Abstract
The biochemical relapse of prostate cancer is diagnostically challenging but of high clinical impact for subsequent patient treatment. PET/CT with radiolabeled PSMA ligands outperforms conventional diagnostic methods in the detection of tumor recurrence. Several radiopharmaceuticals were and are available for use. The aim of this study was to investigate whether the routinely applied [68Ga]Ga-PSMA ligands PSMA-617, -I&T and -11 (HBED-CC) differ in physiological and pathological distribution, or in tumor detection rate. A retrospective evaluation of 190 patients (39 patients received PSMA-617, 68 patients PSMA-I&T and 83 patients PSMA-11) showed significant differences in tracer accumulation within all organs examined. The low retention within the compartments blood pool, bone and muscle tissue is a theoretical advantage of PSMA-11. Evaluation of tumor lesion uptake and detection rate did not reveal superiority of one of the three radiopharmaceuticals, neither in the whole population, nor in particularly challenging subgroups like patients with very low PSA levels. We conclude that all three [68Ga]Ga-PSMA ligands are equally feasible in this clinically important scenario, and may replace each other in case of unavailability or production restrictions.
Highlights
Tumor recurrence of prostate cancer is common and challenging for diagnostics and treatment [1]
Whereas the overall model for ADT was without significant difference, ADT had been applied in patients receiving prostatespecific membrane antigen (PSMA)-617 more often than in those receiving PSMA-11 (p = 0.024) and PSMA-I&T (p = 0.032), respectively
The tumor-to-background ratio compared with blood pool or soft tissue appears to be relevant for the detection of local recurrence and lymph node metastases, which could potentially be superior for PSMA-11 with lower blood and muscle accumulation, but without showing impact on detection rate in the data presented here
Summary
Tumor recurrence of prostate cancer is common and challenging for diagnostics and treatment [1]. Depending on the initial treatment, a tumor relapse can occur in 20–50% [3,4,5]. Initial tumor staging and differentiation (i.e., Gleason score) are well-known prognostic indicators [2]. An increase in the PSA level after temporary suppression—a so-called biochemical relapse—indicates a recurrence of the tumor disease. The detection of the structural correlate, and the differentiation between local and systemic tumor recurrence, is decisive for the subsequent treatment of the patient [7,8]. Multiple diagnostic modalities like ultrasound, CT, MRI, bone scan or biopsy are available to reveal tumor manifestations, but frequently remain insufficient for this purpose [9,10]
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