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Jonmarker O, Nilsson T, Axelsson R, Ericson LH, Tran TA, Tzortzakakis A, Savitcheva I, Holstensson M. [ 18 F]-PSMA-1007 PET imaging optimization and inter-rater reliability - a comparison of three different reconstructions read by four radiologists. Nucl Med Commun 2024; 45:389-395. [PMID: 38312095 DOI: 10.1097/mnm.0000000000001823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To increase understanding of optimal imaging parameters [ 18 F]PSMA-1007 when imaging patients with prostate cancer and to determine interrater agreement using [ 18 F]PSMA-1007. METHODS In this observational study, four independent physicians read reconstruction sets using bedtimes of 1, 2 and 3 minutes of patients undergoing [ 18 F]PSMA-1007. positron emission topography. Clear and equivocal lesions and their locations were recorded. Image noise was rated on a four-point scale. Lesion counts were compared using inter-class correlation whereas noise ratings were compared using generalized estimating equations. Repeated cases were used to assess intra-rater agreement. RESULTS Sixty reconstruction sets of 16 consecutively examined participants were included. Participants had a mean age of 71.5 years, six of them were examined prior to any treatment, three had a history of radiotherapy and seven of prostatectomy. Median Gleason score of primary tumors was 7. Imaging was performed after a mean of 132 min using a mean 3.95 MBq/Kg body weight of [ 18 F] PSMA-1007. Neither the total number of lesions per location nor the proportion of equivocal lesions varied consistently between bedtimes. Inter-rater reliability scores varied depending on location from 0.40 to 1.0 and were similar for all bedtimes. Intra-rater reliability varied between 0.70 and 0.76 for the three different bedtimes. Noise ratings were significantly lower for 1 minute than 3 minutes per bed. CONCLUSION In the setting of [ 18 F]PSMA-1007 PET CT, 1, 2 and 3 minutes per bed produce similar results unlikely to affect clinical interpretation. Image noise ratings favor 2 and 3 minutes per bed.
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Affiliation(s)
- Olof Jonmarker
- Medical Diagnostics Karolinska, Karolinska University Hospital,
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet,
| | - Ted Nilsson
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet,
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital,
| | - Rimma Axelsson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital,
- Department of Molecular Medicine and Surgery, Karolinska Institutet,
| | | | - Thuy A Tran
- Radiopharmacy, Medical Diagnostics Karolinska, Karolinska University Hospital and
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Antonios Tzortzakakis
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet,
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital,
| | - Irina Savitcheva
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital,
| | - Maria Holstensson
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet,
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital,
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Ghezzo S, Mapelli P, Samanes Gajate AM, Palmisano A, Cucchiara V, Brembilla G, Bezzi C, Suardi N, Scifo P, Briganti A, De Cobelli F, Chiti A, Esposito A, Picchio M. Diagnostic accuracy of fully hybrid [ 68Ga]Ga-PSMA-11 PET/MRI and [ 68Ga]Ga-RM2 PET/MRI in patients with biochemically recurrent prostate cancer: a prospective single-center phase II clinical trial. Eur J Nucl Med Mol Imaging 2024; 51:907-918. [PMID: 37897615 DOI: 10.1007/s00259-023-06483-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE To compare the diagnostic accuracy and detection rates of PET/MRI with [68Ga]Ga-PSMA-11 and [68Ga]Ga-M2 in patients with biochemical recurrence of prostate cancer (PCa). METHODS Sixty patients were enrolled in this prospective single-center phase II clinical trial from June 2020 to October 2022. Forty-four/60 completed all study examinations and were available at follow-up (median: 22.8 months, range: 6-31.5 months). Two nuclear medicine physicians analyzed PET images and two radiologists interpreted MRI; images were then re-examined to produce an integrated PET/MRI report for both [68Ga]Ga-PSMA-11 and [68Ga]Ga-RM2 examinations. A composite reference standard including histological specimens, response to treatment, and conventional imaging gathered during follow-up was used to validate imaging findings. Detection rates, accuracy, sensitivity, specificity, positive, and negative predictive value were assessed. McNemar's test was used to compare sensitivity and specificity on a per-patient base and detection rate on a per-region base. Prostate bed, locoregional lymph nodes, non-skeletal distant metastases, and bone metastases were considered. p-value significance was defined below the 0.05 level after correction for multiple testing. RESULTS Patients' median age was 69.8 years (interquartile range (IQR): 61.8-75.1) and median PSA level at time of imaging was 0.53 ng/mL (IQR: 0.33-2.04). During follow-up, evidence of recurrence was observed in 31/44 patients. Combining MRI with [68Ga]Ga-PSMA-11 PET and [68Ga]Ga-RM2 PET resulted in sensitivity = 100% and 93.5% and specificity of 69.2% and 69.2%, respectively. When considering the individual imaging modalities, [68Ga]Ga-RM2 PET showed lower sensitivity compared to [68Ga]Ga-PSMA-11 PET and MRI (61.3% vs 83.9% and 87.1%, p = 0.046 and 0.043, respectively), while specificity was comparable among the imaging modalities (100% vs 84.6% and 69.2%, p = 0.479 and 0.134, respectively). CONCLUSION This study brings further evidence on the utility of fully hybrid PET/MRI for disease characterization in patients with biochemically recurrent PCa. Imaging with [68Ga]Ga-PSMA-11 PET showed high sensitivity, while the utility of [68Ga]Ga-RM2 PET in absence of a simultaneous whole-body/multiparametric MRI remains to be determined.
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Affiliation(s)
- Samuele Ghezzo
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Paola Mapelli
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Ana Maria Samanes Gajate
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Anna Palmisano
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Vito Cucchiara
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giorgio Brembilla
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Carolina Bezzi
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Nazareno Suardi
- IRCCS Ospedale Policlinico San Martino, University of Genoa, Largo Benzi 10, 16132, Genoa, Italy
| | - Paola Scifo
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Arturo Chiti
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonio Esposito
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Maria Picchio
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy.
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Ren X, Nur Salihin Yusoff M, Hartini Mohd Taib N, Zhang L, Wang K. 68Ga-prostate specific membrane antigen-11 PET/CT versus multiparametric MRI in the detection of primary prostate cancer: A systematic review and head-to-head comparative meta-analysis. Eur J Radiol 2024; 170:111274. [PMID: 38147764 DOI: 10.1016/j.ejrad.2023.111274] [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: 08/27/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE The goal of this study was to evaluate the effectiveness of two diagnostic methods, 68Ga-PSMA-11 PET/CT and mpMRI, in detecting primary prostate cancer without limitations on the Gleason score. METHODS We conducted a comprehensive literature review, searching databases such as PubMed, Embase, and Web of Science until June 2023. Our objective was to identify studies that compared the efficacy of 68Ga-PSMA-11 PET/CT and mpMRI in detecting primary prostate cancer. To determine heterogeneity, the I2 statistic was used. Meta-regression analysis and leave-one-out sensitivity analysis were conducted to identify potential sources of heterogeneity. RESULTS Initially, 1286 publications were found, but after careful evaluation, only 16 studies involving 1227 patients were analyzed thoroughly. The results showed that the 68Ga-PSMA-11 PET/CT method had a pooled sensitivity and specificity of 0.87 (95 % CI: 0.80-0.92) and 0.80 (95 % CI: 0.69-0.89), respectively, for diagnosing prostatic cancer. Similarly, the values for mpMRI were determined as 0.84 (95 % CI: 0.75-0.92) and 0.74 (95 % CI: 0.61-0.86), respectively. There were no significant differences in diagnostic effectiveness observed when comparing two primary prostate cancer methodologies (pooled sensitivity P = 0.62, pooled specificity P = 0.50). Despite this, the funnel plots showed symmetry and the Egger test results (P values > 0.05) suggested there was no publication bias. CONCLUSIONS After an extensive meta-analysis, it was found that both 68Ga-PSMA-11 PET/CT and mpMRI demonstrate similar diagnostic effectiveness in detecting primary prostate cancer. Future larger prospective studies are warranted to investigate this issue further.
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Affiliation(s)
- Xiaolu Ren
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan 750004, China; School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | - Nur Hartini Mohd Taib
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Li Zhang
- Department of Urology, People's Hospital of Wuzhong, Wuzhong 751100, China
| | - Kehua Wang
- Department of Vascular Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
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Singh MK, Mohan VSK, Kaushik C. Operational and Performance Experience with uMI550 Digital PET-CT during Routine Quality Control Procedures. World J Nucl Med 2023; 22:267-275. [PMID: 38152105 PMCID: PMC10751135 DOI: 10.1055/s-0043-1777696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction The quality control (QC) procedures for positron emission tomography (PET) scanners are covered by National Electrical Manufacturers Association and International Electrotechnical Commission. QC must be carried out at regular intervals according to the specifications of the scanner manufacturer. Daily and weekly QC plays a valuable role in monitoring positron emission tomography (PET) scanner performance changes. This study shares operational and performance experience of QC procedures that do not require a radioactive Ge-68 source to perform daily QC and experience with fluorodeoxyglucose F18 ( 18 F-FDG) as a substitute for germanium-68/sodium-22 (Ge-68/Na-22) source for weekly QC. Method This study was performed on an uMI550 digital positron emission tomography-computed tomography (PET-CT) scanner. In this scanner daily QC checks system temperature and humidity, system count rate, data link status, and voltage. QC was performed at the console control, the position of the scanner table was in the home position pulled out from the gantry, and the room was closed during the quick QC. Weekly full QC check items include look-up table drift, energy drift, time-of-flight status, C-map status, temperature and humidity, and voltage. Weekly full QC was performed with a 18 F-FDG source in a rod phantom source. Results Over 200 daily QC tests without a radioactive source Ge-68 phantom and 50 full weekly QC tests using a 18 F-FDG rod phantom were performed with this scanner according to the manufacturer's instructions and a test report was generated. No daily QC errors or warnings were observed during this period. Conclusion The new approach for the daily PET QC does not expose operators to radiation. This translates into commercial and operational merits with consistent performance and results. Implications for Practice Reduction in radiation exposure to operating staff during QC procedure in PET-CT scanner.
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Affiliation(s)
- Manoj Kumar Singh
- Medikabazaar, Technopolis Knowledge Park, Mumbai, Maharashtra, India
| | | | - Chanchal Kaushik
- School of Health and Society, University of Salford, Manchester, United Kingdom
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Taylor Z, Kjelstrom S, Buckley M, Cahn D. Overall Survival and Associations of Insurance Status Among Hispanic Men With High-Risk Prostate Cancer. Cureus 2023; 15:e45723. [PMID: 37876384 PMCID: PMC10591534 DOI: 10.7759/cureus.45723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Objectives Our objectives were to (1) determine the association between ethnicity and high-risk prostate cancer (PCa) survival and (2) determine whether this association is modified by insurance status. Methods We performed a retrospective review of the National Cancer Database (NCDB) from 2004 to 2017 of non-Hispanic White (NHW), Hispanic White (HW), or Black men with high-risk PCa. A multivariate Cox regression model was built to test the association between overall survival (OS) and race/ethnicity, insurance status, and their interaction, controlling for various socioeconomic and disease-specific variables. Results A total of 94,708 men with high-risk PCa were included in the analysis. Both HW and Black men had lower socioeconomic status characteristics and lower rates of private insurance. Race/ethnicity was significantly associated with OS in the adjusted analysis. Only Medicare demonstrated significantly worse OS. NHW (covariate-adjusted hazard ratio (aHR): 1.83, 95% CI: 1.45-2.32) and Black (aHR: 1.71, 05% CI: 1.34-2.19) men demonstrated significantly worse survival when compared to HW men. Subgroup analysis demonstrated significant differences occurring among HW men with private insurance/managed care when compared to those not insured, Medicaid, Medicare, and other government insurance types. Conclusion Despite socioeconomic and demographic disadvantages, HW men demonstrate improved OS compared to NHW men. Furthermore, HW men demonstrated improved OS compared to NHW men within nearly each insurance status type. This finding is likely the result of a complex multifactorial web and as such serves as an interesting hypothesis-generating study.
