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【Objective】 To develop a clinical prediction model based on 68Ga-prostate-specific membrane antigen-11 (68Ga-PSMA-11), positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mpMRI) parameters to stratify prostate cancer patients undergoing targeted biopsy, so as to avoid unnecessary systematic biopsy. 【Methods】 A total of 96 clinically significant prostate cancer (csPCa) patients who underwent 68Ga-PSMA-11 PET/CT and mpMRI prior to prostate targeted biopsy with systematic biopsy during Jan.2020 and Feb.2023 in Nanjing Drum Tower Hospital were retrospectively analyzed.By univariate and multivariate logistic regression analyses, maximum standard uptake value (SUVmax) in 68Ga-PSMA-11 PET/CT and minimum apparent diffusion coefficien (ADCmin) in mpMRI, as well as clinical parameters were evaluated to identify the independent predictors correlative with the effective diagnosis of targeted biopsy, and a clinical prediction model was constructed. 【Results】 Multivariate logistic regression analysis showed that SUVmax (OR=0.878, 95%CI: 0.804-0.959, P=0.004) and ADCmin (OR=1.005, 95%CI:1.001-1.010, P=0.027) were independent predictors of the effective diagnosis of targeted biopsy alone.The sensitivity, specificity, accuracy and area under the receiver operator characteristic curve (AUC) of the model were 0.80, 0.80, 0.83 and 0.84, respectively. 【Conclusion】 The clinical prediction model based on 68Ga-PSMA-11 PET/CT and mpMRI parameters is helpful to improve the effective diagnosis of targeted biopsy alone, and has practical value to stratify patients with csPCa so as to safely avoid systematic biopsy and effectively balance the benefits and risks.
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INTRODUCTION@#68Ga-PSMA PET is an effective imaging modality in the evaluation of prostate cancer. However, there is limited data on its use in the evaluation of therapeutic response, particularly in radioligand therapy.@*OBJECTIVE@#Our aim is to investigate the diagnostic accuracy of 68Ga-PSMA PET hybrid imaging in evaluating response to 177Lu-PSMA therapy in patients with mCRPC compared with the standard use of serum PSA.@*METHODOLOGY@#A systematic review was done according to the Cochrane diagnostic accuracy reviews guidelines and the PRISMA checklist of literature from January 2015 to August 2020. Literature search, study selection, and data extraction were conducted by 2 reviewers. Statistical analysis of data was done using Meta-DiSc v1.4@*RESULTS@#A total of 5 studies were included following screening. A total of 128 patients were included in the review. Using PSA response as the reference standard, the pooled sensitivity and specificity of 68Ga-PSMA PET hybrid imaging to evaluate treatment response to 177Lu-PSMA therapy was 85% (Cl: 74 to 92%) and 74% (Cl: 62 to 84%), respectively. The computed diagnostic accuracy was 79.7%.@*CONCLUSION@#68Ga-PSMA PET hybrid imaging is an effective diagnostic procedure in evaluating treatment response to 177Lu-PSMA therapy ligand therapy with good sensitivity, specificity, and diagnostic accuracy.
