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Dawod M, Rush E, Nagib PB, Aduwo J, Bodempudi P, Appiah-Kubi E. The Utility of Prostate-Specific Membrane Antigen-11 PET in Detection and Management of Central Nervous System Neoplasms. Clin Nucl Med 2024; 49:e340-e345. [PMID: 38598534 DOI: 10.1097/rlu.0000000000005157] [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: 04/12/2024]
Abstract
ABSTRACT We present a case series of 5 patients diagnosed with schwannoma and 1 patient diagnosed with astrocytoma who underwent PSMA PET imaging for tumor detection. We retrospectively analyzed the records of 4 male and 2 female patients (mean age, 53.2 ± 13.2) who underwent PSMA PET imaging between March and September 2023. PET interpretation showed increased Ga-PSMA-11 accumulation in all patients with a mean SUV max of 3.11 ± 1.8. This series underscores PSMA PET's potential for CNS neoplasm detection.
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Affiliation(s)
- Mina Dawod
- From the The Ohio State University College of Medicine
| | - Evan Rush
- Department of Radiology, The Ohio State University College of Medicine
| | - Paul B Nagib
- From the The Ohio State University College of Medicine
| | - Jessica Aduwo
- From the The Ohio State University College of Medicine
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2
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Aggarwal P, Ambalavanan N, Sood A, Gupta K, Dahiya D, Mittal BR. Prostate-Specific Membrane Antigen-Avid Neurofibroma Mimicking Cutaneous Metastasis in Metastatic Castration-Resistant Prostate Cancer on 18 F-PSMA-1007 PET/CT. Clin Nucl Med 2024; 49:e286-e287. [PMID: 38598513 DOI: 10.1097/rlu.0000000000005228] [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: 04/12/2024]
Abstract
ABSTRACT The occurrence of cutaneous metastases in prostate cancer is exceedingly rare. Many benign lesions and nonprostatic cancers can express the prostate-specific membrane antigen (PSMA). They can potentially mimic metastasis of prostate cancer and lead to misinterpretation of PSMA PET/CT findings. Additionally, it has significant management and prognostic implications. We present a rare case of an 88-year-old man with metastatic castration-resistant prostate cancer who showed a PSMA-expressing subcutaneous nodule in the scalp on 18 F-PSMA-1007 PET/CT, raising the suspicion of cutaneous metastasis. However, its biopsy revealed a neurofibroma, altering the disease prognosis and management.
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Affiliation(s)
- Piyush Aggarwal
- From the Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, India
| | - Nivetha Ambalavanan
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, India
| | - Ashwani Sood
- From the Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, India
| | - Kirti Gupta
- From the Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, India
| | - Divya Dahiya
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- From the Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, India
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3
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Denmeade SR. Resolute Progress Down a Long and Winding Road Leads to the Promised Land of Prostate-Specific Membrane Antigen-Based Therapies for Prostate Cancer. J Clin Oncol 2024; 42:852-856. [PMID: 38181307 DOI: 10.1200/jco.23.02310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 01/07/2024] Open
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4
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Chen J, Bui P, Bui C, Mansberg R. Incidental Prostate-Specific Membrane Antigen-Avid Vestibular Schwannoma Detected on 68 Ga-Prostate-Specific Membrane Antigen PET/CT. Clin Nucl Med 2024; 49:234-236. [PMID: 38271251 DOI: 10.1097/rlu.0000000000005028] [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: 01/27/2024]
Abstract
ABSTRACT A 62-year-old man was referred for a 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT scan for newly diagnosed prostate cancer (ISUP grade 5), on the background of left vestibular schwannoma treated with surgical excision 25 years ago. PSMA PET study confirmed the presence of PSMA-avid malignancy in the left prostate lobe with no evidence of PSMA-avid nodal or distant metastasis. An incidental PSMA-avid focus (SUV max , 4.3) was identified in the region of the left cerebellopontine angle, which corresponded to a homogeneous enhancing lesion centered at the left internal acoustic canal and left cerebellopontine angle on MRI. The combined PSMA PET findings and MRI characteristics were consistent with recurrent vestibular schwannoma.
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Affiliation(s)
- Jeffrey Chen
- From the Department of Nuclear Medicine and PET, Nepean Hospital
| | - Paul Bui
- From the Department of Nuclear Medicine and PET, Nepean Hospital
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5
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Voter AF, Werner RA, Savas H, Gafita A, Ross AE, Gorin MA, Solnes LB, Pomper MG, Rowe SP, Sheikhbahaei S. A Practical Guide to the Pearls and Pitfalls of PSMA PET Imaging. Semin Nucl Med 2024; 54:119-131. [PMID: 37980186 DOI: 10.1053/j.semnuclmed.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/20/2023]
Abstract
Prostate-specific membrane antigen (PSMA)-targeted PET agents have revolutionized the care of patients with prostate cancer, supplanting traditional methods of imaging prostate cancer, and improving the selection and delivery of therapies. This has led to a rapid expansion in both the number of PSMA PET scans performed and the imaging specialists required to interpret those scans. To aid those imagers and clinicians who are new to the interpretation of PSMA PET, this review provides an overview of the interpretation of PSMA PET/CT imaging and pearls for overcoming commonly encountered pitfalls. We discuss the physiologic distribution of the clinically available PSMA-targeted radiotracers, the commonly encountered patterns of prostate cancer spread, as well as the benign and malignant mimics of prostate cancer. Additionally, we review the standardized PSMA PET reporting systems and the role of PSMA in selecting appropriate patients for PSMA-targeted therapies.