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Affiliation(s)
| | | | - Meghan Buckley
- Statistics, Lankenau Institute for Medical Research, Wynnewood, USA
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Mojsak M, Szumowski P, Amelian A, Hladunski M, Kubas B, Myśliwiec J, Kochanowicz J, Moniuszko M. Application of 18F-PSMA-1007 PET/MR Imaging in Early Biochemical Recurrence of Prostate Cancer: Results of a Prospective Study of 60 Patients with Very Low PSA Levels ≤ 0.5 ng/mL. Cancers (Basel) 2023; 15:4185. [PMID: 37627213 PMCID: PMC10453039 DOI: 10.3390/cancers15164185] [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: 07/11/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The use of 18F-PSMA-1007 and the role of PET/MR in the diagnosis of prostate cancer are not conclusively confirmed. There are reports indicating the potential pros and cons of using 18F-PSMA-1007 as well as the PET/MR technique in prostate cancer recurrence, but they are not yet included in the EAU guidelines. The aim of the study was to assess the effectiveness of 18F-PSMA-1007 PET/MR in detecting BCR lesions at very low PSA levels <0.5 ng/mL. METHODS Sixty patients with BCR after radical prostatectomy (RP) with PSA ranged 0.1-0.5 ng/mL were enrolled in a prospective study. All patients underwent simultaneous whole-body and pelvic 18F-PSMA-1007 PET/MR. The obtained results were verified by 12-month follow-up. RESULTS Fifty-three lesions were detected in 45 patients with 75% detection rate. The mean PSA value was 0.31 ng/mL. Of all PSMA-positive foci, 91% were localized in the pelvis, and only 9% of lesions were located in the extrapelvic region. Local recurrences were detected in 29%, PSMA-positive lymph nodes were detected in 64% of patients and bone metastases lesions were detected in 7% of patients. CONCLUSIONS 18F-PSMA-1007 PET/MR seems to be an excellent diagnostic tool in patients with early BCR with very low PSA levels, especially with dt PSA < 6 months. The synergistic effect of combining 18F-PSMA-1007 and whole-body PET/MR with precise multiparametric assessment of pelvic lesions is of particular benefit in early BCR.
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Affiliation(s)
- Małgorzata Mojsak
- Independent Laboratory of Molecular Imaging, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.A.)
| | - Piotr Szumowski
- Department of Nuclear Medicine, Medical University of Bialystok, 15-276 Bialystok, Poland; (P.S.)
| | - Anna Amelian
- Independent Laboratory of Molecular Imaging, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.A.)
| | - Marcin Hladunski
- Independent Laboratory of Molecular Imaging, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.A.)
| | - Bożena Kubas
- Department of Radiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Janusz Myśliwiec
- Department of Nuclear Medicine, Medical University of Bialystok, 15-276 Bialystok, Poland; (P.S.)
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Marcin Moniuszko
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, 15-276 Bialystok, Poland;
- Clinical Department of Allergic and Internal Diseases, Medical University of Bialystok, 15-276 Bialystok, Poland
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Cereser L, Evangelista L, Giannarini G, Girometti R. Prostate MRI and PSMA-PET in the Primary Diagnosis of Prostate Cancer. Diagnostics (Basel) 2023; 13:2697. [PMID: 37627956 PMCID: PMC10453091 DOI: 10.3390/diagnostics13162697] [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: 06/15/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Over the last years, prostate magnetic resonance imaging (MRI) has gained a key role in the primary diagnosis of clinically significant prostate cancer (csPCa). While a negative MRI can avoid unnecessary prostate biopsies and the overdiagnosis of indolent cancers, a positive examination triggers biopsy samples targeted to suspicious imaging findings, thus increasing the diagnosis of csPCa with a sensitivity and negative predictive value of around 90%. The limitations of MRI, including suboptimal positive predictive values, are fueling debate on how to stratify biopsy decisions and management based on patient risk and how to correctly estimate it with clinical and/or imaging findings. In this setting, "next-generation imaging" imaging based on radiolabeled Prostate-Specific Membrane Antigen (PSMA)-Positron Emission Tomography (PET) is expanding its indications both in the setting of primary staging (intermediate-to-high risk patients) and primary diagnosis (e.g., increasing the sensitivity of MRI or acting as a problem-solving tool for indeterminate MRI cases). This review summarizes the current main evidence on the role of prostate MRI and PSMA-PET as tools for the primary diagnosis of csPCa, and the different possible interaction pathways in this setting.
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Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, 20072 Milan, Italy;
- University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Gianluca Giannarini
- Urology Unit, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, 20072 Milan, Italy;
- University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
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da Silva ACB, de Toledo LGM, de Carvalho Fernandes R, Ziroldo AR, Sawczyn GV, Alarcon ST, Lewin F. Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System. Ann Surg Oncol 2023; 30:4541-4549. [PMID: 36995451 PMCID: PMC10062252 DOI: 10.1245/s10434-023-13365-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Prostate cancer (PCa) is the most common malignant tumor in males and conventional imaging does not provide accurate primary staging. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) presents superior performance and strongly affects therapeutic choice. OBJECTIVE The aim of this study was to evaluate the impact of PSMA PET, compared with conventional imaging methods, on the therapeutic approach in primary staging scenarios in patients with PCa treated at the Brazilian National Public Health System. METHODS Overall, 35 patients diagnosed with PCa were evaluated using PSMA after conventional staging imaging with multiparametric magnetic resonance (MMR) and/or total abdominal computed tomography (CT) scan and bone scintigraphy (BS). The PCa extension identified by PET was compared with conventional imaging; staging changes and the management impact were then determined. PET comparison with conventional imaging, staging, and decision-making changes was analyzed using descriptive statistics. RESULTS PET revealed local disease (LD) in 15 (42.9%) patients, seminal vesicle invasion (SVI) in 5 (14.3%) patients, pelvic nodal impairment (PNI) in 7 (20%) patients, pelvic and distant nodes in 3 (8.6%) patients, pelvic nodes and bone metastasis in 4 (11.4%) patients, and pelvic and distant nodes and bone metastasis in 1 (2.8%) patient. Staging changes were observed in 60% of patients, with downstaging predominance (76.2%). Volume increase was identified in 11 (31.4%) patients (only 4 related to upstaging, 36.4%). The board changed management decisions for 60% of the patients. The main limitations of this study were the sample size and its retrospective nature. CONCLUSIONS PSMA findings changed the management decisions in more than half of the patients, which made the majority eligible for locoregional treatment and avoided unnecessary procedures in the systemic disease scenario.
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Lo Greco MC, Marletta G, Marano G, Fazio A, Buffettino E, Iudica A, Liardo RLE, Milazzotto R, Foti PV, Palmucci S, Basile A, Marletta F, Cuccia F, Ferrera G, Parisi S, Pontoriero A, Pergolizzi S, Spatola C. Hypofractionated Radiotherapy in Localized, Low-Intermediate-Risk Prostate Cancer: Current and Future Prospectives. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1144. [PMID: 37374348 DOI: 10.3390/medicina59061144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
At the time of diagnosis, the vast majority of prostate carcinoma patients have a clinically localized form of the disease, with most of them presenting with low- or intermediate-risk prostate cancer. In this setting, various curative-intent alternatives are available, including surgery, external beam radiotherapy and brachytherapy. Randomized clinical trials have demonstrated that moderate hypofractionated radiotherapy can be considered as a valid alternative strategy for localized prostate cancer. High-dose-rate brachytherapy can be administered according to different schedules. Proton beam radiotherapy represents a promising strategy, but further studies are needed to make it more affordable and accessible. At the moment, new technologies such as MRI-guided radiotherapy remain in early stages, but their potential abilities are very promising.
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Affiliation(s)
- Maria Chiara Lo Greco
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giulia Marletta
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giorgia Marano
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Alessandro Fazio
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Emanuele Buffettino
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Arianna Iudica
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Rocco Luca Emanuele Liardo
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Roberto Milazzotto
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Pietro Valerio Foti
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Antonio Basile
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | | | | | | | - Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Corrado Spatola
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
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Ioppolo JA, Alvarez de Eulate E, Cullen DR, Mohamed S, Morandeau L. Development of a high-performance liquid chromatography method for rapid radiochemical purity measurement of [ 18 F]PSMA-1007, a PET radiopharmaceutical for detection of prostate cancer. J Labelled Comp Radiopharm 2023; 66:58-72. [PMID: 36649714 DOI: 10.1002/jlcr.4013] [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: 10/02/2022] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
Since first becoming commercially available in 2018, the PET radiopharmaceutical [18 F]PSMA-1007 has been used widely for the diagnosis and staging of prostate cancer. A pharmacopoeia monograph first became available in 2021, prescribing a radiochemical purity specification of >91%, based on analytical results from both TLC (for [18 F]fluoride impurity alone) and HPLC (for all other 18 F-impurities). Though this monograph has provided clarity for the quality control testing of [18 F]PSMA-1007, it prescribes a HPLC method using phosphate buffer mobile phase that may present a risk of precipitation of phosphate salts in the HPLC system. The method also requires specialised hardware not immediately available to all laboratories. This work describes the development of a simple, rapid reversed-phase HPLC method utilising 0.1 M ammonium formate mobile phase for the accurate assessment of both [18 F]fluoride impurity and overall radiochemical purity in a single test. This method is especially useful for assessment of product stability over time. A more accurate TLC method for [18 F]fluoride impurity is also described.
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Affiliation(s)
- Joseph A Ioppolo
- Radiopharmaceutical Production and Development Centre (RAPID), Medical Technology and Physics Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
- National Imaging Facility, Centre for Microscopy, Characterisation and Analysis, University of Western Australia, Crawley, Western Australia, Australia
| | - Eva Alvarez de Eulate
- Radiopharmaceutical Production and Development Centre (RAPID), Medical Technology and Physics Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
| | - Danica R Cullen
- Radiopharmaceutical Production and Development Centre (RAPID), Medical Technology and Physics Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
| | - Shifaza Mohamed
- Radiopharmaceutical Production and Development Centre (RAPID), Medical Technology and Physics Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
| | - Laurence Morandeau
- Radiopharmaceutical Production and Development Centre (RAPID), Medical Technology and Physics Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
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11
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Burgard C, Hoffmann MA, Frei M, Buchholz HG, Khreish F, Marlowe RJ, Schreckenberger M, Ezziddin S, Rosar F. Detection Efficacy of 68Ga-PSMA-11 PET/CT in Biochemical Recurrence of Prostate Cancer with Very Low PSA Levels: A 7-Year, Two-Center "Real-World" Experience. Cancers (Basel) 2023; 15:cancers15051376. [PMID: 36900169 PMCID: PMC10000220 DOI: 10.3390/cancers15051376] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
In biochemical recurrence of prostate cancer (BCR), prompt tumor localization guides early treatment, potentially improving patient outcomes. Gallium-68 prostate-specific membrane antigen-11 positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) detection rates of lesions suspicious for prostate cancer are well known to rise along with prostate-specific antigen (PSA) concentration. However, published data are limited regarding very low values (≤0.2 ng/mL). We retrospectively analyzed ~7-year "real-world" experience in this setting in a large post-prostatectomy cohort (N = 115) from two academic clinics. Altogether 44 lesions were detected in 29/115 men (25.2%) (median [minimum-maximum] 1 [1-4]/positive scan). The apparent oligometastatic disease was found in nine patients (7.8%) at PSA as low as 0.03 ng/mL. Scan positivity rates were highest when PSA was >0.15 ng/mL, PSA doubling time was ≤12 months, or the Gleason score was ≥7b (in 83 and 107 patients, respectively, with available data); these findings were statistically significant (p ≤ 0.04), except regarding PSA level (p = 0.07). Given the benefits of promptly localizing recurrence, our observations suggest the potential value of 68Ga-PSMA-11 PET/CT in the very low PSA BCR setting, especially in cases with more rapid PSA doubling time or with high-risk histology.