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Gálio , Lutécio , Neoplasias da PróstataRESUMO
ABSTRACT Objectives: Accurate preoperative prediction of adverse pathology is crucial for treatment planning of renal cell carcinoma (RCC). Previous studies have emphasized the potential of prostate-specific membrane antigen positron emission tomography / computed tomography (PSMA PET/CT) in differentiating between benign and malignant localized renal tumors. However, there is a scarcity of case reports elucidating the identification of aggressive pathological features using PET/CT. Our study was designed to prospectively compare the diagnostic value of enhanced CT, 68Ga-PSMA-11 and 18F-fluorodeoxyglucose (18F-FDG) PET/CT in clear-cell renal cell carcinoma (ccRCC) with necrosis or sarcomatoid or rhabdoid differentiation. Materials and Methods: A prospective case series of patients with a newly diagnosed renal mass who underwent enhanced CT, 68Ga-PSMA-11 and 18F-FDG PET/CT within 30 days prior to nephrectomy was included. Complete preoperative and postoperative clinicopathological data were recorded. Patients who received neoadjuvant targeted therapy, declined enhanced CT or PET/CT scanning, refused surgical treatment or had non-ccRCC pathological indications were excluded. Radiological parameters were compared within subgroups of pathological characteristics. Bonferroni corrections were used to adjust for multiple testing and statistical significance was set at a p-value less than 0.017. Results: Seventy-two patients were available for the final analysis. Enhanced CT demonstrated poor performance in identifying necrosis, sarcomatoid or rhabdoid differentiation and adverse pathology (all P > 0.05). The maximum standardized uptake value (SUVmax) of 68Ga-PSMA-11 PET/CT was more effective than 18F-FDG PET/CT in identifying tumor necrosis and adverse pathology, with an area under the curve (AUC) of 0.85 (cutoff value=25.26, p<0.001; Delong test z=2.709, p=0.007) for tumor necrosis and AUC of 0.90 (cutoff value=25.26, p<0.001; Delong test z=3.433, p<0.001) for adverse pathology. However, no significant statistical difference was found between 68Ga-PSMA-11 and 18F-FDG PET/CT in predicting sarcomatoid or rhabdoid feature (AUC of 0.91 vs.0.75, Delong test z=1.998, p=0.046). Subgroup analyses based on age, sex, tumor location, maximal diameter, stage and WHO/ISUP grade demonstrated that 68Ga-PSMA-11 PET/CT SUVmax had a significant predictive value for adverse pathology. Enhanced CT value and SUVmax demonstrated strong reliability [intraclass correlation coefficient (ICC) > 0.80], indicating a robust correlation. Conclusions: 68Ga-PSMA-11 PET/CT demonstrates distinct advantages in identifying aggressive pathological features of primary ccRCC when compared to enhanced CT and 18F-FDG PET/CT. Further research and assessment are warranted to fully establish the clinical utility of 68Ga-PSMA-11 PET/CT in ccRCC.
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This study reviewed 37 patients who received neoadjuvant ADT in our center and analyzed the change of 68Ga-PSMA PET/CT before and after treatment. This study found that neoadjuvant ADT significantly reduced the tumor visibility on 68Ga-PSMA PET/CT.
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Introduction@#Prostate cancer is the third most common cancer among Filipino males. Ga-68 PSMA PET-CT and Lu-177 PRLT have been introduced in the Philippines for the diagnostics and therapy of prostate cancer. @*Objective@#The aim of this study is to compare treatment outcomes of standard therapy plus Lu-177 PSMA radioligand therapy and standard therapy alone among patients with prostatic cancer status-post castration using Ga-68 PET-CT as an outcome indicator. @*Methodology@#This is an ambispective cohort study on Ga-68 PSMA PET-CT scans performed between January 1, 2018 and July 31, 2021. Serum PSA data taken within one month of the PET-CT scans were also collected when available. The PET-CT images were reviewed by a radiologist for RECIST response, and by a nuclear medicine physician for PERCIST response . @*Results@#A total of 11 participants were included in the study. Six participants (55.5%) received standard therapy, while five participants (45.5%) received Lu-177 PSMA radioligand therapy plus standard therapy. There was no significant difference in the baseline and follow-up CT as shown by all p values > 0.05. A trend towards higher number of participants with non-complete/non-progressive RECIST response was noted in the control group than the treatment group, as well as higher number of participants with progressive or stable disease using the PERCIST response. @*Conclusion@#There were no significant differences noted in the clinical outcomes of participants who received Lu-177 PRLT and those with standard therapy alone. A trend towards decreasing serum PSA, CT and PET measurements were noted among patients given Lu-177 PRLT than those with standard therapy.