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Affiliation(s)
- Andrew F Voter
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rudolf A Werner
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Hatice Savas
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrei Gafita
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashley E Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lilja B Solnes
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martin G Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven P Rowe
- Department of Radiology, University of North Carolina, Chapel Hill, NC.
| | - Sara Sheikhbahaei
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
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Gualberto RJC, Nister M, Castro PRD, Arantes PBO. Schwannoma: A rare cause of false-positive 68Ga-PSMA PET/CT uptake in the evaluation of metastatic prostate cancer. Urol Case Rep 2022; 41:101974. [PMID: 34976735 PMCID: PMC8683589 DOI: 10.1016/j.eucr.2021.101974] [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: 11/14/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022] Open
Abstract
PSMA expression occurs in epithelial cells in both normal and hyperplastic prostates. In adenocarcinoma, it is present in greater intensity, especially in the more aggressive ones. This made it possible to develop diagnostic tools with greater specificity for detecting prostate cancer metastases like the 68Ga-PSMA PET/CT. Several benign neoplasms with increased marker uptake have been described in the literature. Such false-positives are usually associated with soft tissue injuries, abnormal vascular proliferation, neurogenic injuries, thymomas and adenomas. In the present work we present a case report that exemplifies the above.
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Affiliation(s)
- Rodrigo J C Gualberto
- Hospital Felicio Rocho de Minas Gerais, 9530 contorno Avenue, Belo Horizonte 30110-934, Brazil
| | - Matheus Nister
- Hospital Felicio Rocho de Minas Gerais, 9530 contorno Avenue, Belo Horizonte 30110-934, Brazil
| | - Pedro R de Castro
- Hospital Felício Rocho, 9530 Contorno Avenue, Belo Horizonte, 30110-934, Brazil
| | - Paulo B O Arantes
- Hospital Felício Rocho, 9530 Contorno Avenue, Belo Horizonte, 30110-934, Brazil
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Bohn KP, Alberts I, Mingels C, Rominger A, Afshar-Oromieh A. PSMA-Ligand Uptake in Disseminated Epidermoid Cysts in a PSMA PET/CT of a Patient With Recurrent Prostate Cancer. Clin Nucl Med 2021; 46:e598-e599. [PMID: 34735414 DOI: 10.1097/rlu.0000000000003749] [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: 11/26/2022]
Abstract
ABSTRACT PSMA PET/CT is routinely used for the detection of prostate cancer (PC). However, increased PSMA-ligand uptake has been described in a variety of benign and malignant tissues. A 71-year-old man with biochemical recurrence of PC initially treated with radical prostatectomy was referred for PSMA-ligand PET/CT. Apart from 1 lymph node with intense PSMA-ligand uptake, suspicious for metastasis, disseminated PSMA-ligand-avid subcutaneous lesions were seen. Histopathology of 1 of these lesions revealed an epidermoid cyst. Physicians should remain cognizant of non-PC-related causes of increased PSMA-ligand uptake, of which this case represent yet another example.
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Affiliation(s)
- Karl Peter Bohn
- From the Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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de Galiza Barbosa F, Queiroz MA, Nunes RF, Costa LB, Zaniboni EC, Marin JFG, Cerri GG, Buchpiguel CA. Nonprostatic diseases on PSMA PET imaging: a spectrum of benign and malignant findings. Cancer Imaging 2020; 20:23. [PMID: 32169115 PMCID: PMC7071711 DOI: 10.1186/s40644-020-00300-7] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
PSMA PET imaging was originally used to assess biochemical recurrence of prostate cancer (PCa), but its clinical use was promptly extended to detection, staging and therapy response assessment. The expanding use of PSMA PET worldwide has also revealed PSMA ligand uptake in diverse nonprostatic diseases, which raised questions about the specificity of this imaging modality. Although not very common initially, a growing number of pathologies presenting PSMA uptake on PET have been reported in the last few years, and a proper interpretation of PSMA PET imaging findings suddenly became challenging and, to some extent, confusing. Compared to cytoplasmic PSMA expression in nonprostatic cells, the molecular features of apical PSMA expression in PCa cells can help to distinguish these various conditions. Correlations of imaging findings to patient history, to the expected pattern of disease spread and mainly to computed tomography (CT) and/or magnetic resonance imaging (MRI) characteristics will reinforce the distinction of lesions that are more likely related to PCa from those that could lead to an incorrect diagnosis. The overall benefits of endothelial PSMA expression, which is associated with the neovasculature of malignant neoplasms, will be highlighted, stating the potential use of PSMA ligand uptake as a theranostic tool. This review aims to cover the collection of nonprostatic diseases, including benign and malignant tumors, in a didactic approach according to disease etiology, with discussion of bone-related conditions and inflammatory and infectious processes.