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Affiliation(s)
- Caroline Burgard
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany
| | - Manuela A. Hoffmann
- Department of Nuclear Medicine, Johannes Gutenberg University, 55101 Mainz, Germany
- Institute for Preventive Medicine Bw, 56626 Andernach, Germany
- Correspondence:
| | - Madita Frei
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany
| | - Hans-Georg Buchholz
- Department of Nuclear Medicine, Johannes Gutenberg University, 55101 Mainz, Germany
| | - Fadi Khreish
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany
| | | | | | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany
| | - Florian Rosar
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany
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12
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Ehret F, Hofmann T, Fürweger C, Kufeld M, Staehler M, Muacevic A, Haidenberger A. Single-fraction prostate-specific membrane antigen positron emission tomography- and multiparametric magnetic resonance imaging-guided stereotactic body radiotherapy for prostate cancer local recurrences. BJU Int 2023; 131:101-108. [PMID: 36114771 DOI: 10.1111/bju.15894] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To analyse the efficacy and safety of focal prostate-specific membrane antigen positron emission tomography (PSMA-PET)- and multiparametric magnetic resonance imaging (mpMRI)-guided single-fraction stereotactic body radiotherapy (SBRT) for the treatment of prostate cancer (PCa) local recurrences. PATIENTS AND METHODS Patients with PSMA-PET-positive PCa local recurrences treated with single-fraction SBRT between 2016 and 2020 were included. Identification for subsequent recurrences or metastatic spread based on increasing prostate-specific antigen (PSA) levels were evaluated using PSMA-PET imaging. RESULTS A total of 64 patients were identified. Patients received various treatments before SBRT (31 patients with radical prostatectomy [RP], 18 external beam radiotherapy [EBRT] with RP, five EBRT, and the remaining 10 other combinations). The median follow-up was 21.6 months. The median PSA level before SBRT was 1.47 ng/mL. All patients received a single-fraction treatment with a median prescription dose and isodose line of 21 Gy and 65%, respectively. At the time of SBRT, six patients (9%) received an androgen deprivation therapy (ADT). PSA levels decreased after SBRT (P = 0.03) and three local recurrences were detected during the follow-up. The progression-free survival after 1-, 2-, and 3-years was 85.3%, 65.9%, and 51.2%, respectively. Six patients (9%) started ADT after SBRT due to disease progression. The rates of newly started ADT after 1-, 2-, and 3-years were 1.8%, 7.3%, and 22.7%, respectively. Grade 1 or 2 toxicities occurred in six patients (9%); no high-grade toxicity was observed. CONCLUSION While the available data for SBRT in the PCa local recurrence setting describe outcomes for fractionated irradiations, the findings of this first analysis of single-fraction, PSMA-PET- and mpMRI-guided focal SBRT are encouraging. Such treatment appears to be a safe, efficient, and time-saving therapy even in intensively pretreated patients. Recurrence-directed treatments can delay the use of ADT and could avoid prostate bed irradiation in selected patients.
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Affiliation(s)
- Felix Ehret
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany.,European Radiosurgery Center Munich, Munich, Germany
| | | | - Christoph Fürweger
- European Radiosurgery Center Munich, Munich, Germany.,Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Markus Kufeld
- European Radiosurgery Center Munich, Munich, Germany
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany
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13
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Laschinsky C, Herrmann K, Fendler W, Nader M, Lahner H, Hadaschik B, Sandach P. [Oncological theranostics in nuclear medicine]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:875-884. [PMID: 36112174 DOI: 10.1007/s00117-022-01072-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The theranostic principle describes the diagnostic and therapeutic use of radioactive nuclides linked to biochemically active ligands. The oldest and most prominent field of application of theranostics in oncology is differentiated thyroid cancer treated by radioiodine therapy, which allows imaging of the iodine uptake and thus tumor manifestations by gamma (γ) radiation of radioiodine. Other areas of application include neuroendocrine tumors, castration-resistant prostate cancer and, in the context of individual therapeutic approaches, fibroblastic tumors. Imaging with beta-plus (β+) emitters is mainly performed using so-called hybrid imaging: positron emission tomography (PET) in combination with computed tomography or magnetic resonance imaging (PET/CT or PET/MRI). Beta-minus (β-) emitters are predominantly used in therapy, but the use of alpha (α) emitters is also increasing, thus, enabling targeted cancer treatment with mostly low-grade side effects.
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Affiliation(s)
- Christina Laschinsky
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Ken Herrmann
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Wolfgang Fendler
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Michael Nader
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Harald Lahner
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Boris Hadaschik
- Klinik für Urologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Patrick Sandach
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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14
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Primary Staging of Prostate Cancer Patients with [18F]PSMA-1007 PET/CT Compared with [68Ga]Ga-PSMA-11 PET/CT. J Clin Med 2022; 11:jcm11175064. [PMID: 36078994 PMCID: PMC9457380 DOI: 10.3390/jcm11175064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Hybrid imaging with prostate-specific membrane antigen (PSMA) is gaining importance as an increasingly meaningful tool for prostate cancer (PC) diagnostics and as a guide for therapy decisions. This study aims to investigate and compare the performance of [18F]PSMA-1007 (18F-PSMA) and [68Ga]Ga-PSMA-11 positron emission tomography/computed tomography (68Ga-PSMA) in the initial staging of PC patients. Methods: The data of 88 biopsy-proven patients were retrospectively evaluated. PSMA-avid lesions were compared with the histopathologic Gleason Score (GS) for prostate biopsies, and the results were plotted by receiver operating characteristic (ROC)-curve. Optimal maximum standardized uptake value (SUVmax) cut-off values were rated using the Youden index. Results: 18F-PSMA was able to distinguish GS ≤ 7a from ≥7b with a sensitivity of 62%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 67% for a SUVmax of 8.95, whereas sensitivity was 54%, specificity 91%, PPV 93%, and accuracy 66% for 68Ga-PSMA (SUVmax 8.7). Conclusions: Both methods demonstrated a high concordance of detected PSMA-avid lesions with histopathologically proven PC. 18F-PSMA and 68Ga-PSMA are both suitable for the characterization of primary PC with a comparable correlation of PSMA-avid lesions with GS. Neither method showed a superior advantage. Our calculated SUVmax thresholds may represent valuable parameters in clinical use to distinguish clinically significant PC (csPC) from non-csPC.
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15
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Kertész H, Conti M, Panin V, Cabello J, Bharkhada D, Beyer T, Papp L, Jentzen W, Cal-Gonzalez J, Herraiz JL, López-Montes A, Rausch I. Positron range in combination with point-spread-function correction: an evaluation of different implementations for [124I]-PET imaging. EJNMMI Phys 2022; 9:56. [PMID: 35984531 PMCID: PMC9391565 DOI: 10.1186/s40658-022-00482-y] [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: 03/17/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To evaluate the effect of combining positron range correction (PRC) with point-spread-function (PSF) correction and to compare different methods of implementation into iterative image reconstruction for 124I-PET imaging. MATERIALS AND METHODS Uniform PR blurring kernels of 124I were generated using the GATE (GEANT4) framework in various material environments (lung, water, and bone) and matched to a 3D matrix. The kernels size was set to 11 × 11 × 11 based on the maximum PR in water and the voxel size of the PET system. PET image reconstruction was performed using the standard OSEM algorithm, OSEM with PRC implemented before the forward projection (OSEM+PRC simplified) and OSEM with PRC implemented in both forward- and back-projection steps (full implementation) (OSEM+PRC). Reconstructions were repeated with resolution recovery, point-spread function (PSF) included. The methods and kernel variation were validated using different phantoms filled with 124I acquired on a Siemens mCT PET/CT system. The data was evaluated for contrast recovery and image noise. RESULTS Contrast recovery improved by 2-10% and 4-37% with OSEM+PRC simplified and OSEM+PRC, respectively, depending on the sphere size of the NEMA IQ phantom. Including PSF in the reconstructions further improved contrast by 4-19% and 3-16% with the PSF+PRC simplified and PSF+PRC, respectively. The benefit of PRC was more pronounced within low-density material. OSEM-PRC and OSEM-PSF as well as OSEM-PSF+PRC in its full- and simplified implementation showed comparable noise and convergence. OSEM-PRC simplified showed comparably faster convergence but at the cost of increased image noise. CONCLUSIONS The combination of the PSF and PRC leads to increased contrast recovery with reduced image noise compared to stand-alone PSF or PRC reconstruction. For OSEM-PRC reconstructions, a full implementation in the reconstruction is necessary to handle image noise. For the combination of PRC with PSF, a simplified PRC implementation can be used to reduce reconstruction times.
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Affiliation(s)
- Hunor Kertész
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | | | | | - Jorge Cabello
- Siemens Medical Solutions USA, Inc., Knoxville, TN, USA
| | | | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Laszlo Papp
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Walter Jentzen
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Jacobo Cal-Gonzalez
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Ion Beam Applications, Protontherapy Center Quironsalud, Madrid, Spain
| | - Joaquín L Herraiz
- Nuclear Physics Group and IPARCOS, Faculty of Physical Sciences, University Complutense of Madrid, Madrid, Spain.,Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
| | - Alejandro López-Montes
- Nuclear Physics Group and IPARCOS, Faculty of Physical Sciences, University Complutense of Madrid, Madrid, Spain
| | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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16
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Zhao Y, Simpson BS, Morka N, Freeman A, Kirkham A, Kelly D, Whitaker HC, Emberton M, Norris JM. Comparison of Multiparametric Magnetic Resonance Imaging with Prostate-Specific Membrane Antigen Positron-Emission Tomography Imaging in Primary Prostate Cancer Diagnosis: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14143497. [PMID: 35884558 PMCID: PMC9323375 DOI: 10.3390/cancers14143497] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Multiparametric magnetic-resonance imaging (mpMRI) has proven utility in diagnosing primary prostate cancer. However, the diagnostic potential of prostate-specific membrane antigen positron-emission tomography (PSMA PET) has yet to be established. This study aims to systematically review the current literature comparing the diagnostic performance of mpMRI and PSMA PET imaging to diagnose primary prostate cancer. A systematic literature search was performed up to December 2021. Quality analyses were conducted using the QUADAS-2 tool. The reference standard was whole-mount prostatectomy or prostate biopsy. Statistical analysis involved the pooling of the reported diagnostic performances of each modality, and differences in per-patient and per-lesion analysis were compared using a Fisher’s exact test. Ten articles were included in the meta-analysis. At a per-patient level, the pooled values of sensitivity, specificity, and area under the curve (AUC) for mpMRI and PSMA PET/CT were 0.87 (95% CI: 0.83−0.91) vs. 0.93 (95% CI: 0.90−0.96, p < 0.01); 0.47 (95% CI: 0.23−0.71) vs. 0.54 (95% CI: 0.23−0.84, p > 0.05); and 0.84 vs. 0.91, respectively. At a per-lesion level, the pooled sensitivity, specificity, and AUC value for mpMRI and PSMA PET/CT were lower, at 0.63 (95% CI: 0.52−0.74) vs. 0.79 (95% CI: 0.62−0.92, p < 0.001); 0.88 (95% CI: 0.81−0.95) vs. 0.71 (95% CI: 0.47−0.90, p < 0.05); and 0.83 vs. 0.84, respectively. High heterogeneity was observed between studies. PSMA PET/CT may better confirm the presence of prostate cancer than mpMRI. However, both modalities appear comparable in determining the localisation of the lesions.
