Abstract:Purpose
With increasing use of PSMA PET/CT in the staging and restaging of prostate cancer (PCa), the identification of non-prostate cancer tumours (NPCaT) has become an increasing clinical dilemma. Atypical presentations of PSMA expression in prostate cancer and expression in NPCaT are not well established. Understanding the normal and abnormal distribution of PSMA expression is essential in preparing clinically relevant reports and in guiding multidisciplinary discussion and decisions.
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“…6 ) [ 65 ]. Perry et al retrospectively reviewed 1445 prostate cancer patients with atypical findings on 18F-DCFPyL PSMA PET and found non-prostate cancer tumors only in 1.2% of them with nearly all non-prostate cancer tumors showing no or low PSMA uptake, except renal cell carcinoma [ 66 ]. Fig.…”
Section: Psma In Cancers Other Than Prostatementioning
Prostate cancer is the second leading cause of cancer-related deaths in men in the United States. Imaging techniques such as CT, MRI, and bone scans have traditionally been used for diagnosis and staging. Molecular imaging modalities targeting the prostate-specific membrane antigen (PSMA) have recently gained attention due to their high affinity and accuracy. PSMA PET has been combined with other modalities such as multiparametric MRI for better diagnostic and prognostic performance. PSMA imaging has been studied at different clinical settings with a wide range of disease aggressiveness. In this review we will explore the role of PSMA PET in high-risk prostate cancer staging, biochemical recurrence, and castration-resistant prostate cancer. The primary focus of this review article is to examine the latest developments in the use of PSMA imaging and emphasize the clinical situations where its effectiveness has been demonstrated to significantly impact the treatment of prostate cancer. In addition, we will touch upon the potential future advancements of PSMA PET imaging and its evolving significance in the management of prostate cancer.
Graphical abstract
“…6 ) [ 65 ]. Perry et al retrospectively reviewed 1445 prostate cancer patients with atypical findings on 18F-DCFPyL PSMA PET and found non-prostate cancer tumors only in 1.2% of them with nearly all non-prostate cancer tumors showing no or low PSMA uptake, except renal cell carcinoma [ 66 ]. Fig.…”
Section: Psma In Cancers Other Than Prostatementioning
Prostate cancer is the second leading cause of cancer-related deaths in men in the United States. Imaging techniques such as CT, MRI, and bone scans have traditionally been used for diagnosis and staging. Molecular imaging modalities targeting the prostate-specific membrane antigen (PSMA) have recently gained attention due to their high affinity and accuracy. PSMA PET has been combined with other modalities such as multiparametric MRI for better diagnostic and prognostic performance. PSMA imaging has been studied at different clinical settings with a wide range of disease aggressiveness. In this review we will explore the role of PSMA PET in high-risk prostate cancer staging, biochemical recurrence, and castration-resistant prostate cancer. The primary focus of this review article is to examine the latest developments in the use of PSMA imaging and emphasize the clinical situations where its effectiveness has been demonstrated to significantly impact the treatment of prostate cancer. In addition, we will touch upon the potential future advancements of PSMA PET imaging and its evolving significance in the management of prostate cancer.
Graphical abstract
“…In these PSMA-negative patients, PSMA-PET is ineffective ( 36 ). In addition, metal artifacts low levels of PSMA uptake and bladder overflow are also possible elements of false negatives ( 85 ).Positive images need to be differentiated from normal tissue, benign lesions, and other non-PCa malignant lesions ( 25 , 86 – 88 ). Reports have shown that in normal tissues, high or mild 68 Ga-PSMA-11 uptake was observed in the renal cortex, duodenum, parotid gland, and submandibular salivary glands, spleen, lacrimal gland, and liver ( 89 – 92 ).…”
Section: Pet/ct False Negatives and False Positivesmentioning
Prostate cancer (PCa) induced death is the predominant cause of cancer-related death among men in 48 countries. After radical treatment, biochemical recurrence has become an important factor for prognosis. The early detection and diagnosis of recurrent lesions are very helpful in guiding treatment and improving the prognosis. PET/CT is a promising method for early detection of lesions in patients with biochemical recurrence of prostate cancer. This article reviews the progress of the research on PET/CT in the PCa biochemical recurrence and aims to introduce new technologies and provide more direction for future research.
“…Radioactively labeled ligands bind to PSMA, a protein also known as glutamate carboxypeptidase II, predominantly expressed by prostate cancer cells. In addition, radiopharmaceuticals are also distributed within various organs and compartments, as well as a few other tumor entities [4,5]. Contrary to its name, PSMA is also expressed in other tissues, although usually at lower levels.…”
(1) Background: PSMA ligand PET/CT is increasingly important for diagnostics of prostate cancer and other tumor diseases. In particular, the radiopharmaceutical [68Ga]Ga-PSMA-11 is widely used. Besides its tumor-specific binding, the uptake within the kidneys is dominant and seems to visualize the renal cortex specifically. Kidney diseases may alter the uptake of radiopharmaceuticals. Therefore, the correlation between renal uptake in PET/CT imaging and renal function should be investigated. (2) Methods: A group of 103 male patients were retrospectively evaluated for eGFR according to the CKD-EPI equation, tracer uptake intensity (SUVmax, SUVpeak, SUVmean), the molecular volume of the renal cortex, morphological kidney size, and total renal uptake. Manual and three different computer-assisted contouring methods (thresholds at 50% of SUVmax, 30% of SUVmax, and absolute SUV of 20) were used for measurements. Correlations between parameters were calculated using linear regression models. (3) Results: Renal SUVmax, SUVpeak, and SUVmean do not correlate with eGFR for manual or computer-assisted measurements. In contrast, molecular cortex volume shows a moderate correlation with eGFR (R2 = 0.231, p < 0.001), superior to morphological kidney size. A contouring threshold of 30% of SUVmax outperformed the other settings for renal cortex volume and total renal uptake. (4) Conclusions: Renal uptake of [68Ga]Ga-PSMA-11 cannot predict eGFR, but the functional renal cortex can be quantified by PET/CT imaging.
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