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Prostate cancer is the second most common cancer in men. Its diagnosis and management are still challenging as both PSA levels and imaging have had their limitations. Prostate specific membrane antigen (PSMA) is aprostate specific cell surface protein and has been emerging as a novel target for PET imaging of prostate cancer. 68Ga PSMA PET-CT imaging have been shown as a better imaging technology in primary prostate cancer and at the same time detecting lymph node and bone metastases even in low PSA levels. Moreover, its counterpart 177 Lu PSMA has a great prospectto be used for the treatment of castration resistantprostate cancer. Bangladesh J. Nuclear Med. 22(1): 53-57, Jan 2019

The aim of the study was to retrospectively evaluate the recurrence detection rate of Gallium-68-prostate-specific membrane antigen [(68Ga)PSMA] imaging and therapy (IT by contrast, bicalutamide and MAB were not found as significant factors. In the present study, (68Ga)PSMA I&T was found to be quite successful in determining lesions in the biochemical recurrence, which is consistent with the findings of other I&T studies and studies conducted with different PSMA ligands. Thus, it can be considered that the use of (68Ga)PSMA I&T will become increasingly common.

Die vorliegende Bachelorarbeit behandelt alle Möglichkeiten der bildgebenden Diagnostik, die mittels [68Ga]-PSMA erzielbar sind. Das Hauptaugenmerk liegt auf die schon bekannte [68Ga]-PSMA-PET/ CT Untersuchung. Diese wird heutzutage in je- der nuklearmedizinischen Abteilung mit PET/ CT durchgeführt. Eine [68Ga]-PSMA- PET/ CT ist eine diagnostische Methode, die bei Erkennung von Prostatakarzinomen eingesetzt wird. Diese Arbeit beschäftigt sich mit der Frage ob eine [68Ga]- PSMA-PET/ CT Untersuchung auch bei anderen onkologischen Erkrankungen eingesetzt werden kann. Die Ergebnisse der intensiven Literaturrecherche zeigen, dass [68Ga]-PSMA durchaus bei anderen Indikationen verwendet werden kann, als nur beim Prostatakarzinom. Beispielsweise beim „clear cell kidney carcinom“ spricht solch eine Untersuchung positiv an. Somit ist der diagnostische Nutzen von [68Ga]-PSMA höher als gedacht und kann durch die wissenschaftliche Erkenntnisse dieser Arbeit öfter zur Karzinomprävention eingesetzt werden. This bachelor thesis deals with all the possible imaging diagnostic capabilities that can be achieved with [68Ga] -PSMA. The main focus is on the already known [68Ga]- PSMA-PET/ CT examination. Nowadays this is carried out in every nuclear medicine department that owns a PET/ CT scanner. A [68Ga]-PSMA-PET/ CT scan is a diagnostic method that is used for the detection of prostate cancer. This thesis deals with the question whether a [68Ga]-PSMA-PET/ CT examination can also be used for other oncological diseases. The results of the intensive literary research show that [68Ga]-PSMA can also be used for other indications than just prostate cancer. For example, in the case of "clear cell kidney carcinoma". Such an examination can have a positively respond. Thus, the diagnostic benefit of [68Ga]-PSMA is higher than expected and can be used more often for carcinoma prevention due to the scientific findings of this work.

