1
|
Evangelista L, Filippi L. Structured reporting in prostate cancer: the revolution of quality in nuclear medicine scan interpretation. Eur Radiol 2024; 34:1155-1156. [PMID: 38123691 DOI: 10.1007/s00330-023-10507-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
| | - Luca Filippi
- Nuclear Medicine Unit, Department of Oncohaematology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Werner RA, Hartrampf PE, Fendler WP, Serfling SE, Derlin T, Higuchi T, Pienta KJ, Gafita A, Hope TA, Pomper MG, Eiber M, Gorin MA, Rowe SP. Prostate-specific Membrane Antigen Reporting and Data System Version 2.0. Eur Urol 2023; 84:491-502. [PMID: 37414701 DOI: 10.1016/j.eururo.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/19/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
Prostate-specific Membrane Antigen Reporting and Data System (PSMA-RADS) was introduced for standardized reporting, and PSMA-RADS version 1.0 allows classification of lesions based on their likelihood of representing a site of prostate cancer on PSMA-targeted positron emission tomography (PET). In recent years, this system has extensively been investigated. Increasing evidence has accumulated that the different categories reflect their actual meanings, such as true positivity in PSMA-RADS 4 and 5 lesions. Interobserver agreement studies demonstrated high concordance among a broad spectrum of 68Ga- or 18F-labeled, PSMA-directed radiotracers, even for less experienced readers. Moreover, this system has also been applied to challenging clinical scenarios and to assist in clinical decision-making, for example, to avoid overtreatment in oligometastatic disease. Nonetheless, with an increasing use of PSMA-RADS 1.0, this framework has shown not only benefits, but also limitations, for example, for follow-up assessment of locally treated lesions. Thus, we aimed to update the PSMA-RADS framework to include a refined set of categories in order to optimize lesion-level characterization and best assist in clinical decision-making (PSMA-RADS version 2.0).
Collapse
Affiliation(s)
- Rudolf A Werner
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany; The Russell H Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philipp E Hartrampf
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany; Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kenneth J Pienta
- The Brady Urological Institute Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Andrei Gafita
- The Russell H Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Martin G Pomper
- The Russell H Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Brady Urological Institute Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven P Rowe
- The Russell H Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Brady Urological Institute Johns Hopkins School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
4
|
Khojasteh E, Dehdashti F, Shokeen M. Molecular imaging of bone metastasis. J Bone Oncol 2023; 40:100477. [PMID: 37193117 PMCID: PMC10182320 DOI: 10.1016/j.jbo.2023.100477] [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: 01/30/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 05/18/2023] Open
Abstract
Recent advances in molecularly targeted modular designs for in vivo imaging applications has thrusted open possibilities of investigating deep molecular interactions non-invasively and dynamically. The shifting landscape of biomarker concentration and cellular interactions throughout pathological progression requires quick adaptation of imaging agents and detection modalities for accurate readouts. The synergy of state of art instrumentation with molecularly targeted molecules is resulting in more precise, accurate and reproducible data sets, which is facilitating investigation of several novel questions. Small molecules, peptides, antibodies and nanoparticles are some of the commonly used molecular targeting vectors that can be applied for imaging as well as therapy. The field of theranostics, which encompasses joint application of therapy and imaging, is successfully leveraging the multifunctional use of these biomolecules [[1], [2]]. Sensitive detection of cancerous lesions and accurate assessment of treatment response has been transformative for patient management. Particularly, since bone metastasis is one of the dominant causes of morbidity and mortality in cancer patients, imaging can be hugely impactful in this patient population. The intent of this review is to highlight the utility of molecular positron emission tomography (PET) imaging in the context of prostate and breast bone metastatic cancer, and multiple myeloma. Furthermore, comparisons are drawn with traditionally utilized bone scans (skeletal scintigraphy). Both these modalities can be synergistic or complementary for assessing lytic- and blastic- bone lesions.
Collapse
Affiliation(s)
- Eliana Khojasteh
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Farrokh Dehdashti
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Monica Shokeen
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
- Corresponding author at: Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
| |
Collapse
|
5
|
Turkbey B, Oto A, Allen BC, Akin O, Alexander LF, Ari M, Froemming AT, Fulgham PF, Gettle LM, Maranchie JK, Rosenthal SA, Schieda N, Schuster DM, Venkatesan AM, Lockhart ME. ACR Appropriateness Criteria® Post-Treatment Follow-up of Prostate Cancer: 2022 Update. J Am Coll Radiol 2023; 20:S164-S186. [PMID: 37236741 DOI: 10.1016/j.jacr.2023.02.012] [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: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Prostate cancer has a wide spectrum ranging between low-grade localized disease and castrate-resistant metastatic disease. Although whole gland and systematic therapies result in cure in the majority of patients, recurrent and metastatic prostate cancer can still occur. Imaging approaches including anatomic, functional, and molecular modalities are continuously expanding. Currently, recurrent and metastatic prostate cancer is grouped in three major categories: 1) Clinical concern for residual or recurrent disease after radical prostatectomy, 2) Clinical concern for residual or recurrent disease after nonsurgical local and pelvic treatments, and 3) Metastatic prostate cancer treated by systemic therapy (androgen deprivation therapy, chemotherapy, immunotherapy). This document is a review of the current literature regarding imaging in these settings and the resulting recommendations for imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Mim Ari
- The University of Chicago, Chicago, Illinois, Primary care physician
| | | | - Pat F Fulgham
- Urology Clinics of North Texas, Dallas, Texas; American Urological Association
| | | | | | - Seth A Rosenthal
- Sutter Medical Group, Sacramento, California; Commission on Radiation Oncology
| | - Nicola Schieda
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
| | - David M Schuster
- Emory University, Atlanta, Georgia; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
6
|
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.