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Affiliation(s)
- Felipe de Galiza Barbosa
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Marcelo Araujo Queiroz
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil.
| | - Rafael Fernandes Nunes
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Larissa Bastos Costa
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Elaine Caroline Zaniboni
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - José Flavio Gomes Marin
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Giovanni Guido Cerri
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
| | - Carlos Alberto Buchpiguel
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91, Sao Paulo, ZIP: 01308-050, Brazil
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Shooli H, Dadgar H, Wáng YXJ, Vafaee MS, Kashuk SR, Nemati R, Jafari E, Nabipour I, Gholamrezanezhad A, Assadi M, Larvie M. An update on PET-based molecular imaging in neuro-oncology: challenges and implementation for a precision medicine approach in cancer care. Quant Imaging Med Surg 2019; 9:1597-1610. [PMID: 31667145 DOI: 10.21037/qims.2019.08.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PET imaging using novel radiotracers show promises for tumor grading and molecular characterization through visualizing molecular and functional properties of the tumors. Application of PET tracers in brain neoplasm depends on both type of the neoplasm and the research or clinical significance required to be addressed. In clinical neuro-oncology, 18F-FDG is used mainly to differentiate tumor recurrence from radiation-induced necrosis, and novel PET agents show attractive imaging properties. Novel PET tracers can offer biologic information not visible via contrast-enhanced MRI or 18F-FDG PET. This review aims to provide an update on the complementary role of PET imaging in neuro-oncology both in research and clinical settings along with presenting interesting cases in this context.
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Affiliation(s)
- Hossein Shooli
- The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Habibollah Dadgar
- Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran
| | - Yì-Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Manochehr Seyedi Vafaee
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Translational Neuroscience, BRIDGE, University of Southern Denmark, Odense, Denmark.,Neuroscience Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saman Rassaei Kashuk
- The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Reza Nemati
- Department of Neurology, Bushehr Medical University Hospital, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Esmail Jafari
- The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ali Gholamrezanezhad
- Department of Diagnostic Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mykol Larvie
- Department of Nuclear Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.,Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Sheikhbahaei S, Werner RA, Solnes LB, Pienta KJ, Pomper MG, Gorin MA, Rowe SP. Prostate-Specific Membrane Antigen (PSMA)-Targeted PET Imaging of Prostate Cancer: An Update on Important Pitfalls. Semin Nucl Med 2019; 49:255-270. [DOI: 10.1053/j.semnuclmed.2019.02.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Shetty D, Patel D, Le K, Bui C, Mansberg R. Pitfalls in Gallium-68 PSMA PET/CT Interpretation-A Pictorial Review. ACTA ACUST UNITED AC 2018; 4:182-193. [PMID: 30588504 PMCID: PMC6299744 DOI: 10.18383/j.tom.2018.00021] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The novel Gallium-68 prostate-specific membrane antigen (PSMA)-bis [2-hydroxy-5-(carboxyethyl)benzyl] ethylenediamine-diacetic acid positron emission tomography (PET) tracer is increasingly used in the evaluation of prostate cancer, particularly in the detection of recurrent disease. However, PSMA is expressed in nonprostatic tissues, as well as in other pathologic conditions. Here we illustrate such interpretive pitfalls with relevant images that one may encounter while reporting PSMA PET/CT. This study aims to show variation in physiological distribution of PSMA activity and uptake in various benign and neoplastic disorders that may be misinterpreted as prostatic metastatic disease. These pitfalls are illustrated to enhance awareness, aiding a more accurate interpretation of the study. Retrospective database of all (68)Ga PSMA PET/CT was created and reviewed. In total, 1115 PSMA PET/CT studies performed between February 27, 2015, and May 31, 2017, were reviewed. Any unusual uptake of PSMA was documented, described, and followed up. All cases were then subdivided into the following 4 categories: physiological uptake, benign pathological uptake, nonprostatic neoplastic uptake, and miscellaneous uptake. A variety of nonprostatic tissues and lesions, including accessory salivary gland, celiac ganglion, gall bladder, Paget's bone disease, reactive lymph nodes, non–small cell lung cancer, renal cell cancer, and neuroendocrine tumor, were found to show PSMA uptake. PSMA uptake is not prostate-specific and can be taken up physiologically and pathologically in nonprostatic tissue. It is important for reporting physicians to recognize these findings and instigate appropriate investigations when required while avoiding unnecessary procedures in physiological variation.
