Dual-Tracer Positron-Emission Tomography Using Prostate-Specific Membrane Antigen and Fluorodeoxyglucose for Staging of Prostate Cancer: A Systematic Review

Abstract

PSMA PET is more accurate than conventional imaging (CT/bone scan) for staging of intermediate- or high-risk prostate cancer (PCa), but 5–10% of primary tumours have low PSMA ligand uptake. FDG PET has been used to further define disease extent in end-stage castrate-resistant PCa and may be beneficial earlier in the disease course for more accurate staging. The objective of this study was to review the available evidence for patients undergoing both FDG and PSMA PET for PCa staging at initial diagnosis and in recurrent disease. A systematic literature review was performed for studies with direct, intraindividual comparison of PSMA and FDG PET for staging of PCa. Assessment for radioligand therapy eligibility was not considered. Risk of bias was assessed. 543 citations were screened and assessed. 13 case reports, three retrospective studies, and one prospective study were included. FDG after PSMA PET improved the detection of metastases from 65% to 73% in high-risk early castration-resistant PCa with negative conventional imaging (M0). Positive FDG PET was found in 17% of men with negative PSMA PET for postprostatectomy biochemical recurrence. Gleason score ≥8 and higher PSA levels predicted FDG-avid metastases in BCR and primary staging. Variant histology (ductal and neuroendocrine) was common in case reports, resulting in PSMA-negative FDG-positive imaging for 3 patients. Dual-tracer PET for PCa may assist in characterising high-risk disease during primary staging and restaging. Further studies are required to determine the additive benefit of FDG PET and if the FDG-positive phenotype may indicate a poorer prognosis.

68Ga-PSMA and 68Ga-FAPI-04 PET/CT Findings With 18F-FDG PET/CT in a Patient With Recurrent Prostate Cancer

“…Unfortunately, the rapid progression of Pca resulted in the patient's death within 2 months. Studies in literature have reported that FDG positivity in Pca is associated with poor prognosis, as seen in our example 1,2 . Also, preliminary studies showed that fibroblast activation protein is expressed from cancer-related fibroblasts in the tumor microenvironment as well as from the metastases of Pca 3,4 .…”

Calibration and standardization of extracellular vesicle measurements by flow cytometry for translational prostate cancer research

“…Lower PSMA expression has been previously reported in treatment-refractory prostate cancer patients. [49][50][51][52][53][54] In response to androgen-deprivation therapy, CRPC tumors can progress towards a neuroendocrine phenotype and lose PSMA expression. Herein, we provide blood-based evidence that both PSMA + and STEAP1 + -EVs can be promising for identification of aggressive prostate cancer including those characterized by neuroendocrine features and low serum PSA levels.…”

Comparison of 68Ga-PSMA PET/CT with fluoride PET/CT for detection of bone metastatic disease in prostate cancer

“…However, fluoride PET/CT had a significantly higher detection rate for bone metastases and could be a relevant complement to PSMA PET in certain scenarios. PSMA-expression might be reduced or absent in dedifferentiated PCa and a discrepancy between PSA levels and PSMA PET findings should potentially trigger additional imaging with higher sensitivity in biochemical relapses after treatments with curative intent (McGeorge et al 2021 ). PSMA PET/CT followed by fluoride PET/CE-CT might also be a relevant combination for ruling out PSMA-negative lesions before treatment with PSMA-targeted radionuclide therapies.…”