Collapse
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.)
| |
Collapse
|
7
|
Li M, Zelchan R, Orlova A. The Performance of FDA-Approved PET Imaging Agents in the Detection of Prostate Cancer. Biomedicines 2022; 10:biomedicines10102533. [PMID: 36289795 PMCID: PMC9599369 DOI: 10.3390/biomedicines10102533] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
Positron emission tomography (PET) incorporated with X-ray computed tomography (PET/CT) or magnetic resonance imaging (PET/MRI) is increasingly being used as a diagnostic tool for prostate cancer (PCa). In this review, we describe and evaluate the clinical performance of some Food and Drug Administration (FDA)-approved agents used for visualizing PCa: [18F]FDG, [11C]choline, [18F]FACBC, [68Ga]Ga-PSMA-11, [18F]DCFPyL, and [18F]-NaF. We carried out a comprehensive literature search based on articles published from 1 January 2010 to 1 March 2022. We selected English language articles associated with the discovery, preclinical study, clinical study, and diagnostic performance of the imaging agents for the evaluation. Prostate-specific membrane antigen (PSMA)-targeted imaging agents demonstrated superior diagnostic performance in both primary and recurrent PCa, compared with [11C]choline and [18F]FACBC, both of which target dividing cells and are used especially in patients with low prostate-specific antigen (PSA) values. When compared to [18F]-NaF (which is suitable for the detection of bone metastases), PSMA-targeted agents were also capable of detecting lesions in the lymph nodes, soft tissues, and bone. However, a limitation of PSMA-targeted imaging was the heterogeneity of PSMA expression in PCa, and consequently, a combination of two PET tracers was proposed to overcome this obstacle. The preliminary studies indicated that the use of PSMA-targeted scanning is more cost efficient than conventional imaging modalities for high-risk PCa patients. Furthering the development of imaging agents that target PCa-associated receptors and molecules could improve PET-based diagnosis of PCa.
Collapse
Affiliation(s)
- Mei Li
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden
- Liaoning Medical Device Test Institute, Shenyang 110171, China
| | - Roman Zelchan
- Department of Nuclear Medicine, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 5 Kooperativny St., 634009 Tomsk, Russia
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, 634050 Tomsk, Russia
| | - Anna Orlova
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, 634050 Tomsk, Russia
- Science for Life Laboratory, Uppsala University, 752 37 Uppsala, Sweden
- Correspondence:
| |
Collapse
|
8
|
Rowe SP, Salavati A, Werner RA, Pienta KJ, Gorin MA, Pomper MG, Solnes LB. 18F-Labeled Radiotracers for Prostate-specific Membrane Antigen. PET Clin 2022; 17:585-593. [DOI: 10.1016/j.cpet.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
9
|
Clinical Applications of PSMA PET Examination in Patients with Prostate Cancer. Cancers (Basel) 2022; 14:cancers14153768. [PMID: 35954432 PMCID: PMC9367427 DOI: 10.3390/cancers14153768] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/21/2022] [Accepted: 07/31/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The prostate specific membrane antigens, abbreviated as PSMAs, are type II membrane proteins that are highly ex-pressed on the surface of malignant prostate tissue in prostate cancer (PCa), particularly in aggressive, andro-gen-deprived, metastatic, and hormone-refractory PCa. Today, radionuclides that bind to these PSMA peptides are widely available for diagnostic and therapeutic purposes to specifically image and target prostate tumor cells at molec-ular level. In this descriptive review, we aimed to emphasize the usefulness of PSMA positron emission tomography (PET) examination in the management of patients with various stages of PCa. In addition, we outlined the main pitfalls and limitations of this scan to avoid misinterpretation of the results and to improve the decision making process in rela-tion to the patient’s further treatment. We concluded that PSMA PET examination in primary PCa patients has an es-sential role in the high-risk group. It is the new imaging standard in patients with in biochemical recurrence PCa and plays an important role in treatment decision. Furthermore, PSMA PET scan is a gold standard for the evaluation of PSMA targeted therapies in patients having progress of the disease. Future prospective studies, particularly on the im-pact of PSMA PET on therapy stratification, may further strengthen the role of PSMA in the treatment of PCa patients. Abstract With the progressive aging of the population in industrially developed countries, as well as advances in diagnostic and biopsy techniques and improvements in patient awareness, the incidence of prostate cancer (PCa) is continuously increasing worldwide. Therefore, PCa is currently considered as the second leading cause of tumor-related death. Early detection of the tumor and its metastasis is essential, as the rate of disease recurrence is high and occurs in 27% to 53% of all patients who underwent curative therapy with radical prostatectomy or local radiotherapy. In this regard, the prostate specific membrane antigens, abbreviated as PSMAs, are type II membrane proteins that are highly expressed on the surface of malignant prostate tissue in PCa, particularly in aggressive, androgen-deprived, metastatic, and hormone-refractory PCa, and they are inversely associated with the androgen level. Up to 95% of adenocarcinomas of the prostate express PSMA receptors on their surface. Today, radionuclides that bind to these PSMA peptides are widely accepted for diagnostic and therapeutic purposes to specifically image and target prostate tumor cells at the molecular level, a process referred to as targeted theranostics. Numerous studies have demonstrated that the integration of these peptides into diagnostic and therapeutic procedures plays a critical role in the primary staging and treatment decisions of especially high-risk PCa, expands therapeutic options for patients with advanced stage of prostate tumor, and prolongs patients’ survival rate. In this review article, we intend to briefly spotlight the latest clinical utilization of the PSMA-targeted radioligand PET imaging modality in patients with different stages of PCa. Furthermore, limitations and pitfalls of this diagnostic technique are presented.
