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Srinivasan R, Cook GJR, Patel N, Subesinghe M. Prostate specific membrane antigen (PSMA) avid nonprostatic benign and malignant disease: a pictorial review. Clin Radiol 2024; 79:639-656. [PMID: 38926052 DOI: 10.1016/j.crad.2024.05.013] [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: 03/12/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Prostate specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET-CT) is revolutionising the management of prostate cancer (PC) in primary staging and assessment of biochemical recurrence (BCR) through its higher diagnostic accuracy compared to both conventional imaging and previously available PET radiopharmaceuticals. PSMA is a transmembrane glycoprotein, highly expressed in prostate cancer, with its extracellular domain the target for PSMA PET radiopharmaceuticals. However, PSMA expression is not prostate specific and resultant PSMA uptake on PET-CT is not restricted to pathologies arising from the prostate gland. The increasing use of PSMA PET-CT has revealed PSMA uptake in a variety of non-prostatic benign and malignant diseases, which adds complexity to PET-CT interpretation and subsequent clinical management. This pictorial review will provide a thorough knowledge and understanding of the comprehensive range of PSMA avid non-prostatic benign and malignant diseases demonstrable on PSMA PET-CT, whilst highlighting the complimentary nature of other imaging modalities.
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Affiliation(s)
- R Srinivasan
- King's College London & Guy's and St Thomas' PET Centre, London, UK; Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - G J R Cook
- King's College London & Guy's and St Thomas' PET Centre, London, UK; Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - N Patel
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Subesinghe
- King's College London & Guy's and St Thomas' PET Centre, London, UK; Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
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2
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Mainta IC, Neroladaki A, Wolf NB, Benamran D, Boudabbous S, Zilli T, Garibotto V. [ 68Ga]Ga-PSMA-11 PET and Prostate Cancer Bone Metastases: Diagnostic Performance of Available Standardized Criteria. J Nucl Med 2024:jnumed.124.267899. [PMID: 39117453 DOI: 10.2967/jnumed.124.267899] [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: 04/15/2024] [Accepted: 07/04/2024] [Indexed: 08/10/2024] Open
Abstract
In up to two thirds of prostate-specific membrane antigen (PSMA) PET scans, unspecific bone uptake has been described. The aim of this study was to estimate the diagnostic accuracy of [68Ga]Ga-PSMA-11 PET/CT for bone metastases and the occurrence of equivocal lesions. Methods: We analyzed retrospectively 118 patients who underwent a [68Ga]Ga-PSMA-11 PET/CT for initial staging or recurrence evaluation. Lesions were interpreted according to the PSMA reporting and data system (PSMA-RADS) and the prostate cancer molecular imaging standardized evaluation (PROMISE) criteria. The SUVmax and the localization of each lesion were recorded. A combination of prior or follow-up examinations was used as a reference standard to categorize benign and malignant lesions. Correlation between the final diagnosis and imaging or clinicobiochemical parameters was tested. The diagnostic accuracy was calculated for different cutoffs of PSMA-RADS criteria, for PROMISE criteria, and the sequential combination of both. Results: In total, 265 bone abnormalities were identified in 70 of 118 patients. Among these, 148 (55.8%) lesions in 50 (42.4%) patients were classified as PSMA-RADS-3B. There were no PSMA-RADS-3D lesions in our cohort. Equivocal lesions were more frequent on the ribs (30.6%) followed by the pelvis (26.5%), but in the ribs, such an uptake was malignant in 33.3% of cases versus 66.7% in the pelvis. A significant association was found between the final diagnosis and the SUVmax, prostate-specific antigen (PSA), PSA doubling time, International Society of Urological Pathology score, and the number of foci. The sensitivity and specificity were 100% and 63.6% for the PSMA-RADS-3B cutoff, respectively; 40.5% and 100% for the PSMA-RADS-4 cutoff, respectively; and 89.3% and 96.6% for both the PROMISE criteria and the sequential PSMA-RADS/PROMISE strategy, respectively. In the sequential method, the number of equivocal lesions was reduced from 147 to 2. We found that 53% of PSMA-RADS-3B lesions were malignant; 95.5% of lesions classified positive by the sequential method were true positives, whereas 32.6% were false negatives. Conclusion: [68Ga]Ga-PSMA-11 PET/CT has high accuracy for the diagnosis of bone metastases. Equivocal lesions constitute nearly half of the lesions seen on PSMA PET. The sequential combination of PSMA-RADS and PROMISE criteria reduces the number of lesions classified as equivocal. PSMA-RADS-3B lesions which are positive according to the PROMISE criteria should be considered highly suggestive of malignancy.
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Affiliation(s)
- Ismini C Mainta
- Division of Nuclear Medicine, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland;
| | - Angeliki Neroladaki
- Division of Radiology, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland
| | - Nicola Bianchetto Wolf
- Division of Nuclear Medicine, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland
| | - Daniel Benamran
- Division of Urology, Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Sana Boudabbous
- Division of Radiology, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland
| | - Thomas Zilli
- Division of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; and
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
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3
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Bakht MK, Beltran H. Biological determinants of PSMA expression, regulation and heterogeneity in prostate cancer. Nat Rev Urol 2024:10.1038/s41585-024-00900-z. [PMID: 38977769 DOI: 10.1038/s41585-024-00900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 07/10/2024]
Abstract
Prostate-specific membrane antigen (PSMA) is an important cell-surface imaging biomarker and therapeutic target in prostate cancer. The PSMA-targeted theranostic 177Lu-PSMA-617 was approved in 2022 for men with PSMA-PET-positive metastatic castration-resistant prostate cancer. However, not all patients respond to PSMA-radioligand therapy, in part owing to the heterogeneity of PSMA expression in the tumour. The PSMA regulatory network is composed of a PSMA transcription complex, an upstream enhancer that loops to the FOLH1 (PSMA) gene promoter, intergenic enhancers and differentially methylated regions. Our understanding of the PSMA regulatory network and the mechanisms underlying PSMA suppression is evolving. Clinically, molecular imaging provides a unique window into PSMA dynamics that occur on therapy and with disease progression, although challenges arise owing to the limited resolution of PET. PSMA regulation and heterogeneity - including intertumoural and inter-patient heterogeneity, temporal changes, lineage dynamics and the tumour microenvironment - affect PSMA theranostics. PSMA response and resistance to radioligand therapy are mediated by a number of potential mechanisms, and complementary biomarkers beyond PSMA are under development. Understanding the biological determinants of cell surface target regulation and heterogeneity can inform precision medicine approaches to PSMA theranostics as well as other emerging therapies.