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Affiliation(s)
- Yi Zhao
- School of Medicine, Imperial College London, London SW7 2BX, UK
- Correspondence:
| | | | - Naomi Morka
- UCL Medical School, University College London, London WC1E 6BT, UK;
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff CF10 3AT, UK;
| | - Hayley C. Whitaker
- UCL Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (H.C.W.); (M.E.); (J.M.N.)
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (H.C.W.); (M.E.); (J.M.N.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK
| | - Joseph M. Norris
- UCL Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK; (H.C.W.); (M.E.); (J.M.N.)
- Department of Urology, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK
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17
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Introduction of salvage prostatectomy in Denmark: the initial experience. BMC Res Notes 2022; 15:185. [PMID: 35597969 PMCID: PMC9123700 DOI: 10.1186/s13104-022-06076-2] [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: 02/17/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To introduce salvage prostatectomy in Denmark. Prior to this, no national curative treatment for recurrent prostate cancer following radiation therapy existed in Denmark. This pilot study represent our initial experiences and the feasibility of performing salvage robot-assisted radical prostatectomy for true local, high-risk recurrence after initial therapy with external beam radiation for high-risk prostate cancer. RESULTS Five patients underwent sRARP between April 2020 and July 2021. All patients were discharged within 48 h and no major complications were observed within 3 months. All patients had unmeasurable PSA (< 0.1 ng/ml) at follow-up 6 months after surgery. One patient with longer follow-up than 6 months experienced biochemical recurrence. At 3-months follow-up all patients reported considerable incontinence, at 6-month follow-up, pad usage decreased to 1 or 2 pads daily. Based on our initial results, the idea to introduce sRARP as a nationwide option remains and further patients will be included to establish the true role of sRARP in patients with recurrence after primary radiotherapy for PCa.
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18
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Yoshimura K, Muraoka K, Fukasawa M, Fukushima M, Kumagai M, Yabusaki R, Ueda M, Shiraishi Y, Imamura M. Triple combination therapy for clinically nonmetastatic super‐high‐risk prostate cancer. IJU Case Rep 2022; 5:273-275. [PMID: 35795109 PMCID: PMC9249652 DOI: 10.1002/iju5.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/16/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Patients with nonmetastatic but exceptionally high‐risk prostate cancer are liable to have biochemical failure and may even die. Triple combination therapy, which consists of surgery, radiotherapy, and androgen‐deprivation therapy, as first‐line treatment, may control the disease for a long period. Case presentation We treated a patient with super‐high‐risk, nonmetastatic prostate cancer, with triple combination therapy. He was biochemical relapse free at 60 months after the initiation of treatment. Conclusion Triple combination therapy may be an option for super‐high‐risk, nonmetastatic prostate cancer.
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Affiliation(s)
- Koji Yoshimura
- Department of Urology Shizuoka General Hospital Shizuoka City Shizuoka Japan
| | - Kei Muraoka
- Department of Urology Shizuoka General Hospital Shizuoka City Shizuoka Japan
| | - Michiko Fukasawa
- Department of Urology Shizuoka General Hospital Shizuoka City Shizuoka Japan
| | - Mika Fukushima
- Department of Urology Shizuoka General Hospital Shizuoka City Shizuoka Japan
| | - Masatoshi Kumagai
- Department of Urology Shizuoka General Hospital Shizuoka City Shizuoka Japan
| | - Ryo Yabusaki
- Department of Urology Shizuoka General Hospital Shizuoka City Shizuoka Japan
| | - Masakatsu Ueda
- Department of Urology Shizuoka General Hospital Shizuoka City Shizuoka Japan
| | - Yusuke Shiraishi
- Department of Urology Shizuoka General Hospital Shizuoka City Shizuoka Japan
| | - Masaaki Imamura
- Department of Urology Shizuoka General Hospital Shizuoka City Shizuoka Japan
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19
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Kaewput C, Vinjamuri S. Update of PSMA Theranostics in Prostate Cancer: Current Applications and Future Trends. J Clin Med 2022; 11:jcm11102738. [PMID: 35628867 PMCID: PMC9144463 DOI: 10.3390/jcm11102738] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/02/2023] Open
Abstract
There is now an increasing trend for targeting cancers to go beyond early diagnosis and actually improve Progression-Free Survival and Overall Survival. Identifying patients who might benefit from a particular targeted treatment is the main focus for Precision Medicine. Radiolabeled ligands can be used as predictive biomarkers which can confirm target expression by cancers using positron emission tomography (PET). The same ligand can subsequently be labeled with a therapeutic radionuclide for targeted radionuclide therapy. This combined approach is termed “Theranostics”. The prostate-specific membrane antigen (PSMA) has emerged as an attractive diagnostic and therapeutic target for small molecule ligands in prostate cancer. It can be labeled with either positron emitters for PET-based imaging or beta and alpha emitters for targeted radionuclide therapy. This review article summarizes the important concepts for Precision Medicine contributing to improved diagnosis and targeted therapy of patients with prostate cancer and we identify some key learning points and areas for further research.
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Affiliation(s)
- Chalermrat Kaewput
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Correspondence:
| | - Sobhan Vinjamuri
- Department of Nuclear Medicine, Royal Liverpool University Hospital, Liverpool L7 8XP, UK;
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20
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Kertész H, Beyer T, Panin V, Jentzen W, Cal-Gonzalez J, Berger A, Papp L, Kench PL, Bharkhada D, Cabello J, Conti M, Rausch I. Implementation of a Spatially-Variant and Tissue-Dependent Positron Range Correction for PET/CT Imaging. Front Physiol 2022; 13:818463. [PMID: 35350691 PMCID: PMC8957980 DOI: 10.3389/fphys.2022.818463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Aim To develop and evaluate a new approach for spatially variant and tissue-dependent positron range (PR) correction (PRC) during the iterative PET image reconstruction. Materials and Methods The PR distributions of three radionuclides (18F, 68Ga, and 124I) were simulated using the GATE (GEANT4) framework in different material compositions (lung, water, and bone). For every radionuclide, the uniform PR kernel was created by mapping the simulated 3D PR point cloud to a 3D matrix with its size defined by the maximum PR in lung (18F) or water (68Ga and 124I) and the PET voxel size. The spatially variant kernels were composed from the uniform PR kernels by analyzing the material composition of the surrounding medium for each voxel before implementation as tissue-dependent, point-spread functions into the iterative image reconstruction. The proposed PRC method was evaluated using the NEMA image quality phantom (18F, 68Ga, and 124I); two unique PR phantoms were scanned and evaluated following OSEM reconstruction with and without PRC using different metrics, such as contrast recovery, contrast-to-noise ratio, image noise and the resolution evaluated in terms of full width at half maximum (FWHM). Results The effect of PRC on 18F-imaging was negligible. In contrast, PRC improved image contrast for the 10-mm sphere of the NEMA image quality phantom filled with 68Ga and 124I by 33 and 24%, respectively. While the effect of PRC was less noticeable for the larger spheres, contrast recovery still improved by 5%. The spatial resolution was improved by 26% for 124I (FWHM of 4.9 vs. 3.7 mm). Conclusion For high energy positron-emitting radionuclides, the proposed PRC method helped recover image contrast with reduced noise levels and with improved spatial resolution. As such, the PRC approach proposed here can help improve the quality of PET data in clinical practice and research.
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Affiliation(s)
- Hunor Kertész
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Vladimir Panin
- Siemens Medical Solutions USA, Inc., Knoxville, TN, United States
| | - Walter Jentzen
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Jacobo Cal-Gonzalez
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ion Beam Applications, Quirónsalud Proton Therapy Center, Madrid, Spain
| | - Alexander Berger
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Laszlo Papp
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Peter L Kench
- Discipline of Medical Imaging Science and Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Deepak Bharkhada
- Siemens Medical Solutions USA, Inc., Knoxville, TN, United States
| | - Jorge Cabello
- Siemens Medical Solutions USA, Inc., Knoxville, TN, United States
| | - Maurizio Conti
- Siemens Medical Solutions USA, Inc., Knoxville, TN, United States
| | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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21
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Michael J, Neuzil K, Altun E, Bjurlin MA. Current Opinion on the Use of Magnetic Resonance Imaging in Staging Prostate Cancer: A Narrative Review. Cancer Manag Res 2022; 14:937-951. [PMID: 35256864 PMCID: PMC8898014 DOI: 10.2147/cmar.s283299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022] Open
Abstract
Accurate staging is critical for treatment planning and prognosis in men with prostate Cancer. Prostate magnetic imaging resonance (MRI) may aid in the staging evaluation by verifying organ-confined status, assessing the status of the pelvic lymph nodes, and establishing the local extent of the tumor in patients being considered for therapy. MRI has a high specificity for diagnosing extracapsular extension, and therefore may impact the decision to perform nerve sparing prostatectomy, along with seminal vesicle invasion and lymph node metastases; however, its sensitivity remains limited. Current guidelines vary significantly regarding endorsing the use of MRI for staging locoregional disease. For high-risk prostate cancer, most guidelines recommend cross sectional imaging, including MRI, to evaluate for more extensive disease that may merit change in radiation field, extended androgen deprivation therapy, or guiding surgical planning. Although MRI offers reasonable performance characteristics to evaluate bone metastases, guidelines continue to support the use of bone scintigraphy. Emerging imaging technologies, including coupling positron emission tomography (PET) with MRI, have the potential to improve the accuracy of prostate cancer staging with the use of novel radiotracers.