Collapse
|
10
|
Indeterminate skeletal and lymph node lesion on 18F PSMA 1007 PET/CT scanning: lessons from a review at 12 months with PSMA-RADS. Nucl Med Commun 2022; 43:1034-1041. [PMID: 35833288 DOI: 10.1097/mnm.0000000000001600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS OF THE STUDY The study utilizes the prostate-specific membrane antigen-reporting and data system (PSMA-RADS) version 1.0 in a real-world patient scenario in the evaluation of equivocal lesions using the PSMA-RADS categorization for patient management and communication in multidisciplinary team (MDT) meetings. METHODS A retrospective analysis of 203 patients who had 18F PSMA PET/CT for either restaging or staging over 12 months was undertaken. The scans were evaluated for local disease, lymph node involvement and distant metastases. The scan findings were classified as suspicious for metastases, and equivocal and benign lesions. Experience with PSMA ligand imaging was considered while classifying the lesions, equivocal lesions were assessed with PSMA-RADS and followed up with complementary imaging and/or clinical follow-up assessment or MDT for further patient management. RESULTS A total of 91 of 203 patients had equivocal lesions. Follow-up assessment was performed in 47 of 91 patients with imaging (n = 36) or MDT discussion (n = 11).On follow-up imaging (n = 36), equivocal lesion was seen in skeletal lesions (n = 24), pelvic lymph nodes (n = 6), both skeletal and pelvic nodes (n = 4), hilar and mediastinal lymph nodes (n = 1) and spleen (n = 1). The patients were reclassified as benign, metastatic with few lesion remained equivocal. Overall follow-up assessment impacted clinical management in 47% patients. CONCLUSION 18F PSMA PET/CT may show equivocal lesions; many of them in the skeleton, a small proportion of which are ultimately proven metastatic. In contrast, a higher proportion of the equivocal nodes in the pelvis end up being metastatic on follow-up. A structured reporting with PSMA-RADS grading helps in the proper classification of lesions and standardization of reports.
Collapse
|
11
|
Rowe SP, Buck A, Bundschuh RA, Lapa C, Serfling SE, Derlin T, Higuchi T, Gorin MA, Pomper MG, Werner RA. [18F]DCFPyL PET/CT for Imaging of Prostate Cancer. Nuklearmedizin 2022; 61:240-246. [PMID: 35030637 DOI: 10.1055/a-1659-0010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Prostate-specific membrane antigen (PSMA)-directed positron emission tomography (PET) has gained increasing interest for imaging of men affected by prostate cancer (PC). In recent years, 68Ga-labeled PSMA compounds have been widely utilized, although there is a trend towards increased utilization of 18F-labeled agents. Among others, [18F]DCFPyL (piflufolastat F 18, PYLARIFY) has been tested in multiple major trials, such as OSPREY and CONDOR, which provided robust evidence on the clinical utility of this compound for staging, restaging, and change in management. Recent explorative prospective trials have also utilized [18F]DCFPyL PET/CT for response assessment, e.g., in patients under abiraterone or enzalutamide, rendering this 18F-labeled PSMA radiotracer as an attractive biomarker for image-guided strategies in men with PC. After recent approval by the U.S. Food and Drug Administration, one may expect more widespread use, not only in the U.S., but also in Europe in the long term. In the present review, we will provide an overview of the current clinical utility of [18F]DCFPyL in various clinical settings for men with PC.
