Prostate-specific membrane antigen-directed imaging and radioguided surgery with single-photon emission computed tomography: state of the art and future outlook

Filippi, Luca; Palumbo, Barbara; Frantellizzi, Viviana; Nuvoli, Susanna; Vincentis, Giuseppe De; Spanu, Angela; Schillaci, Orazio

doi:10.1080/17434440.2022.2146999

Cited by 6 publications

(5 citation statements)

References 61 publications

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“…Although it has not been implemented in national and international guidelines, RGS is increasingly considered by uro-oncologic surgeons to delay systemic antihormonal treatment 24–26 . Radioguidance in a primary or salvage lymph node dissection strategy aims at correctly identifying lymph node metastases and thus contributes to less invasive surgery concepts 27 . Results of several radionuclides and PC-directed ligands have been published, but none of the studies described 67 Ga as radionuclide before 1,9,17,28 .…”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26] Radioguidance in a primary or salvage lymph node dissection strategy aims at correctly identifying lymph node metastases and thus contributes to less invasive surgery concepts. 27 Results of several radionuclides and PC-directed ligands have been published, but none of the studies described 67 Ga as radionuclide before. 1,9,17,28 Specifically, the ligand used in this study, PSMA I&T has been conjugated with 68 Ga, Cu-64, 111 In, 177 Lu, and 225 Ac.…”

Section: Rgs With Different Radionuclides and Ligandsmentioning

confidence: 99%

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67Ga-PSMA I&T for Radioguided Surgery of Lymph Node Metastases in Patients With Biochemical Recurrence of Prostate Cancer

Winkens

Berger²,

Foller³

et al. 2023

Clin Nucl Med

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Purpose: Radioguided lymph node dissection in patients with prostate cancer, and suffering from biochemical recurrence has been described thoroughly during the past few years. Several prostate-specific membrane antigen (PSMA)-directed ligands labeled with 111 In, 99m Tc, and 68 Ga have been published; however, limitations regarding availability, short half-life, high costs, and unfavorable high energy might restrict frequent use. This study aims at introducing 67 Ga as a promising radionuclide for radioguided surgery. Methods: Retrospective analysis was performed on 6 patients with 7 PSMApositive lymph node metastases. 67 Ga-PSMA I&T (imaging and therapy) was synthesized in-house and intravenously applied according to §13 2b of the German Medicinal Products Act. Radioguided surgery was performed 24 hours after injection of 67 Ga-PSMA I&T using a gamma probe. Patient urine samples were collected. Occupational and waste dosimetry was performed to describe hazards arising from radiation. Results: 67 Ga-PSMA application was tolerated without adverse effects. Five of 7 lymph nodes were detected on 22-hour SPECT/CT in 4 of 6 patients. During surgery, all 7 lymph node metastases were identified by positive gamma probe signal. Relevant accumulation of 67 Ga was observed in lymph node metastases (32.1 ± 15.1 kBq). Histology analysis of near-field lymph node dissection revealed more lymph node metastases than PET/CT (and gamma probe measurements) identified. Waste produced during inpatient stay required decay time of up to 11 days before reaching exemption limits according to German regulations. Conclusions: Radioguided surgery using 67 Ga-PSMA I&T is a safe and feasible option for patients suffering from biochemical recurrence of prostate cancer. 67 Ga-PSMA I&Twas successfully synthesized according to Good Manufacturing Practice guidelines. Radioguided surgery with 67 Ga-PSMA I&T does not lead to relevant radiation burden to urology surgeons and represents a novel interdisciplinary approach in nuclear medicine and urology.

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Section: Discussionmentioning

confidence: 99%

Section: Rgs With Different Radionuclides and Ligandsmentioning

confidence: 99%

67Ga-PSMA I&T for Radioguided Surgery of Lymph Node Metastases in Patients With Biochemical Recurrence of Prostate Cancer

Winkens

Berger²,

Foller³

et al. 2023

Clin Nucl Med

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“…High 18 F-FTT uptake prior to PARPi treatment in patients with high-grade serous ovarian carcinoma also predicted response 42 . Additional PARP-targeted agents have also been developed for PET imaging, and PARP PET imaging has been used to study the pharmacodynamics of PARPi drug target engagement in animal models of small cell lung cancer and evaluated in first-in-human studies in patients with brain cancers and head and neck cancers 43–47 . These data together suggest the potential for PARP PET imaging to provide insights into better understanding in vivo PARPi behavior and improving patient selection for PARPi therapy.…”

