastoma. Front Oncol 2019; 9:1134. [PMID: 31737567 PMCID: PMC6839136 DOI: 10.3389/fonc.2019.01134] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022] Open
Abstract
Although rare, glioblastomas account for the majority of primary brain lesions, with a dreadful prognosis. Magnetic resonance imaging (MRI) is currently the imaging method providing the higher resolution. However, it does not always succeed in distinguishing recurrences from non-specific temozolomide, have been shown to improve -related changes caused by the combination of radiotherapy, chemotherapy, and targeted therapy, also called pseudoprogression. Strenuous attempts to overcome this issue is highly required for these patients with a short life expectancy for both ethical and economic reasons. Additional reliable information may be obtained from positron emission tomography (PET) imaging. The development of this technique, along with the emerging of new classes of tracers, can help in the diagnosis, prognosis, and assessment of therapies. We reviewed the current data about the commonly used tracers, such as 18F-fluorodeoxyglucose (18F-FDG) and radiolabeled amino acids, as well as different PET tracers recently investigated, to report their strengths, limitations, and relevance in glioblastoma management.
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Affiliation(s)
| | | | | | | | - David Kryza
- UNIV Lyon - Université Claude Bernard Lyon 1, LAGEPP UMR 5007 CNRS Villeurbanne, Villeurbanne, France
- Hospices Civils de Lyon, Lyon, France
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Reply to Bingzhi Wang, Huan Deng, and Lan Cao's Letter to the Editor re: Hojjat Ahmadzadehfar, Markus Essler. Prostate-specific Membrane Antigen Imaging: A Game Changer in Prostate Cancer Diagnosis and Therapy Planning. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2019.02.028. Eur Urol 2019; 76:e126-e127. [DOI: 10.1016/j.eururo.2019.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 11/22/2022]
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Ruigrok EAM, van Weerden WM, Nonnekens J, de Jong M. The Future of PSMA-Targeted Radionuclide Therapy: An Overview of Recent Preclinical Research. Pharmaceutics 2019; 11:E560. [PMID: 31671763 PMCID: PMC6921028 DOI: 10.3390/pharmaceutics11110560] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022] Open
Abstract
Prostate specific membrane antigen (PSMA) has become a major focus point in the research and development of prostate cancer (PCa) imaging and therapeutic strategies using radiolabeled tracers. PSMA has shown to be an excellent target for PCa theranostics because of its high expression on the membrane of PCa cells and the increase in expression during disease progression. Therefore, numerous PSMA-targeting tracers have been developed and (pre)clinically studied with promising results. However, many of these PSMA-targeting tracers show uptake in healthy organs such as the salivary glands, causing radiotoxicity. Furthermore, not all patients respond to PSMA-targeted radionuclide therapy (TRT). This created the necessity of additional preclinical research studies in which existing tracers are reevaluated and new tracers are developed in order to improve PSMA-TRT by protecting the (PSMA-expressing) healthy organs and improving tumor uptake. In this review we will give an overview of the recent preclinical research projects regarding PCa-TRT using PSMA-specific radiotracers, which will give an indication of where the PSMA-TRT research movement is going and what we can expect in future clinical trials.