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Affiliation(s)
- Jamie Michael
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Kevin Neuzil
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Correspondence: Marc A Bjurlin, Associate Professor, Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, 2nd Floor, Chapel Hill, NC, USA, Email
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22
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Wang J, Han Y, Lin L, Zhang L, Li J, Gao H, Fu P. Systematic review & meta-analysis of positron emission tomography/computed tomography and bone scan in the diagnosis of prostate lesions. Transl Androl Urol 2022; 10:4231-4240. [PMID: 34984188 PMCID: PMC8661258 DOI: 10.21037/tau-21-912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/03/2021] [Indexed: 01/17/2023] Open
Abstract
Background To date, the results of studies into the effectiveness of positron emission tomography (PET) combined with computed tomography (CT) and bone scan (BS) in the diagnosis of malignant prostate lesions have been inconsistent, and the advantages and disadvantages of the two methods cannot be accurately judged. Methods Articles were retrieved from the China National Knowledge Infrastructure (CNKI) database, Wan Fang Medical Network, PubMed, Excerpta Medica data BASE (EMBASE), Medline, and Cochrane database. The keywords used in the search were: 68Ga-prostate specific membrane antibody (68Ga-PSMA), PET/CT, prostate lesions, prostate adenocarcinoma, bone metastasis, and BS. Results Ultimately, 3 publications were selected for inclusion in the meta-analysis. A total of 215 patients were considered in the 3 articles that met the inclusion criteria. All of the included articles were small sample studies, with sample sizes ranging from 28 to 113 cases. In this study, from the 3 randomized controlled trials, only 2 (66.67%) randomized controls described the correct randomized allocation method, and only 1 (33.33%) described the hidden allocation scheme in detail. The highest sensitivity for 68Ga-PSMA PET/CT was 0.96, with 95% CI: 0.87, 1.00, and the highest specificity was 1.00, with 95% CI: 0.96, 1.00. The highest sensitivity and specificity of BS were 0.92 with 95% CI: 0.81, 0.98 and 0.96 with 95% CI: 0.78, 1.00, respectively. The results of meta-analysis of 68Ga-PSMA PET/CT diagnosis with confirmation by surgical and histopathological examination showed that the area under the summary receiver operating characteristics (SROC) curve (AUC) =0.826 and standard error (SE) (AUC) =0.0425. The results of meta-analysis of BS diagnosis with confirmation by surgical and histopathological examination showed that the area under the SROC curve (AUC) =0.714 and SE (AUC) =0.0034. Discussion The meta-analysis showed that 68Ga-PSMA PET/CT has clear advantages over BS in the diagnosis of bone metastases of malignant prostate tumors, and could improve the diagnostic accuracy of bone metastases.
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Affiliation(s)
- Jiafu Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue Han
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Lin
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Linhan Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jin Li
- Department of Integrative Medicine Oncology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huiqi Gao
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Peng Fu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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23
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Introduction to PET. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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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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25
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Lu X, Wu M, Wang S, Hai W, Li P. Development and preliminary evaluation of an integrin α 2β 1-targeted PET probe as a supplement and alternative of PSMA imaging for prostate cancer. Bioorg Med Chem 2021; 54:116583. [PMID: 34952297 DOI: 10.1016/j.bmc.2021.116583] [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: 10/28/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/02/2022]
Abstract
An integrin α2β1-targeted PET probe (68Ga-IABtP) was developed to serve as a supplement and alternative of PSMA imaging for prostate cancer. 68Ga-IABtP was synthesized by labeling the precursor peptide with 68Ga with 93% labeling yield and 4.14 MBq/μg specific radioactivity. 68Ga-IABtP showed no specific uptake in LNCaP prostate cancer cell with low integrin α2β1 expression but significantly increased uptake in PC-3 prostate cancer cell with high integrin α2β1 expression, which could be specifically blocked by the integrin α2β1 monoclonal antibody. The efflux experiments demonstrated that 68Ga-IABtP could rapidly penetrate into PC-3 cell after cell binding, thereby prolonging the residence time in the tumor and allow enough time for probe clearance from the circulation and non-specific organs. The biodistribution study indicated that 68Ga-IABtP showed no specific accumulation in non-target organs and was quickly cleared from the kidney. The in vivo PET-CT imaging demonstrated that 68Ga-IABtP showed no specific uptake in LNCaP tumor but could specifically accumulate in the PC-3 tumor, and was rapidly cleared from spleen, intestine, kidney and liver, resulting in excellent contrast effect with low background signal and high target to non-target ratios.
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Affiliation(s)
- Xinmiao Lu
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Muyu Wu
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Siwen Wang
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Wangxi Hai
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China.
| | - Peiyong Li
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China.
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26
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Zhao Y, Morka N, Simpson BSS, Freeman A, Kirkham A, Kelly D, Whitaker HC, Emberton M, Norris JM. Prostate-specific membrane antigen positron emission tomography compared to multiparametric MRI for prostate cancer diagnosis: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e052277. [PMID: 34893484 PMCID: PMC8666885 DOI: 10.1136/bmjopen-2021-052277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The introduction of multiparametric MRI (mpMRI) has improved almost every aspect of the prostate cancer diagnostic pathway. However, the novel imaging technique, prostate-specific membrane antigen positron emission tomography (PSMA PET) may have demonstrable accuracy in detecting and staging prostate cancer. Here, we describe a protocol for a systematic review and meta-analysis comparing mpMRI to PSMA PET for the diagnosis of suspected prostate cancer. METHODS AND ANALYSIS A systematic search of MEDLINE, EMBASE, PubMed and Cochrane databases will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed for screening, data extraction, statistical analysis and reporting. Included papers will be full-text articles providing original data, written in English articles and comparing the use of PSMA PET with mpMRI in the diagnosis of prostate cancer. All studies published between July 1977 and March 2021 will be eligible for inclusion. Study bias and quality will be assessed using Quadas-2 score. To ensure the quality of the reporting of studies, this protocol is written following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. ETHICS AND DISSEMINATION Ethical approval will not be required for this systematic review. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences. PROSPERO REGISTRATION NUMBER CRD42021239296.
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Affiliation(s)
- Yi Zhao
- Imperial College London, London, UK
| | - Naomi Morka
- University College London Medical School, London, UK
| | | | - Alex Freeman
- Department of Histopathology, University College Hospital London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Hayley C Whitaker
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital, London, UK
| | - Joseph M Norris
- UCL Division of Surgery & Interventional Science, University College London, London, UK
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27
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Petrov SA, Zyk NY, Machulkin AE, Beloglazkina EK, Majouga AG. PSMA-targeted low-molecular double conjugates for diagnostics and therapy. Eur J Med Chem 2021; 225:113752. [PMID: 34464875 DOI: 10.1016/j.ejmech.2021.113752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022]
Abstract
This review presents data on dual conjugates of therapeutic and diagnostic action for targeted delivery to prostate cancer cells. The works of the last ten years on this topic were analyzed. The mail attention focuses on low-molecular-weight conjugates directed to the prostate-specific membrane antigen (PSMA); the comparison of high and low molecular weight PSMA-targeted conjugates was made. The considered conjugates were divided in the review into two main classes: diagnostic bimodal conjugates (which are containing two fragments for different types of diagnostics), theranostic conjugates (containing both therapeutic and diagnostic agents); also bimodal high molecular weight therapeutic conjugates containing two therapeutic agents are briefly discussed. The data of in vitro and in vivo studies for PSMA-targeted double conjugates available by the beginning of 2021 have been analyzed.
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Affiliation(s)
- Stanislav A Petrov
- Department of Chemistry, Lomonosov Moscow State University, Moscow, Russia
| | - Nikolay Y Zyk
- Department of Chemistry, Lomonosov Moscow State University, Moscow, Russia
| | | | | | - Alexander G Majouga
- Department of Chemistry, Lomonosov Moscow State University, Moscow, Russia; Laboratory of Biomedical Nanomaterials, National University of Science and Technology MISiS, Moscow, Russia; Mendeleev University of Chemical Technology of Russia, Moscow, Russia
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28
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18F FDG imaging - response criteria in tumors. Eur J Radiol 2021; 147:110054. [PMID: 34933213 DOI: 10.1016/j.ejrad.2021.110054] [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: 01/15/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
Abstract
With the progress of medical oncology, it became apparent that anatomical imaging is oftentimes insufficient for therapy response evaluation. Hybrid imaging, namely 18F-FDG PET/CT has helped to overcome these limitations. The aim of this paper is to emphasize the utility and impact in clinical use of 18F-FDG PET/CT, and to give an overview of the most important 18F-FDG PET/CT tumor response criteria. We also focus on standardization of hybrid imaging techniques as this is of outmost importance to provide reliable imaging evaluation.
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29
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The Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Magnetic Resonance Imaging in Primary and Recurrent Prostate Cancer: A Systematic Review of the Literature. Eur Urol Focus 2021; 8:942-957. [PMID: 34538633 DOI: 10.1016/j.euf.2021.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/28/2021] [Accepted: 08/31/2021] [Indexed: 12/30/2022]
Abstract
CONTEXT Prostate-specific membrane antigen (PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI) is a novel imaging technique with several potential applications in the prostate cancer (PCa) setting. OBJECTIVE To perform a systematic review of the current evidence regarding the diagnostic performance of PSMA PET/MRI in patients with primary and recurrent PCa. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE and Cochrane Library databases was performed in October 2020. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Studies were deemed eligible if they assessed patients with primary or recurrent PCa (P) undergoing PSMA PET/MRI (I) with or without comparison with other imaging techniques (C) in order to evaluate its diagnostic performance (O). Retrospective and prospective primary clinical studies were included. Results of previous meta-analyses were reported. EVIDENCE SYNTHESIS A total of 23 original articles and three meta-analyses were included. Limited evidence on PSMA PET/MRI is available, especially in the setting of partial gland ablation. PET/MRI can be an effective imaging modality for detecting primary PCa, showing higher accuracy than multiparametric MRI alone. It provides accurate local staging of primary PCa; however, there are contradictory results in this context when its performance is compared with other imaging techniques. PET/MRI also shows high performance for restaging and detecting tumor recurrence, even at low prostate-specific antigen levels. CONCLUSIONS PSMA PET/MRI could represent a valuable tool in the management of patients with primary and recurrent PCa. No specific recommendations can be provided. PATIENT SUMMARY Encouraging data regarding the benefits of prostate-specific membrane antigen positron emission tomography/magnetic resonance imaging in patients with prostate cancer are emerging from the literature.
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30
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Coşar U, Şen İ, Aydos U, Koparal MY, Uçar M, Tokgöz N, Gönül İI, Akdemir ÜÖ, Atay LÖ, Sözen TS. Diagnostic accuracy of 68 Ga-PSMA PET/MRI and multiparametric MRI in detecting index tumours in radical prostatectomy specimen. Int J Clin Pract 2021; 75:e14287. [PMID: 33931929 DOI: 10.1111/ijcp.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of the 68 gallium (68 Ga) prostate-specific membrane antigen (PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI) and multiparametric MRI (mpMRI) by region-based comparison of index tumour localisations using histopathological tumour maps of patients who underwent radical prostatectomy because of clinically significant prostate cancer. PATIENTS AND METHODS The study included 64 patients who underwent radical prostatectomy after primary staging with mpMRI and 68 Ga-PSMA PET/MRI. Diagnostic analysis was performed by dividing the prostate into four anatomic regions as left/right anterior and left/right posterior. The extension of the lesions in mpMRI and the pathological uptake in 68 Ga-PSMA PET/MRI were matched separately for each region with the extension of the index tumour into each region. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and the accuracy of mpMRI and 68 Ga-PSMA PET/MRI are shown as 55.7%, 91.8%, 80.6%, 77.2%, 78.1%, and 60.8%, 94.3%, 86.8% 79.8%, 83.5%, respectively. 68 Ga-PSMA PET/MRI has higher sensitivity and specificity compared with mpMRI. However, no statistically significant difference was found (P = .464). Combined imaging had significantly higher diagnostic accuracy compared with mpMRI and 68 Ga-PSMA PET/MRI (change in AUC: 0.084 and 0.046, P < .001 and P = .028, respectively), while no statistically significant difference was found between mpMRI and 68 Ga-PSMA PET/MRI (change in AUC: 0.038, P = .246). CONCLUSION 68 Ga-PSMA PET/MRI had higher clinical diagnostic accuracy in prostate cancer compared with mpMRI. Diagnostic accuracy was significantly increased in the combined use of both imaging modalities.