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Affiliation(s)
- Martin K Bakht
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Himisha Beltran
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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4
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DeSai C, Flynt L, Tewari SO, Lu Y. Enchondroma on Bone Scan and PSMA PET/CT in a Patient With Prostate cancer. Clin Nucl Med 2024; 49:683-684. [PMID: 38537209 DOI: 10.1097/rlu.0000000000005205] [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: 06/05/2024]
Abstract
ABSTRACT A 54-year-old man with Gleason 9 prostate cancer with reported nodal and skeletal metastases was referred to us. Outside hospital reports described abnormal left proximal humerus activity on bone scan concerning for metastasis; however, concurrent PSMA PET/CT did not show activity in this lesion. Further review of the PET/CT images revealed characteristic features of enchondroma in the left humeral lesion.
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Affiliation(s)
- Charisma DeSai
- From the Department of Nuclear Medicine, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center
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5
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Rizzo A, Morbelli S, Albano D, Fornarini G, Cioffi M, Laudicella R, Dondi F, Grimaldi S, Bertagna F, Racca M, Treglia G, Bauckneht M. The Homunculus of unspecific bone uptakes associated with PSMA-targeted tracers: a systematic review-based definition. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06797-5. [PMID: 38884773 DOI: 10.1007/s00259-024-06797-5] [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: 03/14/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Prostate-Specific Membrane Antigen (PSMA)-targeted Positron Emission Tomography (PET) has revolutionised prostate cancer (PCa) diagnosis and treatment, offering superior diagnostic accuracy over traditional methods and enabling theragnostic applications. However, a significant diagnostic challenge has emerged with identifying unspecific bone uptakes (UBUs), which could lead to over-staging and inappropriate treatment decisions if misinterpreted. This systematic review explores the phenomenon of UBUs in PCa patients undergoing PSMA-PET imaging. METHODS Studies assessing the prevalence, topographical distribution, and potential clinical implications of UBUs were selected according to the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) method and evaluated with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS The percentage of PCa patients with UBUs on PSMA-PET scans ranged from 0 to 71.7%, depending on the radiopharmaceutical used, with [18F]PSMA-1007 showing the highest incidence. The ribs are the primary site of UBUs across all PSMA-targeted radiopharmaceuticals. The spine is the second most frequent UBU site for [68Ga]Ga-PSMA-11, [18F]DCFPyL, [18F]rhPSMA-7, while the pelvic girdle represents the second most frequent site for [18F]PSMA-1007. The average maximum Standardized Uptake Value (SUVmax) of UBUs varied from 3.4 to 7.7 and was generally lower than that of bone metastases. CONCLUSIONS Our findings underscore the need for heightened awareness and precise interpretation of UBUs to avoid potential over-staging and subsequent inappropriate treatment decisions. Considering the radiopharmaceutical used, PET-derived semiquantitative parameters, the topographical distribution of UBUs, and accurately evaluating the pre-test probability based on clinical and laboratory parameters may aid nuclear medicine physicians in interpreting PSMA-PET findings.
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Affiliation(s)
- Alessio Rizzo
- Nuclear Medicine, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Silvia Morbelli
- Nuclear Medicine, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
- University of Turin, Turin, Italy
| | - Domenico Albano
- Nuclear Medicine, ASST Spedali Civili of Brescia, Brescia, Italy
- Radiological Sciences and Public Health Department, University of Brescia, Brescia, Italy
| | | | | | - Riccardo Laudicella
- Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesco Dondi
- Nuclear Medicine, ASST Spedali Civili of Brescia, Brescia, Italy
- Radiological Sciences and Public Health Department, University of Brescia, Brescia, Italy
| | - Serena Grimaldi
- Nuclear Medicine, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Bertagna
- Nuclear Medicine, ASST Spedali Civili of Brescia, Brescia, Italy
- Radiological Sciences and Public Health Department, University of Brescia, Brescia, Italy
| | - Manuela Racca
- Nuclear Medicine, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Giorgio Treglia
- Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy.