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Affiliation(s)
- Eline A M Ruigrok
- Dept. of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
- Dept. of Experimental Urology, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
| | | | - Julie Nonnekens
- Dept. of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
- Dept. of Molecular Genetics, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
- Oncode Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
| | - Marion de Jong
- Dept. of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
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Evidence of Prostate-Specific Membrane Antigen Expression in Hepatocellular Carcinoma Using 68Ga-PSMA PET/CT. Clin Nucl Med 2019; 44:702-706. [PMID: 31348076 DOI: 10.1097/rlu.0000000000002701] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Prostate specific membrane antigen (PSMA) expression has been demonstrated in tumor neovasculature of many solid tumors, including hepatocellular carcinoma (HCC). The purpose of this study is to evaluate PSMA expression in patients with HCC. MATERIALS AND METHODS Nineteen HCC patients who underwent F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) as part of restaging procedure also underwent Ga-PSMA PET. F-FDG PET and Ga-PSMA findings were compared visually as well as quantitatively using maximized standardized uptake values (SUVmax). RESULTS FDG was positive in 15 patients while 16 patients demonstrated PSMA expression. The only extrahepatic finding was one metastatic lymph node detected by both tracers. Mean SUVmax of liver lesions on FDG PET/CT was 8.3 ± 2.3 and mean tumor to background ratio was 2.3 ± 1.5. Respective values for Ga-PSMA PET/CT were 17.4 ± 9 and 3.3 ± 2.2. On visual and quantitative evaluation uptake was higher with PSMA in nine patients and higher with FDG in four patients. PSMA and FDG activity were similar in three patients. One of the FDG positive patients was PSMA negative whereas two patients were PSMA positive but FDG negative. Heterogeneous uptake pattern was observed in three patients. Comparison of mean SUVmax and T/B values between PET studies revealed no statistically significant difference (P > 0.1). The mean survival was 25 months (range: 18-32 months) and SUVmax of PSMA (P = 0.05) and FDG (P = 0.012) showed medium strength of correlation with overall survival. CONCLUSION PSMA expression in advanced HCC can be demonstrated by Ga-PSMA PET but is not superior to FDG PET however it could be useful for identifying patients with limited therapeutic options.
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Pozzessere C, Bassanelli M, Ceribelli A, Rasul S, Li S, Prior JO, Cicone F. Renal Cell Carcinoma: the Oncologist Asks, Can PSMA PET/CT Answer? Curr Urol Rep 2019; 20:68. [PMID: 31605269 DOI: 10.1007/s11934-019-0938-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW To critically review the potential clinical applications of prostate-specific membrane antigen (PSMA) radioactive ligands in renal cell carcinoma (RCC). RECENT FINDINGS Radioactive probes targeting PSMA hold promise in several malignancies in addition to prostate cancer, owing to the expression of PSMA by tumor neovasculature. The majority of clear cell RCCs (ccRCC), the most malignant RCC subtype, express PSMA on tumor-associated neovasculature. The endothelium of less aggressive RCC subtypes is PSMA positive in a lower, but still significant percentage of cases. PSMA might therefore represent an interesting theragnostic target in RCC. The preliminary data available suggest a potential role for PSMA-targeting radiopharmaceuticals in complementing conventional imaging for staging ccRCC patients at risk of nodal involvement and oligometastatic disease. Additional applications of PSMA imaging may be the selection and the response assessment of patients receiving anti-angiogenic treatments. The effectiveness of PSMA-targeting radionuclide therapy should also be investigated.
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Affiliation(s)
- Chiara Pozzessere
- Department of Radiology, AUSL Toscana Centro San Giuseppe Hospital, Viale Boccaccio 20, 50053, Empoli, Italy.
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Maria Bassanelli
- Division of Medical Oncology, San Camillo De Lellis Hospital, Rieti, Italy
| | - Anna Ceribelli
- Division of Medical Oncology, San Camillo De Lellis Hospital, Rieti, Italy
| | - Sazan Rasul
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Shuren Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Francesco Cicone
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Historical review of pharmacological development and dosimetry of PSMA-based theranostics for prostate cancer. J Radioanal Nucl Chem 2019. [DOI: 10.1007/s10967-019-06800-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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85
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68Ga-PSMA PET/CT in Giant Retroperitoneal Liposarcoma. Clin Nucl Med 2019; 44:e612-e613. [PMID: 31524684 DOI: 10.1097/rlu.0000000000002762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary retroperitoneal liposarcoma is an extremely rare malignant tumor. Herein, we report a case with an incidentally detected giant retroperitoneal liposarcoma on Ga-PSMA PET/CT during primary staging for prostate cancer.