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Affiliation(s)
- Deepa Shetty
- Department of PET and Nuclear Medicine, Nepean Hospital, Sydney, NSW, Australia; and
| | - Dhruv Patel
- Department of PET and Nuclear Medicine, Nepean Hospital, Sydney, NSW, Australia; and
| | - Ken Le
- Department of PET and Nuclear Medicine, Nepean Hospital, Sydney, NSW, Australia; and
| | - Chuong Bui
- Department of PET and Nuclear Medicine, Nepean Hospital, Sydney, NSW, Australia; and.,Nepean Clinical School, University of Sydney, NSW, Australia
| | - Robert Mansberg
- Department of PET and Nuclear Medicine, Nepean Hospital, Sydney, NSW, Australia; and.,Nepean Clinical School, University of Sydney, NSW, Australia
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12
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Heitkötter B, Trautmann M, Grünewald I, Bögemann M, Rahbar K, Gevensleben H, Wardelmann E, Hartmann W, Steinestel K, Huss S. Expression of PSMA in tumor neovasculature of high grade sarcomas including synovial sarcoma, rhabdomyosarcoma, undifferentiated sarcoma and MPNST. Oncotarget 2018; 8:4268-4276. [PMID: 28002805 PMCID: PMC5354830 DOI: 10.18632/oncotarget.13994] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/30/2016] [Indexed: 11/25/2022] Open
Abstract
AIMS PSMA (prostate specific membrane antigen) is physiologically expressed in normal prostate tissue. It is overexpressed in prostate cancer cells and has been suggested as a target for antibody-based radioligand therapy. As PSMA expression so far has not been systematically analyzed in soft tissue tumors, the current study aims at investigating a large cohort of different subtypes. METHODS AND RESULTS Immunohistochemistry was used to detect PSMA expression in 779 samples of soft tissue tumors and Ewing sarcoma as a primary bone malignancy. CD34 coexpression was employed to study PSMA expression in the neovasculature. PSMA expression was found in the tumor-associated neovasculature of 151/779 soft tissue/bone tumors (19.38%) and was more frequent in malignant tumors compared to tumors with intermediate or benign biological potential (p=0.078). Strong neovascular PSMA expression was predominantly observed in subsets of different sarcomas including 3/20 rhabdomyosarcomas (15%), 4/21 malignant peripheral nerve sheath tumors (19.05%), 6/16 synovial sarcomas (35.29%) and 6/33 undifferentiated pleomorphic sarcomas (18.18%). CONCLUSION We conclude that PSMA is expressed in the neovasculature of a subset of soft tissue tumors to a variable extent. Our observation of strong PSMA expression predominantly occurring in sarcomas might provide a rationale to evaluate PSMA-targeted radioligand therapy in these entities.
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Affiliation(s)
- Birthe Heitkötter
- Gerhard Domagk Institute of Pathology, University Hospital Münster, University of Münster, Germany
| | - Marcel Trautmann
- Gerhard Domagk Institute of Pathology, University Hospital Münster, University of Münster, Germany
| | - Inga Grünewald
- Gerhard Domagk Institute of Pathology, University Hospital Münster, University of Münster, Germany
| | - Martin Bögemann
- Department of Urology, University Hospital Münster, University of Münster, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, University of Münster, Germany
| | - Heidrun Gevensleben
- Institute of Pathology, University Hospital Bonn, University of Bonn, Germany
| | - Eva Wardelmann
- Gerhard Domagk Institute of Pathology, University Hospital Münster, University of Münster, Germany
| | - Wolfgang Hartmann
- Gerhard Domagk Institute of Pathology, University Hospital Münster, University of Münster, Germany
| | - Konrad Steinestel
- Gerhard Domagk Institute of Pathology, University Hospital Münster, University of Münster, Germany
| | - Sebastian Huss
- Gerhard Domagk Institute of Pathology, University Hospital Münster, University of Münster, Germany
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Extraosseous Extension of Aggressive Vertebral Hemangioma as a Potential Pitfall on 68Ga-PSMA PET/CT. Clin Nucl Med 2018. [PMID: 28632693 DOI: 10.1097/rlu.0000000000001731] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 74-year-old man with newly diagnosed prostate cancer underwent Ga-PSMA PET/CT, which demonstrated intense uptake in and adjacent the L2 vertebral body. Subsequent MRI of the lumbar spine showed an aggressive L2 hemangioma with adjacent soft tissue extension. There was congruence of the intraosseous and extraosseous components of the hemangioma and the PSMA PET uptake. This is a rare but important potential pitfall in Ga-PSMA PET/CT-a soft tissue lesion with intense tracer uptake related not to a nodal metastasis of prostate cancer but to extraosseous extension of an aggressive vertebral body hemangioma.
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Backhaus P, Noto B, Avramovic N, Grubert LS, Huss S, Bögemann M, Stegger L, Weckesser M, Schäfers M, Rahbar K. Targeting PSMA by radioligands in non-prostate disease—current status and future perspectives. Eur J Nucl Med Mol Imaging 2018; 45:860-877. [DOI: 10.1007/s00259-017-3922-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/25/2017] [Indexed: 12/11/2022]
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15
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Abstract
Aim PSMA (prostate-specific membrane antigen) is physiologically expressed in normal prostate tissue and over expressed in prostate cancer cells, therefore constituting a potential target for antibody-based radioligand therapy. Very recent imaging findings reported PSMA-PET/CT uptake in various thyroid lesions. We were therefore encouraged to systematically analyse PSMA expression in different benign and malignant thyroid lesions. Methods Immunohistochemistry was used to detect PSMA expression in 101 thyroid lesions, while neovasculature was identified by CD34 immunostaining. Results PSMA expression in the neovasculature was significantly more frequent in malignant tumors (36/63; 57.1%) compared to benign diseases (5/38; 13.2%; p = 0.0001). In addition, PSMA expression levels in the neovasculature of poorly and undifferentiated thyroid cancers were significantly higher compared to differentiated thyroid tumors (p = 0.021). However, one case with a strong expression in follicular adenoma was identified. Conclusions We conclude that neovascular PSMA expression is common in thyroid cancer but may also rarely be found in benign thyroid diseases, such as follicular adenoma. High expression in the tumor-associated neovasculature is predominantly found in poorly differentiated and undifferentiated (anaplastic) thyroid cancer. This knowledge is highly relevant when interpreting PSMA/PET-CT scans from patients with prostate cancer. In addition, our findings might provide a rationale for further evaluation of PSMA-targeted anti-neovascular or radioligand therapy in metastatic dedifferentiated thyroid cancer.
