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Purpose: To analyze ⁶⁸ Ga-PSMA-617 PET/CT or PET/MR and delayed PET/MR images in patients diagnosed with or suspicion of prostate cancer, and to explore the optimal use of PET/CT and PET/MR for initial diagnosis and staging in prostate cancer.
Methods: Images from conventional scan by ⁶⁸ Ga-PSMA whole-body PET/CT or PET/MR followed by delayed pelvi...
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Background:
Intraprostatic inflammation is frequently observed in the prostate and linked to prostatic diseases, including prostatitis, benign prostatic hyperplasia (BPH), and cancer. The etiology of prostate diseases is unclear. Periodontal diseases are associated with an increased risk of prostate diseases. In men, chronic prostatitis and moderat...
Citations
... Prostate cancer (PCa) ranks as the second most prevalent cancer in men and constitutes a significant contributor to global cancer mortality [1]. The implementation of [ 68 Ga]Ga-PSMA positron emission tomography/computed tomography (PET/CT) is critical for initial staging and biochemical recurrence (BCR) for the localization of prostate cancer lesions [2][3][4][5][6][7]. While early [ 68 Ga]Ga-PSMA PET/CT is performed at 60 min post-injection (p.i.) of radiotracer [8,9], later image acquisition could detect more lesions and clarify ambiguous findings due to the increase in lesion uptake and an improved target-to-background ratio over time [10][11][12]. ...
... Previous studies have shown that the combination of early and delayed [ 68 Ga]Ga-PSMA PET/CT scans can enhance lesion detectability, especially in BCR patients [16,[18][19][20]. Furosemide administration with abundant hydration could further delineate local recurrence lesions [3]. However, due to the short half-life of Gallium-68, the image quality of delayed image in standard PET/CT is poor with a low counting rate. ...
... . Patient no.[1][2][3][4][5][6].Interms of the locations of 13 additionally detected LNM in the delayed [ 68 Ga]Ga-PSMA-11 LFOV PET/CT (98 at 3 h p.i. vs. 85 at 1 h p.i.), eight (61.5%) were in the pelvic region, and the remaining five (38.5%) were in the extra-pelvic region. The LFOV PET/CT proved advantageous for the detection of PSMA-avid lesions in the extra-pelvic region (Fig. 4. tiles E-J). ...
Background
Previous studies have demonstrated that delayed [⁶⁸ Ga]Ga-PSMA PET/CT imaging improves lesion detection compared to early [⁶⁸ Ga]Ga-PSMA PET/CT in patients with prostate cancer. However, the sole use of delayed [⁶⁸ Ga]Ga-PSMA PET/CT has been limited due to the insufficient number of photons obtained with standard PET/CT scanners. The combination of early and delayed [⁶⁸ Ga]Ga-PSMA standard PET/CT may be considered, and it is challenging to incorporate into a high-demand clinical setting. Long field-of-view (LFOV) PET/CT scanners have higher sensitivity compared to standard PET/CT. However, it remains unknown whether the image quality of solitary delayed [⁶⁸ Ga]Ga-PSMA LFOV PET/CT imaging is adequate to satisfy clinical diagnostic requirements. Therefore, the purpose of this study was to evaluate the image quality of delayed [⁶⁸ Ga]Ga-PSMA LFOV PET/CT and examine the feasibility of utilizing delayed [⁶⁸ Ga]Ga-PSMA LFOV PET/CT imaging alone in patients with prostate cancer.
Methods
The study sample consisted of 56 prostate cancer patients who underwent [⁶⁸ Ga]Ga-PSMA-11 LFOV PET/CT scanning between December 2020 and July 2021. All patients were subjected to early LFOV PET/CT imaging at 1-h post-injection as well as delayed LFOV PET/CT imaging at 3-h post-injection using [⁶⁸ Ga]Ga-PSMA-11. The image quality and diagnostic efficiency of solitary delayed [⁶⁸ Ga]Ga-PSMA-11 LFOV PET/CT imaging was analyzed.
Results
The results showed that delayed [⁶⁸ Ga]Ga-PSMA-11 LFOV PET/CT yielded satisfactory image quality that fulfilled clinical diagnostic benchmarks. Compared to early imaging, delayed [⁶⁸ Ga]Ga-PSMA-11 LFOV PET/CT demonstrated heightened lesion SUVmax values (11.0 [2.3–193.6] vs. 7.0 [2.0–124.3], P < 0.001) and superior tumor-to-background ratios (3.3 [0.5–62.2] vs. 1.7 [0.3–30.7], P < 0.001). Additionally, delayed [⁶⁸ Ga]Ga-PSMA-11 LFOV PET/CT detected supplementary lesions in 14 patients (25%) compared to early imaging, resulting in modifications to disease staging and management plans.