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86
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Prostate-specific membrane antigen expression in hepatocellular carcinoma: potential use for prognosis and diagnostic imaging. Oncotarget 2019; 10:4149-4160. [PMID: 31289613 PMCID: PMC6609242 DOI: 10.18632/oncotarget.27024] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 05/26/2019] [Indexed: 12/15/2022] Open
Abstract
Aim The prostate-specific membrane antigen (PSMA) is currently being established as a potent diagnostic marker in many tumor types. So far, its evidence in hepatocellular carcinoma (HCC) is sparse. The aim of our study was a comprehensive evaluation of PSMA expression and its prognostic role in patients with hepatocellular carcinoma as well as feasibility test of PSMA as an agent for diagnostic imaging. Methods The cohort for immunohistochemistry consisted of 153 patients with HCC. For validation purposes the HCC cohort (n = 359) of The Cancer Genome Atlas was analyzed on transcript level as well. Results On immunohistochemistry, non-tumorous liver tissue showed PSMA expression on canalicular membranes in all cases. In tumor tissue two patterns of expression, with a canalicular (41.1% of tumors) and a neovascular (89.9% of tumors) staining were seen. Completely negative for both two patterns were only 4.1% of tumors; conversely, 79.2% of the tumors showed high levels of PSMA protein expression at any location. At mRNA level higher FOLH1 (PSMA) expression rates were statistically significant and independently associated with longer overall survival times.Additionally, a case report of successful diagnostic 68Ga-PSMA-11 PET/CT in a patient with HCC progression on multiple therapy lines is provided. Conclusions Majority of hepatocellular carcinomas show high levels of PSMA expression on tumor vessels and on canalicular membrane of the tumor cells. Putative diagnostic, prognostic and therapeutic value of PSMA in HCC warrants further clinically oriented investigations.
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87
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Gallium-68-Labeled Prostate-Specific Membrane Antigen-11 PET/CT of Prostate and Nonprostate Cancers. AJR Am J Roentgenol 2019; 213:286-299. [PMID: 31166760 DOI: 10.2214/ajr.19.21084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The purpose of this study is to provide a concise summary of the current experience with 68Ga-labeled prostate-specific membrane antigen (PSMA)-11 imaging of prostate and nonprostate malignancies and benign conditions. CONCLUSION. PSMA is overexpressed in prostate cancer and in the neovasculature of many other malignancies. The relevance of PSMA as a biologic target, coupled with advances in the design, synthesis, and evaluation of PSMA-based radionuclides for imaging and therapy, is anticipated to play a major role in patient care.
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89
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Valstar MH, Owers EC, Al-Mamgani A, Smeele LE, van de Kamer JB, Sonke JJ, Vogel WV. Prostate-specific membrane antigen positron emission tomography/computed tomography as a potential tool to assess and guide salivary gland irradiation. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 9:65-68. [PMID: 33458427 PMCID: PMC7807566 DOI: 10.1016/j.phro.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 11/28/2022]
Abstract
PSMA PET/CT allows visualisation of salivary glands with good spatial and contrast resolution. Evaluable glands include minor and less well-known gland locations. PSMA PET/CT can visualise damage to salivary glands from external beam radiotherapy. PSMA PET/CT has the potential to guide optimisation of radiotherapy to the head and neck. The potential benefit of PSMA PET/CT is to avoid salivary gland toxicity and preserve quality of life.
Evaluation of salivary gland damage after head and neck radiotherapy (RT) is difficult with current tools, such as subjective patient-reported outcome measures. We demonstrate the use of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) as an objective non-invasive tool to visualize damage to salivary glands resulting from RT. In three clinical cases, the PSMA-ligand distribution correlates to the RT dose distribution including intra-gland dose gradients and matches patient-reported toxicity, suggesting a dose-response relation. These findings support further exploration of PSMA PET/CT to guide and evaluate RT, with the ultimate aim to reduce salivary gland toxicity.