Diese Arbeit vergleicht die Hybridbildgebung SPECT-CT, PET-CT und PET-MR bei der Beurteilung des metastasierenden Prostatakarzinoms. Dabei beschränkt sie sich auf die [⁶⁸Ga]-PSMA- und [⁹⁹ᵐTc]-PSMA-Tracer. Es wird auf technische Grundlagen eingegangen und die Bildgebungsmethoden werden Anhand von statistischen Werten verglichen. Die Onlinedatenbanken des Springer Verlages, des Thieme Verlages, der US National Library of Medicine (PubMed) und des National Institute of Health wurden herangezogen und bis Juli 2022 nach geeigneten Studien, die einen direkten Vergleich [⁶⁸Ga]-PSMA-SPECT und [⁹⁹ᵐTc]-PSMA-PET zuließen, durchsucht. Aus den Sensitivitäts- und Spezifitäts-Werten wurden LR+, LR-, Mittelwert, Median und Varianz errechnet, interpretiert und mit den Mitteln der deskriptiven Statistik gegenüberstellt. 18 Studien mit 3845 Patienten wurden inkludiert. Die nach Studienpopulation gewichteten Werte für Sensitivität für SPECT-CT, PET-CT und PET-MR betragen: 83,56%, 82,44% und 84,06%. Die nach Studienpopulation gewichteten Werte für Spezifität von SPECT-CT, PET-CT und PET-MR betragen: 88,08%, 90,56% und 82,73%. Es hat sich gezeigt, dass sich die Sensitivität nach Studienpopulation gewichtet von SPECT-CT (0,84) , PET-CT (0,82) und PET-MR (0,84) nicht signifikant (Signifikanz: >5%) unterscheiden. Mit einer nach Studienpopulation gewichteten Spezifität der PET-CT von 0,91 und der SPECT-CT von 0,88 haben beide einen signifikant höheren Wert als die PET-MR mit 0,83. Nach der positiven Likelihood-Ratio (LR+) bewertet, eignet sich die PET-CT (LR+ = 8,73) am besten, um falsch positive Ergebnisse zu vermeiden. Die breite Verfügbarkeit des SPECT-CT und dessen positive Likelihood-Ratio von 7,01, machen es zu einer etwas schlechteren Alternative zum PET-CT. This thesis deals with the comparison the hybrid imaging technologies SEPCT-CT, PET-CT and PET-MR in the imaging of metastasized prostate cancer. The focus lies on the Tracers [⁶⁸Ga]-PSMA- and [⁹⁹ᵐTc]-PSMA. First a technical overview is given. Afterwards statistical analysis is conducted. The online databases of Springer Verlag, Thieme Verlag, the US National Library of Medicine (PubMed), and the National Institute of Health were used for literature research up until July 2022. Studies appropriate for direct comparison of [⁶⁸Ga]- PSMA-SPECT and [⁹⁹ᵐTc]-PSMA-PET were included. Values for sensitivity and specificity were used to calculate averages, LR+, LR-, median and variances. Those were discussed and graphs are presented. 18 studies with 3845 patients were included. The mean values for sensitivity weighted by individual study population for SPECT-CT, PET-CT, and PET-MR were: 83.56%, 82.44%, and 84.06%, respectively. The mean value for specificity, weighted by population, were 88.08%, 90.56% and 82.73%, respectively. Sensitivity weighted by study population was not shown to be significantly different (significancy: >5%) for SPECT-CT (0.84) , PET-CT (0.82), and PET-MR (0.84). Whereas compared to PET-MR (0.83) specificity weighted by study population was significantly higher in PET-CT (0.91) and SPECT-CT (0.88). With a positive likelihood ratio (LR+) of 8.73, PET-CT is most suited to avoid false positives. It is followed by SPECT-CT (7.01), which makes it an alternative, if PET-CT isn´t available.

Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga PSMA PET/CT) outperforms CT and bone scintigraphy in terms of diagnostic accuracy for the primary staging of prostate cancer and has become widely used. However, 68Ga PSMA uptake is also encountered in nonprostatic tissue. We present a 63-year-old male with newly diagnosed high-risk prostate cancer who underwent bone scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT), which showed inhomogeneous elevated uptake in sclerotic bone lesions in the pelvis. Likewise, 68Ga PSMA PET/CT revealed inhomogeneous uptake in the same areas. Subsequent biopsy revealed hyperplastic bone marrow without signs of malignancy. The patient underwent radical prostatectomy, and the prostate-specific antigen level dropped to less than 0.1 ng/mL.

To determine the impact of Gallium-68-labled prostate-specific membrane antigen positron-emission tomography/computed tomography ([68Ga]PSMA PET/CT) on radiotherapy planning for primary disease, biochemical cancer relapse, and advanced disease of prostate cancer. A total of 106 patients with prostate cancer scheduled for radiation therapy underwent 120 [68Ga]PSMA PET/CT scans prior to radiotherapy treatment. In 20 cases, patients underwent [68Ga]PSMA PET/CT for primary therapy (PT), 75 cases were referred for biochemical relapse after surgery (RL), and 25 cases were intended for palliative treatment of localized metastases (MD). We retrospectively compared the impact of [68Ga]PSMA PET/CT on lesion detection and treatment decision to CT alone. [68Ga]PSMA PET/CT revealed a total of 271 positive lesions, whereas CT detected 86 lesions (32%). Overall, the radiotherapy regime was changed in 55 of 120 cases (46%) based on the higher detection rate of [68Ga]PSMA PET/CT: in 15% of cases with PT, in 43% of cases with RL, and in 44% of cases with MD. [68Ga]PSMA PET/CT is superior to CT alone for lesion detection in prostate cancer, thereby significantly impacting on radiotherapy planning for primary disease, biochemical cancer relapse, and advanced disease of prostate cancer.

