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Patel KS, Singh T, Raghuvanshi K, Sonar S, Chaudhari R. A comparison study of 68gallium-prostate-specific membrane antigen positron emission tomography-computed tomography and multiparametric magnetic resonance imaging for locoregional staging of prostate cancer. UROLOGICAL SCIENCE 2024; 35:36-41. [PMID: 38566885 PMCID: PMC10984629 DOI: 10.1097/us9.0000000000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 04/04/2024] Open
Abstract
Purpose Prostate cancer (PCa) is the most common malignancy in men aged 50 years and older and the second cause of cancer death among men. Accurate staging of PCa preoperatively is of high importance for treatment decisions and patient management. Conventional imaging modalities (ultrasound, computed tomography [CT], and magnetic resonance imaging) are inaccurate for the staging of PCa. Newer modality multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scan show promising results for the staging of PCa. Only fewer studies are available for comparison of these modalities with histopathology as reference. The objective of our study is to evaluate the diagnostic accuracy of independent 68gallium PSMA (68Ga-PSMA) PET-CT compared with mpMRI for preoperative staging of PCa, using histopathology as the reference standard. Materials and methods From August 2021 to December 2022, 30 patients of biopsy-proven PCa were prospectively enrolled as per eligibility criteria. Preoperatively, 68Ga-PSMA PET scan and mpMRI were done in all the patients. Extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymph node metastasis (LNM) were investigated separately. Subsequently, the patients underwent robotic-assisted radical prostatectomy with bilateral pelvic lymph node dissection. Results mpMRI prostate was more sensitive (66.66%) but less specific than PSMA PET-CT (55.55%) for ECE. mpMRI and PSMA PET-CT both had similar sensitivity (83.3%) and specificity (87.5%) for SVI. PSMA PET-CT was more sensitive (85.71%) and specific (95.6%) than mpMRI prostate (62.5% and 91.30%, respectively) for LNM. Conclusion PSMA PET-CT is more specific for the detection of ECE and more sensitive and specific for the detection of LNM than mpMRI, and similar for the detection of SVI. mpMRI provides only local staging, while PSMA PET-CT provides information about local, regional, and distal staging. Overall, PSMA PET-CT is superior to mpMRI for locoregional staging of PCa.
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Affiliation(s)
| | - Tarun Singh
- Department of Nuclear Medicine, Ruby Hall Clinic
| | | | - Sameer Sonar
- Department of Nuclear Medicine, Ruby Hall Clinic
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2
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Afshar-Oromieh A, Eiber M, Fendler W, Schmidt M, Rahbar K, Ahmadzadehfar H, Umutlu L, Hadaschik B, Hakenberg OW, Fornara P, Kurth J, Neels O, Wester HJ, Schwaiger M, Kopka K, Haberkorn U, Herrmann K, Krause BJ. [Procedure Guideline for Prostate Cancer Imaging with PSMA-ligand PET/CT]. Nuklearmedizin 2023; 62:5-19. [PMID: 36746147 DOI: 10.1055/a-1984-8167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PSMA-PET/CT for imaging prostate cancer (PC) has spread worldwide since its clinical introduction in 2011. The majority of experiences have been collected for PSMA-PET-imaging of recurrent PC. Data for primary staging of high-risk PC are highly promising. Meanwhile, a plethora of PSMA-ligands are available for clinical use (e. g. 68Ga-PSMA-11, 68Ga-PSMA-I&T, 68Ga-PSMA-617, 18F-DCFBC, 18F-DCFPyL, 18F-PSMA-1007, 18F-rhPSMA-7 and 18F-JK-PSMA-7). However, an official approval is available only for 68Ga-PSMA-11 (approved by the US FDA in 2020) and 18F-DCFPyL (approved by the US FDA in 2021).Recommendations for acquisition times vary from 1-2 h p. i. It has been shown that for the majority of tumour lesions, the contrast in PSMA-PET/CT increases with time. Therefore, additional late imaging can help to clarify unclear findings. PSMA-PET/CT should be performed prior to commencing an androgen deprivation therapy (ADT) since (long term) ADT reduces the visibility of PC lesions. Following injection of PSMA-ligands, hydration and forced diuresis are recommended for PSMA-ligands with primarily excretion via the kidneys in order to increase the visibility of tumour lesions adjacent to the urinary bladder.PSMA-ligands are physiologically taken up in multiple normal organs. For some 18F-labelled PSMA-ligands, presence of unspecific focal bone uptake has been reported. When using these tracers, focal bone uptake without CT-correlate should be interpreted with great caution. Besides prostate cancer, practically all solid tumors express PSMA in their neovasculature thereby taking up PSMA-ligands, although usually at a lower extent compared to PC. Also multiple benign lesions and inflammatory processes (e. g. lymph nodes) take up PSMA-ligands, also usually at lower extent compared to PC.
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Affiliation(s)
- Ali Afshar-Oromieh
- Universitätsklinikum Bern, Inselspital, Klinik für Nuklearmedizin, Universität Bern, Schweiz
| | - Matthias Eiber
- Technische Universität München, Klinik für Nuklearmedizin
| | | | - Matthias Schmidt
- Universitätsklinikum Köln, Klinik und Poliklinik für Nuklearmedizin
| | - Kambiz Rahbar
- Universitätsklinikum Münster, Klinik für Nuklearmedizin
| | | | - Lale Umutlu
- Universitätsklinikum Essen, Klinik für Radiologie
| | - Boris Hadaschik
- Universitätsklinikum Essen, Klinik und Poliklinik für Urologie, Kinderurologie und Uroonkologie
| | | | - Paolo Fornara
- Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Urologie
| | - Jens Kurth
- Universitätsmedizin Rostock, Klinik und Poliklinik für Nuklearmedizin
| | - O Neels
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institut für Radiopharmazeutische Krebsforschung.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Dresden
| | | | | | - Klaus Kopka
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institut für Radiopharmazeutische Krebsforschung.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Dresden
| | - Uwe Haberkorn
- Universitätsklinikum Heidelberg, Abteilung Nuklearmedizin der Radiologischen Klinik
| | - Ken Herrmann
- Universitätsklinikum Essen, Klinik für Nuklearmedizin
| | - Bernd J Krause
- Universitätsmedizin Rostock, Klinik und Poliklinik für Nuklearmedizin
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Parihar AS, Hofman MS, Iravani A. 177Lu-Prostate-specific Membrane Antigen Radioligand Therapy in Patients with Metastatic Castration-resistant Prostate Cancer. Radiology 2023; 306:e220859. [PMID: 36125377 DOI: 10.1148/radiol.220859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 76-year-old man with metastatic castration-resistant prostate carcinoma progressing with antiandrogen and taxane therapy was treated with lutetium 177 prostate-specific membrane antigen (PSMA)-617 and showed marked biochemical and imaging response, with improvement in clinical status and osseous pain. A summary of nuclear medicine theranostics with emphasis on PSMA targeting agents is presented.
