Abstract
The advent of gallium 68 prostate specific membrane antigen (PSMA) PET imaging has revolutionized the diagnosis and treatment of prostate cancer. PSMA is a transmembrane glycoprotein that is overexpressed in prostate cancer and yields images with high tumor-to-background contrast. Effective “one-stop-shop” imaging of the prostate, lymph nodes, soft tissue, and bone is achieved with PSMA PET. Compared to conventional imaging, PSMA PET provides superior sensitivity and specificity and plays a pivotal role in staging high-risk prostate cancer as well as in biochemical recurrence by identifying oligometastatic disease. PSMA PET furthermore assists in the selection of patients with metastatic castrate resistant prostate cancer for possible treatment (e.g., labeled with a beta emitter lutetium 177) by using a theranostic approach. The term “prostate specific” is a misnomer as PSMA is also present in other malignant and benign conditions since it acts as a folate hydrolase. To avoid pitfalls and false-positives, a sound knowledge of the normal biodistribution of PSMA as well as other potential causes for false-positive uptake is imperative. This review will describe the expected patterns of distribution of Ga 68 PSMA PET imaging and the common pitfalls noted in published literature since the topic is still evolving.
Highlights
The advent of PET/CT has revolutionized medical imaging
prostate specific membrane antigen (PSMA) is encoded by the folate hydrolase 1 (FOLH1) gene
Therapeutic applications are possible given the endocytosis mediated internalization following PSMA ligand binding. It is the apical membrane rather than the cytoplasmic membrane PSMA expression that is significantly enhanced in prostate cancer cells [4]
Summary
The advent of PET/CT (positron emission tomography/computer tomography) has revolutionized medical imaging. Does it provide for anatomical detail but merged onto the anatomical images is a molecular map of the specific disease process being interrogated. The advent of Ga-68 PSMA PET/CT has revolutionized the diagnosis and treatment of prostate carcinoma. Therapeutic applications are possible given the endocytosis mediated internalization following PSMA ligand binding It is the apical membrane rather than the cytoplasmic membrane PSMA expression that is significantly enhanced in prostate cancer cells [4]. It is worth noting that other PET tracers exist to image prostate cancer (F18-NaF, C11-acetate, C11/F18 Choline, amino acid analogs (F18-FACBC), F18 dihydrotestosterone analogs) [5]. A sound knowledge of the normal biodistribution of PSMA is essential for correct image interpretation and reporting
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