Prospective intra-individual blinded comparison of [18F]PSMA-1007 and [68 Ga]Ga-PSMA-11 PET/CT imaging in patients with confirmed prostate cancer

Pattison, David A.; Debowski, Maciej; Gulhane, Brook; Arnfield, Evyn; Pelecanos, Anita; Garcia, Peter L.; Latter, Melissa J.; Lin, Charles; Roberts, Matthew J.; Ramsay, Stuart C.; Thomas, Paul

doi:10.1007/s00259-021-05520-y

Cited by 59 publications

(98 citation statements)

References 30 publications

(21 reference statements)

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“…The imaging data for prostatic lesions were compared with histopathologic prostate biopsy results expressed as GS. Our results showed concordant findings with both tracers, which is in line with other studies comparing 18 F-PSMA and 68 Ga-PSMA in primary staging [ 8 , 9 , 10 ]. Kuten et al reported in a head-to-head comparison that the identification of all intermediate- and high-risk PC lesions was comparable by both methods [ 8 ].…”

Section: Discussionsupporting

confidence: 92%

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

Hoffmann

Müller-Hübenthal²,

Rosar

et al. 2022

JCM

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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.

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Section: Discussionsupporting

confidence: 92%

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

Hoffmann

Müller-Hübenthal²,

Rosar

et al. 2022

JCM

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“…It is not feasible to pathologically confirm every disease site due to patient factors, location or small lesion size. However, sufficient evidence now exists to use [ 18 F]PSMA-1007 PET/CT as a standard of reference and a substitute for histopathological validation, as explained in the methods section [ 4 , 13 , 14 , 26 – 30 ]. Thirdly, a common issue with the [ 18 F]PSMA-1007 radiotracer is focal uptake in non-specific bone lesions (NSBLs) without an underlying CT correlate definite for prostate metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…This is based on strong evidence with multiple studies using both [ 18 F]PSMA-1007 PET/CT and [ 68 Ga]Ga-PSMA-11 PET/CT confirming an excellent diagnostic accuracy and high positive predictive value for the detection of metastatic disease with histopathological validation [ 4 , 13 , 14 , 26 – 29 ]. Additionally, a recent prospective intra-individual comparative study has demonstrated excellent concordance between [ 18 F]PSMA-1007 and [ 68 Ga]Ga-PSMA-11 PET/CT [ 30 , 31 ]. Therefore, we consider [ 18 F]PSMA-1007 PET/CT as an acceptable substitute for histopathological validation based on this extensive literature.…”

Section: Methodsmentioning

confidence: 99%

Risk of metastatic disease using [18F]PSMA-1007 PET/CT for primary prostate cancer staging

et al. 2021

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Background Accurate prostate cancer imaging is critical for patient management. Multiple studies have demonstrated superior diagnostic accuracy of [68Ga]-PSMA-11 PET/CT over conventional imaging for disease detection, with validated clinical and biochemical predictors of disease detection. More recently [18F]PSMA-1007 offers theoretical imaging advantages, but there is limited evidence of clinical and biochemical predictors of scan findings in the staging population. This study investigates the association of clinical variables with imaging characteristics among patients who underwent [18F]PSMA-1007 PET/CT for primary staging of men with histopathologically confirmed prostate carcinoma. A retrospective review of 194 consecutive patients imaged between May 2019 to May 2020 was performed. Association between imaging variables (presence and distribution of metastatic disease, primary tumour SUVmax) and clinical variables (EAU risk criteria) were assessed using descriptive statistics, logistic regression model and ROC analysis. Results The median age, PSA level and ISUP grade were 70 years, 10 ng/mL and ISUP grade 3, respectively. There were 36.6% of patients with intermediate-risk and 60.8% of patients with high-risk disease. ISUP grade was associated with the presence of metastasis overall (p = 0.008) as well as regional nodal (p = 0.003), non-regional nodal (p = 0.041) and bone (p = 0.006) metastases. PSA level was associated with metastatic disease overall (p = 0.001), regional (p = 0.001) and non-regional nodal metastases (p = 0.004), but not with bone metastases (p = 0.087). There were too few visceral metastases for meaningful analysis. SUVmax of the primary prostatic tumour was associated with ISUP grade (p = 0.004), PSA level (p < 0.001) and AJCC stage (p = 0.034). PSA > 20 ng/mL and ISUP grade > 3 had a specificity of 85% (95% CI 78–91%) and 60% (95% CI 50–68%) and a sensitivity of 36% (95% CI 25–49%) and 62% (95% CI 49–74%), respectively, for detection of metastatic disease. Conclusion Metastatic disease according to [18F]PSMA-1007 PET/CT was associated with ISUP grade and PSA level. This is the largest study using [18F]PSMA-1007 PET/CT to confirm a positive correlation of PSA level, ISUP grade and stage with primary prostate tumour SUVmax.