Collapse
Affiliation(s)
- Steven P Rowe
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, United States.,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, United States.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Andreas Buck
- Nuclear Medicine, Würzburg University Medical Center Clinic for Nuclear Medicine, Würzburg, Germany
| | - Ralph A Bundschuh
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Sebastian E Serfling
- Nuclear Medicine, Würzburg University Medical Center Clinic for Nuclear Medicine, Würzburg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Takahiro Higuchi
- Nuclear Medicine, Würzburg University Medical Center Clinic for Nuclear Medicine, Würzburg, Germany.,Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, United States.,Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Martin G Pomper
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, United States.,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, United States.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Rudolf A Werner
- Nuclear Medicine, Würzburg University Medical Center Clinic for Nuclear Medicine, Würzburg, Germany
| |
Collapse
|
12
|
Basso Dias A, Finelli A, Bauman G, Veit-Haibach P, Berlin A, Ortega C, Avery L, Metser U. Impact of 18F-DCFPyL PET on Staging and Treatment of Unfavorable Intermediate or High-Risk Prostate Cancer. Radiology 2022; 304:600-608. [PMID: 35608445 DOI: 10.1148/radiol.211836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Data regarding 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine 3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) PET in primary staging of prostate cancer (PCa) are limited. Purpose To compare the performance of 18F-DCFPyL PET/CT or PET/MRI (PET) with bone scan and CT with or without multiparametric MRI (hereafter, referred to as conventional imaging) in the initial staging of men with unfavorable intermediate or high-risk PCa and to assess treatment change after PET. Materials and Methods This prospective study evaluated men with biopsy-proven, untreated, unfavorable intermediate or high-risk PCa with 0 to four metastases or equivocal for extensive metastases (more than four) who underwent PET between May 2018 and December 2020. The diagnostic performance of PET in detecting pelvic nodal and distant metastases was compared with conventional imaging alone. Metastatic sites at conventional imaging and PET were compared with a composite reference standard including histopathologic analysis, correlative imaging, and/or clinical and biochemical follow-up. The intended treatment before PET was compared with the treatment plan established after performing PET. Detection rate, sensitivity, and specificity of conventional imaging and PET were compared by using McNemar exact test on paired proportions. Results The study consisted of 108 men (median age, 66 years; IQR, 61-73 years) with no metastases (n = 84), with oligometastases (four or fewer metastases; 22 men), or with equivocal findings for extensive metastases (n = 2). Detection rates at PET and conventional imaging for nodal metastases were 34% (37 of 108) and 11% (12 of 108) (P < .001), respectively, and those for distant metastases were 22% (24 of 108) and 10% (11 of 108) (P = .02), respectively. PET altered stage in 43 of 108 (40%) and treatment in 24 of 108 (22%) men. The most frequent treatment change was from systemic to local-regional therapy in 10 of 108 (9%) and from local-regional to systemic therapy in nine of 108 (8%) men. Equivocal findings were encountered less frequently with PET (one of 108; 1%) than with conventional imaging (29 of 108; 27%). Conclusion Initial staging with 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine 3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) PET after conventional imaging (bone scan and CT with or without multiparametric MRI) helped to detect more nodal and distant metastases than conventional imaging alone and changed treatment in 22% of men. Clinical trial registration no. NCT03535831, NCT03718260 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Jadvar in this issue.
Collapse
Affiliation(s)
- Adriano Basso Dias
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Antonio Finelli
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Glenn Bauman
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Patrick Veit-Haibach
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Alejandro Berlin
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Claudia Ortega
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Lisa Avery
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Ur Metser
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| |
Collapse
|
13
|
Voter AF, Werner RA, Pienta KJ, Gorin MA, Pomper MG, Solnes LB, Rowe SP. Piflufolastat F-18 ( 18F-DCFPyL) for PSMA PET imaging in prostate cancer. Expert Rev Anticancer Ther 2022; 22:681-694. [DOI: 10.1080/14737140.2022.2081155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Andrew F. Voter
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Transitional Year Residency Program, Aurora St. Luke’s Medical Center, Advocate Aurora Health, Milwaukee, WI, USA
| | - Rudolf A. Werner
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Kenneth J. Pienta
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A. Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martin G. Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lilja B. Solnes
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
14
|
Mei R, Farolfi A, Morigi JJ, Fanti S. The role of prostate-specific membrane antigen PET/computed tomography in the management of prostate cancer patients: could we ask for more? Curr Opin Urol 2022; 32:269-276. [PMID: 35552308 PMCID: PMC10810346 DOI: 10.1097/mou.0000000000000982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Thanks to the development of novel PSMA-based peptides, molecular imaging, such as PET/CT paired with theranostic-based approaches have recently been proposed for treatment of prostate cancer. Patient selection, however, remains challenging because of the absence of strong prospective data to interpret and translate imaging scans into effective and well tolerated treatment regimens. RECENT FINDINGS In this review, we discuss the latest findings in PSMA imaging in prostate cancer patients. Particularly, we go into detail into the impact of PSMA imaging on the treatment management in primary staging, biochemical recurrence and in advanced prostate cancer. SUMMARY For primary prostate cancer staging, PSMA PET/CT seems crucial for primary therapy assessment, being able in some cases to detect lesions outside the surgical template, thus permitting a change in management. Moreover, N+ condition at PSMA has been correlated with a worse biochemical recurrence-free and therapy-free survival. The early detection of PSMA-positive findings in recurrent prostate cancer is associated with a better time to relapse survival. Similarly, for advanced prostate cancer patients, accurate restaging with PSMA imaging is gaining importance for early prediction of response to systemic therapies and to assure the best outcome possible. With regards to theranostics, appropriate selection of patients eligible for 177Lu-PSMA requires PSMA imaging, whereas the role of added FDG-PET for discriminating those with PSMA/FDG discordance needs to be further evaluated.
