1
|
Huang B, Yang Q, Li X, Wu Y, Liu Z, Pan Z, Zhong S, Song S, Zuo C. Deep learning-based whole-body characterization of prostate cancer lesions on [ 68Ga]Ga-PSMA-11 PET/CT in patients with post-prostatectomy recurrence. Eur J Nucl Med Mol Imaging 2024; 51:1173-1184. [PMID: 38049657 DOI: 10.1007/s00259-023-06551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE The automatic segmentation and detection of prostate cancer (PC) lesions throughout the body are extremely challenging due to the lesions' complexity and variability in appearance, shape, and location. In this study, we investigated the performance of a three-dimensional (3D) convolutional neural network (CNN) to automatically characterize metastatic lesions throughout the body in a dataset of PC patients with recurrence after radical prostatectomy. METHODS We retrospectively collected [68 Ga]Ga-PSMA-11 PET/CT images from 116 patients with metastatic PC at two centers: center 1 provided the data for fivefold cross validation (n = 78) and internal testing (n = 19), and center 2 provided the data for external testing (n = 19). PET and CT data were jointly input into a 3D U-Net to achieve whole-body segmentation and detection of PC lesions. The performance in both the segmentation and the detection of lesions throughout the body was evaluated using established metrics, including the Dice similarity coefficient (DSC) for segmentation and the recall, precision, and F1-score for detection. The correlation and consistency between tumor burdens (PSMA-TV and TL-PSMA) calculated from automatic segmentation and artificial ground truth were assessed by linear regression and Bland‒Altman plots. RESULTS On the internal test set, the DSC, precision, recall, and F1-score values were 0.631, 0.961, 0.721, and 0.824, respectively. On the external test set, the corresponding values were 0.596, 0.888, 0.792, and 0.837, respectively. Our approach outperformed previous studies in segmenting and detecting metastatic lesions throughout the body. Tumor burden indicators derived from deep learning and ground truth showed strong correlation (R2 ≥ 0.991, all P < 0.05) and consistency. CONCLUSION Our 3D CNN accurately characterizes whole-body tumors in relapsed PC patients; its results are highly consistent with those of manual contouring. This automatic method is expected to improve work efficiency and to aid in the assessment of tumor burden.
Collapse
Affiliation(s)
- Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Qinqin Yang
- Department of Nuclear Medicine, Shanghai Changhai Hospital, Shanghai, China
| | - Xiao Li
- Department of Nuclear Medicine, Shanghai Changhai Hospital, Shanghai, China
| | - Yuxuan Wu
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Zhantao Liu
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Zhaohong Pan
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Shaonan Zhong
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China.
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Changjing Zuo
- Department of Nuclear Medicine, Shanghai Changhai Hospital, Shanghai, China.
| |
Collapse
|
2
|
Analysis of Pros and Cons in Using [ 68Ga]Ga-PSMA-11 and [ 18F]PSMA-1007: Production, Costs, and PET/CT Applications in Patients with Prostate Cancer. Molecules 2022; 27:molecules27123862. [PMID: 35744985 PMCID: PMC9227284 DOI: 10.3390/molecules27123862] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
The aim of this work is to compare [68Ga]Ga-PSMA-11 and [18F]PSMA-1007 PET/CT as imaging agents in patients with prostate cancer (PCa). Comparisons were made by evaluating times and costs of the radiolabeling process, imaging features including pharmacokinetics, and impact on patient management. The analysis of advantages and drawbacks of both radioligands might help to make a better choice based on firm data. For [68Ga]Ga-PSMA-11, the radiochemical yield (RCY) using a low starting activity (L, average activity of 596.55 ± 37.97 MBq) was of 80.98 ± 0.05%, while using a high one (H, average activity of 1436.27 ± 68.68 MBq), the RCY was 71.48 ± 0.04%. Thus, increased starting activities of [68Ga]-chloride negatively influenced the RCY. A similar scenario occurred for [18F]PSMA-1007. The rate of detection of PCa lesions by Positron Emission Tomography/Computed Tomography (PET/CT) was similar for both radioligands, while their distribution in normal organs significantly differed. Furthermore, similar patterns of biodistribution were found among [18F]PSMA-1007, [68Ga]Ga-PSMA-11, and [177Lu]Lu-PSMA-617, the most used agent for RLT. Moreover, the analysis of economical aspects for each single batch of production corrected for the number of allowed PET/CT examinations suggested major advantages of [18F]PSMA-1007 compared with [68Ga]Ga-PSMA-11. Data from this study should support the proper choice in the selection of the PSMA PET radioligand to use on the basis of the cases to study.