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Affiliation(s)
- Ashwin Singh Parihar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Suite 3433, MIR East Building, St Louis, MO 63110 (A.S.P., A.I.); and Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (M.S.H.)
| | - Michael S Hofman
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Suite 3433, MIR East Building, St Louis, MO 63110 (A.S.P., A.I.); and Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (M.S.H.)
| | - Amir Iravani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Suite 3433, MIR East Building, St Louis, MO 63110 (A.S.P., A.I.); and Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (M.S.H.)
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4
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Prostate specific membrane antigen positron emission tomography in primary prostate cancer diagnosis: First-line imaging is afoot. Cancer Lett 2022; 548:215883. [PMID: 36027998 DOI: 10.1016/j.canlet.2022.215883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022]
Abstract
Prostate specific membrane antigen positron emission tomography (PSMA PET) is an excellent molecular imaging technique for prostate cancer. Currently, PSMA PET for patients with primary prostate cancer is supplementary to conventional imaging techniques, according to guidelines. This supplementary function of PSMA PET is due to a lack of systematic review of its strengths, limitations, and potential development direction. Thus, we review PSMA ligands, detection, T, N, and M staging, treatment management, and false results of PSMA PET in clinical studies. We also discuss the strengths and challenges of PSMA PET. PSMA PET can greatly increase the detection rate of prostate cancer and accuracy of T/N/M staging, which facilitates more appropriate treatment for primary prostate cancer. Lastly, we propose that PSMA PET could become the first-line imaging modality for primary prostate cancer, and we describe its potential expanded application.
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5
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Ong JS, Hofman MS. PET imaging of prostate cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gühne F, Radke S, Winkens T, Kühnel C, Greiser J, Seifert P, Drescher R, Freesmeyer M. Differences in Distribution and Detection Rate of the [ 68Ga]Ga-PSMA Ligands PSMA-617, -I&T and -11-Inter-Individual Comparison in Patients with Biochemical Relapse of Prostate Cancer. Pharmaceuticals (Basel) 2021; 15:ph15010009. [PMID: 35056066 PMCID: PMC8779232 DOI: 10.3390/ph15010009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
The biochemical relapse of prostate cancer is diagnostically challenging but of high clinical impact for subsequent patient treatment. PET/CT with radiolabeled PSMA ligands outperforms conventional diagnostic methods in the detection of tumor recurrence. Several radiopharmaceuticals were and are available for use. The aim of this study was to investigate whether the routinely applied [68Ga]Ga-PSMA ligands PSMA-617, -I&T and -11 (HBED-CC) differ in physiological and pathological distribution, or in tumor detection rate. A retrospective evaluation of 190 patients (39 patients received PSMA-617, 68 patients PSMA-I&T and 83 patients PSMA-11) showed significant differences in tracer accumulation within all organs examined. The low retention within the compartments blood pool, bone and muscle tissue is a theoretical advantage of PSMA-11. Evaluation of tumor lesion uptake and detection rate did not reveal superiority of one of the three radiopharmaceuticals, neither in the whole population, nor in particularly challenging subgroups like patients with very low PSA levels. We conclude that all three [68Ga]Ga-PSMA ligands are equally feasible in this clinically important scenario, and may replace each other in case of unavailability or production restrictions.
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7
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UĞur A, ElÇİ ŞG, YÜksel D. Validation of HPLC method for the determination of chemical andradiochemical purity of a 68Ga-labelled EuK-Sub-kf-(3-iodo-y-) DOTAGA. Turk J Chem 2021; 45:26-34. [PMID: 33679149 PMCID: PMC7925295 DOI: 10.3906/kim-2003-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 09/29/2020] [Indexed: 11/21/2022] Open
Abstract
The prostate-specific membrane antigen (PSMA) represents an ideal biomarker for molecular imaging. Various PSMA-targeted radioligands are available for prostate cancer imaging. In this study, labeling of PSMA I&T with 68Ga, as well as validation of the radiochemical purity of the synthesis product by reverse phase radio high-performance liquid chromatography (HPLC) method are intended. Since the standard procedure for the quality control (QC) was not available, definition of chemical and radiochemical purity of 68Ga-PSMA I&T was carried out according to the Q2 (R1) ICH guideline. The standard QC tests were analyzed with Scintomics 8100 radio-HPLC system equipped with a radioactivity detector. The method was evaluated in terms of linearity, precision and accuracy, LOQ, robustness parameters, and specificity. To assess the radiochemical and chemical purity of 68Ga-PSMA I&T, the developed method was validated to apply safely to patients. An excellent linearity was found between 1μg/mL and 30 μg/mL, with a limit of detection and limit of quantitation of 0.286 μg/mL and 0.866 μg/mL, respectively for 68Ga-PSMA I&T. The recovery was 96.8 ± 3.8%. The quality control of the final product was performed many times with validated radio-HPLC method and was found to comply with ICH requirements, thus demonstrating the accuracy and robustness of the method for routine clinical practice.