Collapse
Affiliation(s)
- Riccardo Mei
- Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna
- DIMES, University of Bologna, Bologna, Italy
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna
| | - Joshua James Morigi
- PET/CT Unit, Department of Medical Imaging, Royal Darwin Hospital, Darwin, Australia
| | - Stefano Fanti
- Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna
- DIMES, University of Bologna, Bologna, Italy
| |
Collapse
|
15
|
Griffiths GL, Vasquez C, Escorcia F, Clanton J, Lindenberg L, Mena E, Choyke PL. Translating a radiolabeled imaging agent to the clinic. Adv Drug Deliv Rev 2022; 181:114086. [PMID: 34942275 PMCID: PMC8889912 DOI: 10.1016/j.addr.2021.114086] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/30/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023]
Abstract
Molecular Imaging is entering the most fruitful, exciting period in its history with many new agents under development, and several reaching the clinic in recent years. While it is unusual for just one laboratory to take an agent from initial discovery through to full clinical approval the steps along the way are important to understand for all interested participants even if one is not involved in the entire process. Here, we provide an overview of these processes beginning at discovery and preclinical validation of a new molecular imaging agent and using as an exemplar a low molecular weight disease-specific targeted positron emission tomography (PET) agent. Compared to standard drug development requirements, molecular imaging agents may benefit from a regulatory standpoint from their low mass administered doses, they nonetheless still need to go through a series of well-defined steps before they can be considered for Phase 1 human testing. After outlining the discovery and preclinical validation approaches, we will also discuss the nuances of Phase 1, Phase 2 and Phase 3 studies that may culminate in an FDA general use approval. Finally, some post-approval aspects of novel molecular imaging agents are considered.
Collapse
Affiliation(s)
- Gary L. Griffiths
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Frederick, MD
| | - Crystal Vasquez
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | - Freddy Escorcia
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | | | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | - Peter L. Choyke
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| |
Collapse
|
16
|
Fedrigo R, Kadrmas DJ, Edem PE, Fougner L, Klyuzhin IS, Petric MP, Bénard F, Rahmim A, Uribe C. Quantitative evaluation of PSMA PET imaging using a realistic anthropomorphic phantom and shell-less radioactive epoxy lesions. EJNMMI Phys 2022; 9:2. [PMID: 35032234 PMCID: PMC8761183 DOI: 10.1186/s40658-021-00429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET) with prostate specific membrane antigen (PSMA) have shown superior performance in detecting metastatic prostate cancers. Relative to [18F]fluorodeoxyglucose ([18F]FDG) PET images, PSMA PET images tend to visualize significantly higher-contrast focal lesions. We aim to evaluate segmentation and reconstruction algorithms in this emerging context. Specifically, Bayesian or maximum a posteriori (MAP) image reconstruction, compared to standard ordered subsets expectation maximization (OSEM) reconstruction, has received significant interest for its potential to reach convergence with minimal noise amplifications. However, few phantom studies have evaluated the quantitative accuracy of such reconstructions for high contrast, small lesions (sub-10 mm) that are typically observed in PSMA images. In this study, we cast 3 mm-16-mm spheres using epoxy resin infused with a long half-life positron emitter (sodium-22; 22Na) to simulate prostate cancer metastasis. The anthropomorphic Probe-IQ phantom, which features a liver, bladder, lungs, and ureters, was used to model relevant anatomy. Dynamic PET acquisitions were acquired and images were reconstructed with OSEM (varying subsets and iterations) and BSREM (varying β parameters), and the effects on lesion quantitation were evaluated. RESULTS The 22Na lesions were scanned against an aqueous solution containing fluorine-18 (18F) as the background. Regions-of-interest were drawn with MIM Software using 40% fixed threshold (40% FT) and a gradient segmentation algorithm (MIM's PET Edge+). Recovery coefficients (RCs) (max, mean, peak, and newly defined "apex"), metabolic tumour volume (MTV), and total tumour uptake (TTU) were calculated for each sphere. SUVpeak and SUVapex had the most consistent RCs for different lesion-to-background ratios and reconstruction parameters. The gradient-based segmentation algorithm was more accurate than 40% FT for determining MTV and TTU, particularly for lesions [Formula: see text] 6 mm in diameter (R2 = 0.979-0.996 vs. R2 = 0.115-0.527, respectively). CONCLUSION An anthropomorphic phantom was used to evaluate quantitation for PSMA PET imaging of metastatic prostate cancer lesions. BSREM with β = 200-400 and OSEM with 2-5 iterations resulted in the most accurate and robust measurements of SUVmean, MTV, and TTU for imaging conditions in 18F-PSMA PET/CT images. SUVapex, a hybrid metric of SUVmax and SUVpeak, was proposed for robust, accurate, and segmentation-free quantitation of lesions for PSMA PET.
Collapse
Affiliation(s)
- Roberto Fedrigo
- Department of Integrative Oncology, BC Cancer Research Institute, 675 W 10th Avenue, Vancouver, BC, V5Z1L3, Canada
- Department of Physics and Astronomy, University of British Columbia, 325-6224 Agricultural Road, Vancouver, BC, V6T1Z1, Canada
| | - Dan J Kadrmas
- Department of Radiology and Imaging Sciences, University of Utah, 201 Presidents' Cir, Salt Lake City, UT, 84112, USA
| | - Patricia E Edem
- Functional Imaging, BC Cancer, 600 W 10th Avenue, Vancouver, BC, V5Z4E6, Canada
| | - Lauren Fougner
- Functional Imaging, BC Cancer, 600 W 10th Avenue, Vancouver, BC, V5Z4E6, Canada
| | - Ivan S Klyuzhin
- Department of Integrative Oncology, BC Cancer Research Institute, 675 W 10th Avenue, Vancouver, BC, V5Z1L3, Canada
- Department of Physics and Astronomy, University of British Columbia, 325-6224 Agricultural Road, Vancouver, BC, V6T1Z1, Canada
| | - M Peter Petric
- Functional Imaging, BC Cancer, 600 W 10th Avenue, Vancouver, BC, V5Z4E6, Canada
| | - François Bénard
- Department of Integrative Oncology, BC Cancer Research Institute, 675 W 10th Avenue, Vancouver, BC, V5Z1L3, Canada
- Department of Physics and Astronomy, University of British Columbia, 325-6224 Agricultural Road, Vancouver, BC, V6T1Z1, Canada
- Department of Molecular Oncology, BC Cancer Research Institute, 675 W 10th Avenue, Vancouver, BC, V5Z1L3, Canada
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, 675 W 10th Avenue, Vancouver, BC, V5Z1L3, Canada
- Department of Physics and Astronomy, University of British Columbia, 325-6224 Agricultural Road, Vancouver, BC, V6T1Z1, Canada
- Department of Radiology, University of British Columbia, 675 W 10th Avenue, Vancouver, BC, V5Z1L3, Canada
| | - Carlos Uribe
- Functional Imaging, BC Cancer, 600 W 10th Avenue, Vancouver, BC, V5Z4E6, Canada.