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Neoplasias da PróstataRESUMO
Background@#Non-specific focal uptake in the skeleton is a diagnostic pitfall on 18F-PSMA-1007 PET/CT, but adjunctive measures to aid interpretation of these lesions are currently lacking. We present two cases where dual time point imaging provided additional information. @*Case Presentation@#The first patient had a PI-RADS 3 lesion on MRI. No PSMA-avid abnormality was seen on PET, save for focal uptake in the right pubis with no anatomic correlate. Additional imaging showed a decrease in lesion SUV, and this was interpreted as benign. Another patient, diagnosed with prostate cancer, had multiple PSMA-avid pelvic foci. Two suspiciously malignant bone lesions had increasing SUV trend after dual time point imaging despite only faint sclerosis on CT. In contrast, one faint PSMA-avid lesion with no anatomic abnormality was read as benign after a decrease in SUV. A decrease in lesion SUV may point to a benign etiology, while an increase would heighten suspicion for malignancy. One possible molecular explanation is that a true PSMA-overexpressing lesion would bind to the tracer for a longer period than a false positive.@*Conclusion@#Dual time point imaging provides additional information that may be useful in the interpretation of non-specificskeletal lesions with increased 18F-PSMA-1007 uptake.
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Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaRESUMO
The American Urological Association (AUA), European Association of Urology (EUA) and International Urological Society (SIU) annual meetings were held in 2022. Studies on prostate cancer reported in the meetings mainly focus on the advances of diagnostic biomarkers (such as α-2, 3-1inked sialylation of terminal N-glycan on free PSA density, SelectMDx) and imaging techniques [such as multiparametric magnetic resonance imaging, prostate specific membrane antigen(PSMA)-PET/CT], the new method for prostate biopsy, the new treatments of prostate cancer including [177Lu] Ludotadipep and DROP-IN PSMA probe, and the prognosis assessment of prostate cancer (such as AR-V7). This article provides an overview on the research hotspots of three international academic meetings.
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Masculino , Humanos , Urologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias da Próstata/patologia , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Radioisótopos de GálioRESUMO
Entre el 14 y 15 de abril del 2023 se realizó la reunión académica organizada por la Sociedad Colombiana de Urología y la Sociedad Peruana de Urología en Lima (Perú), donde los panelistas expertos en cáncer de próstata en el área de urología oncológica, urología funcional, oncología clínica, radioterapia oncológica y medicina nuclear debatieron sobre la evidencia actual en los diferentes escenarios de la enfermedad, logrando el primer Consenso Colombo-Peruano de Cáncer de Próstata.
Between April 14 and 15, 2023, the academic meeting organized by the Colombian Society of Urology and the Peruvian Society of Urology was held in Lima (Peru), where expert panelists in prostate cancer in the area of oncological urology, functional urology, clinical oncology, oncological radiotherapy and nuclear medicine discussed the current evidence in the different scenarios of the disease, achieving the first Colombo-Peruvian Consensus on Prostate Cancer.
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Humanos , Masculino , Peru , ColômbiaRESUMO
Resumen Introducción: La tomografía por emisión de positrones (PET) con antígeno de membrana específico de próstata (PSMA) mejora la estadificación del cáncer de próstata. Además, la intensidad de captación intraprostática del PSMA puede predecir resultados oncológicos clínicamente relevantes. Nuestro objetivo fue evaluar si la intensidad de captación de PSMA se asocia con el cáncer de próstata clínicamente significativo y poder conocer qué valor de captación de PSMA discrimina mejor esta relación. Métodos: Se realizó un estudio de cohorte de 40 pacientes con cáncer de próstata comprobado por biopsia previo a la realización de radioterapia externa. Se evaluó correlación entre intensidad de captación del PSMA intraprostático y los resulta dos patológicos adversos en la biopsia prostática. Se estudió qué valor de captación de PSMA discrimina mejor el cáncer de próstata clínicamente significativo utilizando curvas ROC. Resultados: El 40% de los pacientes tuvieron un cáncer de próstata clínicamente significativo, el maximum standardized uptake value (SUV max) tuvo una media de 11.5 (DE ± 7). La muestra arrojó un coeficiente de correlación Spearman de 0.4 (p = 0.007). El área bajo la curva (AUC) fue de 0.73, mostrando el punto de corte un SUV max ≥ 9.5, sensibilidad 0.81 y especificidad 0.71 en la detección de cáncer de próstata clínicamente significativo. Conclusión: la intensidad de captación del PSMA intraprostático puede ser una nueva herramienta diagnóstica en la detección del cáncer de próstata clínicamente significativo. Una intensidad de captación ≥ 9.5 tuvo una buena correlación con el cáncer de próstata clínicamente significativo.