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Mesenchymal tumors of the prostate. Mod Pathol 2018; 31:S133-142. [PMID: 29297486 DOI: 10.1038/modpathol.2017.155] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 12/12/2022]
Abstract
Mesenchymal tumors of the prostate are rare but often cause considerable diagnostic difficulty when encountered. These may be either benign or malignant and can arise within the prostate gland or in adjacent tissues. This review covers prostatic stromal proliferations (prostatic stromal tumor of uncertain malignant potential and stromal sarcoma), solitary fibrous tumor, myofibroblastic proliferations, smooth muscle neoplasms (leiomyoma and leiomyosarcoma), gastrointestinal stromal tumor, schwannoma, rhabdomyosarcoma, sarcomatoid carcinoma, postradiation sarcoma, and mixed epithelial stromal tumor of the seminal vesicle. Differential diagnostic considerations are emphasized, including descriptions of helpful histological and/or clinical clues and the use of adjuvant diagnostic techniques.
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68Ga-PSMA Uptake in Neurofibromas Demonstrated on PET/CT in a Patient With Neurofibromatosis Type 1. Clin Nucl Med 2017; 42:776-778. [DOI: 10.1097/rlu.0000000000001777] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging. Eur J Nucl Med Mol Imaging 2017; 44:2117-2136. [PMID: 28765998 DOI: 10.1007/s00259-017-3780-7] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/12/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND The rapidly expanding clinical adaptation of prostate-specific membrane antigen (PSMA)-targeted PET imaging in the evaluation of patients with prostate cancer has placed an increasing onus on understanding both the potential pearls of interpretation as well as limitations of this new technique. As with any new molecular imaging modality, accurate characterization of abnormalities on PSMA-targeted PET imaging can be accomplished only if one is aware of the normal distribution pattern, physiological variants of radiotracer uptake, and potential sources of false-positive and false-negative imaging findings. In recent years, a growing number of reports have come to light describing incidental non-prostatic benign or malignant pathologies with high uptake on PSMA-targeted PET imaging. In this review, we have summarized the published literature regarding the potential pearls and technical and interpretive pitfalls of this imaging modality. Knowledge of these limitations can increase the confidence of interpreting physicians and thus improve patient care. CONCLUSIONS As PSMA-targeted PET is expected to be evaluated in larger prospective trials, the dissemination of potential diagnostic pitfalls and the biologic underpinning of those findings will be of increased importance.
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Biopsy-Proven Diffuse Mediastinal Prostate Cancer Metastases Negative on 18F-Fluorocholine, Diagnosed on 68Ga-PSMA and 18F-PSMA PET/CT. Clin Nucl Med 2017; 42:801-802. [PMID: 28719448 DOI: 10.1097/rlu.0000000000001766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 72-year-old man with prostate cancer (stage T3b, Gleason score 7) treated by radical prostatectomy was found to have biochemical failure (prostate-specific antigen 8.5 ng/mL) and a suspicious growing nodularity at the left prostate bed on MRI. F-fluorocholine PET/CT failed to demonstrate any site of uptake suggestive of malignancy. A bone scan did exclude bone metastases. Ga-PSMA PET/CT revealed various positive lymph nodes in the supraclavicular, mediastinal, and hilar regions. This was confirmed on F-DCFPyl PET/CT, with the addition of a suspicious right axillary lymph node. Mediastinal biopsy confirmed metastatic prostate cancer.
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Kanthan GL, Hsiao E, Vu D, Schembri GP. Uptake in sympathetic ganglia on 68
Ga-PSMA-HBED PET/CT: A potential pitfall in scan interpretation. J Med Imaging Radiat Oncol 2017. [DOI: 10.1111/1754-9485.12622] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gowri L Kanthan
- Department of Nuclear Medicine; Royal North Shore Hospital; St Leonards New South Wales Australia
- Prince of Wales Hospital Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - Edward Hsiao
- Department of Nuclear Medicine; Royal North Shore Hospital; St Leonards New South Wales Australia
| | - Dzung Vu
- Department of Anatomy; University of Notre Dame; Sydney New South Wales Australia
| | - Geoffrey Paul Schembri
- Department of Nuclear Medicine; Royal North Shore Hospital; St Leonards New South Wales Australia
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21
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68Ga-PSMA PET/CT Uptake in Intramuscular Myxoma Imitates Prostate Cancer Metastasis. Clin Nucl Med 2017; 42:487-488. [DOI: 10.1097/rlu.0000000000001654] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Abstract
Prostate-specific membrane antigen (PSMA) is a cell surface glycoprotein which is frequently overexpressed on prostate cancer cells. Ga-PSMA PET/CT plays an increasing role in prostate cancer management. However, growing evidence suggests increased PSMA uptake in a variety of other malignant tumor entities and in some benign lesions. This report describes PSMA uptake in numerous thoracic lymph nodes in a patient with known mediastinal sarcoidosis. Knowledge and recognition of these possibilities are important to avoid scan misinterpretation.
