The Diagnostic Performance of 18F-PSMA-1007 PET/CT in Prostate Cancer Patients with Early Recurrence after Definitive Therapy with a PSA <10 ng/ml

[18F]PSMA-1007 PET for biochemical recurrence of prostate cancer, a comparison with [18F]Fluciclovine

AIM

The objective of this study was to compare the detection rates of [18F]PSMA-1007 and [18F]Fluciclovine in early biochemical recurrence (BCR) of prostate cancer, i.e. with low prostate-specific antigen (PSA) levels (0.2-5.0 µg/L).

METHODS

This was a prospective, single-center (Radboudumc; Nijmegen, The Netherlands), comparative phase II diagnostic imaging study (NCT04239742). The main inclusion criteria were histologically proven adenocarcinoma of the prostate, BCR after radical treatment with two consecutive (rising) PSA values (0.2-5.0 µg/L). Patients underwent both [18F]PSMA-1007 PET/CT and [18F]Fluciclovine PET/CT within two weeks. Both scans were blindly scored by three independent nuclear medicine physicians. Hereafter, a result per scan and region was generated by consensus. The primary outcome was to compare the detection rate on a patient and region level. Secondary objectives were to determine detection rate stratified for PSA value, inter-reader agreement, and SUV measurements. For lesion confirmation a composite reference score was established using follow-up data.

RESULTS

Data of fifty patients were included, median age of 71 (IQR: 67-74) years and median PSA value of 0.38 (IQR: 0.30-1.55) µg/L. Detection rates were 68% (34/50) for [18F]PSMA-1007 and 42% (21/50) for [18F]Fluciclovine on a patient level (p < 0.001). Detection rates stratified for PSA value of [18F]PSMA-1007 in comparison with [18F]Fluciclovine were for PSA 0.2-0.5 µg/L; 60.7% versus 25.0% (p = 0.002); and for PSA ≥ 0.5 µg/L; 77.3% versus 63.6% (p = 0.250). There was a trend for higher inter-reader agreement with [18F]PSMA-1007. SUVmax (p < 0.001) was significantly higher for [18F]PSMA-1007 in comparison to [18F]Fluciclovine.

CONCLUSION

In patients with early BCR of prostate cancer after radical surgery or radiotherapy, [18F]PSMA-1007 demonstrated a significantly higher detection rate than [18F]Fluciclovine. This is particularly relevant since earlier and more accurate detection of a BCR can guide salvage therapy into a tailored strategy which may improve outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04239742. Registered 02 January 2020, https://clinicaltrials.gov/study/NCT04239742 .

Advancements in PSMA ligand radiolabeling for diagnosis and treatment of prostate cancer: a systematic review

Prostate cancer(PCa), a leading global health concern, profoundly impacts millions of men worldwide. Progressing through two stages, it initially develops within the prostate and subsequently extends to vital organs such as lymph nodes, bones, lungs, and the liver. In the early phases, castration therapy is often employed to mitigate androgen effects. However, when prostate cancer becomes resistant to this treatment, alternative strategies become imperative. As diagnostic and treatment methodologies for prostate cancer continually advance, radioligand therapy (RLT) has emerged as a promising avenue, yielding noteworthy outcomes. The fundamental principle of RLT involves delivering radionuclide drugs to cancerous lesions through specific carriers or technologies. Subsequently, these radionuclide drugs release radioactive energy, facilitating the destruction of cancer cell tissues. At present, the positron emission tomography (PET) targeting PSMA has been widely developed for the use of diagnosis and staging of PCa. Notably, FDA-approved prostate-specific membrane antigen (PSMA) targeting agents, such as 68Ga-PSMA-11 and 177Lu-PSMA-617, represent significant milestones in enhancing diagnostic precision and therapeutic efficacy. This review emphasizes the current research status and outcomes of various radionuclide-labeled PSMA ligands. The objective is to provide valuable insights for the continued advancement of diagnostic and therapeutic approaches in the realm of prostate cancer.

Recurrent Prostate Cancer Diagnostics with 18F-PSMA-1007 PET/CT: A Systematic Review of the Current State

BACKGROUND

Early diagnosis of recurrent prostate cancer is a cornerstone for further adequate therapy planning. Therefore, clinical practice and research still focuses on diagnostic tools that can detect prostate cancer in early recurrence when it is undetectable in conventional diagnostic imaging. ¹⁸F-PSMA-1007 PET/CT is a novel method to evaluate patients with biochemical recurrent PCa. The aim of this review was to evaluate the role of ¹⁸F-PSMA-1007 PET/CT in prostate cancer local recurrence, lymph node metastases and bone metastases detection.

METHODS

Original studies, reviews and five meta-analyses were included in this article. A total of 70 studies were retrieved, 31 were included in the study.

RESULTS

All patients described in the studies underwent ¹⁸F-PSMA-1007 PET/CT. The administered ¹⁸F-PSMA-1007 individual dose ranged from 159 ± 31 MBq to 363.93 ± 69.40 MBq. Results showed that ¹⁸F-PSMA-1007 PET/CT demonstrates a good detection rate in recurrent prostate cancer.

CONCLUSIONS

¹⁸F-PSMA-1007 PET/CT appears to achieve reliable performance in detecting recurrent prostate cancer. The high detection rate of ¹⁸F-PSMA-1007 PET/CT in recurrent prostate cancer was confirmed, especially in local recurrence and small lymph nodes with non-specific characteristics on conventional diagnostic imaging methods. However, several authors emphasize some limitations for this tracer-for example, non-specific uptake in bone lesions that can mimic bone metastases.