- Department of Radiology, University of British Columbia, 675 W 10th Avenue, Vancouver, BC, V5Z1L3, Canada.
| |
Collapse
|
17
|
Cheng X, Ma L. Enzymatic synthesis of fluorinated compounds. Appl Microbiol Biotechnol 2021; 105:8033-8058. [PMID: 34625820 PMCID: PMC8500828 DOI: 10.1007/s00253-021-11608-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 12/31/2022]
Abstract
Fluorinated compounds are widely used in the fields of molecular imaging, pharmaceuticals, and materials. Fluorinated natural products in nature are rare, and the introduction of fluorine atoms into organic compound molecules can give these compounds new functions and make them have better performance. Therefore, the synthesis of fluorides has attracted more and more attention from biologists and chemists. Even so, achieving selective fluorination is still a huge challenge under mild conditions. In this review, the research progress of enzymatic synthesis of fluorinated compounds is summarized since 2015, including cytochrome P450 enzymes, aldolases, fluoroacetyl coenzyme A thioesterases, lipases, transaminases, reductive aminases, purine nucleoside phosphorylases, polyketide synthases, fluoroacetate dehalogenases, tyrosine phenol-lyases, glycosidases, fluorinases, and multienzyme system. Of all enzyme-catalyzed synthesis methods, the direct formation of the C-F bond by fluorinase is the most effective and promising method. The structure and catalytic mechanism of fluorinase are introduced to understand fluorobiochemistry. Furthermore, the distribution, applications, and future development trends of fluorinated compounds are also outlined. Hopefully, this review will help researchers to understand the significance of enzymatic methods for the synthesis of fluorinated compounds and find or create excellent fluoride synthase in future research.Key points• Fluorinated compounds are distributed in plants and microorganisms, and are used in imaging, medicine, materials science.• Enzyme catalysis is essential for the synthesis of fluorinated compounds.• The loop structure of fluorinase is the key to forming the C-F bond.
Collapse
Affiliation(s)
- Xinkuan Cheng
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Industrial Microbiology, Ministry of Education, Tianjin Key Laboratory of Industry Microbiology, National and Local United Engineering Laboratory of Metabolic Control Fermentation Technology, College of Biotechnology, Tianjin University of Science & Technology, No. 29, Thirteenth Street, Binhai New District, Tianjin, 300457, China
| | - Long Ma
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Industrial Microbiology, Ministry of Education, Tianjin Key Laboratory of Industry Microbiology, National and Local United Engineering Laboratory of Metabolic Control Fermentation Technology, College of Biotechnology, Tianjin University of Science & Technology, No. 29, Thirteenth Street, Binhai New District, Tianjin, 300457, China.
| |
Collapse
|
18
|
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.
Collapse
|
19
|
Abstract
Piflufolastat F 18 (PYLARIFY®) is an 18F-labelled diagnostic imaging agent that has been developed by Progenics Pharmaceuticals Inc., a Lantheus company, for positron emission tomography (PET) that targets prostate-specific membrane antigen (PSMA). Piflufolastat F 18 was approved in the USA on 27 May 2021 for PET of PSMA positive lesions in men with prostate cancer with suspected metastasis who are candidates for initial definitive therapy or with suspected recurrence based on elevated serum prostate specific antigen (PSA) level. This article summarizes the milestones in the development of piflufolastat F 18 leading to this approval as a radioactive diagnostic agent in prostate cancer.
Collapse
Affiliation(s)
- Susan J Keam
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| |
Collapse
|
20
|
Role of 18F-Fluciclovine and Prostate-Specific Membrane Antigen PET/CT in Guiding Management of Oligometastatic Prostate Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 216:851-859. [PMID: 33206564 DOI: 10.2214/ajr.20.24711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Twenty-five years ago, oligometastatic disease was proposed as an intermediary clinical state of cancer with unique implications for therapies that may impact cancer evolution and patient outcome. Identification of limited metastases that are potentially amenable to targeted therapies fundamentally depends on the sensitivity of diagnostic tools, including new-generation imaging methods. For men with biochemical recurrence after definitive therapy of the primary prostate cancer, PET/CT using either the FDA-approved radiolabeled amino acid analogue 18F-fluciclovine or investigational radiolabeled agents targeting prostate-specific membrane antigen (PSMA) enables identification of early metastases at lower serum PSA levels than was previously feasible using conventional imaging. Evidence supports PSMA PET/CT as the most sensitive imaging modality available for identifying disease sites in oligometastatic prostate cancer. PSMA PET/CT will likely become the modality of choice after regulatory approval and will drive the development of trials of emerging metastasis-directed therapies such as stereotactic ablative body radiation and radioguided surgery. Indeed, numerous ongoing or planned clinical trials are studying advances in management of oligometastatic prostate cancer based on this heightened diagnostic capacity. In this rapidly evolving clinical environment, radiologists and nuclear medicine physicians will play major roles in facilitating clinical decision making and management of patients with oligometastatic prostate cancer.