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Affiliation(s)
- Ayşe UĞur
- Department of Nuclear Medicine, Pamukkale University, Education and Research Hospital, Denizli Turkey
| | - Şükrü Gökhan ElÇİ
- Department of Biomedical Engineering, Faculty of Technology, Pamukkale University, Denizli Turkey
| | - Doğangün YÜksel
- Department of Nuclear Medicine, Medical Faculty, Pamukkale University, Denizli Turkey
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9
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Pastorino S, Riondato M, Uccelli L, Giovacchini G, Giovannini E, Duce V, Ciarmiello A. Toward the Discovery and Development of PSMA Targeted Inhibitors for Nuclear Medicine Applications. Curr Radiopharm 2020; 13:63-79. [PMID: 31362683 PMCID: PMC7509769 DOI: 10.2174/1874471012666190729151540] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The rising incidence rate of prostate cancer (PCa) has promoted the development of new diagnostic and therapeutic radiopharmaceuticals during the last decades. Promising improvements have been achieved in clinical practice using prostate specific membrane antigen (PSMA) labeled agents, including specific antibodies and small molecular weight inhibitors. Focusing on molecular docking studies, this review aims to highlight the progress in the design of PSMA targeted agents for a potential use in nuclear medicine. RESULTS Although the first development of radiopharmaceuticals able to specifically recognize PSMA was exclusively oriented to macromolecule protein structure such as radiolabeled monoclonal antibodies and derivatives, the isolation of the crystal structure of PSMA served as the trigger for the synthesis and the further evaluation of a variety of low molecular weight inhibitors. Among the nuclear imaging probes and radiotherapeutics that have been developed and tested till today, labeled Glutamate-ureido inhibitors are the most prevalent PSMA-targeting agents for nuclear medicine applications. CONCLUSION PSMA represents for researchers the most attractive target for the detection and treatment of patients affected by PCa using nuclear medicine modalities. [99mTc]MIP-1404 is considered the tracer of choice for SPECT imaging and [68Ga]PSMA-11 is the leading diagnostic for PET imaging by general consensus. [18F]DCFPyL and [18F]PSMA-1007 are clearly the emerging PET PSMA candidates for their great potential for a widespread commercial distribution. After paving the way with new imaging tools, academic and industrial R&Ds are now focusing on the development of PSMA inhibitors labeled with alpha or beta minus emitters for a theragnostic application.
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Affiliation(s)
- Sara Pastorino
- Nuclear Medicine Department, S. Andrea Hospital, Via Vittorio Veneto 197, 19124 La Spezia, Italy
| | - Mattia Riondato
- Nuclear Medicine Department, S. Andrea Hospital, Via Vittorio Veneto 197, 19124 La Spezia, Italy
| | - Licia Uccelli
- Morphology, Surgery and Experimental Medicine Department, University of Ferrara, Via L. Borsari 46, 44121 Ferrara, Italy.,Nuclear Medicine Unit, University Hospital, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Giampiero Giovacchini
- Nuclear Medicine Department, S. Andrea Hospital, Via Vittorio Veneto 197, 19124 La Spezia, Italy
| | - Elisabetta Giovannini
- Nuclear Medicine Department, S. Andrea Hospital, Via Vittorio Veneto 197, 19124 La Spezia, Italy
| | - Valerio Duce
- Nuclear Medicine Department, S. Andrea Hospital, Via Vittorio Veneto 197, 19124 La Spezia, Italy
| | - Andrea Ciarmiello
- Nuclear Medicine Department, S. Andrea Hospital, Via Vittorio Veneto 197, 19124 La Spezia, Italy
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10
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Çelen S, Gültekin A, Özlülerden Y, Mete A, Sağtaş E, Ufuk F, Yüksel D, Yağcı B, Zümrütbaş AE. Comparison of 68Ga-PSMA-I/T PET-CT and Multiparametric MRI for Locoregional Staging of Prostate Cancer Patients: A Pilot Study. Urol Int 2020; 104:684-691. [PMID: 32750695 DOI: 10.1159/000509974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM The objective of this work was to assess the value of 68Ga-DOTAGA-(3-iodo-y)fk(Sub-KuE) positron emission tomography (68Ga-PSMA-I/T PET-CT) and multiparametric magnetic resonance imaging (mp-MRI) for preoperative staging in prostate cancer (PCa) patients who underwent radical prostatectomy (RP) by validating with postoperative histopathology data. MATERIALS AND METHODS We prospectively investigated 30 consecutive PCa patients who had both mp-MRI and 68Ga-PSMA-I/T PET-CT before laparoscopic RP. The seminal vesicle invasion (SVI), lymph node metastasis (LNM), bladder neck invasion (BNI), and extracapsular extension (ECE) were investigated separately. The diagnostic performances of mp-MRI and 68Ga-PSMA-I/T PET-CT were assessed using histopathological results. RESULTS Both mp-MRI and 68Ga-PSMA-I/T PET-CT were not statistically significant in the evaluation of SVI, BNI, and ECE preoperatively but had statistically significant results in the assessment of LNM. mp-MRI had higher overall sensitivity for ECE, overall specificity for SVI, ECE, and BNI, and positive predictive value for ECE, SVI, BNI. 68Ga-PSMA-I/T PET-CT had higher overall sensitivity for BNI, and negative predictive value for BNI and LNM. CONCLUSION mp-MRI has superior specificity, sensitivity, and accuracy for assessing ECE and SVI. Both imaging modalities had similar specificity, sensitivity, and accuracy for determining BNI. However, both imaging modalities had low diagnostic accuracy for LNM on histopathology.
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Affiliation(s)
- Sinan Çelen
- Department of Urology, Faculty of Medicine, University of Pamukkale, Denizli, Turkey,
| | - Aziz Gültekin
- Department of Nuclear Medicine, Faculty of Medicine, University of Pamukkale, Denizli, Turkey
| | - Yusuf Özlülerden
- Department of Urology, Faculty of Medicine, University of Pamukkale, Denizli, Turkey
| | - Aslı Mete
- Department of Anesthesiology, Faculty of Medicine, University of Pamukkale, Denizli, Turkey
| | - Ergin Sağtaş
- Department of Radiology, Faculty of Medicine, University of Pamukkale, Denizli, Turkey
| | - Furkan Ufuk
- Department of Radiology, Faculty of Medicine, University of Pamukkale, Denizli, Turkey
| | - Doğangün Yüksel
- Department of Nuclear Medicine, Faculty of Medicine, University of Pamukkale, Denizli, Turkey
| | - Baki Yağcı
- Department of Radiology, Faculty of Medicine, University of Pamukkale, Denizli, Turkey
| | - Ali Ersin Zümrütbaş
- Department of Urology, Faculty of Medicine, University of Pamukkale, Denizli, Turkey
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Jackson JA, Hungnes IN, Ma MT, Rivas C. Bioconjugates of Chelators with Peptides and Proteins in Nuclear Medicine: Historical Importance, Current Innovations, and Future Challenges. Bioconjug Chem 2020; 31:483-491. [PMID: 31990543 DOI: 10.1021/acs.bioconjchem.0c00015] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Molecular radiopharmaceuticals based on bioconjugates of chelators with peptides and proteins have had significant clinical impact in the diagnosis and treatment of several types of cancers. In the 1990s, indium-111 and yttrium-90 labeled chelator-peptide/protein conjugates established the clinical utility of these radiopharmaceuticals for receptor-targeted γ-scintigraphy imaging and systemic radiotherapy. Second-generation bioconjugates based on peptides targeting the somatostatin II receptor and the prostate-specific membrane antigen are now widely used for management of neuroendocrine and prostate cancer, respectively. These bioconjugates are typically radiolabeled with gallium-68 for imaging of target receptor expression with positron emission tomography, and the β--emitter, lutetium-177, for targeted radiotherapy. Innovations in radioisotope technology and biomolecular therapies are likely to drive the future clinical development of radiopharmaceuticals based on radiometals. New chelator-peptide and chelator-protein bioconjugates will underpin nuclear medicine advances in molecular imaging and radiotherapy.
