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Rathke H, Winter E, Bruchertseifer F, Röhrich M, Giesel FL, Haberkorn U, Morgenstern A, Kratochwil C. Deescalated 225Ac-PSMA-617 Versus 177Lu/ 225Ac-PSMA-617 Cocktail Therapy: A Single-Center Retrospective Analysis of 233 Patients. J Nucl Med 2024; 65:1057-1063. [PMID: 38844358 DOI: 10.2967/jnumed.123.267206] [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: 12/17/2023] [Accepted: 04/25/2024] [Indexed: 07/03/2024] Open
Abstract
The aim of this work is to evaluate our clinical real-world data obtained with 225Ac-PSMA-617 (AcPSMA), which were acquired under compassionate care regulations in patients with advanced-stage prostate cancer. The objective parameters that could be derived from this evaluation are compared with previous literature about AcPSMA and 177Lu-PSMA-617 (LuPSMA). Methods: The medical files of all patients who had received AcPSMA on an individual patient basis at the Heidelberg University Hospital since January 2014 were analyzed retrospectively. Previously published patients were excluded. The remaining patients were tailored into 2 subgroups with different treatment strategies: group 1 received AcPSMA as a deescalated monotherapy, and group 2 received LuPSMA plus AcPSMA as a cocktail regimen. Baseline characteristics, serum prostate-specific antigen (PSA) response, and overall survival were compared with the most appropriate historical controls. Results: Of 287 patients treated, 54 were excluded because of previous publication and 233 were evaluated, 104 of whom received AcPSMA monotherapy (median, 6 MBq). In this group, 55 patients (53%) presented with a best PSA response of at least 50%. The other 129 patients received a cocktail therapy of AcPSMA (median, 4 MBq) plus LuPSMA (4 GBq). In this group, a best PSA response of at least 50% was observed in 74 patients (57%). The median overall survival in the monogroup was 9 mo and in the cocktail group was 15 mo. If adjusted for prognostic baseline characteristics, the efficacy of both regimens was not significantly different. Conclusion: Deescalated treatment activities of AcPSMA or AcPSMA and LuPSMA cocktail regimens present better tolerability with regard to xerostomia than previous regimens of at least 100 kBq/kg while retaining high antitumor activity in poor-prognosis prostate cancer patients.
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Affiliation(s)
- Hendrik Rathke
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany;
- Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland
| | - Erik Winter
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Manuel Röhrich
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Nuclear Medicine, Mainz University Hospital, Mainz, Germany; and
| | - Frederik Lars Giesel
- Department of Nuclear Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Clemens Kratochwil
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
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Chandekar KR, Satapathy S, Singh H, Kumar R, Kumar S, Kakkar N, Mittal BR, Singh SK. Utility of PSMA-PET derived volumetric parameters in initial risk stratification and prediction of prostate cancer metastasis - a head-to-head comparison of the radiotracers 18F-PSMA-1007 and 68Ga-PSMA-11. Nucl Med Commun 2024:00006231-990000000-00314. [PMID: 38932503 DOI: 10.1097/mnm.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE This study aimed to explore and compare the utility of baseline 18F-PSMA-1007 and 68Ga-PSMA-11 PET/computed tomography (CT) derived volumetric parameters in initial risk stratification and prediction of prostate cancer (PCa) metastasis. METHODS Forty treatment-naïve, biopsy-proven intermediate-/high-risk PCa patients were prospectively recruited. Each patient underwent PET/CT with 68Ga-PSMA-11 and 18F-PSMA-1007 (within 2 weeks). The maximum and mean standardized uptake values (SUVmax and SUVmean) of primary tumor, prostate PSMA-tumor volume (PSMA-TVp), and prostate total lesion PSMA (TL-PSMAp) were measured. RESULTS PSMA-TVp and TL-PSMAp (with both radiotracers) mostly exhibited moderate-to-strong correlation with Gleason score, serum prostate-specific antigen level and clinical tumor stage (Spearman ρ = 0.361-0.783, P-values ≤0.022). Primary tumor SUVmax values were similar across initial risk categories. PSMA-TVp and TL-PSMAp, however, were significantly higher in high-risk PCa compared to intermediate-risk PCa (P-values ≤0.001). Receiver operating characteristic (ROC) curve analysis revealed that F-PSMA-TVp, Ga-PSMA-TVp, F-TL-PSMAp, and Ga-TL-PSMAp (optimal cutoff values of 20.9, 23.4, 142.5, and 144.8, respectively) could effectively differentiate high-risk from intermediate-risk PCa [area under the ROC curve (AUCs) 0.859-0.898, P-values <0.001] with high sensitivity (~68.8-75%) and excellent specificity (100%). PSMA-TVp and TL-PSMAp (with both radiotracers) could predict presence of regional and extraregional nodal metastasis (AUCs 0.703-0.801, P-values ≤0.03) with moderate sensitivity (~47.8-70.6%) and excellent specificity (~82.6-94.1%). CONCLUSION Our results suggest that baseline PSMA-PET primary tumor volumetric parameters provide a noninvasive, objective, and accurate index for initial risk stratification and can predict presence of regional and extraregional nodal metastasis in PCa patients. Larger studies are warranted to evaluate their incremental role over conventional parameters.