Abstract Introduction: Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) improves prostate cancer staging. Furthermore, the intensity of intraprostatic uptake of PSMA can predict clinically relevant oncologic outcomes. The objective of this study is to evaluate whether the intensity of PSMA uptake is associated with clinically significant prostate cancer and to determine which value of PSMA uptake best dis criminates this relationship. Methods: A cohort study of 40 patients with biopsy-proven prostate cancer prior to external radiotherapy was conducted. The correlation between intraprostatic PSMA uptake intensity and adverse pathological findings in prostate biopsy was evaluated. Which PSMA uptake value better discriminates clinically significant prostate cancer was assessed using ROC curves. Results: Forty percent of the patients had a clinically significant prostate cancer and the maximum standardized uptake value (SUV max) had a mean of 11.5 (SD ± 7). The sample showed a Spearman correlation coefficient of 0.4 (p = 0.007). The area under the curve (AUC) was 0.73 and a SUV max ≥ 9.5 showed a sensitivity of 0.81 and a specificity of 0.71 in the detection of clinically significant prostate cancer. Conclusion: Intraprostatic PSMA uptake intensity can be a new diagnostic tool in the detection of clinically significant prostate cancer. An uptake intensity equal or greater than 9.5 is correlated with clinically significant prostate cancer.
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【Objective】 To investigate the diagnostic efficiency of 18F-PSMA-1007 PET/CT in assessing the metastasis of newly diagnosed prostate cancer (PC), and evaluate its relationship with clinical risk classification. 【Methods】 The clinical data of 257 newly diagnosed PC patients who underwent 18F-PSMA-1007 PET/CT between March 2019 and April 2021 were retrospectively reviewed in this study. All images were interpreted by two senior PET/CT diagnostic specialists. According to the D’Amico risk classification, the patients were divided into low-, intermediate- and high-risk groups. According to Gleason score (GS), the patients were divided into GS≤6, GS=7, and GS≥8 groups. According to the level of serum total prostate-specific antigen (tPSA), the patients were divided into <10 ng/mL, 10-20 ng/mL, and >20 ng/mL groups. Finally, in the groups with D’Amico risk classification, the subgroups were divided according to tPSA level and GS, and the differences of 18F-PSMA-1007 PET/CT in the detection of metastasis were compared among the subgroups. 【Results】 A total of 257 patients were enrolled with a median tPSA 16.34 (3.38-783.12) ng/mL and median Gleason score (GS) 8 (range: 6-10). There were 10 (3.89%), 36 (15.01%), and 211(80.10%) PC patients in the low-, intermediate-, and high-risk groups, respectively. The rate of metastasis in high-risk group, GS ≥ 8 group, and tPSA >20 ng/mL group was 45.02%, 46.50%, and 47.02%, respectively. The rate of metastasis in low-risk group, GS ≤6 group and tPSA <10 ng/mL group was 0, 8.82%, and 15.63%, respectively. When tPSA <10 ng/mL, the rate of metastasis in low-risk group (0) was lower than that in high-risk group (33.33%). When tPSA was 10-20 ng/mL, the rate of metastasis in intermediate-risk group (7.69%) was lower than that in high-risk group (38.71%). When GS ≤6, the rate of metastasis in low-risk group (0) was lower than that in high-risk group (38.71%). 【Conclusion】 The detection rate of metastasis in patients with newly diagnosed prostate cancer by 18F-PSMA-1007 PET/CT is positively correlated with GS, preoperative tPSA level, and D’Amico risk grade.
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Objective To evaluate the diagnostic value of 18F-labeled PSMA PET/CT for regional lymph node metastasis in prostate cancer. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP and Wanfang database from January 1, 2000 to May 31, 2021 for the studies about the diagnosis of 18F-labeled PSMA PET/CT for regional lymph node metastasis and staging in prostate cancer. Two investigators screened literature, extracted relevant data and assessed the quality of the literature independently. The meta-analysis was performed using Meta-disc 1.4 and Stata 16.0 software. Results A total of 8 studies were finally included for the analysis, consisting of 754 prostate cancer patients and 2101 lymph nodes. The results of this meta-analysis showed pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio and diagnostic ratio were 0.82 (95%CI: 0.61-0.93), 0.98 (95%CI: 0.91-1.00), 45.7 (95%CI: 9.0-231.3), 0.18 (95%CI: 0.07-0.45) and 251 (95%CI: 34-1851), respectively. The area under the SROC curve was 0.97 (95%CI: 0.95-0.98). Conclusion 18F-labeled PSMA PET/CT has a high diagnostic value for regional lymph node metastasis in prostate cancer.