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Affiliation(s)
- Jessica A Jackson
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Ingebjørg N Hungnes
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Michelle T Ma
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Charlotte Rivas
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
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12
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Rangger C, Haubner R. Radiolabelled Peptides for Positron Emission Tomography and Endoradiotherapy in Oncology. Pharmaceuticals (Basel) 2020; 13:E22. [PMID: 32019275 PMCID: PMC7169460 DOI: 10.3390/ph13020022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 02/07/2023] Open
Abstract
This review deals with the development of peptide-based radiopharmaceuticals for the use with positron emission tomography and peptide receptor radiotherapy. It discusses the pros and cons of this class of radiopharmaceuticals as well as the different labelling strategies, and summarises approaches to optimise metabolic stability. Additionally, it presents different target structures and addresses corresponding tracers, which are already used in clinical routine or are being investigated in clinical trials.
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Affiliation(s)
| | - Roland Haubner
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria;
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Cusnir R, Cakebread A, Cooper MS, Young JD, Blower PJ, Ma MT. The effects of trace metal impurities on Ga-68-radiolabelling with a tris(3-hydroxy-1,6-dimethylpyridin-4-one) (THP) chelator. RSC Adv 2019; 9:37214-37221. [PMID: 35542301 PMCID: PMC9075519 DOI: 10.1039/c9ra07723e] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
GMP-grade 68Ge/68Ga generators provide access to positron-emitting 68Ga, enabling preparation of Positron Emission Tomography (PET) tracers and PET imaging at sites that do not have access to cyclotron-produced radionuclides. Radiotracers based on tris(3-hydroxy-1,6-dimethylpyridin-4-one) (THP) chelators enable simple one-step preparations of 68Ga PET radiopharmaceuticals from pre-fabricated kits without pre-processing of generator eluate or post-purification. However, trace metal impurities eluted along with 68Ga could compete for THP and reduce radiochemical yields (RCY). We have quantified trace metal impurities in 68Ga eluate from an Eckert & Ziegler (E&Z) generator using ICP-MS. The metals Al, Fe, natGa, Pb, Ti and natZn were present in generator eluate in significantly higher concentrations than in the starting eluent solution. Concentrations of Fe and natGa in eluate were in the range of 0.01-0.1 μM, Al, Zn and Pb in the range of 0.1-1 μM, and Ti in the range of 0.9-1.5 μM. To assess the ability of THP to chelate 68Ga in the presence of such metal ions, radiolabelling reactions were undertaken in which selected metal ions were added to make them equimolar with THP, or higher. Al3+, Fe3+, natGa3+ and Ti4+ reduced RCY at concentrations equimolar with THP and higher, but at lower concentrations they did not affect RCY. Pb2+, Zn2+, Ni2+ and Cr3+ had no effect on RCY (even under conditions in which each metal ion was present in 100-fold molar excess over THP). The multi-sample ICP-MS analysis reported here is (to date) the most comprehensive and robust quantification of metal impurities in the widely used E&Z 68Ga generator. 68Ga from an E&Z generator enables near-quantitative radiolabelling of THP at chelator concentrations as low as 5 μM (lower than other common gallium chelators) without pre-processing. The combination of Al3+, Fe3+, natGa3+ and Ti4+ in unprocessed 68Ga eluate is likely to decrease RCY of 68Ga radiolabelling if a lower amount of THP chelator is used, and future kit design should take this into account. To increase specific activities by using even lower THP concentrations, purification of 68Ga from trace metal ions will likely be required.
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Affiliation(s)
- Ruslan Cusnir
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital London SE1 7EH UK
- Laboratory of Radiochemistry, Paul Scherrer Institute 5232 Villigen-PSI Switzerland
| | - Andrew Cakebread
- Mass Spectrometry Facility, King's College London Franklin Wilkins Building, 150 Stamford St London SE1 9NH UK
| | - Margaret S Cooper
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital London SE1 7EH UK
| | - Jennifer D Young
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital London SE1 7EH UK
| | - Philip J Blower
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital London SE1 7EH UK
| | - Michelle T Ma
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital London SE1 7EH UK
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Cytawa W, Seitz AK, Kircher S, Fukushima K, Tran-Gia J, Schirbel A, Bandurski T, Lass P, Krebs M, Połom W, Matuszewski M, Wester HJ, Buck AK, Kübler H, Lapa C. 68Ga-PSMA I&T PET/CT for primary staging of prostate cancer. Eur J Nucl Med Mol Imaging 2019; 47:168-177. [PMID: 31529265 DOI: 10.1007/s00259-019-04524-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/04/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The present study is based on a retrospective analysis of Gallium-68 (68Ga)-labelled prostate-specific membrane antigen (68Ga-PSMA I&T) PET/CT performed in newly diagnosed, treatment-naïve prostate cancer (PCa) patients prior to definitive treatment. METHODS A total of 82 men were included in the study and were imaged with 68Ga-PSMA I&T PET/CT to assess the distribution of PSMA-avid disease for staging purposes (11 with low-risk, 32 with intermediate-risk, and 39 with high-risk PCa). Forty patients (20 with intermediate- and 20 with high-risk disease) underwent subsequent radical prostatectomy with extended pelvic lymph node dissection which allowed for correlation of imaging findings with histopathologic data. RESULTS PSMA-positive disease was detected in 83% of patients with 66/82 (80.5%) primary tumours being visualized. PSMA-avid lymph nodes were recorded in 17/82 patients (20.7%, 3 with intermediate-risk and 14 with high-risk PCa); distant disease was found in 14/82 subjects (17.1%, 2 with intermediate-risk and 12 with high-risk PCa). No extraprostatic disease was found in low-risk PCa. SUVmax of primary tumours showed a weak but significant correlation with serum PSA values (r = 0.51, p < 0.001) and Gleason scores (GSC; r = 0.35, p = 0.001), respectively. In correlation with histopathology, calculated per-region sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of lymph node metastases were 35.0%, 98.4%, 63.6%, 95.0%, and 93.0%, respectively. CONCLUSIONS In patients with initial diagnosis of intermediate- and high-risk prostate cancer, 68Ga-PSMA I&T PET/CT emerges as a relevant staging procedure by identifying nodal and/or distant metastases. Due to the low prevalence of extraprostatic disease, its value seems to be limited in low-risk disease.