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Affiliation(s)
- Kunal Ramesh Chandekar
- Department of Nuclear Medicine
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi
| | | | | | | | - Nandita Kakkar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh
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Yazdani E, Geramifar P, Karamzade-Ziarati N, Sadeghi M, Amini P, Rahmim A. Radiomics and Artificial Intelligence in Radiotheranostics: A Review of Applications for Radioligands Targeting Somatostatin Receptors and Prostate-Specific Membrane Antigens. Diagnostics (Basel) 2024; 14:181. [PMID: 38248059 PMCID: PMC10814892 DOI: 10.3390/diagnostics14020181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
Radiotheranostics refers to the pairing of radioactive imaging biomarkers with radioactive therapeutic compounds that deliver ionizing radiation. Given the introduction of very promising radiopharmaceuticals, the radiotheranostics approach is creating a novel paradigm in personalized, targeted radionuclide therapies (TRTs), also known as radiopharmaceuticals (RPTs). Radiotherapeutic pairs targeting somatostatin receptors (SSTR) and prostate-specific membrane antigens (PSMA) are increasingly being used to diagnose and treat patients with metastatic neuroendocrine tumors (NETs) and prostate cancer. In parallel, radiomics and artificial intelligence (AI), as important areas in quantitative image analysis, are paving the way for significantly enhanced workflows in diagnostic and theranostic fields, from data and image processing to clinical decision support, improving patient selection, personalized treatment strategies, response prediction, and prognostication. Furthermore, AI has the potential for tremendous effectiveness in patient dosimetry which copes with complex and time-consuming tasks in the RPT workflow. The present work provides a comprehensive overview of radiomics and AI application in radiotheranostics, focusing on pairs of SSTR- or PSMA-targeting radioligands, describing the fundamental concepts and specific imaging/treatment features. Our review includes ligands radiolabeled by 68Ga, 18F, 177Lu, 64Cu, 90Y, and 225Ac. Specifically, contributions via radiomics and AI towards improved image acquisition, reconstruction, treatment response, segmentation, restaging, lesion classification, dose prediction, and estimation as well as ongoing developments and future directions are discussed.
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Affiliation(s)
- Elmira Yazdani
- Medical Physics Department, School of Medicine, Iran University of Medical Sciences, Tehran 14496-14535, Iran;
- Finetech in Medicine Research Center, Iran University of Medical Sciences, Tehran 14496-14535, Iran
| | - Parham Geramifar
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran 14117-13135, Iran; (P.G.); (N.K.-Z.)
| | - Najme Karamzade-Ziarati
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran 14117-13135, Iran; (P.G.); (N.K.-Z.)