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“…Muehlematter et al could illustrate in a retrospective assessment of 40 consecutive men who performed mpMRI and PSMA PET-MRI followed by a RP due to intermediate- to high-risk PCa a better sensitivity of PSMA-PET/MRI to detect extracapsular extension and infiltration of the seminal vesicle than with mpMRI [ 24 ]. Actually, despite the limited availability of comparative head-to-head studies with [ 18 F]F-PSMA-1007 and [ 68 Ga]Ga-PSMA-11 for prostate tumor staging, several studies have reported that both these tracers can equally identify predominant prostate lesions in patients with intermediate- or high-risk PCa, although the nonurinary excretion of [ 18 F]F-PSMA-1007 may help evaluate lesions near the urinary bladder better than [ 68 Ga]Ga-PSMA-11 [ 25 , 26 , 27 ].…”

Section: Clinical Indications Of Psma Pet Examinations In Prostate Ca...mentioning

confidence: 99%

Clinical Applications of PSMA PET Examination in Patients with Prostate Cancer

Rasul

Haug

2022

Cancers

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With the progressive aging of the population in industrially developed countries, as well as advances in diagnostic and biopsy techniques and improvements in patient awareness, the incidence of prostate cancer (PCa) is continuously increasing worldwide. Therefore, PCa is currently considered as the second leading cause of tumor-related death. Early detection of the tumor and its metastasis is essential, as the rate of disease recurrence is high and occurs in 27% to 53% of all patients who underwent curative therapy with radical prostatectomy or local radiotherapy. In this regard, the prostate specific membrane antigens, abbreviated as PSMAs, are type II membrane proteins that are highly expressed on the surface of malignant prostate tissue in PCa, particularly in aggressive, androgen-deprived, metastatic, and hormone-refractory PCa, and they are inversely associated with the androgen level. Up to 95% of adenocarcinomas of the prostate express PSMA receptors on their surface. Today, radionuclides that bind to these PSMA peptides are widely accepted for diagnostic and therapeutic purposes to specifically image and target prostate tumor cells at the molecular level, a process referred to as targeted theranostics. Numerous studies have demonstrated that the integration of these peptides into diagnostic and therapeutic procedures plays a critical role in the primary staging and treatment decisions of especially high-risk PCa, expands therapeutic options for patients with advanced stage of prostate tumor, and prolongs patients’ survival rate. In this review article, we intend to briefly spotlight the latest clinical utilization of the PSMA-targeted radioligand PET imaging modality in patients with different stages of PCa. Furthermore, limitations and pitfalls of this diagnostic technique are presented.

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Prospective intra-individual blinded comparison of [18F]PSMA-1007 and [68 Ga]Ga-PSMA-11 PET/CT imaging in patients with confirmed prostate cancer

Cited by 59 publications

References 30 publications

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

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

Risk of metastatic disease using [18F]PSMA-1007 PET/CT for primary prostate cancer staging

Clinical Applications of PSMA PET Examination in Patients with Prostate Cancer

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