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Affiliation(s)
- Wojciech Cytawa
- Department of Nuclear Medicine, Medical University of Gdańsk, Smoluchowskiego Str. 17, 80-952, Gdańsk, Poland.,Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | | | - Stefan Kircher
- Institute of Pathology, Comprehensive Cancer Center Mainfranken (CCCMF), University of Würzburg, Würzburg, Germany
| | - Kazuhito Fukushima
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Andreas Schirbel
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Tomasz Bandurski
- Department of Radiology Informatics and Statistics, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Lass
- Department of Nuclear Medicine, Medical University of Gdańsk, Smoluchowskiego Str. 17, 80-952, Gdańsk, Poland
| | - Markus Krebs
- Department of Urology, University Hospital Würzburg, Würzburg, Germany
| | - Wojciech Połom
- Department of Urology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technische Universität München, Munich, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Hubert Kübler
- Department of Urology, University Hospital Würzburg, Würzburg, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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15
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Asokendaran ME, Meyrick DP, Skelly LA, Lenzo NP, Henderson A. Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography compared with diagnostic computed tomography in relapsed prostate cancer. World J Nucl Med 2019; 18:232-237. [PMID: 31516365 PMCID: PMC6714155 DOI: 10.4103/wjnm.wjnm_59_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate if prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has a higher detection rate compared to standard contrast CT imaging for patients with a rising prostate-specific antigen (PSA) following definitive treatment (i.e., curative radical prostatectomy, radiotherapy, and brachytherapy) for prostate cancer in a private hospital setting. A retrospective single-site clinical audit was conducted on 150 PSMA PET/CT scans done for patients with a rising PSA after definitive treatment for prostate cancer. All studies were performed using I and T Ga-68 PSMA produced on a Scintomics radiopharmaceutical unit (Munich). All scans were performed on a GE 710 PET/CT scanner. All studies were compared to standard CT and other imaging. Of the 150 patients who had a 68Gallium (Ga)-PSMA PET/CT for a rise in their PSA levels, 102/150 (68%) of patients had PSMA-avid scans compared to the conventional imaging group which had an overall detection rate of 42% (63/150). The rates of detection were 100%, 90%, 92%, 67%, and 25% at PSA levels of >10 μg/L, 5–10 μg/L, >1.5 μg/L, 0.5–1.5 μg/L, and <0.5 μg/L, respectively. PSMA PET/CT also solely picked up 39/102 (38%) of prostate cancer relapses compared to the conventional imaging group. In our study of 150 patients with biochemical recurrence of prostate cancer, 68Ga-PSMA PET/CT demonstrated a superior detection rate (P < 0.05) compared to conventional imaging, including patients with low PSA levels (<0.5 μg/L).
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Affiliation(s)
| | | | - Laura A Skelly
- TeleMed Health Services, Busselton, Bussell Highway, West Busselton, Australia
| | - Nat P Lenzo
- Department of Nuclear Medicine, Fiona Stanley Hospital, Murdoch, Australia.,Theranostics Australia, East Fremantle, Australia.,Faculty of Health and Medical Sciences, UWA Medical School, Crawley, Australia
| | - Andrew Henderson
- Nuclear Medicine, Perth Radiological Clinic, Nedlands, Western Australia, Australia
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68Ga-PSMA-11 PET/CT in newly diagnosed prostate cancer: diagnostic sensitivity and interobserver agreement. Abdom Radiol (NY) 2019; 44:2545-2556. [PMID: 30963182 DOI: 10.1007/s00261-019-02006-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the diagnostic sensitivity and interobserver agreement of Gallium 68-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) imaging for diagnosis and staging of patients with newly diagnosed prostate cancer (PC). MATERIALS AND METHODS One hundred and seventy-three men (mean age, 68 ± 7.7 years; range 46-84 years) with newly diagnosed, untreated PC were enrolled in this prospective study between January 2017 and August 2018. All patients underwent a 68Ga-PSMA-11 PET/CT examination. For each patient, we determined the disease stage, the Gleason score, and the maximum standardized uptake value (SUVmax) for primary prostatic tumor and extraprostatic metastases. The diagnostic sensitivity and interobserver agreement of 68Ga-PSMA-11 PET/CT for diagnosis and staging of PC were established by histopathology as the reference standard. RESULTS 68Ga-PSMA-11 PET/CT examinations were interpreted as positive for PC in 166 of 173 patients (101 patients had primary prostatic tumor only, two patients had extraprostatic metastases only and 63 patients had combined lesions). The sensitivity of 68Ga-PSMA-11 PET/CT examination in the diagnosis of PC was 96%. 68Ga-PSMA-11 PET/CT produced a significant change of stage in 28.6% patients with an upstage in 17.9% patients and a downstage in 10.7% patients. The interobserver agreements were almost good to perfect (k = 0.63-0.89) for visual image interpretation, SUVmax measurement, and tumor staging. CONCLUSION 68Ga-PSMA-11 PET/CT is a valuable tool with high diagnostic sensitivity (96%) and high reproducibility for diagnosis and staging of patients with newly diagnosed PC.