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6
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Oldan JD, Almaguel F, Voter AF, Duran A, Gafita A, Pomper MG, Hope TA, Rowe SP. PSMA-Targeted Radiopharmaceuticals for Prostate Cancer Diagnosis and Therapy. Cancer J 2024; 30:176-184. [PMID: 38753752 DOI: 10.1097/ppo.0000000000000718] [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: 05/18/2024]
Abstract
ABSTRACT Prostate cancer (PCa) is the most common noncutaneous malignancy in men. Until recent years, accurate imaging of men with newly diagnosed PCa, or recurrent or low-volume metastatic disease, was limited. Further, therapeutic options for men with advanced, metastatic, castration-resistant disease were increasingly limited as a result of increasing numbers of systemic therapies being combined in the upfront metastatic setting. The advent of urea-based, small-molecule inhibitors of prostate-specific membrane antigen (PSMA) has partially addressed those shortcomings in diagnosis and therapy of PCa. On the diagnostic side, there are multiple pivotal phase III trials with several different agents having demonstrated utility in the initial staging setting, with generally modest sensitivity but very high specificity for determining otherwise-occult pelvic nodal involvement. That latter statistic drives the utility of the scan by allowing imaging interpreters to read with very high sensitivity while maintaining a robust specificity. Other pivotal phase III trials have demonstrated high detection efficiency in patients with biochemical failure, with high positive predictive value at the lesion level, opening up possible new avenues of therapy such as metastasis-directed therapy. Beyond the diagnostic aspects of PSMA-targeted radiotracers, the same urea-based chemical scaffolds can be altered to deliver therapeutic isotopes to PCa cells that express PSMA. To date, one such agent, when combined with best standard-of-care therapy, has demonstrated an ability to improve overall survival, progression-free survival, and freedom from skeletal events relative to best standard-of-care therapy alone in men with metastatic, castration-resistant PCa who are post chemotherapy. Within the current milieu, there are a number of important future directions including the use of artificial intelligence to better leverage diagnostic findings, further medicinal chemistry refinements to the urea-based structure that may allow improved tumor targeting and decreased toxicities, and the incorporation of new radionuclides that may better balance efficacy with toxicities than those nuclides that are available.
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Affiliation(s)
- Jorge D Oldan
- From the Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Frankis Almaguel
- Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA
| | - Andrew F Voter
- The Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alfonso Duran
- Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA
| | - Andrei Gafita
- The Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martin G Pomper
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Steven P Rowe
- From the Department of Radiology, University of North Carolina, Chapel Hill, NC
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7
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Moran S, Cheng HH, Weg E, Kim EH, Chen DL, Iravani A, Ippolito JE. Prostate-specific membrane antigen-positron emission tomography (PSMA-PET) of prostate cancer: current and emerging applications. Abdom Radiol (NY) 2024; 49:1288-1305. [PMID: 38386156 DOI: 10.1007/s00261-024-04188-w] [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: 02/11/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 02/23/2024]
Abstract
Prostate-specific membrane antigen-positron emission tomography (PSMA-PET) is transforming the management of patients with prostate cancer. In appropriately selected patients, PSMA-PET offers superior sensitivity and specificity compared to conventional imaging (e.g., computed tomography and bone scintigraphy) as well as choline and fluciclovine PET, with the added benefit of consolidating bone and soft tissue evaluation into a single study. Despite being a newly available imaging tool, PSMA-PET has established indications, interpretation guidelines, and reporting criteria, which will be reviewed. The prostate cancer care team, from imaging specialists to those delivering treatment, should have knowledge of physiologic PSMA radiotracer uptake, patterns of disease spread, and the strengths and limitations of PSMA-PET. In this review, current and emerging applications of PSMA-PET, including appropriateness use criteria as well as image interpretation and pitfalls, will be provided with an emphasis on clinical implications.
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Affiliation(s)
- Shamus Moran
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Emily Weg
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Eric H Kim
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Delphine L Chen
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Amir Iravani
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 4559 Scott Ave., Mail Stop Code: 8131, St. Louis, MO, 63110, USA.
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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8
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McKone EL, Sutton EA, Johnson GB, Phillips RM. Application of Advanced Imaging to Prostate Cancer Diagnosis and Management: A Narrative Review of Current Practice and Unanswered Questions. J Clin Med 2024; 13:446. [PMID: 38256579 PMCID: PMC10816977 DOI: 10.3390/jcm13020446] [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: 12/15/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Major advances in prostate cancer diagnosis, staging, and management have occurred over the past decade, largely due to our improved understanding of the technical aspects and clinical applications of advanced imaging, specifically magnetic resonance imaging (MRI) and prostate-cancer-specific positron emission tomography (PET). Herein, we review the established utility of these important and exciting technologies, as well as areas of controversy and uncertainty that remain important areas for future study. There is strong evidence supporting the utility of MRI in guiding initial biopsy and assessing local disease. There is debate, however, regarding how to best use the imaging modality in risk stratification, treatment planning, and assessment of biochemical failure. Prostate-cancer-specific PET is a relatively new technology that provides great value to the evaluation of newly diagnosed, treated, and recurrent prostate cancer. However, its ideal use in treatment decision making, staging, recurrence detection, and surveillance necessitates further research. Continued study of both imaging modalities will allow for an improved understanding of their best utilization in improving cancer care.
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Affiliation(s)
| | - Elsa A. Sutton
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Geoffrey B. Johnson
- Department of Radiology, Nuclear Medicine Division, Mayo Clinic, Rochester, MN 55905, USA
| | - Ryan M. Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Mohseninia N, Zamani-Siahkali N, Harsini S, Divband G, Pirich C, Beheshti M. Bone Metastasis in Prostate Cancer: Bone Scan Versus PET Imaging. Semin Nucl Med 2024; 54:97-118. [PMID: 37596138 DOI: 10.1053/j.semnuclmed.2023.07.004] [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: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 08/20/2023]
Abstract
Prostate cancer is the second most common cause of malignancy among men, with bone metastasis being a significant source of morbidity and mortality in advanced cases. Detecting and treating bone metastasis at an early stage is crucial to improve the quality of life and survival of prostate cancer patients. This objective strongly relies on imaging studies. While CT and MRI have their specific utilities, they also possess certain drawbacks. Bone scintigraphy, although cost-effective and widely available, presents high false-positive rates. The emergence of PET/CT and PET/MRI, with their ability to overcome the limitations of standard imaging methods, offers promising alternatives for the detection of bone metastasis. Various radiotracers targeting cell division activity or cancer-specific membrane proteins, as well as bone seeking agents, have been developed and tested. The use of positron-emitting isotopes such as fluorine-18 and gallium-68 for labeling allows for a reduced radiation dose and unaffected biological properties. Furthermore, the integration of artificial intelligence (AI) and radiomics techniques in medical imaging has shown significant advancements in reducing interobserver variability, improving accuracy, and saving time. This article provides an overview of the advantages and limitations of bone scan using SPECT and SPECT/CT and PET imaging methods with different radiopharmaceuticals and highlights recent developments in hybrid scanners, AI, and radiomics for the identification of prostate cancer bone metastasis using molecular imaging.