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Abstract
Ga prostate-specific membrane antigen (PSMA) PET/CT is a new imaging technique that is significantly more sensitive to prostate cancer lesions than other conventional imaging modalities. Various other benign and malignant neoplasms may also express PSMA and show uptake on PSMA PET/CT scan. We report a case of 66-year-old man who had a PSMA PET/CT scan for restaging of prostate carcinoma. A PSMA-avid left femoral lymph node was identified. Subsequent biopsy confirmed the diagnosis of follicular lymphoma. It is important to be aware of this possibility to avoid scan misinterpretation. Biopsy of any atypical or clinically unexpected lesions should be considered.
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Abstract
68Ga-prostate-specific membrane antigen (PSMA) PET/CT imaging is a relatively new imaging technique used to evaluate the extent of disease in prostate carcinoma. Various other neoplasms may also express PSMA and show uptake on PSMA PET/CT scan. We report a case of a 62-year-old man who had a PSMA PET/CT scan for restaging of prostate carcinoma. A PSMA-avid thyroid lesion was identified, and subsequent tissue sampling confirmed the diagnosis of follicular thyroid adenoma. It is important to be aware of this possibility to avoid scan misinterpretation. Tissue biopsy of PSMA-avid thyroid lesions should be considered to exclude a primary thyroid neoplasm.
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PET–CT with (68 Ga)Gallium-Labeled PSMA Ligand for the Diagnosis of Prostate Cancer: Clinical Applications and Protocols. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nonneoplastic Neuroma After Radical Prostatectomy Is Not a Mimicker of Lymph Node Metastases on 68Ga–PSMA Ligand PET/CT. Clin Nucl Med 2016; 41:785-6. [DOI: 10.1097/rlu.0000000000001333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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68Ga-PSMA PET/MR Showing Intense PSMA Uptake in Nodular Fasciitis Mimicking Prostate Cancer Metastasis. Clin Nucl Med 2016; 41:e443-4. [DOI: 10.1097/rlu.0000000000001310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Elevated 68Ga Prostate-Specific Membrane Antigen Activity in Metastatic Non–Small Cell Lung Cancer. Clin Nucl Med 2016; 41:414-6. [DOI: 10.1097/rlu.0000000000001139] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barinka C, Ptacek J, Richter A, Novakova Z, Morath V, Skerra A. Selection and characterization of Anticalins targeting human prostate-specific membrane antigen (PSMA). Protein Eng Des Sel 2016; 29:105-15. [PMID: 26802163 DOI: 10.1093/protein/gzv065] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 01/25/2023] Open
Abstract
Although prostate carcinoma (PCa) is by far the most commonly diagnosed neoplasia in men, corresponding diagnostic and therapeutic modalities have limited efficacy at present. Anticalins comprise a novel class of binding proteins based on a non-immunoglobulin scaffold that can be engineered to specifically address molecular targets of interest. Here we report the selection and characterization of Anticalins that recognize human prostate-specific membrane antigen (PSMA), a membrane-tethered metallopeptidase constituting a disease-related target for imaging and therapy of PCa as well as solid malignancies in general. We used a randomized lipocalin library based on the human lipocalin 2 (Lcn2) scaffold together with phage display and ELISA screening to select PSMA-specific variants. Five Anticalin candidates from the original panning were expressed in Escherichia coli as soluble monomeric proteins, revealing affinities toward PSMA down to the low nanomolar range. Binding characteristics of the most promising candidate were further improved via affinity maturation by applying error-prone PCR followed by selection via phage display as well as bacterial surface display under more stringent conditions. In BIAcore measurements, the dissociation constant of the best Anticalin was determined as ∼500 pM, with a substantially improved dissociation rate compared with the first-generation candidate. Finally, immunofluorescence microscopy revealed specific staining of PSMA-positive tumor cell lines while flow cytometric analysis confirmed the ability of the selected Anticalins to detect PSMA on live cells. Taken together, Anticalins resulting from this study offer a viable alternative to antibody-based PSMA binders for biomedical applications, including in vivo imaging of PCa or neovasculature of solid tumors.