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17
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The role of (68Ga)PSMA I&T in biochemical recurrence after radical prostatectomy: detection rate and the correlation between the level of PSA, Gleason score, and the SUVmax. Ann Nucl Med 2019; 33:545-553. [DOI: 10.1007/s12149-019-01360-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/28/2019] [Indexed: 01/26/2023]
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18
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Diao W, Cai H, Chen L, Jin X, Liao X, Jia Z. Recent Advances in Prostate-Specific Membrane Antigen-Based Radiopharmaceuticals. Curr Top Med Chem 2019; 19:33-56. [PMID: 30706785 DOI: 10.2174/1568026619666190201100739] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/13/2018] [Accepted: 12/15/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Prostate cancer (PCa) is the most common sex-related malignancy with high mortality in men worldwide. Prostate-specific membrane antigen (PSMA) is overexpressed on the surface of most prostate tumor cells and considered a valuable target for both diagnosis and therapy of prostate cancer. A series of radiolabeled agents have been developed based on the featured PSMA ligands in the previous decade and have demonstrated promising outcomes in clinical research of primary and recurrent PCa. Furthermore, the inspiring response and safety of lutetium-177-PSMA-617 (177Lu-PSMA-617) radiotherapy represent the potential for expanded therapeutic options for metastatic castration-resistant PCa. Retrospective cohort studies have revealed that radiolabeled PSMA agents are the mainstays of the current success, especially in detecting prostate cancer with metastasis and biochemical recurrence. OBJECTIVE This review is intended to present a comprehensive overview of the current literature on PSMA ligand-based agents for both radionuclide imaging and therapeutic approaches, with a focus on those that have been clinically adopted. CONCLUSION PSMA-based diagnosis and therapy hold great promise for improving the clinical management of prostate cancer.
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Affiliation(s)
- Wei Diao
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Huawei Cai
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Lihong Chen
- Department of Biochemistry & Molecular Biology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Xi Jin
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Xinyang Liao
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 610041, Chengdu, China
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19
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Özülker F. Efficacy of early imaging with 68Ga-PSMA I&T in the discrimination of pelvic lesions in prostate cancer patients. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Imaging Characteristics and First Experience of [ 68Ga]THP-PSMA, a Novel Probe for Rapid Kit-Based Ga-68 Labeling and PET Imaging: Comparative Analysis with [ 68Ga]PSMA I&T. Mol Imaging Biol 2019; 20:650-658. [PMID: 29344901 DOI: 10.1007/s11307-018-1160-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE [68Ga]Trishydroxypyridinone (THP)-prostate-specific membrane antigen (PSMA) is a novel tracer that can be labeled in one step by cold reconstitution of a kit with unprocessed generator eluate, targeting PSMA via the lysine-urea-glutamate (KuE) motif. The aim of this study was to evaluate the human imaging characteristics of [68Ga]THP-PSMA. PROCEDURES [68Ga]THP-PSMA positron emission tomography (PET)/x-ray computed tomography (CT) was performed in 25 patients with biochemical recurrence after radical prostatectomy for prostate cancer. Urinary and biliary excretion and tumor lesion uptake were quantified using standardized uptake values (SUVs). Imaging characteristics were assessed in terms of non-target organ uptake, background activity, target-to-background ratios (TBRs) of tumor lesions, and frequency of bladder halo artifacts. Findings were compared to a matched cohort of 25 patients undergoing PET/CT with the established agent [68Ga]PSMA I&T. RESULTS Physiologic uptake of [68Ga]THP-PSMA was significantly lower in salivary glands (P < 0.0001), liver (P < 0.0001), spleen (P < 0.0001), and kidneys (P < 0.0001) than with [68Ga]PSMA I&T. While biliary tracer excretion of [68Ga]THP-PSMA was negligible, urinary tracer excretion of [68Ga]THP-PSMA was fast, and significantly higher than for [68Ga]PSMA I&T, contributing to a higher frequency of bladder artifacts. Malignant lesion uptake of [68Ga]THP-PSMA assessed as either SUV or TBR was significantly lower than with [68Ga]PSMA I&T. CONCLUSION [68Ga]THP-PSMA yields suitable in vivo uptake characteristics. The simplified synthesis method for [68Ga]THP-PSMA may facilitate wider application and higher patient throughput with PSMA imaging. However, direct intraindividual comparison studies are needed to assess the relative performance of [68Ga]THP-PSMA vs other PSMA ligands in terms of clinical detection rate and image quality.
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21
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Theranostics for Advanced Prostate Cancer: Current Indications and Future Developments. Eur Urol Oncol 2019; 2:152-162. [PMID: 31017091 DOI: 10.1016/j.euo.2019.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 12/24/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022]
Abstract
CONTEXT Advanced prostate cancer (PCa) is a prominent cause of cancer death in men; positron emission tomography (PET) imaging may play a relevant role in detecting metastases and thus allowing a more tailored therapy in these patients. Radioligand therapy (RLT) may also gain relevance as a treatment strategy in advanced disease. OBJECTIVE The aim of this review is to highlight how the recently developed theranostic processes may become a part of both the available diagnostic and the therapy arsenal in advanced PCa patients. EVIDENCE ACQUISITION An expert panel of nuclear medicine physicians and a urologist, highly experienced in the fields of radionuclide imaging and RLT in advanced PCa, performed a nonsystematic review of the current indications, performance, limitations, and potential future developments of the currently available options in PCa theranostics. EVIDENCE SYNTHESIS Among PET radiotracers, prostate-specific membrane antigen (PSMA)-based compounds in advanced PCa are the focus of a continuously growing interest, mostly due to their potential relevance as theranostic agents. The impact of PSMA-based PET/computed tomography imaging on treatment strategies and prognosis is promising, but still not unquestionably clear. Potential applications may include a role as a gatekeeper to PSMA-directed RLT, as well as monitoring the spread of systemic disease. Currently, initial results seem to substantiate the role of PSMA-directed RLT in terms of feasibility and efficacy. CONCLUSIONS PSMA is a promising molecule for both imaging and therapy in advanced PCa patients; nevertheless, further studies are needed to investigate its role and to determine the impact of its side effects and its overall strategy outcome. PATIENT SUMMARY Prostate-specific membrane antigen (PSMA), a protein, is highly expressed on prostate cancer cells. The possibility to perform diagnostic imaging and subsequently administer therapies by the means of the same molecule is called "theranostics". In patients with advanced prostate cancer, PSMA might have a role in detecting disease spread through both positron emission tomography and single-photon emission computed tomography imaging, while treating prostate cancer systemic localizations with radioligand therapy. Further studies are needed to better determine patients' risks and benefits of these therapeutic approaches.