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Affiliation(s)
- Nasibeh Mohseninia
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Department of Nuclear Medicine, Research center for Nuclear Medicine and Molecular Imaging, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Harsini
- Department of Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | | | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria.
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Lu Y, Wilson ZJ, Xu G, Xu Z, Pan T, Wei P. Diagnostic Performance of PSMA-Based 18 F-DCFPyL PET/CT in Prostate Cancer Patients After Definitive Treatment With PSA Level ≤0.2 ng/mL. Clin Nucl Med 2023; 48:1021-1027. [PMID: 37801580 DOI: 10.1097/rlu.0000000000004893] [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: 10/08/2023]
Abstract
PURPOSE The aim of this study was to investigate the role of 18 F-DCFPyL PET/CT in the evaluation of prostate cancer (PC) patients after definitive treatment and with low-level prostate-specific antigen (PSA) level of ≤0.2 ng/mL. PATIENTS AND METHODS This retrospective study was conducted in PC patients who received definitive treatments with PSA level of ≤0.2 ng/mL and underwent 18 F-DCFPyL PET/CT within a 1-week interval of PSA examination, and without interval treatment change or history of other cancer. Patient and tumor characteristics at initial diagnosis, treatment regimens, and findings on 18 F-DCFPyL PET/CT were collected. Patients with minimal 6-month (median, 11 months; range, 6-21 months) follow-up or definitive biopsy results of the suspected PET/CT findings were included. Imagine findings were reached with consensus among experienced board-certified nuclear medicine physicians. Comprehensive follow-up and/or biopsy results were used as definitive determination of presence or absence of disease. Comparisons between groups of positive and negative 18 F-DCFPyL PET/CT were done by using descriptive statistics. RESULTS A total of 96 18 F-DCFPyL PET/CTs from 93 patients met the inclusion criteria. The median Gleason score (GS) of positive group is 8 (range, 6-10), whereas negative group is 7 (range, 6-10). The median age of positive group is 71 (range, 50-90), whereas negative group is 69 (range, 45-88). There were 49 positive (51%) and 47 negative 18 F-DCFPyL PET/CTs (49%). Detection rates at PSA level of ≤0.1 and 0.2 ng/mL were 58.7% (27/46) and 44% (22/50), respectively. The scan-based sensitivity, specificity, positive predictive value, and negative predictive value are 100%, 95%, 96%, and 100% in group with PSA level of ≤0.1 ng/mL, and 100%, 97%, 95%, and 100% in group with PSA level of 0.2 ng/mL, respectively. Sites of involvement on positive 18 F-DCFPyL PET/CTs were prostate bed, pelvic lymph nodes, bone, chest and supraclavicular lymph nodes, lung, and adrenal glands. The SUV max value on positive lesions ranged from 1.9 to 141.4; the smallest positive lymph node was 0.4 cm. High GS of 8-10, known metastatic status (M1), presence of extraprostatic extension, presence of seminal vesicle invasion, and very high-risk PC are significantly associated with positive 18 F-DCFPyL PET/CT results ( P < 0.05). Of all analyzed treatment regimes, upfront surgery (radical prostatectomy with or without pelvic lymph node dissection) had strong correlation with negative PET/CT results ( P < 0.001). If patients received ADT only, or ADT plus chemotherapy, the PET/CT results were most likely positive ( P = 0.026). For other treatment regimes, there were no statistical differences between the groups ( P > 0.05). CONCLUSIONS In the presence of low PSA level in PC patients after definitive treatment, 18 F-DCFPyL PET/CT is most beneficial in detection of disease in patients with GS of 8 or higher at the time of diagnosis, and the ones who have history of ADT only, or ADT plus chemotherapy. There is excellent negative prediction value of 18 F-DCFPyL PET/CT. However, there is no cutoff PSA level for 18 F-DCFPyL PET/CT indication and no correlation between PSA level and SUV max of positive lesions on 18 F-DCFPyL PET/CT.
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Affiliation(s)
- Yang Lu
- From the Division of Diagnostic Imaging, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center
| | | | - Guofan Xu
- From the Division of Diagnostic Imaging, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center
| | | | - Tinsu Pan
- Division of Diagnostic Imaging, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Ninatti G, Pini C, Gelardi F, Ghezzo S, Mapelli P, Picchio M, Antunovic L, Briganti A, Montorsi F, Landoni C, Sollini M, Chiti A. The potential role of osteoporosis in unspecific [ 18F]PSMA-1007 bone uptake. Eur J Nucl Med Mol Imaging 2023; 51:304-311. [PMID: 37698646 DOI: 10.1007/s00259-023-06424-9] [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: 06/12/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
AIM Unspecific bone uptake is one of the main limitations of PET imaging with some PSMA-targeting radiopharmaceuticals, especially with [18F]PSMA-1007. We explored the potential association between osteoporosis and the occurrence of unspecific [18F]PSMA-1007 bone uptake investigating markers which might correlate with bone mineral density. MATERIALS AND METHODS We retrospectively analyzed treatment-naïve patients with a confirmed diagnosis of prostate adenocarcinoma who underwent staging [18F]PSMA-1007 positron emission tomography (PET). Qualitative image analysis was performed independently by three experienced nuclear medicine physicians. Patients were divided in two groups according to the presence/absence of unspecific bone uptake. Clinical information, blood count parameters (assessed within 3 months to the PET scan), body mass index (BMI), and bone density as estimated by computed tomography were collected. The Kruskal-Wallis and t-test were used to compare parameters. RESULTS We analyzed 77 patients: 29 of them (38%) had unspecific bone uptake at [18F]PSMA-1007 PET, most commonly in the pelvic bones (69%) and ribs (62%). We did not find any significant difference in clinical parameters in the two groups. In patients with unspecific bone uptake, white blood cell, and neutrophil counts were significantly higher; in the same group, we observed lower values of BMI and bone density, although not statistically different. CONCLUSIONS We observed unspecific bone uptake on [18F]PSMA-1007 PET in more than 1/3 of patients. In this exploratory analysis, we found a significant correlation between blood count parameters and unspecific [18F]PSMA-1007 bone uptake. We may speculate that [18F]PSMA-1007 unspecific bone uptake could be associated with osteoporosis. This hypothesis needs to be further investigated in larger populations and exploring more specific markers of osteoporosis.