Collapse
|
21
|
Weber M, Hadaschik B, Ferdinandus J, Rahbar K, Bögemann M, Herrmann K, Fendler WP, Kesch C. Prostate-specific Membrane Antigen-based Imaging of Castration-resistant Prostate Cancer. Eur Urol Focus 2021; 7:279-287. [PMID: 33483289 DOI: 10.1016/j.euf.2021.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/10/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022]
Abstract
CONTEXT Positron emission tomography (PET) targeting prostate-specific membrane antigen (PSMA) has unprecedented accuracy for localization of initial or recurrent prostate cancer (PC). There is now growing evidence regarding the value of PSMA-PET in patients with advanced PC. OBJECTIVE To review the value of PSMA-PET/computed tomography (CT) in the context of castration-resistant PC (CRPC). EVIDENCE ACQUISITION A search of the PubMed database using the terms "PSMA PET castration resistant prostate cancer" (years 2011-2020) was performed. Reviews, case reports/series, non-English articles, preclinical studies, access-restricted studies, and studies on PSMA radioligand therapy without further analysis of PSMA-PET parameters were subsequently excluded. EVIDENCE SYNTHESIS Compared to conventional imaging, PSMA-PET better identifies the true extent of CRPC, especially nonmetastatic CRPC. The clinical benefit of this stage migration is still unclear and needs to be evaluated in further studies. High accuracy of PSMA-PET holds promise for better, PET-guided metastasis-directed treatment in patients with oligometastatic CRPC. PSMA-PET is an essential eligibility criterion for [177Lu]-PSMA theranostic applications. Preliminary evidence indicates the value of PSMA-PET for the assessment of treatment responses. CONCLUSIONS Among other applications, PSMA-PET offers more precise staging for nonmetastatic CRPC. In particular, target localization for metastasis-directed therapy and target expression assessment for PSMA radioligand therapy also hold promise. Potential translation of this diagnostic tool into an oncologic benefit needs to be defined in future trials. PATIENT SUMMARY This review describes how prostate-specific membrane antigen positron emission tomography (PSMA-PET), a new sensitive imaging tool for prostate cancer, might help to guide clinicians in making treatment decisions for advanced prostate cancer.
Collapse
Affiliation(s)
- Manuel Weber
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; West German Cancer Center.
| | - Boris Hadaschik
- West German Cancer Center; Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Justin Ferdinandus
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; West German Cancer Center
| | - Kambiz Rahbar
- West German Cancer Center; Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Martin Bögemann
- West German Cancer Center; Department of Urology, University Hospital Münster, Münster, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; West German Cancer Center
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; West German Cancer Center
| | - Claudia Kesch
- West German Cancer Center; Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| |
Collapse
|
22
|
Rowe SP, Johnson GB, Pomper MG, Gorin MA, Behr SC. Recent updates and developments in PET imaging of prostate cancer. Abdom Radiol (NY) 2020; 45:4063-4072. [PMID: 32417934 DOI: 10.1007/s00261-020-02570-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A number of positron emission tomography (PET) radiotracers have been developed to improve the sensitivity and specificity of imaging for prostate cancer. These radiotracers include the bone-seeking agent Na18F as well as more tumor-specific compounds such as 11C-choline and 18F-fluciclovine. In this review, we will discuss the advantages and disadvantages of these PET radiotracers for the imaging of men with prostate cancer across a range of clinical contexts. We will also touch upon radiotracers in late clinical development that have not gained regulatory approval, including those targeted against prostate-specific membrane antigen (PSMA) and gastrin-releasing peptide receptor (GRPR).
Collapse
Affiliation(s)
- Steven P Rowe
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Martin G Pomper
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gorin
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
23
|
Wondergem M, van der Zant FM, Broos WAM, Roeleveld TA, Donker R, Ten Oever D, Geenen RWF, Knol RJJ. 18F-DCFPyL PET/CT for primary staging in 160 high-risk prostate cancer patients; metastasis detection rate, influence on clinical management and preliminary results of treatment efficacy. Eur J Nucl Med Mol Imaging 2020; 48:521-531. [PMID: 32719916 DOI: 10.1007/s00259-020-04782-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/19/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Prostate-specific membrane antigen (PSMA) PET/CT shows better diagnostic performance for detection of lymph node and bone metastases as compared to conventional imaging. Studies of PSMA PET/CT in primary staging comprise highly selected patient cohorts. This study evaluates 18F-DCFPyL PET/CT as first-line imaging modality for primary staging of high-risk prostate cancer. MATERIAL From February 2018 until April 2019, all patients with high-risk prostate cancer received 18F-DCFPyL PET/CT for staging of prostate cancer. Baseline characteristics, findings at 18F-DCFPyL PET/CT, number and type of required additional diagnostic procedures, findings at additional diagnostic procedures, and effects of therapy on PSA levels for all patients treated with curative intent were collected and evaluated. RESULTS One hundred-sixty patients were included in the study of which 90 (56%) had evidence of metastasized disease (N1, M1a, M1b and, M1c in 49%, 28%, 31%, and 3% respectively). Additional diagnostic imaging was needed in 2/160 patients (1%) because of equivocal findings on 18F-DCFPyL PET/CT. Eighty-one patients had evidence of PSMA-positive lymph node metastases, of whom 39 (48%) had no enlarged lymph nodes on CT; 18F-DCFPyL PET detected additional metastatic lymph nodes in 41/42 patients that had evidence of lymph node metastases on CT. 18F-DCFPyL PET altered patients' management in 17% of patients. CONCLUSION 18F-DCFPyL PET/CT can be used as first-line imaging modality for therapy selection in patients with primary high-risk prostate cancer, without need for further diagnostic imaging procedures in the majority of patients.