Collapse
|
3
|
Wichmann CW, Ackermann U, Poniger S, Young K, Nguyen B, Chan G, Sachinidis J, Scott AM. Automated radiosynthesis of [ 68 Ga]Ga-PSMA-11 and [ 177 Lu]Lu-PSMA-617 on the iPHASE MultiSyn module for clinical applications. J Labelled Comp Radiopharm 2021; 64:140-146. [PMID: 33067810 PMCID: PMC8048907 DOI: 10.1002/jlcr.3889] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/10/2020] [Accepted: 08/27/2020] [Indexed: 11/11/2022]
Abstract
Prostate-specific membrane antigen (PSMA)-targeted imaging and therapy of prostate cancer using theranostic pairs is rapidly changing clinical practice. To facilitate clinical trials, fully automated procedures for the radiosyntheses of [68 Ga]Ga-PSMA-11 and [177 Lu]Lu-PSMA-617 were developed from commercially available precursors using the cassette based iPHASE MultiSyn module. Formulated and sterile radiopharmaceuticals were obtained in 76 ± 3% (n = 20) and 91 ± 4% (n = 15) radiochemical yields after 17 and 20 min, respectively. Radiochemical purity was always >95% and molar activities exceeded 792 ± 100 and 88 ± 6 GBq/μmol, respectively. Quality control showed conformity with all relevant release criteria and radiopharmaceuticals were used in the clinic.
Collapse
Affiliation(s)
- Christian W. Wichmann
- Tumor Targeting LaboratoryOlivia Newton‐John Cancer Research InstituteHeidelbergVictoriaAustralia
- School of Cancer MedicineLa Trobe UniversityBundooraVictoriaAustralia
- Department of Molecular Imaging and TherapyAustin HealthHeidelbergVictoriaAustralia
- Department of MedicineUniversity of MelbourneParkvilleVictoriaAustralia
| | - Uwe Ackermann
- Tumor Targeting LaboratoryOlivia Newton‐John Cancer Research InstituteHeidelbergVictoriaAustralia
- Department of Molecular Imaging and TherapyAustin HealthHeidelbergVictoriaAustralia
- Department of MedicineUniversity of MelbourneParkvilleVictoriaAustralia
| | - Stan Poniger
- Department of Molecular Imaging and TherapyAustin HealthHeidelbergVictoriaAustralia
| | - Kenneth Young
- Department of Molecular Imaging and TherapyAustin HealthHeidelbergVictoriaAustralia
| | - Benjamin Nguyen
- Department of Molecular Imaging and TherapyAustin HealthHeidelbergVictoriaAustralia
| | - Gordon Chan
- Department of Molecular Imaging and TherapyAustin HealthHeidelbergVictoriaAustralia
| | - John Sachinidis
- Department of Molecular Imaging and TherapyAustin HealthHeidelbergVictoriaAustralia
| | - Andrew M. Scott
- Tumor Targeting LaboratoryOlivia Newton‐John Cancer Research InstituteHeidelbergVictoriaAustralia
- School of Cancer MedicineLa Trobe UniversityBundooraVictoriaAustralia
- Department of Molecular Imaging and TherapyAustin HealthHeidelbergVictoriaAustralia
- Department of MedicineUniversity of MelbourneParkvilleVictoriaAustralia
| |
Collapse
|
4
|
Waterhouse NN, Amor-Coarasa A, Nikolopoulou A, Babich JW. Otto: a 4.04 GBq (109 mCi) 68Ge/ 68Ga generator, first of its kind - extended quality control and performance evaluation in the clinical production of [ 68Ga]Ga-PSMA-11. EJNMMI Radiopharm Chem 2020; 5:5. [PMID: 32016646 PMCID: PMC6997319 DOI: 10.1186/s41181-019-0087-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Here we report on the comprehensive quality control of a 4.04 GBq (109 mCi) generator supplied by itG (Munich, Germany), and used for routine production of [68Ga]Ga-PSMA-11 for clinical imaging. The performance of the 4.04 GBq itG 68Ge/68Ga generator was studied for a year and parameters including elution yield, elution profile, radioactive and stable contaminants were collected. The production yields of a series of 175 [68Ga]Ga-PSMA-11 clinical batches are also reported herein. RESULTS This first-of-its-kind GMP grade 68Ge/68Ga generator from itG with a nominal activity of 4.04 GBq (109 mCi) showed a stable 68Ga elution profile with elution efficiency averaging 58.3 ± 3.7%. 