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Affiliation(s)
- Matthijs H Valstar
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Emilia C Owers
- Department of Nuclear Medicine, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ludwig E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Radiation Oncology, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Abstract
The prostate-specific membrane antigen (PSMA) is highly expressed in prostatic cancer. However, PSMA expression is also noted in various benign and malignant nonprostatic neoplasms in the endothelial cells of tumor-associated neovasculature. We performed Ga-PSMA PET/CT in a 14-year-old boy with juvenile nasal angiofibroma (JNA) to explore its theranostic potential. The scan revealed high uptake in the lesion. Performance of PSMA PET/CT in JNA opens up new frontiers with respect to radiological staging, early recurrence identification, and perhaps even radioligand therapy of residual/recurrent JNAs in the future.
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Rowe SP, Gorin MA, Pomper MG. Imaging of Prostate-Specific Membrane Antigen with Small-Molecule PET Radiotracers: From the Bench to Advanced Clinical Applications. Annu Rev Med 2019; 70:461-477. [DOI: 10.1146/annurev-med-062117-073027] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In recent years, small-molecule inhibitors of prostate-specific membrane antigen (PSMA) labeled with radionuclides that allow for positron emission tomography (PET) imaging have been extensively studied in many clinical contexts in men with prostate cancer (PCa). The high sensitivity and specificity of these agents for identifying sites of PCa has quickly led to their widespread adoption as a de facto clinical standard of care throughout much of the world. PSMA-targeted PET radiotracers have been particularly well-studied in preoperatively staging men with high-risk PCa, evaluating biochemical recurrence following definitive therapy, and guiding metastasis-directed therapy in patients suspected of having oligorecurrent/oligometastatic disease. Furthermore, the expression of PSMA on the tumor neovasculature of many nonprostate malignancies has enabled a burgeoning subfield concentrated on delineating the potential utility of PSMA-targeted PET agents for imaging other cancers. In this review, we highlight the preclinical development of key small molecules that are now being clinically utilized for PCa imaging, discuss the roles of PSMA-targeted agents in guiding patient management, and consider the role these compounds may play in imaging nonprostate cancers.
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Affiliation(s)
- Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA;,
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Michael A. Gorin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA;,
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Martin G. Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA;,
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Abstract
Ga-prostate-specific membrane antigen (PSMA) PET/CT scan for primary staging discovered increased Ga-PSMA uptake in a known anal fistula in a recently diagnosed high-risk prostate cancer patient. The patient had an ongoing history of surgical revisions of complex fistulas in the perianal region, contributing to active inflammation and infection. Recently, reports have demonstrated increased Ga-PSMA uptake in different benign inflammatory conditions. This case demonstrates another case of a benign condition associated with increased Ga-PSMA uptake.
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93
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Barbosa FG, Queiroz MA, Nunes RF, Viana PCC, Marin JFG, Cerri GG, Buchpiguel CA. Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of Spread. Radiographics 2019; 39:186-212. [DOI: 10.1148/rg.2019180079] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Felipe G. Barbosa
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Marcelo A. Queiroz
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Rafael F. Nunes
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Publio C. C. Viana
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - José Flávio G. Marin
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Giovanni G. Cerri
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
| | - Carlos A. Buchpiguel
- From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.)
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94
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Gastric GIST Incidentally Detected on 68Ga-PSMA-PET/CT: Correlation Between Functional Imaging and Histology. Clin Nucl Med 2018; 43:e488-e491. [PMID: 30358621 DOI: 10.1097/rlu.0000000000002347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Prostate-specific membrane antigen (PSMA) is specific for prostate cancer cells; nevertheless when finding uptake in abnormal locations for prostate cancer metastases, it is important to consider other hypothesis, including second cancers. There are several papers about PSMA expression in many different types of cancer, but few reported expression in gastrointestinal stromal tumors (GIST). In this case, we documented the GIST lesion not only by PET/CT but also by gastroscopy and histology. Additionally, PSMA immunochemistry was performed, showing PSMA expression in tumoral GIST cells (not in endothelial cells), evidencing a good correlation between PET/CT image and histology.