Collapse
Affiliation(s)
- M Wondergem
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
| | - F M van der Zant
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - W A M Broos
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - T A Roeleveld
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - R Donker
- Department of Radiation Oncology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - D Ten Oever
- Department of Oncology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - R W F Geenen
- Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - R J J Knol
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| |
Collapse
|
24
|
Cook GJR, Goh V. Molecular Imaging of Bone Metastases and Their Response to Therapy. J Nucl Med 2020; 61:799-806. [PMID: 32245899 DOI: 10.2967/jnumed.119.234260] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/30/2020] [Indexed: 12/18/2022] Open
Abstract
Bone metastases are common, especially in more prevalent malignancies such as breast and prostate cancer. They cause significant morbidity and draw on health-care resources. Molecular and hybrid imaging techniques, including SPECT/CT, PET/CT, and whole-body MRI with diffusion-weighted imaging, have improved diagnostic accuracy in staging the skeleton compared with previous standard imaging methods, allowing earlier tailored treatment. With the introduction of several effective treatment options, it is now even more important to detect and monitor response in bone metastases accurately. Conventional imaging, including radiographs, CT, MRI, and bone scintigraphy, are recognized as being insensitive and nonspecific for response monitoring in a clinically relevant time frame. Early reports of molecular and hybrid imaging techniques, as well as whole-body MRI, promise an earlier and more accurate prediction of response versus nonresponse but have yet to be adopted routinely in clinical practice. We summarize the role of new molecular and hybrid imaging methods, including SPECT/CT, PET/CT, and whole-body MRI. These modalities are associated with improvements in diagnostic accuracy for the staging and response assessment of skeletal metastases over standard imaging methods, being able to quantify biologic processes related to the bone microenvironment as well as tumor cells. The described improvements in the imaging of bone metastases and their response to therapy have led to adoption of some of these methods into routine clinical practice in some centers. These methods also provide a better way to assess the treatment response of bone metastases in clinical trials.
Collapse
Affiliation(s)
- Gary J R Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Vicky Goh
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| |
Collapse
|
25
|
Prostate Specific Antigen and Prostate Specific Antigen Doubling Time Predict Findings on 18F-DCFPyL Positron Emission Tomography/Computerized Tomography in Patients with Biochemically Recurrent Prostate Cancer. J Urol 2020; 204:496-502. [PMID: 32250727 DOI: 10.1097/ju.0000000000001064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Prostate specific membrane antigen targeted 18F-DCFPyL positron emission tomography/computerized tomography may offer superior image quality and sensitivity for the detection of biochemically recurrent prostate cancer. We examined the association of Gleason sum, serum prostate specific antigen and prostate specific antigen doubling time with any detectable and pelvic confined disease in patients with biochemically recurrent prostate cancer. MATERIALS AND METHODS Data from 108 patients with biochemically recurrent prostate cancer after radical prostatectomy who underwent prostate specific membrane antigen targeted 18F-DCFPyL positron emission tomography/computerized tomography were analyzed. Data were collected on positive positron emission tomography findings as well as pelvic confined disease. Associations between Gleason sum, prostate specific antigen and prostate specific antigen doubling time were retrospectively explored. RESULTS Serum prostate specific antigen was associated with positive prostate specific membrane antigen targeted imaging as continuous (OR 3.08, 95% CI 1.60-7.95, p=0.005) and categorical values (ie prostate specific antigen greater than 2.0 to 5.0 vs 0.5 ng/ml or less, OR 16.92, 95% CI 3.13-315.81, p=0.008). No relationship between Gleason sum or prostate specific antigen doubling time with overall positive imaging was observed. Patients with a prostate specific antigen greater than 2.0 to 5.0 ng/ml were significantly less likely to be diagnosed with pelvic confined disease compared with the 0.5 ng/ml or less subgroup (OR 0.21, 95% CI 0.06-0.69, p=0.013). A prostate specific antigen doubling time of 9 months or more (OR 4.20, 95% CI 1.57-11.89, p=0.005) or prostate specific antigen doubling time of 12 months or more (OR 3.03, 95% CI 1.12-8.76, p=0.033) was significantly associated with pelvic confined disease. No relationship between Gleason sum and pelvic confined disease was observed. CONCLUSIONS Absolute prostate specific antigen was positively associated with the presence of findings on prostate specific membrane antigen targeted imaging and negatively associated with pelvic confined disease. Prostate specific antigen doubling time did not predict for overall disease detection, but long prostate specific antigen doubling times were associated with pelvic confined prostate cancer.
Collapse
|