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Affiliation(s)
- Gaia Ninatti
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristiano Pini
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Fabrizia Gelardi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Samuele Ghezzo
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Mapelli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Picchio
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Lidija Antunovic
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele, Milan, Italy
| | - Claudio Landoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Nuclear Medicine Department, IRCCS Monza, San Gerardo Hospital, Monza, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Nuclear Medicine-IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Arturo Chiti
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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12
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Houshmand S, Lawhn-Heath C, Behr S. PSMA PET imaging in the diagnosis and management of prostate cancer. Abdom Radiol (NY) 2023; 48:3610-3623. [PMID: 37493837 PMCID: PMC10682054 DOI: 10.1007/s00261-023-04002-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/27/2023]
Abstract
Prostate cancer is the second leading cause of cancer-related deaths in men in the United States. Imaging techniques such as CT, MRI, and bone scans have traditionally been used for diagnosis and staging. Molecular imaging modalities targeting the prostate-specific membrane antigen (PSMA) have recently gained attention due to their high affinity and accuracy. PSMA PET has been combined with other modalities such as multiparametric MRI for better diagnostic and prognostic performance. PSMA imaging has been studied at different clinical settings with a wide range of disease aggressiveness. In this review we will explore the role of PSMA PET in high-risk prostate cancer staging, biochemical recurrence, and castration-resistant prostate cancer. The primary focus of this review article is to examine the latest developments in the use of PSMA imaging and emphasize the clinical situations where its effectiveness has been demonstrated to significantly impact the treatment of prostate cancer. In addition, we will touch upon the potential future advancements of PSMA PET imaging and its evolving significance in the management of prostate cancer.
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Affiliation(s)
- Sina Houshmand
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Spencer Behr
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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13
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Vanden Berg RNW, Zilli T, Achard V, Dorff T, Abern M. The diagnosis and treatment of castrate-sensitive oligometastatic prostate cancer: A review. Prostate Cancer Prostatic Dis 2023; 26:702-711. [PMID: 37422523 DOI: 10.1038/s41391-023-00688-w] [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: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Oligometastatic prostate cancer (OMPCa) is emerging as a transitional disease state between localized and polymetastatic disease. This review will assess the current knowledge of castrate-sensitive OMPCa. METHODS A review of the current literature was performed to summarize the definition and classification of OMPCa, assess the diagnostic methods and imaging modalities utilized, and to review the treatment options and outcomes. We further identify gaps in knowledge and areas for future research. RESULTS Currently there is no unified definition of OMPCa. National guidelines mostly recommend systemic therapies without distinguishing oligometastatic and polymetastatic disease. Next generation imaging is more sensitive than conventional imaging and has led to early detection of metastases at initial diagnosis or recurrence. While mostly retrospective in nature, recent studies suggest that treatment (surgical or radiation) of the primary tumor and/or metastatic sites might delay initiation of androgen deprivation therapy while increasing survival in selected patients. CONCLUSIONS Prospective data are required to better assess the incremental improvement in survival and quality of life achieved with various treatment strategies in patients with OMPCa.
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Affiliation(s)
| | - Thomas Zilli
- Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vérane Achard
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland
| | - Tanya Dorff
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Michael Abern
- Department of Urology, Duke University, Durham, NC, USA.
- Duke Cancer Institute, Durham, NC, USA.
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14
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Ulaner GA, Thomsen B, Bassett J, Torrey R, Cox C, Lin K, Patel T, Techasith T, Mauguen A, Rowe SP, Lindenberg L, Mena E, Choyke P, Yoshida J. 18F-DCFPyL PET/CT for Initially Diagnosed and Biochemically Recurrent Prostate Cancer: Prospective Trial with Pathologic Confirmation. Radiology 2022; 305:419-428. [PMID: 35852431 PMCID: PMC9619197 DOI: 10.1148/radiol.220218] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 08/26/2023]
Abstract
Background Prostate-specific membrane antigen (PSMA) PET is standard for newly diagnosed high-risk and biochemically recurrent (BCR) prostate cancer. Although studies suggest high specificity of 2-(3-{1-carboxy-5-[(6-[(18)F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (DCFPyL) for targeting PSMA, false-positive findings have been identified and most studies lack histologic confirmation of malignancy. Purpose To estimate the positive predictive value (PPV) of DCFPyL PET/CT by providing histopathologic proof for DCFPyL-avid lesions suspected of being distant metastases at initial diagnosis and recurrence in BCR prostate cancer. Materials and Methods In this prospective trial, men with newly diagnosed high-risk prostate cancer (sample 1) or BCR prostate cancer and negative findings at conventional CT and/or bone scanning (sample 2) were enrolled between January and December 2021. All men underwent DCFPyL PET/CT. Suspected distant metastases and/or recurrences were biopsied. PPV was calculated. Results A total of 92 men with newly diagnosed prostate cancer (median age, 70 years; IQR, 64-75 years) (sample 1) and 92 men with BCR prostate cancer (median age, 71 years; IQR, 66-75 years) (sample 2) were enrolled. In sample 1, 25 of the 92 men (27%) demonstrated DCFPyL-avid lesions suspicious for distant metastases. Biopsy was performed in 23 of the 25 men (92%), with 17 of the 23 (74%) biopsies positive for malignancy and six (26%) benign. Of the six benign biopsies, three were solitary rib foci and three were solitary pelvic bone foci. In sample 2, 57 of the 92 men (62%) demonstrated DCFPyL-avid lesions suspicious for recurrence. Biopsy was performed in 37 of the 57 men (65%), with 33 of the 37 (89%) biopsies positive for malignancy and four (11%) benign. Of the four benign biopsies, two were subcentimeter pelvic nodes and/or nodules, one was a rib, and one was a pelvic bone focus. Conclusion PET/CT with 2-(3-{1-carboxy-5-[(6-[(18)F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (DCFPyL) had a high biopsy-proven positive predictive value for distant metastases in newly diagnosed prostate cancer (74%) and for recurrence sites in men with biochemical recurrence (89%). However, there were DCFPyL-avid false-positive findings (particularly in ribs and pelvic bones). Solitary DCFPyL avidity in these locations should not be presumed as malignant. Biopsy may still be needed prior to therapy decisions. ClinicalTrials.gov registration no. NCT04700332 © RSNA, 2022 See also the editorial by Zukotynski and Kuo in this issue.