68Ge contaminant in the eluent slightly increased over time but remained 100x lower than those reported for comparable 1.85 GBq (50 mCi) itG generators. Metal impurities were found in concentrations lower than 100 ng/ml (ppb) throughout the study. [68Ga]Ga-PSMA-11 was obtained in 89 ± 4% radiochemical yields and > 99% radiochemical and chemical purities. CONCLUSION 4.04 GBq (109 mCi) itG 68Ge/68Ga generator is suitable for routinely produced 68Ga tracers used in the clinic. Up to 30% higher amount of final drug product was obtained as compared to the 1.85 GBq (50 mCi) itG generator, and as a result larger number of studies could be performed, while reducing the synthetic burden.
Collapse
Affiliation(s)
- Nicole N Waterhouse
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, 516 E 72nd St, New York, NY, 10021, USA
| | - Alejandro Amor-Coarasa
- Radiochemistry Laboratory, Albert Einstein College of Medicine, Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Anastasia Nikolopoulou
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, 516 E 72nd St, New York, NY, 10021, USA.,Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Cornell Medicine, Belfer Research Building, Room 1600, 413 E 69th St, New York, NY, 10021, USA
| | - John W Babich
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, 516 E 72nd St, New York, NY, 10021, USA. .,Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Cornell Medicine, Belfer Research Building, Room 1600, 413 E 69th St, New York, NY, 10021, USA. .,Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, NY, USA. .,Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
5
|
Kuten J, Fahoum I, Savin Z, Shamni O, Gitstein G, Hershkovitz D, Mabjeesh NJ, Yossepowitch O, Mishani E, Even-Sapir E. Head-to-Head Comparison of 68Ga-PSMA-11 with 18F-PSMA-1007 PET/CT in Staging Prostate Cancer Using Histopathology and Immunohistochemical Analysis as a Reference Standard. J Nucl Med 2019; 61:527-532. [DOI: 10.2967/jnumed.119.234187] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022] Open
|
6
|
Kelly JM, Amor-Coarasa A, Ponnala S, Nikolopoulou A, Williams C, Thiele NA, Schlyer D, Wilson JJ, DiMagno SG, Babich JW. A Single Dose of 225Ac-RPS-074 Induces a Complete Tumor Response in an LNCaP Xenograft Model. J Nucl Med 2018; 60:649-655. [PMID: 30413660 DOI: 10.2967/jnumed.118.219592] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/03/2018] [Indexed: 12/13/2022] Open
Abstract
Promising biochemical responses to 225Ac-prostate-specific membrane antigen (PSMA) 617, even in patients who are refractory to β-particle radiation, illustrate the potential of targeted α-therapy for the treatment of metastatic castration-resistant prostate cancer. However, side effects such as xerostomia are severe and irreversible. To fully harness the potential of targeted α-therapy, it is necessary to increase the therapeutic index of the targeted radioligands. One emerging strategy is to increase clearance half-life through enhanced binding to serum albumin. We have evaluated the albumin-binding PSMA-targeting ligand RPS-074 in a LNCaP xenograft model to determine its potential value to the treatment of prostate cancer. Methods: 225Ac-RPS-074 was evaluated in male BALB/c mice bearing LNCaP xenograft tumors. A biodistribution study was performed over 21 d to determine the dosimetry in tumors and normal tissue. The dose response was measured in groups of 7 mice using 37, 74, and 148 kBq of 225Ac-RPS-074 and compared with positive and negative control