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Affiliation(s)
- Uğur Coşar
- Department of Urology, School of Medicine, Gazi University, Ankara, Turkey
| | - İlker Şen
- Department of Urology, School of Medicine, Gazi University, Ankara, Turkey
| | - Uğuray Aydos
- Department of Nuclear Medicine, School of Medicine, Gazi University, Ankara, Turkey
| | - Murat Yavuz Koparal
- Department of Urology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - Murat Uçar
- Department of Radiology, School of Medicine, Gazi University, Ankara, Turkey
| | - Nil Tokgöz
- Department of Radiology, School of Medicine, Gazi University, Ankara, Turkey
| | - İpek Işık Gönül
- Department of Pathology, School of Medicine, Gazi University, Ankara, Turkey
| | - Ümit Özgür Akdemir
- Department of Nuclear Medicine, School of Medicine, Gazi University, Ankara, Turkey
| | - Lütfiye Özlem Atay
- Department of Nuclear Medicine, School of Medicine, Gazi University, Ankara, Turkey
| | - Tevfik Sinan Sözen
- Department of Urology, School of Medicine, Gazi University, Ankara, Turkey
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Aalbersberg EA, Verwoerd D, Mylvaganan-Young C, de Barros HA, van Leeuwen PJ, Sonneborn-Bols M, Donswijk ML. Occupational radiation exposure of radiopharmacy-, nuclear medicine-, and surgical personnel during use of [ 99mTc]Tc-PSMA-I&S for prostate cancer surgery. J Nucl Med Technol 2021; 49:334-338. [PMID: 34330802 DOI: 10.2967/jnmt.121.262161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: The aim of this study was to estimate and subsequently measure the occupational radiation exposure for all personnel involved in the production, administration, imaging, or surgery with [99mTc]Tc-PSMA-I&S, which has been introduced for identification of tumor-positive lymph nodes during salvage prostate cancer surgery Materials and Methods: The effective dose was estimated and subsequently measured with electronic personal dosimeters for the following procedures and personnel: labeling and quality control by the radiopharmacy technician, syringe preparation by the nuclear medicine laboratory technician, patient administration by the nuclear medicine physician, patient imaging by the nuclear medicine imaging technician, and robot-assisted laparoscopic salvage lymph node dissection attended by an anesthesiology technician, scrub nurse, surgical nurse, and surgeon. The dose rate of the patient was measured immediately after administration of [99mTc]Tc-PSMA-I&S, after imaging, and after surgery. Results: The estimated dose per procedure ranged from 1.59x10-10 µSv (imaging technician) to 9.74 µSv (scrub nurse). The measured effective dose ranged from 0 to 5 µSv for all personnel during one procedure with [99mTc]Tc-PSMA-I&S. The highest effective dose was received by the scrub nurse (3.2±1.3 µSv), whilst the lowest dose was measured for the surgical nurse (0.2±0.5 µSv). If a single scrub nurse would perform as much as 100 procedures with [99mTc]Tc-PSMA-I&S in a year, the total effective dose would be 3.2x10-1 mSv/year. Immediately after administration, the dose rate at 50 cm from the patient was 18.5±1.6 µSv/h, which dropped to 1.8±0.3 µSv/h after imaging the following day and reducing even further to 0.56±0.33 µS/h after surgery. Conclusion: The effective dose for personnel involved in handling [99mTc]Tc-PSMA-I&S is comparable to that of other 99mTc-radiopharmaceuticals and therefore safe for imaging and radioguided surgery.
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Manfredi C, Fernández-Pascual E, Linares-Espinós E, Couñago F, Martínez-Salamanca JI. New frontiers in focal therapy for prostate cancer: Prostate-specific membrane antigen positron emission tomography/magnetic resonance imaging. World J Clin Oncol 2021; 12:61-68. [PMID: 33680874 PMCID: PMC7918526 DOI: 10.5306/wjco.v12.i2.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
Imaging has a central role in the context of focal therapy (FT) for prostate cancer (PCa). Prostate-specific membrane antigen (PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI) is a novel imaging modality that combines the morpho-functional information of MRI with the molecular characterization of PET. Some papers reported the potential advantages of PSMA PET/MRI in different clinical scenarios. Limited evidence on PSMA PET/MRI is available in the setting of FT. PSMA PET/MRI can be an effective imaging modality for detecting primary PCa and seems to provide accurate local staging of primary PCa. PSMA PET/MRI also shows high performance for restaging and detecting tumor recurrence. The higher soft-tissue contrast and the reduction of ionizing radiation are the main advantages reported in the literature compared to PET/computed tomography. PSMA PET/MRI could represent a turning point in the management of patients with PCa in the context of FT. Further studies are needed to confirm its applications in this specific clinical setting.
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Affiliation(s)
- Celeste Manfredi
- Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania “Luigi Vanvitelli”, Naples 81110, Italy
| | - Esaú Fernández-Pascual
- Department of Urology, Hospital Universitario La Paz, Madrid 28046, Spain
- LYX Institute of Urology, Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón 28223, Madrid, Spain
| | - Estefanía Linares-Espinós
- Department of Urology, Hospital Universitario La Paz, Madrid 28046, Spain
- LYX Institute of Urology, Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón 28223, Madrid, Spain
| | - Felipe Couñago
- Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón 28223, Madrid, Spain
| | - Juan Ignacio Martínez-Salamanca
- LYX Institute of Urology, Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón 28223, Madrid, Spain
- Department of Urology, Hospital Universitario Puerta Hierro-Majadahonda, Majadahonda 28222, Madrid, Spain
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Liu A, Zhang M, Huang H, Zhang C, Ruan X, Lin W, Li B, Chen L, Xu D. Clinical Utility of 18F-PSMA-1007 Positron Emission Tomography/Magnetic Resonance Imaging in Prostate Cancer: A Single-Center Experience. Front Oncol 2021; 10:612701. [PMID: 33680933 PMCID: PMC7928386 DOI: 10.3389/fonc.2020.612701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose This study aimed to evaluate the clinical utility of 18F-PSMA-1007 positron emission tomography (PSMA PET)/magnetic resonance imaging (MRI) imaging in patients with suspected or defined prostate cancer. Methods In the pilot study, we retrospectively investigated 62 patients who underwent PSMA-PET/MRI for suspected or defined PCa between June 2019 and June 2020. Patients were grouped into three subgroups: (1) suspected PCa without histological evidence, (2) primary PCa, (3) biochemical recurrent prostate cancer (BRPCa). Two nuclear physicians independently interpreted the results of PSMA-PET/MRI. Management strategies before PSMA-PET/MRI were retrospectively reported, and the management strategy was re-evaluated for each patient considering the PSMA-PET/MRI result. The changes in strategies were recorded. Besides, the correlation between prostate specific antigen (PSA) level and management changes was also accessed by Fisher exact test, and two-side p < 0.05 was assumed as statistical significance. Results There were 28 patients in the suspected PCa group (group 1), 12 in the primary PCa group (group 2), and 22 in the BRPCa group (group 3). Overall, the intended decisions were changed in 26 (41.9%) of 62 patients after PSMA-PET/MRI, including 11/28 (39.3%) in suspected PCa group, 1/12 (8.4%) in primary PCa group, and 14/24 (63.6%) in BCR group. In group 1, the main impact on subsequent management included decreased active surveillance (from 20 to 9) and increased prostate biopsy (from 8 to 19). PSA levels were not significantly associated with management changes in suspected PCa patients (p = 0.865). In group 2, the main impact on subsequent management included decreased radical surgery (from 8 to 7), and multimodal therapy appearance (n = 1). Only in the category of PSA levels of ≥20 ng/ml, the management of primary PCa was changed. In group 3, the main impact on subsequent management included decreased salvage radiotherapy (from 5 to 2), increased systemic therapy (from 6 to 7), and increased multimodal therapy (from 11 to 13). The highest proportion of management changes occurred in BCR patients with 0.5≤PSA<1 ng/ml. Conclusion From our preliminary experience, PSMA-PET/MRI may be a valued tool for defining PCa lesions and changing management. The biggest impact of management intent was in patients with BRPCa, especially in patients with 0.5≤PSA<1 ng/ml. However, further studies are needed to confirm our pilot findings.
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Affiliation(s)
- Ao Liu
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Miao Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hai Huang
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chuanjie Zhang
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaohao Ruan
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenhao Lin
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lu Chen
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Danfeng Xu
- Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Rebello RJ, Oing C, Knudsen KE, Loeb S, Johnson DC, Reiter RE, Gillessen S, Van der Kwast T, Bristow RG. Prostate cancer. Nat Rev Dis Primers 2021. [PMID: 33542230 DOI: 10.1038/s41572-020-0024.3-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Prostate cancer is a complex disease that affects millions of men globally, predominantly in high human development index regions. Patients with localized disease at a low to intermediate risk of recurrence generally have a favourable outcome of 99% overall survival for 10 years if the disease is detected and treated at an early stage. Key genetic alterations include fusions of TMPRSS2 with ETS family genes, amplification of the MYC oncogene, deletion and/or mutation of PTEN and TP53 and, in advanced disease, amplification and/or mutation of the androgen receptor (AR). Prostate cancer is usually diagnosed by prostate biopsy prompted by a blood test to measure prostate-specific antigen levels and/or digital rectal examination. Treatment for localized disease includes active surveillance, radical prostatectomy or ablative radiotherapy as curative approaches. Men whose disease relapses after prostatectomy are treated with salvage radiotherapy and/or androgen deprivation therapy (ADT) for local relapse, or with ADT combined with chemotherapy or novel androgen signalling-targeted agents for systemic relapse. Advanced prostate cancer often progresses despite androgen ablation and is then considered castration-resistant and incurable. Current treatment options include AR-targeted agents, chemotherapy, radionuclides and the poly(ADP-ribose) inhibitor olaparib. Current research aims to improve prostate cancer detection, management and outcomes, including understanding the fundamental biology at all stages of the disease.
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Affiliation(s)
- Richard J Rebello
- Cancer Research UK Manchester Institute, University of Manchester, Manchester Cancer Research Centre, Manchester, UK
| | - Christoph Oing
- Cancer Research UK Manchester Institute, University of Manchester, Manchester Cancer Research Centre, Manchester, UK
- Department of Oncology, Haematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Centre Eppendorf, Hamburg, Germany
| | - Karen E Knudsen
- Sidney Kimmel Cancer Center at Jefferson Health and Thomas Jefferson University, Philadelphia, PA, USA
| | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, Manhattan, NY, USA
| | - David C Johnson
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert E Reiter
- Department of Urology, Jonssen Comprehensive Cancer Center UCLA, Los Angeles, CA, USA
| | | | - Theodorus Van der Kwast
- Laboratory Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Robert G Bristow
- Cancer Research UK Manchester Institute, University of Manchester, Manchester Cancer Research Centre, Manchester, UK.
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Abstract
Prostate cancer is a complex disease that affects millions of men globally, predominantly in high human development index regions. Patients with localized disease at a low to intermediate risk of recurrence generally have a favourable outcome of 99% overall survival for 10 years if the disease is detected and treated at an early stage. Key genetic alterations include fusions of TMPRSS2 with ETS family genes, amplification of the MYC oncogene, deletion and/or mutation of PTEN and TP53 and, in advanced disease, amplification and/or mutation of the androgen receptor (AR). Prostate cancer is usually diagnosed by prostate biopsy prompted by a blood test to measure prostate-specific antigen levels and/or digital rectal examination. Treatment for localized disease includes active surveillance, radical prostatectomy or ablative radiotherapy as curative approaches. Men whose disease relapses after prostatectomy are treated with salvage radiotherapy and/or androgen deprivation therapy (ADT) for local relapse, or with ADT combined with chemotherapy or novel androgen signalling-targeted agents for systemic relapse. Advanced prostate cancer often progresses despite androgen ablation and is then considered castration-resistant and incurable. Current treatment options include AR-targeted agents, chemotherapy, radionuclides and the poly(ADP-ribose) inhibitor olaparib. Current research aims to improve prostate cancer detection, management and outcomes, including understanding the fundamental biology at all stages of the disease.
