PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0

Fendler, Wolfgang P.; Eiber, Matthias; Beheshti, Mohsen; Bomanji, Jamshed; Calais, Jérémie; Ceci, Francesco; Cho, Steve Y.; Fanti, Stefano; Giesel, Frederik L.; Goffin, Karolien; Haberkorn, Uwe; Jacene, Heather A.; Koo, Phillip J.; Kopka, Klaus; Krause, Bernd J.; Lindenberg, Liza; Marcus, Charles; Mottaghy, Felix; Oprea-Lager, Daniela E.; Osborne, Joseph R.; Piert, Morand; Rowe, Steven P.; Schöder, Heiko; Wan, Simon; Wester, Hans‐Jürgen; Hope, Thomas A.; Herrmann, Ken

doi:10.1007/s00259-022-06089-w

Cited by 150 publications

(70 citation statements)

References 146 publications

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“…Again, the effect is hard to evaluate but is likely small. A diagnostic CT is not considered obligatory in PSMA PET imaging (Fendler et al 2023 ).…”

Section: Discussionmentioning

confidence: 99%

“…A possible point of contention is our use of the aortic bifurcation as the classifier for M1a disease, in line with the PROMISE criteria and E-PSMA guidelines but contrary to the 8th edition of the TNM criteria which uses the iliac bifurcation (Fendler et al 2023 ; Brierley et al 2017 ; Ceci et al 2021 ). There is ongoing debate about which is the clinically relevant M1a classifier (Arnfield et al 2022 ; Oprea-Lager et al 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…A study of 40 patients comparing 1 and 2 h uptake time reported increased activity in suspected malignant lesions, and lower background activity, but only one additional possible lymph node metastasis at 2 h compared with 1 h (Rahbar et al 2018 ). Clinical studies of [ 18 F]PSMA-1007 have generally used an uptake time of 90–120 min, and this interval is recommended in the recently published EANM/SNMMI guideline for prostate cancer imaging (Giesel et al 2019 ; Ingvar et al 2022 ; Sprute et al 2021 ; Fendler et al 2023 ). Imaging after 1 h would allow increased production and higher patient comfort compared to a longer interval.…”

Section: Introductionmentioning

confidence: 99%

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PET/CT imaging 2 h after injection of [18F]PSMA-1007 can lead to higher staging of prostate cancer than imaging after 1 h

Hvittfeldt

Bitzén

Minarik

et al. 2023

European J Hybrid Imaging

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Background [18F]PSMA-1007 is a prostate specific membrane antigen (PSMA) ligand for positron emission tomography (PET) imaging of prostate cancer. Current guidelines recommend imaging 90–120 min after injection but strong data about optimal timing is lacking. Our aim was to study whether imaging after 1 h and 2 h leads to a different number of detected lesions, with a specific focus on lesions that might lead to a change in treatment. Methods 195 patients underwent PET with computed tomography imaging 1 and 2 h after injection of [18F]PSMA-1007. Three readers assessed the status of the prostate or prostate bed and suspected metastases. We analyzed the location and number of found metastases to determine N- and M-stage of patients. We also analyzed standardized uptake values (SUV) in lesions and in normal tissue. Results Significantly more pelvic lymph nodes and bone metastases were found and higher N- and M-stages were seen after 2 h. In twelve patients (6.1%) two or three readers agreed on a higher N- or M-stage after 2 h. Conversely, in two patients (1.0%), two readers agreed on a higher stage at 1 h. SUVs in suspected malignant lesions and in normal tissues were higher at 2 h, but lower in the blood pool and urinary bladder. Conclusions Imaging at 2 h after injection of [18F]PSMA-1007 leads to more suspected metastases found than after 1 h, with higher staging in some patients and possible effect on patient treatment.