groups. Mice were sacrificed when tumor volume exceeded 1,500 mm3 Results: 225Ac-RPS-074 was labeled in greater than 98% radiochemical yield and showed high (>10% injected dose/g) and sustained accumulation in LNCaP tumors from 24 h to beyond 14 d. Signal in blood and highly vascularized tissues was evident over the first 24 h after injection and cleared by 7 d. The tumor-to-kidney ratio was 4.3 ± 0.7 at 24 h and 62.2 ± 9.5 at 14 d. A single injection of 148 kBq induced a complete response in 6 of 7 tumors, with no apparent toxic effects. Treatment with 74 kBq induced a partial response in 7 of 7 tumors, but from 42 d, 6 of 7 experienced significant regrowth. The 37-kBq group experienced a survival benefit relative to the negative control but not compared with the positive control group. Conclusion: A single dose of 148 kBq of 225Ac-RPS-074 induced a complete response in 86% of tumors, with tumor-to-normal-tissue ratios that predict an improved therapeutic index. The use of the macropa chelator enabled quantitative radiolabeling and may facilitate the clinical translation of this promising targeted α-therapeutic.
Collapse
Affiliation(s)
- James M Kelly
- Division of Radiopharmaceutical Science, Department of Radiology, Weill Cornell Medicine, New York, New York.,Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Alejandro Amor-Coarasa
- Division of Radiopharmaceutical Science, Department of Radiology, Weill Cornell Medicine, New York, New York.,Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Shashikanth Ponnala
- Division of Radiopharmaceutical Science, Department of Radiology, Weill Cornell Medicine, New York, New York.,Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Anastasia Nikolopoulou
- Division of Radiopharmaceutical Science, Department of Radiology, Weill Cornell Medicine, New York, New York.,Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, New York
| | - Clarence Williams
- Division of Radiopharmaceutical Science, Department of Radiology, Weill Cornell Medicine, New York, New York.,Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Nikki A Thiele
- Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York
| | | | - Justin J Wilson
- Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York
| | - Stephen G DiMagno
- College of Pharmacy, University of Illinois-Chicago, Chicago, Illinois; and
| | - John W Babich
- Division of Radiopharmaceutical Science, Department of Radiology, Weill Cornell Medicine, New York, New York .,Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, New York.,Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, New York.,Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| |
Collapse
|
7
|
Kelly J, Amor-Coarasa A, Nikolopoulou A, Kim D, Williams C, Ponnala S, Babich JW. Synthesis and pre-clinical evaluation of a new class of high-affinity 18F-labeled PSMA ligands for detection of prostate cancer by PET imaging. Eur J Nucl Med Mol Imaging 2016; 44:647-661. [PMID: 27847991 PMCID: PMC5323493 DOI: 10.1007/s00259-016-3556-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/19/2016] [Indexed: 01/18/2023]
Abstract
Purpose Current clinical imaging of PSMA-positive prostate cancer by positron emission tomography (PET) mainly features 68Ga-labeled tracers, notably [68Ga]Ga-PSMA-HBED-CC. The longer half-life of fluorine-18 offers significant advantages over Ga-68, clinically and logistically. We aimed to develop high-affinity PSMA inhibitors labeled with fluorine-18 as alternative tracers for prostate cancer. Methods Six triazolylphenyl ureas and their alkyne precursors were synthesized from the Glu-urea-Lys PSMA binding moiety. PSMA affinity was determined in a