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Sasikumar A, Thampan S, Thomas N, Paul R. 68Ga-Prostate-Specific Membrane Antigen Focal Pulmonary Activity With No Corresponding CT Abnormality. Clin Nucl Med 2021; 46:e88-e89. [PMID: 33031245 DOI: 10.1097/rlu.0000000000003316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT We describe a case of 68Ga-prostate-specific membrane antigen PET/CT scan with focal tracer concentration in the lung without any abnormalities in the CT part. 18F-FDG focal uptake in lungs without corresponding CT lesions is described. Two possible mechanisms proposed to explain this finding in FDG PET/CT scans are iatrogenic pulmonary microembolism and 18F-FDG-avid infection or inflammation that precedes structural findings. Logically, these proposed mechanisms seem to be applicable to 68Ga-prostate-specific membrane antigen as well. In our case, there were no features of any lung infection/inflammation, and the most plausible explanation would be iatrogenic microembolism.
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Affiliation(s)
| | - Sam Thampan
- Believers Church Medical College Hospital, Kerala, India
| | - Nivya Thomas
- From the St Gregorios International Cancer Care Centre
| | - Retcy Paul
- From the St Gregorios International Cancer Care Centre
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Leech M, Osman S, Jain S, Marignol L. Mini review: Personalization of the radiation therapy management of prostate cancer using MRI-based radiomics. Cancer Lett 2020; 498:210-216. [PMID: 33160001 DOI: 10.1016/j.canlet.2020.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022]
Abstract
Decisions on how to treat prostate cancer with radiation therapy are guideline-based but as such guidelines have been developed for populations of patients, this invariably leads to overly aggressive treatment in some patients and insufficient treatment in others. Heterogeneity within prostate tumors and in metastatic sites, even within the same patient, is believed to be a major cause of treatment failure. Radiomics biomarkers, more commonly referred to as radiomics 'features", provide readily available, cost-effective, non-invasive tools for screening, detecting tumors and serial monitoring of patients, including assessments of response to therapy and identification of therapeutic complications. Radiomics offers the potential to analyse whole tumors in 3D, as well as sub-regions or 'habitats' within tumors. Combining quantitative information from imaging with pathology, demographic details and other biomarkers will pave the way for personalised treatment selection and monitoring in prostate cancer. The aim of this review is to consider if MRI-based radiomics can bridge the gap between population-based management and personalised management of prostate cancer.
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Affiliation(s)
- Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College, Dublin, Ireland.
| | - Sarah Osman
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Lisburn Road, Belfast, BT9 7AE, United Kingdom
| | - Suneil Jain
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Lisburn Road, Belfast, BT9 7AE, United Kingdom
| | - Laure Marignol
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College, Dublin, Ireland
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Mjaess G, Vierasu I, Lacroix S, Aoun F, Goldman S, Roumeguère T, Albisinni S. Is there a role for repeating PSMA PET/CT after a negative scan in biochemical recurrent prostate cancer? Acta Oncol 2020; 59:1397-1400. [PMID: 32649263 DOI: 10.1080/0284186x.2020.1790655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Georges Mjaess
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Liban
| | - Irina Vierasu
- Nuclear Medicine Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Simon Lacroix
- Nuclear Medicine Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Fouad Aoun
- Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Liban
- Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Goldman
- Nuclear Medicine Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Ferraro DA, Lehner F, Becker AS, Kranzbühler B, Kudura K, Mebert I, Messerli M, Hermanns T, Eberli D, Burger IA. Improved oncological outcome after radical prostatectomy in patients staged with 68Ga-PSMA-11 PET: a single-center retrospective cohort comparison. Eur J Nucl Med Mol Imaging 2020; 48:1219-1228. [PMID: 33074376 PMCID: PMC8041683 DOI: 10.1007/s00259-020-05058-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Positron emission tomography (PET) targeting the prostate-specific membrane antigen (PSMA) has superior sensitivity over conventional imaging (CI) to stage prostate cancer (PCa) and therefore is increasingly used in staging to stratify patients before radical therapy. Whether this improved diagnostic accuracy translates into improved outcome after radical prostatectomy (RPE) has not yet been shown. Therefore, the aim of this study was to compare the oncological outcome after RPE between patients that underwent preoperative staging with CI or PSMA-PET for intermediate and high-risk PCa. METHODS We retrospectively selected all patients that underwent RPE for intermediate- or high-risk PCa at our institution before PSMA-PET introduction (between March 2014 and September 2016) and compared the oncologic outcome of patients staged with PSMA-PET (between October 2016 and October 2018). Oncological pre-surgical risk parameters (age, PSA, D'Amico score, biopsy-ISUP, and cT stage) were compared between the groups. Oncological outcome was determined as PSA persistence, nerve-sparing rate, and surgical margin status. Wilcoxon rank-sum, Fisher's, and chi-square tests where used for statistical testing. RESULTS One hundred five patients were included, 53 in the CI group and 52 in the PSMA-group. Patients in the PSMA group had higher ISUP grade (p < 0.001) and D'Amico score (p < 0.05). The rate of free surgical margins and PSA persistence after RPE was 64% and 17% for the CI and 77% and 6% for the PSMA group (p = 0.15 and 0.13, respectively). Subgroup analysis with high-risk patients revealed PSA persistence in 7% (3/44) in the PSMA group and 25% (7/28) in the CI group (p = 0.04). Limitations include the retrospective design and choline-PET for some patients in the CI group. CONCLUSION Immediate outcome after RPE was not worse in the PSMA group compared with the CI group, despite a higher-risk cohort. In a comparison of only high-risk patients, PSMA-PET staging was associated with a significantly lower rate of postsurgical PSA persistence.
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Affiliation(s)
- Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Fabienne Lehner
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anton S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Benedikt Kranzbühler
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Iliana Mebert
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland.
- Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.
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Hoffmann MA, Buchholz HG, Wieler HJ, Rosar F, Miederer M, Fischer N, Schreckenberger M. Dual-Time Point [ 68Ga]Ga-PSMA-11 PET/CT Hybrid Imaging for Staging and Restaging of Prostate Cancer. Cancers (Basel) 2020; 12:cancers12102788. [PMID: 32998432 PMCID: PMC7600341 DOI: 10.3390/cancers12102788] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Early diagnosis and tumor characterization of prostate cancer (PCa) are important for accurate treatment. [68Ga]Ga-PSMA-11 PET/CT turns out to constitute a major step toward improved diagnostic procedures to detect primary, recurrent, and metastatic PCa. The aim of our study is to evaluate the effect of a second imaging modality for the staging and restaging of PCa by possibly detecting additional PCa lesions due to the well-known increase of PSMA uptake over time. There was a significant increase in tracer uptake on delayed images in comparison to early [68Ga]Ga-PSMA-11 PET/CT in our study, but the lesion positivity rate was comparable. However, in a few individual cases, additional delayed scans provided an information advantage in PCa lesion detection. The findings of our study are likely to be of major interest to clinicians as well as to researchers defining the algorithms that are necessary to implement this promising method with its specific tracer into clinical routine. Abstract Routine [68Ga]Ga-PSMA-11 PET/CT (one hour post-injection) has been shown to accurately detect prostate cancer (PCa) lesions. The goal of this study is to evaluate the benefit of a dual-time point imaging modality for the staging and restaging of PCa patients. Biphasic [68Ga]Ga-PSMA-11 PET/CT of 233 patients, who underwent early and late scans (one/three hours post-injection), were retrospectively studied. Tumor uptake and biphasic lesion detection for 215 biochemically recurrent patients previously treated for localized PCa (prostatectomized patients (P-P)/irradiated patients (P-I) and 18 patients suspected of having primary PCa (P-T) were separately evaluated. Late [68Ga]Ga-PSMA-11 PET/CT imaging detected 554 PCa lesions in 114 P-P patients, 187 PCa lesions in 33 P-I patients, and 47 PCa lesions in 13 P-T patients. Most patients (106+32 P-P/P-I, 13 P-T) showed no additional PCa lesions. However, 11 PSMA-avid lesions were only detected in delayed images, and 33 lesions were confirmed as malignant by a SUVmax increase. The mean SUVmax of pelvic lymph node metastases was 25% higher (p < 0.001) comparing early and late PET/CT. High positivity rates from routine [68Ga]Ga-PSMA-11 PET/CT for the staging and restaging of PCa patients were demonstrated. There was no decisive influence of additional late imaging with PCa lesion detection on therapeutic decisions. However, in a few individual cases, additional delayed scans provided an information advantage in PCa lesion detection due to higher tracer uptake and improved contrast.
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Affiliation(s)
- Manuela A. Hoffmann
- Department of Occupational Health & Safety, Federal Ministry of Defense, 53123 Bonn, Germany
- Clinic of Nuclear Medicine, Johannes Gutenberg-University, 55101 Mainz, Germany; (H.-G.B.); (F.R.); (M.M.); (M.S.)
- Correspondence:
| | - Hans-Georg Buchholz
- Clinic of Nuclear Medicine, Johannes Gutenberg-University, 55101 Mainz, Germany; (H.-G.B.); (F.R.); (M.M.); (M.S.)
| | - Helmut J Wieler
- Clinic of Nuclear Medicine, Bundeswehr Central Hospital, 56072 Koblenz, Germany;
| | - Florian Rosar
- Clinic of Nuclear Medicine, Johannes Gutenberg-University, 55101 Mainz, Germany; (H.-G.B.); (F.R.); (M.M.); (M.S.)
- Department of Nuclear Medicine, Saarland University Medical Center, 66421 Homburg, Germany
| | - Matthias Miederer
- Clinic of Nuclear Medicine, Johannes Gutenberg-University, 55101 Mainz, Germany; (H.-G.B.); (F.R.); (M.M.); (M.S.)
| | - Nicolas Fischer
- Department of Urology, University of Cologne, 50937 Cologne, Germany;
| | - Mathias Schreckenberger
- Clinic of Nuclear Medicine, Johannes Gutenberg-University, 55101 Mainz, Germany; (H.-G.B.); (F.R.); (M.M.); (M.S.)