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95
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Keidar Z, Gill R, Goshen E, Israel O, Davidson T, Morgulis M, Pirmisashvili N, Ben-Haim S. 68Ga-PSMA PET/CT in prostate cancer patients - patterns of disease, benign findings and pitfalls. Cancer Imaging 2018; 18:39. [PMID: 30382889 PMCID: PMC6211573 DOI: 10.1186/s40644-018-0175-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022] Open
Abstract
Background 68Ga-PSMA PET/CT has an important role in assessment of prostate cancer patients with biochemical recurrence and is evolving in staging high- and intermediate risk disease. The aim of present study was to describe the metastatic patterns and frequency of involved sites of prostate cancer and to assess the incidence of benign Ga68-PSMA avid PET/CT findings in a large patient population. Methods 68Ga-PSMA PET/CT studies performed in two tertiary medical centers over a period of 24 months were retrospectively reviewed. The incidence and location of pathological 68Ga-PSMA avid foci, suspicious to represent malignancy, as well as those of unexpected benign foci of increased 68Ga-PSMA activity were documented and analyzed. Results There were 445 68Ga-PSMA studies in 438 men (mean age 72.4, range 51–92 years) with prostate cancer referred for biochemical failure (n = 270, 61%), staging high-risk disease (n = 112, 25%), response assessment (n = 30, 7%), follow-up (n = 22, 5%) and suspected bone metastases (n = 11, 2%). 68Ga-PSMA avid disease sites were observed in 319 studies (72%), in 181 studies (67%) for biochemical recurrence, 94 studies for staging (84%) (p < 0.05), in 22 studies for response assessment (73%), 10 follow up studies (45%) and in five patients with suspected bone metastases (45%). 68Ga-PSMA avid lesions were most commonly detected in the prostate (n = 193, 43%), loco-regional spread (n = 51, 11%), abdomino-pelvic nodes (n = 129, 29%) and distant metastases (n = 158, 36%), including bone metastases (n = 11, 25%), distant lymphadenopathy (n = 29, 7%) and other organs (n = 18, 4%). Distant 68Ga-PSMA-avid metastases were commonly seen in patients with biochemical recurrence (14/21 lesions), but were not seen in patient referred for staging (p < 0.013). There were 96 non-malignant 68Ga-PSMA avid foci in 81 studies, most common in reactive lymph nodes (n = 36, 38%), nonmalignant bone lesions (n = 21, 22%), thyroid nodules (n = 9, 9%), ganglions (n = 9, 9%) and lung findings (n = 8, 8%). Conclusion The distribution of 68Ga-PSMA avid metastatic lesions is similar to data previously reported mainly from autopsy with comparable detection rates, indicating 68Ga-PSMA PET/CT is an accurate detection tool in patients with metastatic prostate cancer. If confirmed by further prospective studies 68Ga-PSMA PET/CT should be included in the guidelines to evaluate disease extent in these patients.
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Affiliation(s)
- Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel. .,The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Ronit Gill
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Elinor Goshen
- Department of Nuclear Medicine, Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Maryna Morgulis
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | - Simona Ben-Haim
- Department of Medical Biophysics and Nuclear Medicine, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.,University College London and UCL Hospitals, NHS Trust, London, UK
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Abstract
Prostate cancer cells have abundant expression of the cell surface protein prostate-specific membrane antigen (PSMA). In recent years, PET radioligands detecting this protein has therefore gained substantial interest in prostate cancer staging. It turned out that PSMA expression can be evident in both malignant and benign lesions, and we have previously reported that pulmonary opacities and bronchiectasis can be avid on Ga-PSMA PET/CT. Here, we present a case with Ga-PSMA accumulation in nonobstructive middle lobe syndrome, which further indicate that benign changes in the lungs may be falsely interpreted as malignant disease.
