Primary Staging of Prostate Cancer Patients with [18F]PSMA-1007 PET/CT Compared with [68Ga]Ga-PSMA-11 PET/CT

Abstract

Background: Hybrid imaging with prostate-specific membrane antigen (PSMA) is gaining importance as an increasingly meaningful tool for prostate cancer (PC) diagnostics and as a guide for therapy decisions. This study aims to investigate and compare the performance of [18F]PSMA-1007 (18F-PSMA) and [68Ga]Ga-PSMA-11 positron emission tomography/computed tomography (68Ga-PSMA) in the initial staging of PC patients. Methods: The data of 88 biopsy-proven patients were retrospectively evaluated. PSMA-avid lesions were compared with the histopathologic Gleason Score (GS) for prostate biopsies, and the results were plotted by receiver operating characteristic (ROC)-curve. Optimal maximum standardized uptake value (SUVmax) cut-off values were rated using the Youden index. Results: 18F-PSMA was able to distinguish GS ≤ 7a from ≥7b with a sensitivity of 62%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 67% for a SUVmax of 8.95, whereas sensitivity was 54%, specificity 91%, PPV 93%, and accuracy 66% for 68Ga-PSMA (SUVmax 8.7). Conclusions: Both methods demonstrated a high concordance of detected PSMA-avid lesions with histopathologically proven PC. 18F-PSMA and 68Ga-PSMA are both suitable for the characterization of primary PC with a comparable correlation of PSMA-avid lesions with GS. Neither method showed a superior advantage. Our calculated SUVmax thresholds may represent valuable parameters in clinical use to distinguish clinically significant PC (csPC) from non-csPC.

To see clear is not enough; it is the action that counts

“…Staging PSMA PET/CT of high-risk PCa patients detects lymph node metastases for almost a third of the patients and bone metastases for a sixth of the patients, as reported in a recent review ( 25 ). The estimates fit with recent literature ( 6 - 14 ). So staging PSMA shows metastatic PCa for half of the high-risk patients.…”

“…Other studies reported that staging PSMA PET/CT gave a similar or slightly higher frequency of patients with miN1/miM1 ( 6 - 14 ). Zheng et al showed that staging PSMA PET/CT gave pathological upgrading for 27% of the patients and a downgrading for 23% of the patients ( 6 ).…”

Intense PSMA Uptake in Solitary Fibrous Tumor of the Seminal Vesicle

“…FIGURE 2. For staging, 18 F-PSMA-1007 PET/CT scan was performed [1][2][3]. Anterior (A) and lateral (B) MIP PET showed an irregular area (arrows) of heterogeneous activity in the prostate region.…”

“…For staging, 18 F-PSMA-1007 PET/CT scan was performed. [1][2][3] Anterior (A) and lateral (B) MIP PET showed an irregular area (arrows) of heterogeneous activity in the prostate region. Transverse CT at the levels of the mid (C) and basal (D) prostate, corresponding PET (E and F) and fused (G and H) images showed heterogeneous activity (straight arrows) of the prostate and intense heterogeneous activity (curved arrow) with SUV max of 11.9 of the mass of the left seminal vesicle.…”

Prostate-Specific Membrane Antigen Uptake Heterogeneity in Mixed Ductal-Acinar Adenocarcinoma of the Prostate

“…FIGURE 2. For staging, 18 F-prostate-specific membrane antigen (PSMA) 1007 PET/CT scan was performed [1][2][3]. Maximum intensity projection PET (A) showed multifocal activity in the prostatic (straight arrow) and right pelvic regions (arrowheads) and physiologic urinary activity within the bladder (curved arrow).…”