competitive binding assay using LNCaP cells. The [18F]triazoles were isolated following a Cu(I)-catalyzed click reaction between the alkynes and [18F]fluoroethylazide. The 18F-labeled compounds were evaluated in nude mice bearing LNCaP tumors and compared to [68Ga]Ga-PSMA-HBED-CC and [18F]DCFPyL. Biodistribution studies of the two tracers with the highest imaged-derived tumor uptake and highest PSMA affinity were undertaken at 1 h, 2 h and 4 h post-injection (p.i.), and co-administration of PMPA was used to determine whether uptake was PSMA-specific. Results F-18-labeled triazolylphenyl ureas were prepared with a decay-corrected RCY of 20–40 %, >98 % radiochemical and chemical purity, and specific activity of up to 391 GBq/μmol. PSMA binding (IC50) ranged from 3–36 nM. The position of the triazole influenced tumor uptake (3 > 4 > 2), and direct conjugation of the triazole with the phenylurea moiety was preferred to insertion of a spacer group. Image-derived tumor uptake ranged from 6–14 %ID/g at 2 h p.i., the time of maximum tumor uptake; uptake of [68Ga]Ga-PSMA-HBED-CC and [18F]DCFPyL was 5–6 %ID/g at 1–3 h p.i., the time of maximum tumor uptake. Biodistribution studies of the two most promising compounds gave maximum tumor uptakes of 10.9 ± 1.0 % and 14.3 ± 2.5 %ID/g, respectively, as compared to 6.27 ± 1.44 %ID/g for [68Ga]Ga-PSMA-HBED-CC. Conclusions Six [18F]triazolylphenyl ureas were prepared in good radiochemical yield. Compounds showed PSMA-specific uptake in LNCaP tumors as high as 14 % ID/g, more than a 2-fold increase over [68Ga]Ga-PSMA-HBED-CC. The facile and high-yielding radiosynthesis of these 18F-labeled triazoles as well as their promising in vitro and in vivo characteristics make them worthy of clinical development for PET imaging of prostate cancer. Electronic supplementary material The online version of this article (doi:10.1007/s00259-016-3556-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- James Kelly
- Division of Radiopharmaceutical Sciences and Molecular Imaging Innovations Institute, Department of Radiology, Weill Cornell Medicine, Belfer Research Building, Room 1600, 413 East 69th Street, New York, NY, 10021, USA
| | - Alejandro Amor-Coarasa
- Division of Radiopharmaceutical Sciences and Molecular Imaging Innovations Institute, Department of Radiology, Weill Cornell Medicine, Belfer Research Building, Room 1600, 413 East 69th Street, New York, NY, 10021, USA
| | - Anastasia Nikolopoulou
- Division of Radiopharmaceutical Sciences and Molecular Imaging Innovations Institute, Department of Radiology, Weill Cornell Medicine, Belfer Research Building, Room 1600, 413 East 69th Street, New York, NY, 10021, USA.,Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Dohyun Kim
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Clarence Williams
- Division of Radiopharmaceutical Sciences and Molecular Imaging Innovations Institute, Department of Radiology, Weill Cornell Medicine, Belfer Research Building, Room 1600, 413 East 69th Street, New York, NY, 10021, USA
| | - Shashikanth Ponnala
- Division of Radiopharmaceutical Sciences and Molecular Imaging Innovations Institute, Department of Radiology, Weill Cornell Medicine, Belfer Research Building, Room 1600, 413 East 69th Street, New York, NY, 10021, USA
| | - John W Babich
- Division of Radiopharmaceutical Sciences and Molecular Imaging Innovations Institute, Department of Radiology, Weill Cornell Medicine, Belfer Research Building, Room 1600, 413 East 69th Street, New York, NY, 10021, USA. .,Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY, 10021, USA. .,Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10021, USA.
| |
Collapse
|