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Introduction@#18F-PSMA-1007 is a novel prostate-specific membrane antigen (PSMA)-based radiopharmaceutical for imaging prostate cancer. The recommended imaging time is 60 minutes post-injection of the radiotracer. However, during this time there is a physiologic accumulation of the radiotracer in the urinary bladder which sometimes may obscure lesions adjacent to it. @*Objective@#This study aims to determine if early dynamic imaging in addition to the recommended 60-minute postinjection static imaging can improve the detection of PSMA-avid lesions in the staging and restaging of prostate cancer. @*Methods@#This is a retrospective cross-sectional study of the detection rate of early dynamic and static imaging using 18F-PSMA-1007 PET/CT scan in patients with prostate cancer (PCa) who were referred for initial staging or restaging. The McNemar test was used to compare the detection rate between the two imaging. Spearman correlation was used to determine the correlation of Gleason score (GS), PSA, and SUVmax values.@*Results@#18F-PSMA-1007 PET/CT scans of 53 patients with prostate cancer, were referred for either staging (22/53) or restaging (31/53), all of whom had undergone both early dynamic and static imaging. Among the 53 patients, 5 had 2 lesions each, for a total of 58 lesions were included in the analysis. There were 48/58 lesions detected on both early dynamic and static imaging, 2/58 lesions were only detected in the early imaging, 1/58 lesions was only detected in the static imaging, and 7/58 were not detected on both imaging. McNemar the test was not statistically significant (p = 1.000) in the detection rate of the two methods. There is a positive correlation between serum PSA levels and SUVmax measurements for all the patients. Only the correlation between the GS and SUVmax in the static imaging of the staging group was statistically significant. @*Conclusion@#Early dynamic imaging may be an adjunctive procedure in detecting PSMA-avid lesions, particularly in the basal segment of the prostate gland near the urinary bladder. However, it is not recommended as a standard component of the comprehensive protocol for imaging using 18F-PSMA-1007 PET/CT in patients with PCa.
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Neoplasias da PróstataRESUMO
Resumen Objetivo: Evaluar la correlación diagnóstica entre las cinéticas del antígeno específico de la próstata (PSA) y la positividad de la PET/TC 18F-PSMA en pacientes con cáncer de próstata con recaída bioquímica (RCP, recurrencia del cáncer de próstata). Material y métodos: Se realizó un trabajo observacional de corte transversal de pacientes con una RCP que fueron evaluados con PET/TC 18F-PSMA-1007 en los que se analizó la concordancia entre el PET/TC PSMA y las cinéticas del PSA. Resultados: Se analizaron un total de 54 pacientes. La edad media fue de 68 ± 8 años. El PSA disparador de la PET/TC mostró una mediana (Q1-Q3) de 3,14 (0,73-8.69) ng/ml. La PET/TC colina mostró una tasa de positividad del 35%, mientras que la PET/TC 18F-PSMA mostró una tasa de positividad del 80%, pero con un PSA disparador ≥ 2 ng/ml la PET/TC 18F-PSMA tuvo un 100% de positividad; mientras que la PET/TC colina un 55% de positivos. En la valoración de las cinéticas de PSA para PET/TC PSMA las curvas ROC mostraron para PSAV un área bajo la curva de 0,93 (IC 95%: 0,83-1; p = 0,0001), presentado el punto de corte 0,85 ng/ml/año una sensibilidad del 88% y una especificidad del 87%. El 97% de las PET/TC 18F-PSMA fueron positivas con un PSAV > 0,85 ng/ml/año (p = 0,0001). Mientras que las curvas ROC mostraron para PSADT un área bajo de la curva de 0,38 (IC 95%: 0,21-0,57; p = 0,321) sin evidenciar valor diagnóstico. Conclusión: Se evidenció que el PSAV fue un muy buen predictor de positividad en la PET/TC 18F-PSMA en pacientes con RCP, no así el PSADT.