| | - Mahdi Sadeghi
- Medical Physics Department, School of Medicine, Iran University of Medical Sciences, Tehran 14496-14535, Iran;
- Finetech in Medicine Research Center, Iran University of Medical Sciences, Tehran 14496-14535, Iran
| | - Payam Amini
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran 14496-14535, Iran;
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Departments of Radiology and Physics, University of British Columbia, Vancouver, BC V5Z 1L3, Canada
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Chen R, Ng YL, Yang X, Zhu Y, Li L, Zhao H, Zhou Y, Huang G, Liu J. Comparison of parametric imaging and SUV imaging with [ 68 Ga]Ga-PSMA-11 using dynamic total-body PET/CT in prostate cancer. Eur J Nucl Med Mol Imaging 2024; 51:568-580. [PMID: 37792025 DOI: 10.1007/s00259-023-06456-1] [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: 09/23/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Standardized uptake value (SUV) has been prevalently used to measure [68 Ga]Ga-PSMA-11 activity in prostate cancer, but it is susceptible to multiple factors. Parametric imaging allows for absolute quantification of tracer uptake and provides a better diagnostic accuracy that is crucial for lesion detection. However, the clinical significance of total-body parametric imaging of [68 Ga]Ga-PSMA-11 remains to be fully assessed. Therefore, the aim of our study is to delve into the diagnostic implications of total-body parametric imaging of [68 Ga]Ga-PSMA-11 PET/CT for patients with prostate cancer. METHODS Twenty prostate cancer patients were included and underwent a dynamic total-body [68 Ga]Ga-PSMA-11 PET/CT scan. An irreversible two-tissue compartment model (2T3k) was fitted for each tissue time-to-activity curve, and the net influx rate (Ki) was obtained. The image quality and semi-quantitative analysis of lesion-to-background ratio (LBR), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared between parametric images and SUV images. RESULTS Kinetic modeling using 2T3k demonstrated favorable model fitting in both normal organs and lesions. All of the lesions detected on SUV images (55-60 min) could be detected on Ki images. The correlation between Ki, SUVmean, and SUVmax in both normal organs and pathological lesions was found to be positive and statistically significant. Conversely, a moderate positive correlations were found between Ki and K1 (R = 0.69, P < 0.001; R = 0.61, P < 0.001) and Ki and k3 (R = 0.69, P < 0.001; R = 0.62, P < 0.001), in normal organs and pathological lesions, respectively. Visual assessment in Ki images showed less image noise and higher lesions conspicuity compared to SUV images. Ki image-derived LBR, SNR, and CBR of pathological lesions including primary tumors (PTs), lymph node metastases (LNMs) and bone metastases (BMs), exhibited remarkably higher folds (1.4-3.6 folds) compared to those derived from SUV of corresponding lesions. CONCLUSIONS Total-body parametric imaging of [68 Ga]Ga-PSMA-11 enhanced lesion contrast and improved lesion detectability compared to SUV images. This may potentially serve as an imaging biomarker and theranostic tool for precise diagnosis and treatment evaluation in prostate cancer patients.
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Affiliation(s)
- Ruohua Chen
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
- Institute of Clinical Nuclear Medicine, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Yee Ling Ng
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China
| | - Xinlan Yang
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China
| | - Yinjie Zhu
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Lianghua Li
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
- Institute of Clinical Nuclear Medicine, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Haitao Zhao
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
- Institute of Clinical Nuclear Medicine, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Yun Zhou
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China
| | - Gang Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
- Institute of Clinical Nuclear Medicine, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
- Institute of Clinical Nuclear Medicine, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
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Esen B, Herrmann K, Bavbek S, Kordan Y, Tilki D, Esen T. Prostate-specific Membrane Antigen Positron Emission Tomography as a Biomarker to Assess Treatment Response in Patients with Advanced Prostate Cancer. Eur Urol Focus 2023:S2405-4569(23)00040-8. [PMID: 36842919 DOI: 10.1016/j.euf.2023.02.001] [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: 12/21/2022] [Revised: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
CONTEXT Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) has superior accuracy for detection of metastatic lesions in patients with prostate cancer (PC). Although PSMA PET has a prominent role in primary and secondary imaging of PC, data on its role in assessing treatment response in advanced PC are limited. OBJECTIVE To review current data in the literature regarding the impact of antiandrogen therapy on PSMA expression of metastatic sites and the role of serial (baseline and at least 1 follow-up scan) PSMA PET to assess treatment response in patients with metastatic PC. EVIDENCE ACQUISITION A comprehensive literature search in the PubMed database was performed using the terms "PSMA expression prostate", "PSMA regulation", "PSMA PET response assessment", and "serial PSMA PET". EVIDENCE SYNTHESIS Serial PSMA PET studies (baseline and at least 1 follow-up scan) provide valuable data regarding PSMA expression changes after systemic treatment in patients with metastatic PC. PSMA PET-detected flare and upregulation of PSMA expression following hormonal intervention seem to be early events resolving after 3 mo of treatment. PSMA PET imaging is essential in selecting patients for 177Lu-PSMA radioligand therapy (RLT). Growing evidence favors its use in assessing treatment responses after RLT. Preliminary evidence indicates the value of PSMA PET for assessment of the treatment response in patients receiving systemic treatment other than RLT for metastatic PC. CONCLUSIONS PSMA flare following antiandrogen therapy seems to be an early event and thus PET scans should be performed no earlier than 3 mo after the start of treatment. PSMA PET has a promising role in tailoring treatment according to the specific needs of individual patients and assessing responses following systemic treatment in patients with advanced PC. PATIENT SUMMARY This review describes how a sensitive imaging method can be used to assess the tumor response to treatment for metastatic prostate cancer.
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Affiliation(s)
- Barış Esen
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey.
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Sevil Bavbek
- Department of Medical Oncology, VKF American Hospital, Istanbul, Turkey
| | - Yakup Kordan
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Derya Tilki
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tarık Esen
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
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