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Affiliation(s)
- Cyril Barinka
- Institute of Biotechnology, Academy of Sciences of the Czech Republic, Prumyslova 595, 25242 Vestec, Czech Republic
| | - Jakub Ptacek
- Institute of Biotechnology, Academy of Sciences of the Czech Republic, Prumyslova 595, 25242 Vestec, Czech Republic Department of Biochemistry, Faculty of Natural Science, Charles University, Albertov 6, Prague 2, Czech Republic
| | - Antonia Richter
- Munich Center for Integrated Protein Science (CIPS-M) and Lehrstuhl für Biologische Chemie, Technische Universität München, 85354 Freising (Weihenstephan), Germany
| | - Zora Novakova
- Institute of Biotechnology, Academy of Sciences of the Czech Republic, Prumyslova 595, 25242 Vestec, Czech Republic
| | - Volker Morath
- Munich Center for Integrated Protein Science (CIPS-M) and Lehrstuhl für Biologische Chemie, Technische Universität München, 85354 Freising (Weihenstephan), Germany
| | - Arne Skerra
- Munich Center for Integrated Protein Science (CIPS-M) and Lehrstuhl für Biologische Chemie, Technische Universität München, 85354 Freising (Weihenstephan), Germany
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Rischpler C, Maurer T, Schwaiger M, Eiber M. Intense PSMA-expression using 68Ga-PSMA PET/CT in a paravertebral schwannoma mimicking prostate cancer metastasis. Eur J Nucl Med Mol Imaging 2015; 43:193-194. [DOI: 10.1007/s00259-015-3235-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/16/2015] [Indexed: 11/28/2022]
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Foss CA, Mease RC, Cho SY, Kim HJ, Pomper MG. GCPII imaging and cancer. Curr Med Chem 2012; 19:1346-59. [PMID: 22304713 DOI: 10.2174/092986712799462612] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 12/26/2011] [Accepted: 12/27/2011] [Indexed: 12/11/2022]
Abstract
Glutamate carboxypeptidase II (GCPII) in the central nervous system is referred to as the prostate-specific membrane antigen (PSMA) in the periphery. PSMA serves as a target for imaging and treatment of prostate cancer and because of its expression in solid tumor neovasculature has the potential to be used in this regard for other malignancies as well. An overview of GCPII/PSMA in cancer, as well as a discussion of imaging and therapy of prostate cancer using a wide variety of PSMA-targeting agents is provided.
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Affiliation(s)
- C A Foss
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical School, Baltimore, MD 21231, USA
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Bařinka C, Rojas C, Slusher B, Pomper M. Glutamate carboxypeptidase II in diagnosis and treatment of neurologic disorders and prostate cancer. Curr Med Chem 2012; 19:856-70. [PMID: 22214450 DOI: 10.2174/092986712799034888] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 11/10/2011] [Accepted: 11/14/2011] [Indexed: 12/14/2022]
Abstract
Glutamate carboxypeptidase II (GCPII) is a membrane-bound binuclear zinc metallopeptidase with the highest expression levels found in the nervous and prostatic tissue. Throughout the nervous system, glia-bound GCPII is intimately involved in the neuron-neuron and neuron-glia signaling via the hydrolysis of N-acetylaspartylglutamate (NAAG), the most abundant mammalian peptidic neurotransmitter. The inhibition of the GCPII-controlled NAAG catabolism has been shown to attenuate neurotoxicity associated with enhanced glutamate transmission and GCPII-specific inhibitors demonstrate efficacy in multiple preclinical models including traumatic brain injury, stroke, neuropathic and inflammatory pain, amyotrophic lateral sclerosis, and schizophrenia. The second major area of pharmacological interventions targeting GCPII focuses on prostate carcinoma; GCPII expression levels are highly increased in androgen-independent and metastatic disease. Consequently, the enzyme serves as a potential target for imaging and therapy. This review offers a summary of GCPII structure, physiological functions in healthy tissues, and its association with various pathologies. The review also outlines the development of GCPII-specific small-molecule compounds and their use in preclinical and clinical settings.
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Affiliation(s)
- C Bařinka
- Institute of Biotechnology, Academy of Sciences of the Czech Republic, Videnska 1083, 14200 Praha 4, Czech Republic.
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Zhao LY, Mao XP, Chao KY, Guo SJ, Qiu SP. Prostate-specific membrane antigen can promote in vivo osseous metastasis of prostate cancer cells in mice. Braz J Med Biol Res 2012; 45:737-45. [PMID: 22584637 PMCID: PMC3854248 DOI: 10.1590/s0100-879x2012007500085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 04/12/2012] [Indexed: 11/22/2022] Open
Abstract
Reports remain insufficient on whether and how prostate-specific membrane antigen (PSMA) can influence in vivo osseous metastasis of prostate cancer (PCa). In the present study, the authors induced stable expression of PSMA in mouse PCa cell line RM-1. In vivo osseous metastasis was induced in 37 6-week-old female C57BL/6 mice weighing 22.45 ± 0.456 g. RM-1 cells were actively injected into the femoral bone cavity, leading to bilateral dissymmetry of bone density in the femoral bone. Tumor cells were also detected in bone tissue by pathological examination. The impact on bone density was demonstrated by the significant difference between animals injected with RM-PSMA cells (0.0738 ± 0.0185 g/cm2) and animals injected with RM-empty plasmid cells (0.0895 ± 0.0241 g/cm2). The lytic bone lesion of the RM-PSMA group (68.4%) was higher than that of the control group (27.8%). Immunohistochemistry showed that the expression of both vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) was distinctly higher in the RM-PSMA group than in the control group, while ELISA and Western blot assay indicated that VEGF and MMP-9 were higher in the RM-PSMA group compared to the control group (in vitro). Thus, the present study proposed and then confirmed for the first time that PSMA can promote in vivo osseous metastasis of PCa by increasing sclerotic destruction of PCa cells. Further analyses also suggested that PSMA functions positively on the invasive ability of RM-1 by increasing the expression of MMP-9 and VEGF by osseous metastases in vivo.