Abstract Introduction: Prostate-specific antigen (PSA) kinetics (PSA velocity [PSAV] and PSA doubling time [PSADT]) are predictors of positivity in Choline PET/CT, but this correlation has not been correctly established in PSMA PET/CT. Objective: To evaluate the diagnostic correlation between PSA kinetics and positivity of 18F PSMA PET/CT in patients with relapsed prostate cancer (RPC). Material and methods: We performed an observational cross-sectional study of 54 patients with RPC that were evaluated with 18F-PSMA PET/CT. The concordance between 18F-PSMA PET/CT and PSA kinetics was analyzed. Results: The mean age was 68 ± 8 years. Time to relapse had a median (Q1-Q3) of 29 (8; 48) months. The trigger PSA showed a median of 3.14 (0.73-8.69) ng/dl. 18F-PSMA PET/CT showed a positivity of 80%. The ROC curves showed an AUC of 0.93 for PSAV (95%CI0.83-1; p = 0.0001). A cut-off points of 0.85 ng/ml/year showed a sensitivity of 88% and a specificity of 87%. 97% of the 18F-PSMA PET/CT were positive with a PSAV > 0.85 ng/ml/year (p = 0.0001). While the ROC curves showed an AUC of 0.38 for PSADT (95%CI 0.21- 0.57; p = 0.321) without showing diagnostic value. Conclusion: PSAV was a predictor of positivity in 18F-PSMA PET/CT in patients with RPC, but PSADT was not.
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Humanos , Masculino , Feminino , Neoplasias da Próstata/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Antígeno Prostático Específico , Neoplasias/químicaRESUMO
ABSTRACT Introduction: Prostate cancer (PC) is the second most commonly diagnosed cancer in males. 68Ga-PSMA PET/CT, a non-invasive diagnostic tool to evaluate PC with prostate-specific membrane antigen (PSMA) expression, has emerged as a more accurate alternative to assess disease staging. We aimed to identify predictors of positive 68Ga-PSMA PET and the accuracy of this technique. Materials and methods: Diagnostic accuracy cross-sectional study with prospective and retrospective approaches. We performed a comprehensive literature search on PubMed, Cochrane Library, and Embase database in search of studies including PC patients submitted to radical prostatectomy or radiotherapy with curative intent and presented biochemical recurrence following ASTRO 1996 criteria. A total of 35 studies involving 3910 patients submitted to 68-Ga-PSMA PET were included and independently assessed by two authors: 8 studies on diagnosis, four on staging, and 23 studies on restaging purposes. The significance level was α=0.05. Results: pooled sensitivity and specificity were 0.90 (0.86-0.93) and 0.90 (0.82-0.96), respectively, for diagnostic purposes; as for staging, pooled sensitivity and specificity were 0.93 (0.86-0.98) and 0.96 (0.92-0.99), respectively. In the restaging scenario, pooled sensitivity and specificity were 0.76 (0.74-0.78) and 0.45 (0.27-0.58), respectively, considering the identification of prostate cancer in each described situation. We also obtained specificity and sensitivity results for PSA subdivisions. Conclusion: 68Ga-PSMA PET provides higher sensitivity and specificity than traditional imaging for prostate cancer.
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Humanos , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia Computadorizada por Raios X , Estudos Transversais , Estudos Prospectivos , Estudos Retrospectivos , Compostos Radiofarmacêuticos , Tomografia por Emissão de PósitronsRESUMO
Abstract Objective: To evaluate the effect that external cooling of the salivary glands (ECSG) has on the uptake of gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA), as an indirect assessment of the capacity of ECSG to reduce the local dose in lutetium-177-PSMA-617 radioligand therapy. Materials and Methods: Ten patients with prostate cancer were submitted to 68Ga-PSMA positron emission tomography/computed tomography with unilateral ECSG. The ECSG was started at 30 min before the injection of the radiotracer and maintained until the end of image acquisition (1 h after injection). Each salivary gland was assessed by determining the maximum, mean, and peak standardized uptake values (SUVmax, SUVmean, and SUVpeak, respectively). The volume of each gland was determined in a volume of interest delineated by a threshold SUVmax of 10%. Paired Student's t-tests were used in order to compare the results. Results: In terms of the SUV parameters, there were no statistically significant differences between the cooled and contralateral salivary glands. However, the mean volume was 27% lower in the cooled parotid glands than in the contralateral parotid glands (p = 0.004). Conclusion: The use of ECSG does not appear to reduce 68Ga-PSMA uptake by the salivary glands. In addition, there is yet no evidence that ECSG is effective in preventing salivary gland toxicity.