OBJECTIVE(S): Prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) is an emerging modality to detect metastatic disease in patients with prostate cancer (PCa). This prospective study aimed to evaluate the role of [(68)Ga]-PSMA PET/CT in the initial workup of intermediate and high-risk PCa. METHODS: Twenty-five patients with newly transrectal ultrasound biopsy-proven, untreated intermediate- and high-risk PCa (mean age, 68.5±6.2 years; range 55–83 years) were enrolled in this prospective study between September 2018 and June 2020 and underwent a [(68)Ga]-PSMA PET/CT examination. All images were analyzed both visually and semiquantitatively by measuring the maximum standardized uptake value (SUV(max)) of the primary prostatic tumor and metastatic lesions. The diagnostic sensitivity of [(68)Ga]-PSMA PET/CT for the diagnosis of PCa was established by histopathology as the reference standard. The associations between SUV(max) of the primary tumors and prostate-specific antigen (PSA) levels, Gleason scores (GSs), and metastatic extent of the disease were studied. RESULTS: All patients had a positive [(68)Ga]-PSMA PET/CT exam. Seventeen patients (58%) showed [(68)Ga]-PSMA avidity in both prostate lobes and 8 (32%) had unilateral uptake. SUV(max) in the primary tumor significantly correlated with serum PSA values (r=0.57, P=0.003). PSMA PET/CT depicted regional lymph node metastases in 32% of patients, distant lymph node metastases in 20%, osseous metastases in 16% and pulmonary metastases in 8% of patients. Sixty percent of PSMA-positive bone metastases and 21.4% of intraprostatic tumoral lesions were missed on the contemporaneous bone scintigraphy and magnetic resonance imaging, respectively. CONCLUSION: [(68)Ga]-PSMA PET/CT shows promise as a valuable imaging modality with high diagnostic sensitivity in the setting of intermediate and high-risk PCa. Moreover, the SUV(max) of the primary tumor has a positive correlation with PSA levels at the time of the scan.

A 67-year-old male patient had undergone total gastrectomy and Roux-en-Y eso-jejunostomy 3 years ago for the treatment of tubular adenocarcinoma located at the corpus of the stomach. The patient was diagnosed with Gleason score 8 (4+4) metastatic prostate cancer during the follow-up period and received hormone therapy. Owing to his elevated prostate-specific antigen levels (77 ng/mL), his clinician referred him gallium-68 (68Ga) prostate-specific membrane antigen 11 (PSMA) positron emission tomography/computed tomography (PET/CT) for restaging. PET/CT showed multiple 68Ga PSMA receptor-positive skeletal lesions and linear PSMA activity at the eso-jejunostomy junction. He was then referred to undergo 18fluorine-fluorodeoxyglucose (18F-FDG) PET/CT to screen for gastric carcinoma recurrence. PET/CT images demonstrated no 18F-FDG avid lesion. However, endoscopy and biopsy performed with samples from the eso-jejunostomy junction revealed superficial benign squamous epithelial fragments.

A 67-year-old male patient had undergone total gastrectomy and Roux-en-Y eso-jejunostomy 3 years ago for the treatment of tubular adenocarcinoma located at the corpus of the stomach. The patient was diagnosed with Gleason score 8 (4+4) metastatic prostate cancer during the follow-up period and received hormone therapy. Owing to his elevated prostate-specific antigen levels (77 ng/mL), his clinician referred him gallium-68 (68Ga) prostate-specific membrane antigen 11 (PSMA) positron emission tomography/computed tomography (PET/CT) for restaging. PET/CT showed multiple 68Ga PSMA receptor-positive skeletal lesions and linear PSMA activity at the eso-jejunostomy junction. He was then referred to undergo 18fluorine-fluorodeoxyglucose (18F-FDG) PET/CT to screen for gastric carcinoma recurrence. PET/CT images demonstrated no 18F-FDG avid lesion. However, endoscopy and biopsy performed with samples from the eso-jejunostomy junction revealed superficial benign squamous epithelial fragments.

