The role of 68Ga-PSMA-I&amp;T PET/CT in the pretreatment staging of primary prostate cancer

Meyrick, Danielle; Asokendaran, Marcus; Skelly, Laura A; Lenzo, Nat; Henderson, Andrew

doi:10.1097/mnm.0000000000000738

Cited by 34 publications

(20 citation statements)

References 29 publications

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“…Given that cellular PSMA expression has been shown to correlate with PSA and Gleason score [ 73 ] and 68 Ga-PSMA PET/CT has been shown to be superior to standard staging modalities, such as CT, the use of 68 Ga-PSMA PET/CT would seem to be a logical clinical extension in staging of primary disease. Early data appear to confirm this contention, with several studies [ 74 , 75 ], including our own [ 76 ], showing high rates of detection of CT occult early metastatic disease ( Figure 2 ). In our recent study there was very good correlation between PSA and Gleason score and the chance of PSMA-avid metastatic disease.…”

Section: 68 Ga-psma Pet/ct In Primary Diseasesupporting

confidence: 59%

Review of Gallium-68 PSMA PET/CT Imaging in the Management of Prostate Cancer

Meyrick²,

2018

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Over 90% of prostate cancers over-express prostate specific membrane antigen (PSMA) and these tumor cells may be accurately targeted for diagnosis by 68Ga-PSMA-positron emission tomography/computed tomography (68Ga-PSMA-PET/CT) imaging. This novel molecular imaging modality appears clinically to have superseded CT, and appears superior to MR imaging, for the detection of metastatic disease. 68Ga-PSMA PET/CT has the ability to reliably stage prostate cancer at presentation and can help inform an optimal treatment approach. Novel diagnostic applications of 68Ga-PSMA PET/CT include guiding biopsy to improve sampling accuracy, and guiding surgery and radiotherapy. In addition to facilitating the management of metastatic castrate resistant prostate cancer (mCRPC), 68Ga-PSMA can select patients who may benefit from targeted systemic radionuclide therapy. 68Ga-PSMA is the diagnostic positron-emitting theranostic pair with the beta emitter Lutetium-177 PSMA (177Lu-PSMA) and alpha-emitter Actinium-225 PSMA (225Ac-PSMA) which can both be used to treat PSMA-avid metastases of prostate cancer in the molecular tumor-targeted approach of theranostic nuclear oncology.

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Section: 68 Ga-psma Pet/ct In Primary Diseasesupporting

confidence: 59%

Review of Gallium-68 PSMA PET/CT Imaging in the Management of Prostate Cancer

Meyrick²,

2018

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“…This highlights the increased sensitivity compared with CT, which bases pathology predominantly on size criteria. The increased sensitivity and specificity of GAPSMA is also now been shown to improve diagnostic accuracy in primary staging by our group[31] and others. [32] This may alter the treatment paradigm and may improve results of primary therapeutic strategies though this has yet to be proven.…”

Section: Discussionmentioning

confidence: 99%

Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography compared with diagnostic computed tomography in relapsed prostate cancer

Asokendaran

Meyrick

Skelly³

et al. 2019

World J Nucl Med

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The aim of this study was to evaluate if prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has a higher detection rate compared to standard contrast CT imaging for patients with a rising prostate-specific antigen (PSA) following definitive treatment (i.e., curative radical prostatectomy, radiotherapy, and brachytherapy) for prostate cancer in a private hospital setting. A retrospective single-site clinical audit was conducted on 150 PSMA PET/CT scans done for patients with a rising PSA after definitive treatment for prostate cancer. All studies were performed using I and T Ga-68 PSMA produced on a Scintomics radiopharmaceutical unit (Munich). All scans were performed on a GE 710 PET/CT scanner. All studies were compared to standard CT and other imaging. Of the 150 patients who had a 68 Gallium (Ga)-PSMA PET/CT for a rise in their PSA levels, 102/150 (68%) of patients had PSMA-avid scans compared to the conventional imaging group which had an overall detection rate of 42% (63/150). The rates of detection were 100%, 90%, 92%, 67%, and 25% at PSA levels of >10 μg/L, 5–10 μg/L, >1.5 μg/L, 0.5–1.5 μg/L, and <0.5 μg/L, respectively. PSMA PET/CT also solely picked up 39/102 (38%) of prostate cancer relapses compared to the conventional imaging group. In our study of 150 patients with biochemical recurrence of prostate cancer, 68 Ga-PSMA PET/CT demonstrated a superior detection rate ( P < 0.05) compared to conventional imaging, including patients with low PSA levels (<0.5 μg/L).

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“…This population exhibits a lower sensitivity (73% sensitivity) compared to intermediate and high risk cancers[27,34]. In this latter group of patients, PSMA PET/CT may be helpful in identifying the more aggressive tumors, however, the value compared to MRI-guided biopsy is unclear at this point[31,35,36]. One potential use for PSMA PET/CT is to limit the number of biopsies to the high uptake lesions, however, this idea must be tested.…”

Section: Psma Pet/ct In Localized Diseasementioning

confidence: 99%

“…[••29]. In general, PSA levels correlate with the likelihood of a positive PSMA scan and with the SUVmax[•26,35]. For instance, comparing patients with mean PSA values below and above 10ng/ml, the mean SUVmax for tumors increases from 7.7 to 17.6[35].…”

Section: Psma Pet/ct In Localized Diseasementioning

confidence: 99%