Resumo Objetivo: Avaliar o impacto do resfriamento externo de glândulas salivares (REGS) na captação de 68Ga-PSMA como marcador indireto dessa intervenção para redução da dose local na terapia com 177Lu-PSMA. Materiais e Métodos: Dez pacientes com câncer de próstata foram submetidos a PET/CT com 68Ga-PSMA com REGS unilateral. O resfriamento se iniciou 30 minutos antes da injeção do radiofármaco até o fim da aquisição de imagem, 1 hora após a injeção. Cada glândula foi avaliada para os valores de captação padronizados máximo, médio e pico (SUVmáx, SUVmédio e SUVpico, respectivamente). O volume foi definido por um isocontorno usando 10% do SUVmáx. Os resultados foram comparados com o teste t de Student. Resultados: Não houve diferença estatisticamente significante entre os valores de SUV das glândulas resfriadas e seus controles. Houve 27% de redução volumétrica (p = 0,004) nas parótidas resfriadas em comparação ao controle. Conclusão: Não houve redução da captação de 68Ga-PSMA nas glândulas salivares ao REGS. Atualmente não há evidências que suportem essa prática clínica.
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@#The decision to proceed with radical prostatectomy has to be supported with biopsy-proven prostate cancer. However, when a patient has persistently multiple negative prostate biopsies and a high PSA, a serious diagnostic and therapeutic dilemma arises. The PIRADS score generated by the multiparametric-MRI of the prostate provides a guide for a template biopsy using MRI-ultrasound fusion technology, with the hope of minimizing a false negative result. Fluorine-18 Prostate-Specific Membrane Antigen (18F-PSMA) PET CT scan, on the other hand, is used mainly for staging prostate cancer after biochemical recurrence. The use of 18F-PSMA PET CT in the primary clinical diagnosis of prostate cancer has never been reported.The authors performed radical prostatectomy on a 66-year-old HIV-positive male with suspicious lesion on 18F-PSMA, PIRADS 5 on mp-MRI, and a persistently elevated PSA >100 despite multiple negative biopsies. The final histopathological analysis confirmed the presence of adenocarcinoma of the prostate, Gleason 7 (3+4), with negative margins. There were no intraoperative complications, and the patient was discharged in good condition. On follow-up, he had a nadir PSA of 0.058 ng/ml, has partial incontinence, and decreased erectile function and was advised phosphodiesterase inhibitors. 18F-PSMA may be utilized in the decision process for patients who are highly suspected with malignancy but have no preoperatively biopsy-proven cancer after multiple negative biopsies.