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“…Again, the effect is hard to evaluate but is likely small. A diagnostic CT is not considered obligatory in PSMA PET imaging (Fendler et al 2023 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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PET/CT imaging 2 h after injection of [18F]PSMA-1007 can lead to higher staging of prostate cancer than imaging after 1 h

Hvittfeldt

Bitzén

Minarik

et al. 2023

European J Hybrid Imaging

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“…Patients underwent clinical routine 68 Ga-PSMA-PET/CT on GE Discovery MI, GE Discovery STE, GE Discovery 710 (GE HealthCare Worldwide Milwaukee, WI, USA) after a single injection of 68 Ga-PSMA-11 (mean dose 2 MBq/kg); low dose CT was acquired (with parameters of 120 KeV and 80 mA) according to the EANM procedure guidelines [ 27 , 28 , 29 ]. Dedicated workstations (AW Server 3.2 Ext.…”

Section: Methodsmentioning

confidence: 99%

Histology and PSMA Expression on Immunohistochemistry in High-Risk Prostate Cancer Patients: Comparison with 68Ga-PSMA PET/CT Features in Primary Staging

Vetrone

Mei

Bianchi

et al. 2023

Cancers

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PSMA-PET/CT is a suitable replacement for conventional imaging in the primary staging of PCa. The aim of this retrospective study was to assess the correlation between parameters discovered by PSMA PET/CT in primary staging and either prostate histopathology (pT) findings or PSMA-IHC expression in a cohort of biopsy-proven high-risk PCa candidates for surgery. Clinical information (age, iPSA-value, and grading group) and PSMA-PET/CT parameters (SUVmax, PSMA tumor volume [PSMA-TV], and total lesion [PSMA-TL]) were compared with pT (including histologic pattern, Gleason grade, and lymphovascular invasion [LVI]) and PSMA-IHC features, including visual quantification (VS) with a four-tiered score (0 = negative, 1+ = weak, 2+ = moderate, 3+ = strong), growth pattern (infiltrative vs expansive), and visual pattern (cytoplasmic vs membranous). In total, 44 patients were enrolled, with a median age of 67 (IQR 57-77); the median iPSA was 9.4 ng/dL (IQR 12.5-6.0). One patient (3%) was grading group (GG) 3, 27/44 (61%) were GG4, and 16/44 (36%) were GG5. PSMA-PET/CT detection rate for the presence of primary prostate cancer was 100%. Fused/poorly formed Gleason grade 4 features were predominant (22/44–50%); a cribriform pattern was present in 18/44 (41%) and acinar in 4/44 (9%). We found that lower PSMA-TVs were mostly related to acinar, while higher PSMA-TVs correlated with a higher probability to have a cribriform pattern (p-value 0.04). LVI was present in 21/44(48%) patients. We found that higher PSMA-TV and PSMA-TL are predictive of LVI p-value 0.002 and p-value 0.01, respectively. There was no correlation between PET-parameters and perineural invasion (PNI), probably because this was present in almost all the patients. Moreover, patients with high PSMA-TL values displayed the highest PSMA-IHC expression (VS3+) with a membranous pattern. In conclusion, PSMA-TV and PSMA-TL are predictors of a cribriform pattern and LVI. These conditions are mostly related to higher aggressiveness and worse outcomes.

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“…A transmembrane protein called PSMA is primarily found in all prostatic tissues. Many malignancies, but most notably prostate cancer, exhibit increased PSMA expression 1 . However, PSMA is not just associated with prostate cancer, and a growing number of nonprostatic diseases have demonstrated PSMA uptake 2–6 .…”

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confidence: 99%

Uptake of 68Ga-PSMA in Avascular Necrosis of the Femoral Head in a Patient With Prostate Cancer

Okudan,

Seven,

Sayan

2023

Clin Nucl Med

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PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0

Cited by 150 publications

References 146 publications

PET/CT imaging 2 h after injection of [18F]PSMA-1007 can lead to higher staging of prostate cancer than imaging after 1 h

PET/CT imaging 2 h after injection of [18F]PSMA-1007 can lead to higher staging of prostate cancer than imaging after 1 h

Histology and PSMA Expression on Immunohistochemistry in High-Risk Prostate Cancer Patients: Comparison with 68Ga-PSMA PET/CT Features in Primary Staging

Uptake of 68Ga-PSMA in Avascular Necrosis of the Femoral Head in a Patient With Prostate Cancer

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