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97
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Abstract
In 2 high-risk prostate cancer patients, PET scans revealed focally increased Ga-prostate-specific membrane antigen uptake in the distal esophagus. Both patients had hiatus herniation on gastroscopy, and esophageal biopsies revealed acute and chronic inflammation in both patients and a benign hyperplastic polyp in one of the patients. Recently, reports have demonstrated that inflammation can cause false-positive findings on Ga-prostate-specific membrane antigen PET/CT, and these cases present this phenomenon in the esophagus as well.
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98
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Incidental Detection of Tracer Avidity in Liposarcoma on 68Ga-Labeled Prostate-Specific Membrane Antigen PET/CT. Clin Nucl Med 2018; 43:e334-e335. [DOI: 10.1097/rlu.0000000000002189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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99
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Rahbar K, Afshar-Oromieh A, Seifert R, Wagner S, Schäfers M, Bögemann M, Weckesser M. Diagnostic performance of 18F-PSMA-1007 PET/CT in patients with biochemical recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2018; 45:2055-2061. [PMID: 30027419 PMCID: PMC6182394 DOI: 10.1007/s00259-018-4089-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The introduction of ligands targeting prostate-specific membrane antigen (PSMA), especially 68Ga-PSMA-11, has changed the management of patients with prostate cancer (PCa). 18F-Labelled ligands can be produced in larger amounts and therefore can improve availability for a larger group of patients. The aim of this study was to evaluate the diagnostic performance of the recently introduced 18F-PSMA-1007 in patients with recurrent PCa. METHODS This retrospective analysis included 100 consecutive patients with biochemical relapse (mean age 68.75 ± 7.6 years) referred for PSMA PET/CT. Whole-body PET/CT imaging (from the lower limbs to the skull) was performed in all patients 120 min after injection of 338 ± 44.31 MBq 18F-PSMA-1007. Prostatectomy, radiation beam therapy of the prostate bed and androgen-deprivation therapy had been performed in 92%, 45% and 27% of the patients, respectively. Radiation beam therapy of the prostate bed had been performed in addition to surgery in 38 patients (38%) and 10 patients (10%) had received all three therapy modalities. The probability of a 18F-PSMA-1007 PET/CT scan suggestive of pathology was compared with the Gleason score (GS) and PSA level. RESULTS Of the 100 patients, 95 (95%) showed at least one pathological finding on 18F-PSMA-1007 PET/CT. The overall median PSA level was 1.34 ng/ml (range 0,04-41.3 ng/ml). The rates of pathological scans were 86%, 89%, 100% and 100% among patients with PSA levels ≤0.5, 0.51-1.0, 1.1-2.0 and > 2.0 ng/ml, respectively. The median GS was 7 (range 5-10). The majority of patients (70) with a GS available had a score in the range 7-9. The rate of pathological scans in these patients was 93% (65/70). The median SUVmax values of the pathological findings were 10.25, 14.32, 13.16 and 28.87 in patients with PSA levels ≤0.5, 0.51-1.0, 1.1-2.0 and >2.0 ng/ml, respectively. The median SUVmax in patients with a PSA level of >2.0 ng/ml was significantly higher than in all other PSA groups. CONCLUSION 18F-PSMA-1007 PET/CT can detect recurrent PCa in a high percentage of patients with biochemical relapse. The probability of a pathological 18F-PSMA-1007 PET/CT scan seems to be high even in patients with a low PSA level ≤0.5 ng/ml, and this may have a significant impact on the management of this relevant group of patients.
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Affiliation(s)
- Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.,Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Stefan Wagner
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Martin Bögemann
- Department of Urology, University Hospital Münster, Münster, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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