To investigate the superiority or contribution of 5th minute pelvic and 2nd hour whole body Gallium68-prostate-specific membrane antigen—HBED-CC [(68Ga)PSMA 11] Positron Emission Tomography/Computed Tomography (PET/CT) images to 1st hour imaging in patients with prostate cancer (PCa). A total of 63 patients diagnosed with PCa who underwent (68Ga)PSMA 11 PET/CT between April 2019 and June 2019 and who had 5th minute and 1st and 2nd hour images were included in the study. Early (5th minute) pelvic region and 1st and 2nd hour full body images were obtained from all patients. The regions of interest (ROI) were drawn from the background tissues and the physiological uptake sites in a way to include the same lesions from primary and metastatic lesions in all three imagings, and SUVmax values, and tumor-background ratio (TBR) were calculated. The mean age of the patients was 69.81 ± 8.78 (min/max: 51/91) years. In the 5th minute images, prostate gland and bed were easier to evaluate, because of low bladder activity. However, lymph node evaluation was more difficult due to high vascular activity. In the prostate gland, lymph nodes and bone metastases, both SUVmax values and TBR rates increased with time from the 5th minute (p

IntroductionIt is estimated that prostate cancer will reach 66 thousand by the triennium 2020-2022 according to the National Cancer Institute (INCA). After initial diagnosis and staging the patient may undergo radical prostatectomy and/or curative radiotherapy. In patients with biochemical relapse (PSA >0.2 ng/ml) initially treated with radical prostatectomy, salvage external radiotherapy is indicated. The [68Ga] Prostate Specific Membrane Antigen Positron Emission Tomography-Computed Tomography (PSMA PET-CT) scan is mainly used for localization of prostate cancer in the setting of first biochemical recurrence and can significantly influence the clinical management of the patient.MethodsThe overall objective of this work is to perform a treatment cost analysis for patients in first biochemical recurrence of prostate cancer after curative radical prostatectomy and after performing [68Ga] PSMA PET-CT from the perspective of the Brazilian Health System (SUS). A decision tree was constructed through consultation with experts to outline the patient’s entire treatment. Values per modelled therapeutic procedure were surveyed in two different scenarios, with and without [68Ga] PSMA PET-CT. The average treatment in scenario 1 was stereotaxic radiation therapy (SBRT), and rescue radiotherapy and androgen deprivation therapy (ADT). In scenario 2, it was salvage radiotherapy and ADT. The reimbursement table was prepared from data collected by SUS system. Variations were analyzed using a sensitivity study. Total average values included: individual procedure, according to medical management (up to 3 years) and population percentage with and without [68Ga] PSMA PET-CT.ResultsValues were calculated in Brazilian currency (BRL) for each procedure. The total amount calculated for scenario 1 was BRL 264,965,465.00 (USD 55,642,747.65) and for scenario 2 was BRL 123,585,612.72 (USD 26,162,978.67).ConclusionsThe reimbursement of line of care adopted after [68Ga] PSMA PET-CT is an important information to expand access to the Brazilian population. It shows an increased cost with [68Ga] PSMA PET-CT adoption. A prospective study should be considered with high follow up.

Background Magnetic resonance imaging (MRI) is the most important imaging modality in the diagnosis and follow-up of glial brain tumors. Objective The aim of our study is to determine the correlation between tumor grade, determined with postoperative pathological examination, and standard uptake value (SUV), a semi-quantitative parameter, in patients who underwent imaging 68Ga-PSMA with using PET/MR. Material-method Thirty-five out of 38 patients’ images whose pathology was consistent with glial tumor, 42 lesions from separate anatomic localizations or with higher activity uptake than the rest of the tumor were evaluated. SUV values measured on PET images and grade relationship were evaluated based on each lesion while mitosis, Ki-67 were evaluated for each patient. Results Grade, Ki-67, mitosis, necrosis and SUVmax/mean/peak were found statistically significant with moderate/high correlation. The parameter with the highest correlation coefficient was mitosis. (For SUVmax r = 0.64, p = 0). When Grade II and III were considered as the first group and IV as the second group, the cutoff values were found to be 2.3 for SUVmax, 0.21 for SUVmean and 0.63 for SUVpeak. In the diagnosis of HGG, PET’s sensitivity is higher than MRI but no statistically difference was found between specificities. Conclusion 68Ga PSMA PET imaging is found to be particularly useful in differentiating Grade IV glial tumors from other grades. This finding is thought to be important in the differentiation the relapse with postoperative tissue changes, which is an important problem in the follow-up.

A 63-year-old man, recently diagnosed with carcinoma of the prostate (Gleason's score 4+4), with serum prostate-specific antigen 189.2 ng/mL, underwent Ga PSMA PET/CT scan for pretreatment staging. The study revealed abnormal tracer uptake in the prostatic bed region, the pelvic, abdominal, and mediastinal lymph nodes and diffuse metastases to the bilateral lungs. The lung metastasis was proved to be metastatic adenocarcinoma from analysis of bronchoalveolar lavage.