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Affiliation(s)
- Gary A. Ulaner
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Beth Thomsen
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Jeffrey Bassett
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Robert Torrey
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Craig Cox
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Kevin Lin
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Trushar Patel
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Tust Techasith
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Audrey Mauguen
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Steven P. Rowe
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Liza Lindenberg
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Esther Mena
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Peter Choyke
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Jeffrey Yoshida
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
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15
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Letang A, Crombé A, Rousseau C, Sargos P, Merlin C, Cantarel C, Cazeau AL. Bone Uptake in Prostate Cancer Patients: Diagnostic Performances of PSMA-RADS v1.0, Clinical, Biological, and 68 Ga-PSMA-11 PET Features to Predict Metastasis After Biochemical Recurrence. Clin Nucl Med 2022; 47:e529-e539. [PMID: 35543633 DOI: 10.1097/rlu.0000000000004259] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE 68 Gallium-labeled prostate-specific membrane antigen-11 (PSMA) PET/CT is the new reference to identify relapse during biochemical recurrence of prostate cancer (PCa). However, this method lacks specificity for bone foci. This study aimed to report the prevalence of PCa bone metastases and to assess the diagnostic performances of PSMA reporting and data systems (RADS), clinical, biological, and imaging features for identification. PATIENTS AND METHODS A multicentric retrospective cohort of consecutive patients with biochemical recurrence after local treatment was analyzed. Clinical and biological features at initial staging and during recurrence were retrieved from medical reports. The metastatic status of each bone uptake on PSMA PET/CT was determined according to histopathology, comparisons with concomitant and previous conventional imaging, prostate-specific antigen kinetic, and follow-up. Two nuclear medicine physicians assessed PSMA-RADS, anatomic location, radiological patterns, SUV max , and the presence of other molecular lesions. Univariate and multivariate analyses were conducted to identify independent predictors of PCa metastases. RESULTS In the eligible population, 98/298 patients (32.9%) showed bone uptake on PSMA PET/CT. In patients with a final diagnosis, 28/81 lesions (34.6%) were metastases. PSMA-RADS-4 or 5 showed sensitivity of 79%, specificity of 94%, and accuracy of 89%. PSMA-RADS had a significantly higher area under the receiver operating characteristic curve than the initial reading in clinical practice (0.91 vs 0.83, P = 0.0074). Initial Gleason score ≥8, age ≤71 years at recurrence, and SUV max >6.21 were independent predictors of PCa metastases in multivariate logistic regression ( P = 0.0314, 0.0179, and 0.0003, respectively). CONCLUSIONS Most bone uptakes at PSMA PET/CT were benign lesions. PSMA-RADS, patients and tumor characteristics, and SUV max could help identify PCa bone metastases.
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Affiliation(s)
| | | | - Caroline Rousseau
- ICO René Gauducheau, F-44800 Saint-Herblain, Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000 Nantes
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux
| | - Charles Merlin
- Department of Nuclear Medicine, Centre Jean Perrin Cancer Center, Clermont-Ferrand
| | - Coralie Cantarel
- Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
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16
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Orevi M, Ben-Haim S, Abourbeh G, Chicheportiche A, Mishani E, Yutkin V, Gofrit ON. False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA Levels. Front Surg 2022; 9:943760. [PMID: 35813044 PMCID: PMC9263625 DOI: 10.3389/fsurg.2022.943760] [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: 05/14/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background PET-CT using prostate-specific membrane antigen (PSMA)-targeting radiopharmaceuticals labeled with 68Ga or 18F has emerged as the most sensitive staging tool in prostate cancer (PC). Nonetheless, the occurrence of false positive (FP) findings presents a major concern of this approach. In this prospective study, we investigated the frequency and pattern of false-positive findings of [18F]PSMA-1007 PET/CT in patients after radical prostatectomy with undetectable serum PSA levels. Any discrete non-physiological accumulation of [18F]PSMA-1007 in this population is by definition FP. Methods Seventeen men after radical prostatectomy, whose serum PSA levels were <0.05 ng/mL at 2–24 months after surgery were prospectively recruited. PET/CT was acquired at both 1 and 2 h after injection of [18F]PSMA-1007. Findings Three studies (18%) were interpreted as completely normal. Thirty-five foci of “non-physiological” uptake were observed in the remaining 14 (82%) patients, including a single skeletal focus in four patients, multiple skeletal foci in five patients and soft tissue uptake in eight, including in a desmoid tumor and in pelvic lymphocele. The SUVmax of all lesions was in the range of 1–7, except for the desmoid tumor which measured 12.7. All foci were visible in both the 1- and the 2 h studies, presenting a minor (<10%), statistically insignificant increase of SUVmax during this time-interval. Interpretation FP [18F]PSMA-1007-avid foci are found in about 80% of patients with undetectable serum PSA levels. Thus, focal uptake of [18F]PSMA-1007 outside its physiological distribution is not a categorical sign of metastasis and can arise from non-specific uptake of the ligand. The interpretation of [18F]PSMA-1007 PET/CT studies should always consider the clinical context, and lesions with SUVmax < 7 are suspicious for FP.
