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Rasul S, Geist BK, Einspieler H, Fajkovic H, Shariat SF, Schmitl S, Mitterhauser M, Bartosch R, Langsteger W, Baltzer PAT, Beyer T, Ferrara D, Haug AR, Hacker M, Rausch I. Direct Patlak Reconstruction of [ 68Ga]Ga-PSMA PET for the Evaluation of Primary Prostate Cancer Prior Total Prostatectomy: Results of a Pilot Study. Int J Mol Sci 2023; 24:13677. [PMID: 37761975 PMCID: PMC10530818 DOI: 10.3390/ijms241813677] [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: 06/20/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
To investigate the use of kinetic parameters derived from direct Patlak reconstructions of [68Ga]Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) to predict the histological grade of malignancy of the primary tumor of patients with prostate cancer (PCa). Thirteen patients (mean age 66 ± 10 years) with a primary, therapy-naïve PCa (median PSA 9.3 [range: 6.3-130 µg/L]) prior radical prostatectomy, were recruited in this exploratory prospective study. A dynamic whole-body [68Ga]Ga-PSMA-11 PET/CT scan was performed for all patients. Measured quantification parameters included Patlak slope (Ki: absolute rate of tracer consumption) and Patlak intercept (Vb: degree of tracer perfusion in the tumor). Additionally, the mean and maximum standardized uptake values (SUVmean and SUVmax) of the tumor were determined from a static PET 60 min post tracer injection. In every patient, initial PSA (iPSA) values that were also the PSA level at the time of the examination and final histology results with Gleason score (GS) grading were correlated with the quantitative readouts. Collectively, 20 individual malignant prostate lesions were ascertained and histologically graded for GS with ISUP classification. Six lesions were classified as ISUP 5, two as ISUP 4, eight as ISUP 3, and four as ISUP 2. In both static and dynamic PET/CT imaging, the prostate lesions could be visually distinguished from the background. The average values of the SUVmean, slope, and intercept of the background were 2.4 (±0.4), 0.015 1/min (±0.006), and 52% (±12), respectively. These were significantly lower than the corresponding parameters extracted from the prostate lesions (all p < 0.01). No significant differences were found between these values and the various GS and ISUP (all p > 0.05). Spearman correlation coefficient analysis demonstrated a strong correlation between static and dynamic PET/CT parameters (all r ≥ 0.70, p < 0.01). Both GS and ISUP grading revealed only weak correlations with the mean and maximum SUV and tumor-to-background ratio derived from static images and dynamic Patlak slope. The iPSA demonstrated no significant correlation with GS and ISUP grading or with dynamic and static PET parameter values. In this cohort of mainly high-risk PCa, no significant correlation between [68Ga]Ga-PSMA-11 perfusion and consumption and the aggressiveness of the primary tumor was observed. This suggests that the association between SUV values and GS may be more distinctive when distinguishing clinically relevant from clinically non-relevant PCa.
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Affiliation(s)
- Sazan Rasul
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (B.K.G.); (H.E.); (S.S.); (M.M.); (R.B.); (W.L.); (A.R.H.); (M.H.)
| | - Barbara Katharina Geist
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (B.K.G.); (H.E.); (S.S.); (M.M.); (R.B.); (W.L.); (A.R.H.); (M.H.)
| | - Holger Einspieler
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (B.K.G.); (H.E.); (S.S.); (M.M.); (R.B.); (W.L.); (A.R.H.); (M.H.)
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria; (H.F.); (S.F.S.)
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria; (H.F.); (S.F.S.)
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, Second Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Stefan Schmitl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (B.K.G.); (H.E.); (S.S.); (M.M.); (R.B.); (W.L.); (A.R.H.); (M.H.)
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (B.K.G.); (H.E.); (S.S.); (M.M.); (R.B.); (W.L.); (A.R.H.); (M.H.)
| | - Rainer Bartosch
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (B.K.G.); (H.E.); (S.S.); (M.M.); (R.B.); (W.L.); (A.R.H.); (M.H.)
| | - Werner Langsteger
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (B.K.G.); (H.E.); (S.S.); (M.M.); (R.B.); (W.L.); (A.R.H.); (M.H.)
| | - Pascal Andreas Thomas Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (T.B.); (D.F.)
| | - Daria Ferrara
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (T.B.); (D.F.)
| | - Alexander R. Haug
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (B.K.G.); (H.E.); (S.S.); (M.M.); (R.B.); (W.L.); (A.R.H.); (M.H.)
- Christian-Doppler Lab Applied Metabolomics (CDL AM), 1090 Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (B.K.G.); (H.E.); (S.S.); (M.M.); (R.B.); (W.L.); (A.R.H.); (M.H.)
| | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (T.B.); (D.F.)
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Combes AD, Palma CA, Calopedos R, Wen L, Woo H, Fulham M, Leslie S. PSMA PET-CT in the Diagnosis and Staging of Prostate Cancer. Diagnostics (Basel) 2022; 12:2594. [PMID: 36359439 PMCID: PMC9689635 DOI: 10.3390/diagnostics12112594] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 08/07/2023] Open
Abstract
Prostate cancer is the most common cancer and the second leading cause of cancer death in men. The imaging assessment and treatment of prostate cancer has vastly improved over the past decade. The introduction of PSMA PET-CT has improved the detection of loco-regional and metastatic disease. PSMA PET-CT also has a role in the primary diagnosis and staging, in detecting biochemical recurrence after curative treatment and in metastasis-directed therapy. In this paper we review the role of PSMA PET-CT in prostate cancer.
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Affiliation(s)
- Alexander D. Combes
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Catalina A. Palma
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Ross Calopedos
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Lingfeng Wen
- Department of Molecular Imaging, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Engineering and Computer Science, University of Sydney, Sydney, NSW 2006, Australia
| | - Henry Woo
- Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia
- Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
| | - Michael Fulham
- Department of Molecular Imaging, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia
| | - Scott Leslie
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia
- Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery, Sydney, NSW 2050, Australia
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Veerman H, Vis AN, Donswijk M, van der Poel HG. Comment on Rosenzweig et al. Very Low Prostate PET/CT PSMA Uptake May Be Misleading in Staging Radical Prostatectomy Candidates. J. Pers. Med. 2022, 12, 410. J Pers Med 2022; 12:800. [PMID: 35629222 PMCID: PMC9145244 DOI: 10.3390/jpm12050800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 12/21/2022] Open
Abstract
With interest, we read the article by Rosenzweig et al. [...].
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Affiliation(s)
- Hans Veerman
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
- Department of Urology, Amsterdam University Medical Centres, Location VU Medical Centre, 1081 HV Amsterdam, The Netherlands;
- Prostate Cancer Network Netherlands, 1066 CX Amsterdam, The Netherlands
| | - André N. Vis
- Department of Urology, Amsterdam University Medical Centres, Location VU Medical Centre, 1081 HV Amsterdam, The Netherlands;
- Prostate Cancer Network Netherlands, 1066 CX Amsterdam, The Netherlands
| | - Maarten Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Henk G. van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
- Department of Urology, Amsterdam University Medical Centres, Location VU Medical Centre, 1081 HV Amsterdam, The Netherlands;
- Prostate Cancer Network Netherlands, 1066 CX Amsterdam, The Netherlands
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