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22
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Efficacy of early imaging with 68Ga-PSMA-I&T in the discrimination of pelvic lesions in prostate cancer patients. Rev Esp Med Nucl Imagen Mol 2018; 38:100-105. [PMID: 30514659 DOI: 10.1016/j.remn.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/22/2018] [Accepted: 06/27/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE 68Ga-PSMA-uptake shows accumulation in the malignant lesions of prostate cancer patients as early as 5min p.i. Studies indicate the value of adding an early image of the pelvis to the imaging protocol of 68Ga-PSMA-11 PET/CT scan showed contradictory results. In this study we planned to assess the significance of an additional early imaging in 68Ga-PSMA-I&T PET/CT imaging in prostate cancer patients. MATERIALS AND METHODS A total of 35 prostate cancer patients referred to 68Ga-PSMA-I&T PET/CT imaging for restaging of the disease due to suspicion of relapse after definitive therapy were enrolled. First an early static pelvic image was obtained at a maximum of 300s following injection of the radiotracer. Sixty minutes postinjection a whole-body PET/CT scan was conducted with an emission time of 3min per bed position. The lesions which were categorized as local recurrence, bone lesion and lymph node metástasis in the early images, were compared with the late images in terms of number of lesions detected and SUVmax values. RESULTS 68Ga-PSMA-I&T PET/CT was positive in 23 of 35 patients (65.7%). A pathological uptake was observed in the prostatic bed site, in the pelvic lymph nodes, and in the bones in 17 patients (48.5%), 12 patients (34.2%), and 13 patients (37.1%), respectively. In one patient, focal pathological increased uptake in the prostatic bed with a SUVmax value of 5.8 was detected but this lesion disappeared in the late images. The average SUVmax values of the lesions in the prostatic bed were 13.7±12.1 versus 26.3±23.8 in the 5min and 60min studies respectively (p<0.001). In one patient, the pathological uptake in the lymph node in the early study cleared in the late study, whereas in another accumulation of activity was detected in a pelvic lymph node in the late study, while there was no lymph node detected in the early study. The average SUVmax values of the lymph nodes were 12.1±8.8 versus 26.3±22.6 in the 5min and 60min studies respectively (p<0.001). The average SUVmax values of the bone lesions were 11.4±6.9 versus 15±10.7 in the 5min and 60min studies respectively. CONCLUSION Our study is the first in the literature to evaluate the impact of adding an early static pelvic image to the 68Ga-PSMA-I&T scan, in the detection rate of the lesions. Although there was no marked discordance between the 2sets of images, the addition of an early image to the imaging protocol of 68Ga-PSMA-I&T scan would increase the efficacy of detection of malignant lesions in the pelvis, which might show rapid clearance and has the risk of being masked by the urinary system activity.
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Czarniecki M, Mena E, Lindenberg L, Cacko M, Harmon S, Radtke JP, Giesel F, Turkbey B, Choyke PL. Keeping up with the prostate-specific membrane antigens (PSMAs): an introduction to a new class of positron emission tomography (PET) imaging agents. Transl Androl Urol 2018; 7:831-843. [PMID: 30456186 PMCID: PMC6212618 DOI: 10.21037/tau.2018.08.03] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/31/2018] [Indexed: 12/11/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) is an emerging prostate cancer imaging method, which has been reported to have a higher sensitivity and specificity than the currently approved PET imaging agents. Multiple PSMA ligands are being investigated around the world and applications range from primary tumor characterization, to local staging, biochemical recurrence, metastasis, and image-guided interventions. The most investigated PET tracers are labelled with 68-Gallium or 18-Fluoride and are discussed in this review. Additionally, 99mTc labeled PSMA agents for single photon emission computed tomography (SPECT) imaging are elucidated as an alternative method of PSMA image acquisition.
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Affiliation(s)
- Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Esther Mena
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Liza Lindenberg
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marek Cacko
- Department of Nuclear Medicine, Medical University Warsaw, Warsaw, Poland
| | - Stephanie Harmon
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Jan Philipp Radtke
- Department of Urology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Frederick Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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68Ga-PSMA-PET: added value and future applications in comparison to the current use of choline-PET and mpMRI in the workup of prostate cancer. Radiol Med 2018; 123:952-965. [PMID: 30116970 DOI: 10.1007/s11547-018-0929-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/07/2018] [Indexed: 12/24/2022]
Abstract
Positron emission tomography (PET) has been commonly and successfully used, in combination with computed tomography (CT) and more recently magnetic resonance (MRI), in the workup of intermediate or high-risk prostate cancer (PCa). Nowadays, new specific receptor targeted PET tracers in prostate cancer imaging have been introduced; one of the most used is 68Ga-PSMA, that evaluates the expression of prostate-specific membrane antigen (PSMA). This tracer has been rapidly taken into account for its better sensitivity and specificity compared to lipid metabolism tracers, such as 11C/18F labelled fluorocholine. Besides, in the era of theranostics, this tracer is having a useful application not only for imaging but also for therapeutic purposes. The aim of this review article is, in the first part, to give an overview of the main indications and future development of 68Ga-PSMA imaging, using PET/CT or PET/MRI, according to the clinical course of the disease and in view of the current use of multiparametric MRI (mpMRI) and choline PET in the management of PCa. In the second part, a brief overview of the promising 18F-labelled PSMA tracers and the current use of PSMA radionuclide therapy will be provided.
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25
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Komek H, Can C, Yilmaz U, Altindag S. Prognostic value of 68 Ga PSMA I&T PET/CT SUV parameters on survival outcome in advanced prostat cancer. Ann Nucl Med 2018; 32:542-552. [PMID: 30006752 DOI: 10.1007/s12149-018-1277-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the association of 68 Ga-PSMA-I&T PET/CT SUV parameters with survival outcome in advanced prostate cancer patients. METHODS A total of 148 consecutive patients mean age: 69.3 ± 7.8 years with advanced prostate cancer who underwent 68 Ga-PSMA-I&T PET/CT were included in this retrospective study. Data on previous treatments, serum PSA levels (ng/mL), 68 Ga-PSMA-I&T PET/CT findings metastases as well as survival data were recorded. RESULTS Multivariate regression analysis revealed that Level 1 LN SUV/Liver SUV ratios > 2.17 (OR 4.262; 95% CI 1.104-16.453, p = 0.035), bone SUV > 10.7(OR 23.650; 95% CI 4.056-137.888, p < 0.001), bone SUV/spleen SUV ratio > 1.842 (OR 25.324; 95% CI 4.204-152.552, p < 0.001), highest SUVmax/liver SUV ratio > 2.32 (OR 19.309; 95% CI 1.730-209.552, p = 0.016) and highest SUVmax/spleen SUV ratio > 1.842 (OR 22.354; 95% CI 2.637-189.493, p = 0.004) were significant in the determination of increased mortality risk in advanced prostate cancer patients. CONCLUSION Our findings, for the first time in literature, provided evidence on potential utility of tracer uptake (SUV) cut-off values on 68 Ga-PSMA PET/CT in identification of the survival outcome of patients with metastatic disease and thereby in assisting in the selection of individualized therapeutic strategies tailored to the expected prognosis.