Conclusions
In summary, the findings indicate that the image quality of delayed [⁶⁸ Ga]Ga-PSMA-11 LFOV PET/CT is satisfactory for meeting clinical diagnostic prerequisites. The use of solitary delayed [⁶⁸ Ga]Ga-PSMA-11 LFOV PET/CT imaging in prostate cancer simplifies the examination protocol and improves patient compliance, compared to [⁶⁸ Ga]Ga-PSMA-11 standard PET/CT which necessitates both early and delayed imaging.
... The current gold standard for diagnosing prostate cancer relies on a transrectal ultrasound-guided, systematic twelve-core random biopsy that is blind to the cancer location, and thus, can lead to false-negative prostate cancer diagnoses (2). Moreover, prostate biopsies often underestimate the final prostate cancer Gleason score compared to histologic examination after radical prostatectomy (3). Repeated biopsy is permitted for patients whose initial biopsy is negative but is still highly suspicious for prostate cancer. ...
Background:
Of the currently available prostate-specific membrane antigen (PSMA) positron emission tomography (PET) tracers, although 68Ga-PSMA-11 and 18F-DCFPyL have been approved by the US Food and Drug Administration (FDA), both tracers are excreted rapidly through the urinary tract, resulting in strong accumulation in the bladder and blurring the prostate.18F-PSMA-7Q is a novel quinoline-containing PSMA PET tracer developed by our team, which is primarily excreted through the liver. It can reduce the incidence of urine-induced false-positives in the prostate. We aimed to explore the diagnostic efficacy of 18F-PSMA-7Q PET/computed tomography (CT), and when 18F-PSMA-7Q PET/CT can be used instead of prostate biopsy to diagnose prostate cancer.
Methods:
Patients who underwent 18F-PSMA-7Q PET/CT for prostate cancer staging or prostate biopsy guidance at our institution between July 2020 and December 2021 were retrospectively enrolled. Molecular imaging PSMA (miPSMA) scores were assigned for intra-prostatic lesions according to the Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria, and the diagnostic efficacy of 18F-PSMA-7Q PET/CT for different miPSMA scores was evaluated using pathological diagnosis as the gold standard.
Results:
Of the 125 enrolled patients, 101 had prostate cancer, and 24 had prostatic hyperplasia or prostatitis. miPSMA ≥2 was the optimal diagnostic threshold, and area under curve (AUC) was 0.948, the sensitivity and specificity were 91.1% and 83.0%. The prostate cancer detection rates of 18F-PSMA-7Q PET/CT were 14.3% (3/21), 60.0% (6/10), 96.7% (58/60), and 100% (34/34) for patients with miPSMA scores of 0, 1, 2, and 3, respectively. There was no significant difference in the detection rate of prostate cancer between groups with miPSMA scores of 2 and 3, but there were significant differences between any other 2 groups.
Conclusions:
The prostate cancer detection rate of 18F-PSMA-7Q PET/CT was high for lesions with greater miPSMA scores of 2 and 3. For patients with a high miPSMA score, particularly those with a miPSMA score of 3, prostate biopsy can be omitted and prostate cancer-related treatment can be considered.
Prostate specific membrane antigen positron emission tomography (PSMA PET) is an excellent molecular imaging technique for prostate cancer. Currently, PSMA PET for patients with primary prostate cancer is supplementary to conventional imaging techniques, according to guidelines. This supplementary function of PSMA PET is due to a lack of systematic review of its strengths, limitations, and potential development direction. Thus, we review PSMA ligands, detection, T, N, and M staging, treatment management, and false results of PSMA PET in clinical studies. We also discuss the strengths and challenges of PSMA PET. PSMA PET can greatly increase the detection rate of prostate cancer and accuracy of T/N/M staging, which facilitates more appropriate treatment for primary prostate cancer. Lastly, we propose that PSMA PET could become the first-line imaging modality for primary prostate cancer, and we describe its potential expanded application.
Prostate cancer (PCa) is one of the most common malignancies and cause of cancer death in men. Prostate-specific antigen (PSA) is the most used biomarker in the detection of early PCa. Lately, scientists have been using prostate-specific membrane antigen (PSMA), a glycol-protein that is over-expressed in PCa cells in positron emission tomography/ computed tomography (PET/CT) scans to detect PCa. Gallium-68-PSMA radiotracers, such as 68Ga-PSMA-11, 68Ga-PSMA-617 and 68Ga-PSMA I&T, were firstly introduced in 2011 and fluorine-18-PSMA based radiotracers followed with 18F-PSMA-1007,N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]- 4-18F-fluorobenzyl-L-cysteine(18F-DCFBC) and 2-(3-(1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl)-ureido)- pentanedioic acid (18F-DCFPyL), also known as PYLARIFY, being the most used and showed superior results compared to conventional imaging techniques. Differences depending on half-life, clearance and normal organ uptake are being detected through research to determine which of the radiotracers, is the most suitable for each patient. Two of them, 68Ga-PSMA-11 and PLYRIFY, have already been approved by the Food and Drug Administration (FDA). The future of hybrid imaging for PCa is very promising if we consider the advantages of PSMA radiotracers compared to non-PSMA radioligands.
