Comparing 99mTc-PSMA to 99mTc-MDP in Prostate Cancer Staging of the Skeletal System

Abstract

Purpose This prospective study was aimed at assessing the ability of 99m Tc-PSMA scan to detect bone metastases in prostate cancer (PCa) against 99m Tc-MDP scan as a standard and assess the correlation of these modalities in PCa staging of bone involvement. Patients and Methods Forty-one patients (41) with histologically confirmed PCa were scanned using both methods. Planar imaging was performed with additional regional SPECT/CT 3 to 4 hours posttracer injection. Scans were reported as positive, negative, or equivocal. In the case of positive scans, lesions were quantified by each of the 3 reporters separately. Planar and SPECT/CT images were reported together to obtain the final report on each scan. Results Our preliminary results showed no significant difference in the detection of bone metastases between the 2 scans. 99m Tc-PSMA detected 52 of the 55 bone lesions detected on 99m Tc-MDP. However, 99m Tc-PSMA provided extra information by reporting lymph nodal metastases in 7 patients and residual disease in the prostate in 2 patients with biochemical progression after radical therapy. In 1 patient, the PSMA scan resulted in change in management with patient now on 177 Lu-PSMA radioligand therapy. Equivocal findings were reported in 4 patients on 99m Tc-MDP and none on 99m Tc-PSMA. Conclusions 99m Tc-PSMA was comparable to 99m Tc-MDP in detection of bone metastases and demonstrated an additional benefit of providing information on visceral disease. 99m Tc-PSMA may be a better alternative to 99m Tc-MDP in staging, restaging, and assessment of patients with biochemical progression after radical therapy of PCa in a resource-limited setup like ours while also assisting to detect patients eligible for PSMA-labeled radioligand therapy.

Head-to-head comparison of 99mTc-PSMA and 99mTc-MDP SPECT/CT in diagnosing prostate cancer bone metastasis: a prospective, comparative imaging trial

“…In this study, 99m Tc-PSMA SPECT/CT and 99m Tc-MDP SPECT/CT were systematically compared using the SPECT/CT imaging mode. Few studies have compared 99m Tc-PSMA SPECT/CT and 99m Tc-MDP SPECT/CT in the detection of PCa bone metastases 11 , 12 ; only one prospective study, reported by Kabunda et al and including 41 patients, has been published 12 . In contrast to previously reported studies, our study was not only a head-to-head prospective study but also analysed the relationship of bone metastasis size and serum PSA level on the detection rate of bone metastases in the two imaging modes.…”

177Lu-DOTA-IBA Therapy in Prostate Cancer With Bone Metastases

“…Early diagnosis and targeted treatment can effectively improve the prognosis. 4,5 The use of radioactive drugs to alleviate bone pain has advantages, including the simultaneous treatment of multiple metastatic lesions, repeatability, and combination with other therapies. 6,7 Bisphosphonates have been used in the treatment of bone metastases with good results.…”

“…Bone is the most common metastatic site in patients with prostate cancer. Early diagnosis and targeted treatment can effectively improve the prognosis 4,5 . The use of radioactive drugs to alleviate bone pain has advantages, including the simultaneous treatment of multiple metastatic lesions, repeatability, and combination with other therapies 6,7 .…”

Prostate-Specific Membrane Antigen Radioguided Surgery for Salvage Pelvic Lymph Node Dissection in a Man With Prostate Cancer

“…Prostate cancer is a global health issue and is the most commonly diagnosed cancer in men worldwide. 1,2 After radical prostatectomy 3 or radiotherapy for primary treatment of prostate cancer, up to 50% of all men develop tumor recurrence, which is determined by rising PSA levels. 468 Ga-labeled ligands targeting PSMA have been used with extraordinary success for PET imaging of prostate cancer.…”

“…Prostate-specific antigen level decreased following surgery (to 2.5 ng/dL). Prostate cancer is a global health issue and is the most commonly diagnosed cancer in men worldwide 1,2 . After radical prostatectomy 3 or radiotherapy for primary treatment of prostate cancer, up to 50% of all men develop tumor recurrence, which is determined by rising PSA levels 4 .…”