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Affiliation(s)
- Halil Komek
- Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital, Kayapınar, Diyarbakir, Turkey.
| | - Canan Can
- Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital, Kayapınar, Diyarbakir, Turkey
| | - Ugur Yilmaz
- Department of Radiation Oncology, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Serdar Altindag
- Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital, Kayapınar, Diyarbakir, Turkey
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Kuo HT, Pan J, Zhang Z, Lau J, Merkens H, Zhang C, Colpo N, Lin KS, Bénard F. Effects of Linker Modification on Tumor-to-Kidney Contrast of 68Ga-Labeled PSMA-Targeted Imaging Probes. Mol Pharm 2018; 15:3502-3511. [DOI: 10.1021/acs.molpharmaceut.8b00499] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Hsiou-Ting Kuo
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Jinhe Pan
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Zhengxing Zhang
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Joseph Lau
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Helen Merkens
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Chengcheng Zhang
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Nadine Colpo
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Kuo-Shyan Lin
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Department of Functional Imaging, BC Cancer, Vancouver, BC V5Z 4E6, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - François Bénard
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Department of Functional Imaging, BC Cancer, Vancouver, BC V5Z 4E6, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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Abstract
The fundamental foundation for precision medicine is accurate and specific targeting of cancer cells. Advances in the understanding of cancer biology, developments in diagnostic technologies, and expansion of therapeutic options have all contributed to the concept of personalized cancer care. Theranostics is the systematic integration of targeted diagnostics and therapeutics. The theranostic platform includes an imaging component that "sees" the lesions followed by administration of the companion therapy agent that "treats" the same lesions. This strategy leads to enhanced therapy efficacy, manageable adverse events, improved patient outcome, and lower overall costs. Radiotheranostics refers to the use of radionuclides for the paired imaging and therapy agents. Radioiodine is the classic radiotheranostic agent that has been used clinically in management of thyroid diseases for nearly 75 years. More recently there have been major exciting strides in radiotheranostics for neuroendocrine tumors and prostate cancer, among other conditions. Regulatory approval of a number of radiotheranostic pairs is anticipated in the near future. Continued support will be needed in research and development to keep pace with the current momentum in radiotheranostics innovations. Moreover, regulatory and reimbursement agencies need to streamline their requirements for seamless transfer of the radiotheranostic agents from the bench to the bedside. In this review, the concept, history, recent developments, current challenges, and outlook for radiotheranostics in the treatment of patients with cancer will be discussed. © RSNA, 2018.
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Affiliation(s)
- Hossein Jadvar
- From the Department of Radiology, Division of Nuclear Medicine, Keck School of Medicine, University of Southern California, 2250 Alcazar St, CSC/IGM 102, Los Angeles, CA 90033 (H.J.); Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Md (X.C.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (W.C.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (U.M.)
| | - Xiaoyuan Chen
- From the Department of Radiology, Division of Nuclear Medicine, Keck School of Medicine, University of Southern California, 2250 Alcazar St, CSC/IGM 102, Los Angeles, CA 90033 (H.J.); Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Md (X.C.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (W.C.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (U.M.)
| | - Weibo Cai
- From the Department of Radiology, Division of Nuclear Medicine, Keck School of Medicine, University of Southern California, 2250 Alcazar St, CSC/IGM 102, Los Angeles, CA 90033 (H.J.); Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Md (X.C.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (W.C.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (U.M.)
| | - Umar Mahmood
- From the Department of Radiology, Division of Nuclear Medicine, Keck School of Medicine, University of Southern California, 2250 Alcazar St, CSC/IGM 102, Los Angeles, CA 90033 (H.J.); Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Md (X.C.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (W.C.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (U.M.)
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28
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Lenzo NP, Meyrick D, Turner JH. Review of Gallium-68 PSMA PET/CT Imaging in the Management of Prostate Cancer. Diagnostics (Basel) 2018; 8:E16. [PMID: 29439481 PMCID: PMC5871999 DOI: 10.3390/diagnostics8010016] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 01/13/2023] Open
Abstract
Over 90% of prostate cancers over-express prostate specific membrane antigen (PSMA) and these tumor cells may be accurately targeted for diagnosis by 68Ga-PSMA-positron emission tomography/computed tomography (68Ga-PSMA-PET/CT) imaging. This novel molecular imaging modality appears clinically to have superseded CT, and appears superior to MR imaging, for the detection of metastatic disease. 68Ga-PSMA PET/CT has the ability to reliably stage prostate cancer at presentation and can help inform an optimal treatment approach. Novel diagnostic applications of 68Ga-PSMA PET/CT include guiding biopsy to improve sampling accuracy, and guiding surgery and radiotherapy. In addition to facilitating the management of metastatic castrate resistant prostate cancer (mCRPC), 68Ga-PSMA can select patients who may benefit from targeted systemic radionuclide therapy. 68Ga-PSMA is the diagnostic positron-emitting theranostic pair with the beta emitter Lutetium-177 PSMA (177Lu-PSMA) and alpha-emitter Actinium-225 PSMA (225Ac-PSMA) which can both be used to treat PSMA-avid metastases of prostate cancer in the molecular tumor-targeted approach of theranostic nuclear oncology.
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Affiliation(s)
- Nat P Lenzo
- Nuclear Oncology, Theranostics Australia, 106/1 Silas Street, Richmond Quarter Building, East Fremantle, WA 6158, Australia.
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Nedlands, WA 6009, Australia.
| | - Danielle Meyrick
- Nuclear Oncology, Theranostics Australia, 106/1 Silas Street, Richmond Quarter Building, East Fremantle, WA 6158, Australia.
| | - J Harvey Turner
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Nedlands, WA 6009, Australia.
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29
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The role of 68Ga-PSMA-I&T PET/CT in the pretreatment staging of primary prostate cancer. Nucl Med Commun 2017; 38:956-963. [DOI: 10.1097/mnm.0000000000000738] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Verburg FA, Luster M. A new perspective for nuclear medicine: expanding the indications for PSMA targeted imaging and therapy. Eur J Nucl Med Mol Imaging 2017; 44:1611-1613. [PMID: 28677048 DOI: 10.1007/s00259-017-3767-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Frederik A Verburg
- Department of Nuclear Medicine, University Hospital Marburg, Baldinger Strasse, 35043, Marburg, Germany.
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Baldinger Strasse, 35043, Marburg, Germany
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