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

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 68Gallium (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, 68Ga-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).

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

OBJECTIVES: This retrospective study aimed to evaluate the role of Ga-PSMA-I&T PET/CT in the primary staging of newly diagnosed prostate cancer (PCa), with a focus on the detection of metastatic nodal disease. Correlation of the rate of detection of metastatic disease by Ga-PSMA-I&T PET/CT with the Gleason score (GS) and serum prostate-specific antigen (PSA) was performed to determine the GS and PSA criteria defining patients who would benefit from Ga-PSMA-I&T PET/CT imaging for staging, risk stratification and therapy optimization. PATIENTS AND METHODS: Patient data and images from 70 patients with a recent diagnosis of prostate cancer who had undergone Ga-PSMA-I&T PET/CT were analysed retrospectively. Data and images were analysed for the rate of detection of primary and metastatic PCa, and correlation with PSA and GS. RESULTS: The rate of detection of primary tumour by Ga-PSMA-I&T for patients with serum PSA less than 5 ng/ml was 73%. The corresponding rate was 90% for patients with PSA 5-10 ng/ml and 97% for patients with PSA more than 10 ng/ml. Metastatic PCa and/or infiltrative disease was detected in 24/70 study patients in total: 1/11 patients with PSA less than 5 ng/ml and 23/59 patients with serum PSA at least 5 ng/ml. The rate of detection of metastatic PCa was greater in patients with GS 9 or more (48%) relative to those with GS 8 (32%) or GS ≤7 (18%). CONCLUSION: A role for Ga-PSMA-I&T PET/CT in primary PCa staging of high-grade disease (GS 8 or more and PSA >10 ng/ml) has been shown. There was a low rate of detection of PSMA-avid metastases in low-grade disease (GS 7 or less and PSA <5 ng/ml), suggesting that there is a limited role for this modality in such cases.

Pre-clinical evaluation of 2,3-dimercaptosuccinic acid as a radiation nephrotoxicity protective agent during radiopeptide therapy of neuroendocrine malignancy.

AIM: To determine if dimercaptosuccinic acid (DMSA), an agent originally developed as a safe non-toxic antidote for heavy metal poisoning, would be useful as a kidney radiation dose reduction agent in patients undergoing radiopeptide therapy for cancer. METHODS: Thirty-six adult male Wistar rats were injected via the penile vein with 10 MBq of 177Lu-DOTA-tyr(3)-octreotate. At 30 min after the radiopeptide injection, 18 of the animals (intervention group) were injected with 0.15 mg x g(-1) of DMSA (i.p.). Samples were collected for gamma counting at 24 (n=12), 48 (n=12) and 72 h (n=12) after administration of the radiopeptide. At each time point, the percentage injected dose per gram of tissue in each sample of the six control animals was compared with that of the six animals from the DMSA injection regimen. RESULTS: The i.p. injection of 0.15 mg x g(-1) of DMSA 30 min following the administration of the 177Lu-DOTATATE reduced the mean (95% CI) kidney retention of radiopeptide by 15.6% (2.6-24.6) at 72 h while not significantly affecting uptake in other organs. Statistical testing of the difference between the two groups of animals (DMSA versus controls) at 72 h post-administration of the radiopeptide indicated only a 3% chance that the magnitude of the reduction in kidney radiopeptide retention observed would be expected due to natural variation (i.e., if there was no difference between the groups). CONCLUSION: This study has indicated that DMSA has the potential to selectively reduce radiopeptide kidney retention. Further work is necessary to determine the most effective dose of DMSA and the most effective timing regimen, and to examine the clinical efficacy of several other chelating agents.