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Hoffmann MA, Buchholz HG, Wieler HJ, Müller-Hübenthal J, Trampert L, Richardsen I, Schreckenberger M. Diagnostic Performance of 68Ga-PSMA-11 Positron-emission-tomography/Computed-tomography in a Large Cohort of Patients with Biochemical Recurrence of Prostate Carcinoma. HEALTH PHYSICS 2020; 119:141-147. [PMID: 32301863 DOI: 10.1097/hp.0000000000001253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gallium-68 (Ga) prostate-specific-membrane-antigen positron-emission-tomography/computed-tomography is a highly promising method for imaging primary and recurrent prostate cancer. These dual-modality imaging technologies enable whole-body functional and anatomical evaluation in a single session. This study investigated the performance of Ga-prostate-specific-membrane-antigen-11 positron-emission-tomography/computed-tomography for detecting prostate carcinoma in patients with rising prostate-specific-antigen after primary therapy. Six hundred sixty (660) patients with biochemical recurrence referred for positron-emission-tomography/computed-tomography with Ga-prostate-specific-membrane-antigen-11 were evaluated retrospectively. Prostate-specific-antigen-stratified cohorts of pathological scan results were analyzed, and relationships between prostate-specific-antigen kinetics and PSMA-positive tumor lesions were correlated. Gallium-68 prostate-specific-membrane-antigen-11 positron-emission-tomography/computed-tomography showed a pathological prostate-specific-membrane-antigen uptake in 76% (500 of 660 patients). Positive scans were positively associated with prostate-specific-antigen (p<0.001). For patients with prostate-specific-antigen <0.2 ng mL, the PSMA-positive tumor lesions rate was 41%. Patients with prostate-specific-antigen of 0.2-<0.5 ng mL, 0.5-<1.0 ng mL, 1.0-<2.0 ng mL, and 2.0-<5.0 ng mL showed rates of 44.7%, 61.7%, 72.3%, 85.2%, respectively, and for prostate-specific-antigen of ≥5.0 ng mL it increased to 94%. Prostate-specific-antigen velocity was also correlated with PSMA-positive tumor lesions (p<0.001). In contrast, no association was found for prostate-specific-antigen doubling time (p=0.74). PSMA-positive tumor lesions were significantly increased in patients with primary intermediate- (Gleason Score7) and high-risk (Gleason Score>7) vs. low-risk prostate cancer (Gleason Score<7) (p<0.001). Our data confirm the high performance of Ga-prostate-specific-membrane-antigen positron-emission-tomography/computed-tomography for the detection of recurrent prostate cancer. This may alter treatment planning and has been documented in other studies as well.
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Affiliation(s)
| | - Hans-Georg Buchholz
- Clinic of Nuclear Medicine, Johannes Gutenberg-University, 55101 Mainz, Germany
| | - Helmut J Wieler
- Clinic of Nuclear Medicine, Bundeswehr Central Hospital, 56072 Koblenz, Germany
| | - Jonas Müller-Hübenthal
- Practice of Radiology and Nuclear Medicine, Praxis im KölnTriangle, Ottoplatz 1, 50679 Köln, Germany
| | - Ludwin Trampert
- Clinic of Nuclear Medicine, Klinikum Mutterhaus der Borromäerinnen, Feldstraße 16, 54290 Trier, Germany
| | - Ines Richardsen
- Clinic of General, Visceral and Thoracic Surgery, Bundeswehr Central Hospital, 56072 Koblenz, Germany
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Milot L. Variation of PI-RADS Interpretations between Experts: A Significant Limitation. Radiology 2020; 296:85-86. [DOI: 10.1148/radiol.2020192650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laurent Milot
- From the Body and VIR Radiology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot 5, place D’Arsonval, 69003 Lyon, France
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Ilhan H, la Fougère C, Krause BJ. [PSMA-based theranostics for prostate cancer : From imaging to treatment]. Urologe A 2020; 59:617-625. [PMID: 32377764 DOI: 10.1007/s00120-020-01193-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In recent years nuclear medicine theranostics using radiolabeled prostate-specific membrane antigen (PSMA) ligands have gained increasing importance in the management of prostate cancer. AIM The aim of this work is to highlight the value of theranostic concepts using radiolabeled PSMA ligands for both the diagnostic work-up and treatment of advanced prostate cancer. MATERIAL AND METHODS The currently available knowledge in the literature is summarized and presented. RESULTS The use of PSMA in positron emission tomography-computed tomography (PET/CT) shows a high sensitivity and specificity for prostate cancer imaging, particularly in patients with biochemical recurrences. Furthermore, promising results are also reported for staging of primary prostate cancer and treatment monitoring. In addition, radioligand therapy using alpha and beta emitters is a promising third line treatment option in intensively pretreated patients with metastases. The reduction of side effects and optimization of the treatment sequence of radioligand therapy is of increasing importance. CONCLUSION Nuclear medicine theranostics have an increasing clinical impact on the diagnostics and treatment of prostate cancer.
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Affiliation(s)
- H Ilhan
- Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81375, München, Deutschland.
| | - C la Fougère
- Nuklearmedizin und Klinische Molekulare Bildgebung, Universitätsklinikum Tübingen, Tübingen, Deutschland.,Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Universität Tübingen, Tübingen, Deutschland
| | - B J Krause
- Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Rostock, Rostock, Deutschland
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Affiliation(s)
- Warren D W Heston
- Glickman Urological Institute and Department of Cancer Biology Lerner Research Institute, Cleveland Clinic.
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45
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(Radio)Theranostic Patient Management in Oncology Exemplified by Neuroendocrine Neoplasms, Prostate Cancer, and Breast Cancer. Pharmaceuticals (Basel) 2020; 13:ph13030039. [PMID: 32151049 PMCID: PMC7151671 DOI: 10.3390/ph13030039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 12/18/2022] Open
Abstract
The role of nuclear medicine in the management of oncological patients has expanded during last two decades. The number of radiopharmaceuticals contributing to the realization of theranostics/radiotheranostics in the context of personalized medicine is increasing. This review is focused on the examples of targeted (radio)pharmaceuticals for the imaging and therapy of neuroendocrine neoplasms (NENs), prostate cancer, and breast cancer. These examples strongly demonstrate the tendency of nuclear medicine development towards personalized medicine.
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PSA and PSA Kinetics Thresholds for the Presence of 68Ga-PSMA-11 PET/CT-Detectable Lesions in Patients With Biochemical Recurrent Prostate Cancer. Cancers (Basel) 2020; 12:cancers12020398. [PMID: 32046318 PMCID: PMC7072299 DOI: 10.3390/cancers12020398] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/22/2020] [Accepted: 02/04/2020] [Indexed: 12/11/2022] Open
Abstract
68Ga-PSMA-11 positron-emission tomography/computed tomography (PET/CT) is commonly used for restaging recurrent prostate cancer (PC) in European clinical practice. The goal of this study is to determine the optimum time for performing these PET/CT scans in a large cohort of patients by identifying the prostate-specific-antigen (PSA) and PSA kinetics thresholds for detecting and localizing recurrent PC. This retrospective analysis includes 581 patients with biochemical recurrence (BC) by definition. The performance of 68Ga-PSMA-11 PET/CT in relation to the PSA value at the scan time as well as PSA kinetics was assessed by the receiver-operating-characteristic-curve (ROC) generated by plotting sensitivity versus 1-specificity. Malignant prostatic lesions were identified in 77%. For patients that were treated with radical prostatectomy (RP) a PSA value of 1.24 ng/mL was found to be the optimal cutoff level for predicting positive and negative scans, while for patients previously treated with radiotherapy (RT) it was 5.75 ng/mL. In RP-patients with PSA value <1.24 ng/mL, 52% scans were positive, whereas patients with PSA ≥1.24 ng/mL had positive scan results in 87%. RT-patients with PSA <5.75 ng/mL had positive scans in 86% and for those with PSA ≥5.75 ng/mL 94% had positive scans. This study identifies the PSA and PSA kinetics threshold levels for the presence of 68Ga-PSMA-11 PET/CT-detectable PC-lesions in BC patients.
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Hoffmann MA, Buchholz HG, Wieler HJ, Höfner T, Müller-Hübenthal J, Trampert L, Schreckenberger M. The positivity rate of 68Gallium-PSMA-11 ligand PET/CT depends on the serum PSA-value in patients with biochemical recurrence of prostate cancer. Oncotarget 2019; 10:6124-6137. [PMID: 31693724 PMCID: PMC6817454 DOI: 10.18632/oncotarget.27239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/10/2019] [Indexed: 01/05/2023] Open
Abstract
Background: The aim of the present study is to analyze the efficacy of 68Gallium (Ga)-PSMA-11 PET/CT for detecting and localizing recurrent prostate carcinoma (PC) in patients with different prostate-specific antigen (PSA), PSA velocity (PSAvel) and doubling time (PSAdt).
Results: The PR of 68Ga-PSMA-11 PET/CT showed a positive relationship with PSA levels. Even at restaging PSA-values (PSAV) of lower than 0.2 ng/ml, PR was 41%. For PSAV of 0.2-<0.5 ng/ml the PR was 45%, 62% for PSAV of 0.5-<1.0 and 72% for PSAV of 1.0-<2.0 ng/ml. The PR increased to 85% for PSAV of 2.0-<5.0 and reached 94% at PSAV of ≥5.0 ng/ml. At PSA of <1 ng/ml/y the PR of PSAvel was 50% and increased to 98% at PSA >5 ng/ml/y. No significant association was found for PSAdt.
Methods: PET/CT scans of 660 patients with biochemical recurrence (BCR) after primary therapy of PC were included in the analysis. We correlated serum PSA levels, measured at the time of imaging with PSMA PET/CT-positivity rates (PR) as well as PSAvel (in 225 patients) and PSAdt (660 patients). Additionally we compared the incidence of localized disease to metastases as related to these PSA-biomarkers.
Conclusion: We have shown, in a large cohort of patients, that 68Ga-PSMA-11 PET/CT is a sensitive tool for restaging PC and has a high detection efficacy, even in patients with very low PSA levels (<0.2 ng/ml). Thus 68Ga-PSMA-11 PET/CT both identify and localize recurrent disease with implications for a more direct treatment approach (localized vs. systemic therapy).
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Affiliation(s)
- Manuela A Hoffmann
- Department of Occupational Health and Safety, Supervisory Center for Radiation Protection, Federal Ministry of Defense, Bonn 53123, Germany.,Clinic of Nuclear Medicine, Johannes Gutenberg-University, Mainz 55101, Germany.,Clinic of Nuclear Medicine, Bundeswehr Central Hospital, Koblenz 56072, Germany
| | - Hans-Georg Buchholz
- Clinic of Nuclear Medicine, Johannes Gutenberg-University, Mainz 55101, Germany
| | - Helmut J Wieler
- Clinic of Nuclear Medicine, Bundeswehr Central Hospital, Koblenz 56072, Germany
| | - Thomas Höfner
- Clinic of Urology, Johannes Gutenberg-University, Mainz 55101, Germany
| | | | - Ludwin Trampert
- Clinic of Nuclear Medicine, Klinikum Mutterhaus der Borromäerinnen, Trier 54290, Germany
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Fernandes M, Rosel D, Brábek J. Solid cancer: the new tumour spread endpoint opens novel opportunities. Br J Cancer 2019; 121:513-514. [PMID: 31427682 PMCID: PMC6889500 DOI: 10.1038/s41416-019-0536-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022] Open
Abstract
Novel androgen deprivation agents delay metastasis in non-metastatic, castration-resistant, prostate cancer (nmCRPC). The recent regulatory guidance: considerations for metastasis-free survival endpoint in clinical trials, opens new opportunities in cell biology, medicinal chemistry and advanced imaging. Past failures are the likely result of equating tumour shrinkage to efficacy, rather than inhibition of tumour spread. In the future, the selection of anti-metastasis drug candidates will probably be based on anti-migratory rather than anti-proliferative potential. Oligometastatic cancer coupled with advanced imaging can serve as a clinical proof-of-concept model.
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Affiliation(s)
| | - Daniel Rosel
- Department of Cell Biology, Faculty of Science and BIOCEV, Charles University, Prague, Czech Republic
| | - Jan Brábek
- Department of Cell Biology, Faculty of Science and BIOCEV, Charles University, Prague, Czech Republic.
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