Section: Imaging Parp Expressionmentioning

confidence: 97%

Positron Emission Tomography Imaging of Tumor Proliferation and DNA Repair

Shields,

Chen

2024

Cancer J

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Positron emission tomography (PET) is an established tool for molecular imaging of cancers, and its role in diagnosis, staging, and phenotyping continues to evolve and expand rapidly. PET imaging of increased glucose utilization with 18F-fluorodeoxyglucose is now entrenched in clinical oncology practice for improving prognostication and treatment response assessment. Additional critical processes for cancer cell survival can also be imaged by PET, helping to inform individualized treatment selections for patients by improving our understanding of cell survival mechanisms and identifying relevant active mechanisms in each patient. The critical importance of quantifying cell proliferation and DNA repair pathways for prognosis and treatment selection is highlighted by the nearly ubiquitous use of the Ki-67 index, an established histological quantitative measure of cell proliferation, and BRCA mutation testing for treatment selection. This review focuses on PET advances in imaging and quantifying cell proliferation and poly(ADP-ribose)polymerase expression that can be used to complement cancer phenotyping approaches that will identify the most effective treatments for each individual patient.

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“…PSMA inhibitors labeled with radionuclides emitting positrons or gamma-photons can be used for imaging with PET/CT or single photon emission computed tomography (SPECT). 87 There are different approaches for obtaining PSMA ligands labeled with gamma-emitting nuclides and discussions for the applications of PSMA SPECT imaging in various clinical settings, as well as its potential use in radioguided surgery (RGS). Intraoperative PSMA-targeted radioguidance has been proven valuable for detecting prostate cancer lesions during open surgery, and the rapid growth of robot-assisted, minimally invasive surgery has led to an increased need for robot-compliant PSMA-RGS.…”

Section: Clinical Significance and Research Implicationsmentioning

confidence: 99%

The current status of prostate cancer treatment and PSMA theranostics

et al. 2023

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In the treatment of cancer, understanding the disease status, or accurate staging, is extremely important, and various imaging techniques are used. Computed tomography (CT), magnetic resonance imaging, and scintigrams are commonly used for solid tumors, and advances in these technologies have improved the accuracy of diagnosis. In the clinical practice of prostate cancer, CT and bone scans have been considered especially important for detecting metastases. Nowadays, CT and bone scans are called conventional methods because positron emission tomography (PET), especially prostate-specific membrane antigen (PSMA)/PET, is extremely sensitive in detecting metastases. Advances in functional imaging, such as PET, are advancing the diagnosis of cancer by allowing information to be added to the morphological diagnosis. Furthermore, PSMA is known to be upregulated depending on the malignancy of the prostate cancer grade and resistance to therapy. Therefore, it is often highly expressed in castration-resistant prostate cancer (CRPC) with poor prognosis, and its therapeutic application has been attempted for around two decades. PSMA theranostics refers to a type of cancer treatment that combines both diagnosis and therapy using a PSMA. The theranostic approach uses a radioactive substance attached to a molecule that targets PSMA protein on cancer cells. This molecule is injected into the patient’s bloodstream and can be used for both imaging the cancer cells with a PET scan (PSMA PET imaging) and delivering radiation directly to the cancer cells (PSMA-targeted radioligand therapy), with the aim of minimizing damage to healthy tissue. Recently, in an international phase III trial, the impact of 177Lu-PSMA-617 therapy was studied in patients with advanced PSMA-positive metastatic CRPC who had previously been treated with specific inhibitors and regimens. The trial revealed that 177Lu-PSMA-617 significantly extended both progression-free survival and overall survival compared to standard care alone. Although there was a higher incidence of grade 3 or above adverse events with 177Lu-PSMA-617, it did not negatively impact the patients’ quality of life. PSMA theranostics is currently being studied and used primarily for the treatment of prostate cancer, but it has the potential to be applied to other types of cancers as well.

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Prostate-specific membrane antigen-directed imaging and radioguided surgery with single-photon emission computed tomography: state of the art and future outlook

Cited by 6 publications

References 61 publications

67Ga-PSMA I&T for Radioguided Surgery of Lymph Node Metastases in Patients With Biochemical Recurrence of Prostate Cancer

67Ga-PSMA I&T for Radioguided Surgery of Lymph Node Metastases in Patients With Biochemical Recurrence of Prostate Cancer

Positron Emission Tomography Imaging of Tumor Proliferation and DNA Repair

The current status of prostate cancer treatment and PSMA theranostics

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