Abstract
PurposeProstate-specific membrane antigen (PSMA) is not only highly expressed on the surface prostate cancer cells but is also elevated during angiogenesis in other cancer cell types, including hepatocellular carcinoma (HCC). This study aimed to evaluate the feasibility of using PET/CT imaging with [68Ga]Ga-PSMA-11 in HCC and its impact on patient management.MethodsFifteen patients (13 men and two women; aged 55.6 ± 18.2 years) with HCC were enrolled in this prospective, single-institution study. All patients underwent contrast-enhanced MRI/CT, [68Ga]Ga-PSMA-11 PET/CT, and histopathological verification of lesions.ResultsNo radiopharmaceutical-related adverse events were noted. Visual interpretation showed increased accumulation of [68Ga]Ga-PSMA-11 in all HCC patients. The tumor-to-liver ratio (TLR) was 3.6 ± 2.1, and the maximal standardized uptake value (SUVmax) was 13.5 ± 7.1. There were no significant differences in the SUVs or TLR between newly diagnosed and recurrent patients. No statistically significant relationship was found between serum concentration of tumor markers (i.e., AFP, CA 19-9, CEA) and PET parameters. Results of the [68Ga]Ga-PSMA-11 PET/CT changed the treatment strategy in five (33%) patients. PSMA staining showed visible heterogeneity in terms of intensity and distribution: the reaction was weak and only observed in a few vessels in pseudoglandular patterns of HCC, while it was homogeneously strong, with some hot spots, in trabecular patterns of HCC.Conclusion[68Ga]Ga-PSMA-11 PET/CT can detect PSMA expression in vivo in patients with HCC and is useful for guiding treatment strategies. Further investigation of the clinical utility of this method in HCC is warranted.
Highlights
Prostate-specific membrane antigen (PSMA) is highly expressed on the surface prostate cancer cells but is elevated during angiogenesis in other cancer cell types, including hepatocellular carcinoma (HCC)
Because [18F]F-choline positron emission tomography (PET)/computed tomography (CT) examination is not available in our hospital and [18F]FDG examination is not reimbursed for HCC, another imaging method for HCC is required. [68Ga]Ga-PSMA-11 was recently introduced for the PET/CT imaging of patients with prostate cancer, but incidental uptake has been described in other cancers, including reports on HCC [12,13,14,15,16,17,18]
The results of [68Ga]Ga-PSMA-11 PET/CT were compared with ceCT/ Magnetic resonance imaging (MRI) for a total of 44 lesions detected in 15 patients
Summary
Prostate-specific membrane antigen (PSMA) is highly expressed on the surface prostate cancer cells but is elevated during angiogenesis in other cancer cell types, including hepatocellular carcinoma (HCC). Conclusion [68Ga]Ga-PSMA-11 PET/CT can detect PSMA expression in vivo in patients with HCC and is useful for guiding treatment strategies. Due to the difficulties associated with a biopsy (e.g., risk of bleeding, difficulty in targeting the tumor, or cancer cells seeding), imaging techniques have become the preferred way to confirm the diagnosis of HCC. The assessment of HCC recurrence after primary treatment is even more difficult, because of post-therapy changes Another imaging option is positron emission tomography (PET) with fluorodeoxyglucose ([18F]FDG), which is widely used in various types of oncological diseases. Prostate-specific membrane antigen (PSMA) has been implicated as a potential target for imaging studies in several tumor types. This study aimed to evaluate the feasibility of PET/CT imaging with [68Ga]Ga-PSMA11 in HCC and its impact on patient management
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