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Affiliation(s)
- Marina Orevi
- Department of Nuclear Medicine and Medical Biophysics, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Simona Ben-Haim
- Department of Nuclear Medicine and Medical Biophysics, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
- University College London and UCL Hospitals, NHS Trust, London, United Kingdom
| | - Galith Abourbeh
- Cyclotron/Radiochemistry Unit, Hadassah Medical Center, Jerusalem, Israel
| | | | - Eyal Mishani
- Cyclotron/Radiochemistry Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Ofer N. Gofrit
- Department of Urology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
- Correspondence: Ofer N. Gofrit
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17
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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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Vollnberg B, Alberts I, Genitsch V, Rominger A, Afshar-Oromieh A. Assessment of malignancy and PSMA expression of uncertain bone foci in [ 18F]PSMA-1007 PET/CT for prostate cancer-a single-centre experience of PET-guided biopsies. Eur J Nucl Med Mol Imaging 2022; 49:3910-3916. [PMID: 35482114 PMCID: PMC9399054 DOI: 10.1007/s00259-022-05745-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/19/2022] [Indexed: 11/20/2022]
Abstract
Purpose Uncertain focal bone uptake (UBU) with intensive radiopharmaceutical avidity are frequently observed in patients undergoing [18F]PSMA-1007 PET/CT for the detection of prostate cancer (PC). Such foci can pose diagnostic conundrums and risk incorrect staging. The aim of this short communication is to share the results of PET-guided biopsies of such foci. Methods A retrospective analysis revealed 10 patients who were referred to our department for PET-guided biopsy of UBU visible in a previous [18F]PSMA-1007 PET/CT. [18F]-PSMA-1007 PET-guided biopsy was conducted for 11 PSMA-avid bone foci in these 10 patients. The biopsy materials were analysed for tissue typing, and immunohistochemistry (IHC) was performed for prostate-specific-membrane-antigen (PSMA) expression. The scans were analysed by two experienced physicians in a consensus read for clinical characteristics and radiopharmaceutical uptake of foci. Results One out of 11 (9.1%) of the foci biopsied was confirmed as bone metastasis of PC with intense PSMA-expression, while 10/11 (90.9%) foci were revealed to be unremarkable bone tissue without evidence of PSMA expression at IHC. Amongst all bone foci assessed by biopsy, eight were visually classified as being at high risk of malignancy in the PET/CT (SUVmean 12.0 ± 8.1; SUVmax 18.8 ± 13.1), three as equivocal (SUVmean 4.6 ± 2.1; SUVmax 7.2 ± 3.0) and zero as low risk. No UBU had any CT correlate. Conclusions This cohort biopsy revealed that a small but relevant number of UBU are true metastases. For those confirmed as benign, no PSMA expression at IHC was observed, suggesting a non-PSMA mediated cause for intensive [18F]PSMA-1007 uptake of which the reason remains unclear. Readers must interpret such foci with caution in order to reduce the risk of erroneous staging and subsequent treatment. PET-guided biopsy, particularly in the absence of morphological changes in the CT, can be a useful method to clarify such foci. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05745-5.
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Affiliation(s)
- Bernd Vollnberg
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Vera Genitsch
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland.
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Simon NI, Parker C, Hope TA, Paller CJ. Best Approaches and Updates for Prostate Cancer Biochemical Recurrence. Am Soc Clin Oncol Educ Book 2022; 42:1-8. [PMID: 35503984 PMCID: PMC9844546 DOI: 10.1200/edbk_351033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Biochemical recurrence develops in almost one-third of men with prostate cancer after treatment with local therapy. There are numerous options for management, including surveillance, salvage radiation, androgen deprivation therapy (ADT), and clinical trials. This article reviews the current approaches to radiation therapy, ADT, and molecular imaging in men with biochemically recurrent prostate cancer. First, radiation therapy, including selection of field, dose, and use of concurrent antiandrogen therapy, is reviewed. Next, molecular imaging is addressed, including prostate-specific membrane antigen PET imaging and its increased sensitivity in identifying sites of disease. Finally, the factors associated with starting ADT are explored, and the data supporting intermittent over continuous ADT are reviewed. Lastly, the use of prostate-specific membrane antigen PET imaging and its potential role influencing therapy are discussed.