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Affiliation(s)
- Liang-Yun Zhao
- Department of Urology, Huangpu Hospital, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Mahato R, Tai W, Cheng K. Prodrugs for improving tumor targetability and efficiency. Adv Drug Deliv Rev 2011; 63:659-70. [PMID: 21333700 PMCID: PMC3132824 DOI: 10.1016/j.addr.2011.02.002] [Citation(s) in RCA: 247] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/14/2011] [Accepted: 02/03/2011] [Indexed: 12/14/2022]
Abstract
As the mainstay in the treatment of various cancers for several decades, chemotherapy is successful but still faces challenges including non-selectivity and high toxicity. Improving the selectivity is therefore a critical step to improve the therapeutic efficacy of chemotherapy. Prodrug is one of the most promising approaches to increase the selectivity and efficacy of a chemotherapy drug. The classical prodrug approach is to improve the pharmaceutical properties (solubility, stability, permeability, irritation, distribution, etc.) via a simple chemical modification. This review will focus on various targeted prodrug designs that have been developed to increase the selectivity of chemotherapy drugs. Various tumor-targeting ligands, transporter-associated ligands, and polymers can be incorporated in a prodrug to enhance the tumor uptake. Prodrugs can also be activated by enzymes that are specifically expressed at a higher level in tumors, leading to a selective anti-tumor effect. This can be achieved by conjugating the enzyme to a tumor-specific antibody, or delivering a vector expressing the enzyme into tumor cells.
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Affiliation(s)
- Rubi Mahato
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108
| | - Wanyi Tai
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108
| | - Kun Cheng
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108
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Gasco J, Kew Y, Livingston A, Rose J, Zhang YJ. Dissemination of prostate adenocarcinoma to the skull base mimicking giant trigeminal schwannoma: anatomic relevance of the extradural neural axis component. Skull Base 2011; 19:425-30. [PMID: 20436844 DOI: 10.1055/s-0029-1224774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report an unusual case of a large metastatic lesion from prostate adenocarcinoma with its epicenter located in Meckel's cave. The patient presented with acute neurological deterioration due to pontomesencephalic, cranial nerve, and temporal lobe compression. This lesion radiologically mimicked a giant trigeminal schwannoma. Complete surgical resection was achieved with improvement in the performance status of the patient. The anatomic relevance the extradural neural axis component in the process of dissemination of prostate adenocarcinoma to the skull base is highlighted.
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Affiliation(s)
- Jaime Gasco
- Methodist Neurological Institute, Houston, Texas
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Chaux A, Eifler J, Karram S, Al-Hussain T, Faraj S, Pomper M, Rodriguez R, Netto GJ. Focal positive prostate-specific membrane antigen (PSMA) expression in ganglionic tissues associated with prostate neurovascular bundle: implications for novel intraoperative PSMA-based fluorescent imaging techniques. Urol Oncol 2011; 31:572-5. [PMID: 21640619 DOI: 10.1016/j.urolonc.2011.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 04/03/2011] [Accepted: 04/03/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Prostate specific membrane antigen (PSMA) is primarily expressed in glandular prostatic tissue and is frequently utilized to detect primary or metastatic prostatic adenocarcinoma (CaP). A purported novel application of PSMA detection is the intraoperative real-time identification of CaP using radioimmunoscintigraphy to define the extension of the surgical resection. Considering that PSMA expression has been reported in other tissues, we evaluated its immunoexpression in prostatic neurovascular bundle elements to assess the convenience and safety of the aforementioned procedure. MATERIALS AND METHODS Twenty consecutive specimens of radical prostatectomy (RP) were retrieved from our surgical pathology archives. PSMA immunoexpression (Clone 3E6, DAKO) was assessed in a representative section from each specimen containing neurovascular bundle elements. RESULTS PSMA expression was documented in 20/20 of examined CaP slides. Most cases exhibited an apical/cytoplasmic or cytoplasmic with membranous accentuation pattern of staining. Focal weak to moderate cytoplasmic staining was detected in associated ganglionic tissue in 3/15 of the examined RP. In all cases, staining was cytoplasmic, less extensive, and weaker than the pattern observed in CaP. None of the peripheral nerve sheath cells or lymphovascular components of the examined neurovascular bundles were positive for PSMA. CONCLUSIONS We found focal positive PSMA expression in the ganglionic cells of the prostatic neurovascular bundle. Our results suggest that the radioimmunoscintigraphic detection of radiolabeled PSMA antibodies might not be entirely specific for prostatic cells; this observation must be taken into account should an intraoperative PSMA-based fluorescent imaging technique be used to define the extension of the surgical procedure.
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Affiliation(s)
- Alcides Chaux
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA
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