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Background@#PSMA-targeted radiopharmaceuticals have been widely studied for their theragnostic role in prostate cancer and were introduced in the Philippines in 2018. The optimal administered activity of 177Lu-PSMA for targeted endoradiotherapy has not yet been established and is thought to be influenced by several factors, including tumor burden. This study investigates the effect of tumor burden on the normal tissue PSMA uptake among Filipino patients with prostate cancer using its diagnostic counterpart, 68Ga-PSMA I&T @*Methods@#One hundred four patients imaged with 68Ga-PSMA I&T PET/CT in our institution from January 2018 to May 2020 were included. Patients were visually classified into low, medium, and high tumor burden groups. Maximum and mean standardized uptake values (SUVmax and SUVmean) of the lacrimal glands, parotid glands, submandibular glands, kidneys, liver, spleen, and bone were measured and compared among tumor burden groups. @*Results and Conclusions@#68Ga-PSMA I&T uptake in the kidneys, the salivary glands, and the liver, were significantly reduced by approximately 25-50% in patients with high tumor burden. This finding supports the hypothesis that patients with higher tumor load can tolerate higher activity doses of 177Lu-PSMA for endoradiotherapy before developing significant damage to the critical organs. This may serve as a guide towards optimizing and personalizing 177Lu-PSMA I&T administered activity dose for radionuclide therapy
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Tomografia por Emissão de Pósitrons , Neoplasias da Próstata , Carga TumoralRESUMO
【Objective】 To compare the detection efficiency of 99mTc-MDP SPECT and PSMA PET/CT in detecting bone metastases in patients with prostate cancer. 【Methods】 We retrospectively collected data of 83 patients diagnosed with prostate cancer in The First Affiliated Hospital of Xi’an Jiaotong University from March 2019 to July 2020, concurrent with 99mTc-MDP SPECT and 18F-PSMA PET/CT whole body imaging in the same period. Two nuclear medicine physicians attending a double-blind interpretation compared whether the patients with bone metastases detected by two imaging methods under different PSA levels and different Gleason scores, and further analyzed the location and number of inconsistent bone metastases as well as the ability of PET/CT to detect metastatic lesions other than bone. 【Results】 Compared with 99mTc-MDP SPECT, 18F-PSMA PET/CT could detect more prostate cancer patients with bone metastases (P<0.001). When TPSA<10 ng/mL or >20 ng/mL, the detection rate of PET/CT for bone metastasis was higher than that of whole body bone scan (P<0.05). When Gleason score>8, PET/CT was more effective in detecting bone metastasis. The detection rate was higher than that of whole body bone scan (P<0.05). The lesions with positive PET/CT but not diagnosed by bone scan were mainly located in the chest bone, spine bone, and pelvic bone; the lesions with positive bone scan but missed by PET/CT were also more common in chest bone, with low nuclide uptake. The average SUVmax was 2.62±0.47 (1.60-3.30), and adjacent to the liver, spleen or salivary glands with higher metabolism. There were 21/51 (41.18%) cases of lymph node metastasis found outside of bone, 5/51 (9.80%) cases of lung metastasis, and 1/51 (1.96%) cases of liver metastasis. 【Conclusion】 18F-PSMA PET/CT imaging is significantly superior to 99mTc-MDP whole-body bone imaging in diagnosing bone metastasis of prostate cancer, and it can detect metastases other than bone.
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Introdução: este estudo trata do controle de qualidade do radiofármaco utilizado em estudos de PET-CT para diagnóstico e/ou estadiamento de pacientes acometidos pelo câncer de próstata. Objetivo: avaliar a qualidade do radiofármaco PSMA-11, marcado com uso de gerador de Ge68-Ga68 itinerante. Metodologia: análise do aspecto visual, pH e pureza radioquímica do radiofármaco marcado a cada recebimento do gerador de Ge68-Ga68. Resultado: todas as marcações realizadas se apresentaram límpidas quanto ao aspecto visual, o pH ficou entre 5,0 e 6,0 e a pureza radioquímica apresentou em 92% dos casos valores ≥ 96%. Conclusão: com os devidos controles de qualidade, pode ser uma opção para uso na clínica médica, em serviços que não disponham de condição para adquirir um sistema, por ser importado.
Introduction: this study works with the quality control of the radiopharmaceutical used in PET-CT studies for diagnosis and / or staging of patients affected with prostate cancer. Objective: evaluate the quality of the PSMA-11 marked radiopharmaceutical using a Ge68-Ga68 itinerant generator. Methodology: analysis of the visual aspect, pH and radiochemical purity of the marked radiopharmaceutical on each receiving of the Ge68-Ga68 generator. Results: all performed markings were clear in terms of visual appearance, pH was between 5.0 and 6.0 and radiochemical purity was 92% with value ≥ 96%. Conclusion: with proper quality controls it can be an option for application in the medical clinic, services centers unable to purchase a system due to importation process.
Assuntos
Neoplasias da Próstata , Controle de Qualidade , Compostos Radiofarmacêuticos , Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaRESUMO
Objective@#To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.@*Methods@#The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m2. Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T2a stage, 2 cases in T2b stage, 17 cases in T2c stage, 1 case in T3a stage, 4 cases in T3b stage and 1 case in T4 stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis.@*Results@#The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007).@*Conclusions@#SUVmax measured on preoperative 68Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.