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Affiliation(s)
- Nicholas I Simon
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Chris Parker
- Royal Marsden NHS Foundation Trust, London, United Kingdom
- Institute of Cancer Research, London, United Kingdom
| | - Thomas A Hope
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Department of Radiology, San Francisco VA Medical Center, San Francisco, CA
| | - Channing J Paller
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD
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Franquet E, Park H. Molecular imaging in oncology: Common PET/CT radiopharmaceuticals and applications. Eur J Radiol Open 2022; 9:100455. [DOI: 10.1016/j.ejro.2022.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/26/2022] Open
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21
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Kesler M, Kerzhner K, Druckmann I, Kuten J, Levine C, Sarid D, Keizman D, Yossepowitch O, Even-Sapir E. Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement. Eur J Nucl Med Mol Imaging 2021; 49:2077-2085. [PMID: 34957528 DOI: 10.1007/s00259-021-05655-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the study was to elaborate the incidence and type of skeletal involvement in a large cohort of patients with newly diagnosed prostate cancer (PCa) referred for Ga-68 PSMA-11 PET/CT staging in a single center. METHODS Study cohort included 963 consecutive patients with newly diagnosed PCa referred for Ga-68 PSMA-11 PET/CT study for staging. The incidence of bone involvement, type of bone metastases, and extent of disease were determined and correlated with the ISUP Grade Group (GG) criteria and PSA levels. RESULTS Bone metastases were found in 188 (19.5%) of 963 patients. Bone metastases were found in 10.7% of patients with PSA < 10 ng/dL and in 27.4% of patients with PSA > 10 ng/dL and in 6.1% of patients with GG ≤ 2/3 and in 8.9% of patients with GG 4/5. In 7.6% of the patients, skeletal involvement was extensive, while 11.9% of patients had oligometastatic disease. Osteoblastic type metastases were the most common type of bone metastases presented in 133 of the patients with malignant bone involvement (70.7%). More than half of them had only osteoblastic lesions (72 patients (38.3%)), while the other (61 patients (32.5%)) had also intramedullary and/or osteolytic type lesions. Intramedullary metastases were found in 97 patients (51.6%), while 41 (21.8%) of them were only intramedullary lesions. Osteolytic metastases were detected in 36 patients (19.2%), of which 8 were only osteolytic lesions. CONCLUSION Although traditionally bone metastases of PCa are considered osteoblastic, osteolytic and intramedullary metastases are common, as identified on PET with labeled PSMA. Skeletal spread may be present also in patients with GG ≤ 2/3 and PSA < 10 ng/dL.
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Affiliation(s)
- Mikhail Kesler
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Kosta Kerzhner
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Ido Druckmann
- Department of Radiology-Musculoskeletal Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel
| | - Jonathan Kuten
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Charles Levine
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - David Sarid
- Department of Oncology (Uro-Oncology Section), Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, 6423906, Tel Aviv, Israel
| | - Daniel Keizman
- Department of Oncology (Uro-Oncology Section), Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, 6423906, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
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22
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Arnfield EG, Thomas PA, Roberts MJ, Pelecanos AM, Ramsay SC, Lin CY, Latter MJ, Garcia PL, Pattison DA. Clinical insignificance of [ 18F]PSMA-1007 avid non-specific bone lesions: a retrospective evaluation. Eur J Nucl Med Mol Imaging 2021; 48:4495-4507. [PMID: 34136957 DOI: 10.1007/s00259-021-05456-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE [18F]PSMA-1007 offers advantages of low urinary tracer excretion and theoretical improved spatial resolution for imaging prostate cancer. However, non-specific bone lesions (NSBLs), defined as mild to moderate focal bone uptake without a typical morphological correlate on CT, are a common finding on [18F]PSMA-1007 PET/CT. The purpose of this study was to investigate the clinical outcomes of patients with [18F]PSMA-1007 avid NSBLs, to determine whether patients with NSBLs represent a higher risk clinical cohort, and to determine whether SUVmax can be used as a classifier of bone metastasis. METHODS A retrospective audit of 214 men with prostate cancer was performed to investigate the clinical outcomes of [18F]PSMA-1007 avid NSBLs according to defined criteria. We also compared the serum PSA, Gleason score, and uptake time of patients with [18F]PSMA-1007 avid NSBLs to patients without [18F]PSMA-1007 avid bone lesions. Finally, we analysed an SUVmax threshold to identify bone metastases using ROC curve analysis. RESULTS Ninety-four of 214 patients (43.9%) demonstrated at least one NSBL. No [18F]PSMA-1007 avid NSBLs met criteria for a likely malignant or definitely malignant lesion after a median 15.8-month follow-up interval (11.9% definitely benign, 50.3% likely benign, and 37.7% equivocal). There were no statistically significant differences in serum PSA, Gleason score, and uptake time between patients with [18F]PSMA-1007 avid NSBLs and those without [18F]PSMA-1007 avid bone lesions. All NSBLs with adequate follow-up had SUVmax ≤ 11.1. The value of the highest SUVmax distinguished between NSBLs and definite prostate cancer bone metastases, whereby an SUVmax threshold of ≥ 7.2 maximized the Youden's index. CONCLUSION [18F]PSMA-1007 avid NSBLs rarely represent prostate cancer bone metastases. When identified in the absence of definite metastatic disease elsewhere, it is appropriate to classify those with SUVmax < 7.2 as likely benign. NSBLs with SUVmax 7.2-11.1 may be classified as equivocal or metastatic, with patient clinical risk factors, scan appearance, and potential management implications used to guide interpretation.
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Affiliation(s)
- Evyn G Arnfield
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Paul A Thomas
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Department of Urology, Redcliffe Hospital, Redcliffe, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Anita M Pelecanos
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Stuart C Ramsay
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Medicine, James Cook University, Townsville, Australia
| | - Charles Y Lin
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Melissa J Latter
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Peter L Garcia
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David A Pattison
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Song H, Iagaru A, Rowe SP. 18F DCFPyL PET Acquisition, Interpretation and Reporting: Suggestions Post Food and Drug Administration Approval. J Nucl Med 2021; 63:855-859. [PMID: 34531266 DOI: 10.2967/jnumed.121.262989] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
18F-DCFPyL was recently approved by the FDA for evaluation prior to definitive therapy and for biochemical recurrence. Here we focus on the key data that justify the clinical use of 18F-DCFPyL, as well as those aspects of protocol implementation and image interpretation that are important to the nuclear medicine physicians and radiologists who will interpret 18F-DCFPyL PET/CT and PET/MR scans.
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