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The superiority of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) over conventional staging methods such as computed tomography (CT) and bone scintigraphy has now been demonstrated for almost all clinical stages of prostate cancer. In primary diagnostics, PSMA-PET/CT is therefore the new standard for risk-adapted whole-body staging. At the same time, PSMA-PET/CT provides a new risk-based classification for predicting overall survival across all early and late stages of the disease. However, the clinical implications of this information are not yet fully understood, particularly as data on systemic therapy for metastatic prostate cancer are still based on conventional imaging. For this reason, clinical follow-up is usually still carried out using conventional imaging. The Prostate Cancer Working Group 4 criteria will represent an initial consensus on therapy monitoring using PSMA-PET/CT. To monitor treatment response using PSMA PET/CT in metastatic castration resistant prostate cancer, there is already a framework (RECIP 1.0) in place. There is no doubt that PSMA PET/CT should be performed prior to PSMA radioligand therapy to optimize patient selection., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: C. Kesch: Forschungsförderung: Novartis, Amgen, Mariana Oncology; Honoraria: Pfizer, Novartis; Reiseunterstützung: Bayer. T. Franiel: Forschungsförderung: Zentrales Innovationsprogramm Mittelstand des Bundesministeriums für Wirtschaft und Energie (ZF4816001BA9), Siemens Healhineers, Beratertätigkeit: Bayer AG, Onkowissen, Honorare für Vorträge und Buchbeiträge: Bayer AG, Saegeling Medizintechnik, Medac Gmbh, Georg Thieme Verlag, Sonstiges: Mitglied der S3 Leitliniengruppe für das Prostatakarzinom. C. Berliner: Beratertätigkeit: Advanced Accelerator Applications, (Novartis Tochterunternehmen); GE Healthcare; Janssen Pharma. W.P. Fendler: Beratertätigkeit: Janssen, Perceptive, Bayer, Novartis, GE Healthcare, Lilly; Forschungsförderung: SOFIE Bioscience, Bayer; Honoraria: Janssen, Perceptive, Bayer, Novartis, Telix, GE Healthcare, Eczacıbaşı Monrol, Abx, Amgen, Urotrials. K. Herrmann: Beratertätigkeit: Advanced Accelerator Applications (Novartis Tochterunternehmen), Amgen, AstraZeneca, Bain Capital, Bayer, Boston Scientific, convergent, CuriumDebiopharm, EcoR1, Fusion, Ge Healthcare, Immedica, Isotopen Technologien München, Janssen, Merck, MSD, Molecular Partners, NVision, POINT Biopharma, Pentixapharm, Pfizer, Radiopharm Theranostics, Rhine Pharma, Siemens Healthineers, Sofie Biosciences, Telix, Theragnostics, ymabs; Forschungsförderung: Advanced Accelerator Applications (Novartis Tochterunternehmen), Boston Scientific, Janssen; Eigentumsanteile: AdvanCell, Aktis Oncology, Convergent, NVision and Sofie Biosciences. B. Hadaschik: Beratertätigkeit: Lightpoint medical, Janssen, Bayer, Abx, Amgen, Astellas, Merck, Amgen, MSD, Novartis, BMS, Onkowissen, POINT Biopharma, Pfizer, Ipsen, Accord Healthcare, Telix; Reiseunterstützung: Amgen, AstraZeneca, Bristol-Myers Squibb, Janssen, Bayer, and Ipsen; Forschungsförderung: Johnson&Johnson, Novartis, BMS. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2025. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The ecosystem of brain tumors is considered immunosuppressed, but our current knowledge may be incomplete. Here we analyzed clinical cell and tissue specimens derived from patients presenting with glioblastoma or nonmalignant intracranial disease to report that the cranial bone (CB) marrow, in juxtaposition to treatment-naive glioblastoma tumors, harbors active lymphoid populations at the time of initial diagnosis. Clinical and anatomical imaging, single-cell molecular and immune cell profiling and quantification of tumor reactivity identified CD8 + T cell clonotypes in the CB that were also found in the tumor. These were characterized by acute and durable antitumor response rooted in the entire T cell developmental spectrum. In contrast to distal bone marrow, the CB niche proximal to the tumor showed increased frequencies of tumor-reactive CD8 + effector types expressing the lymphoid egress marker S1PR1. In line with this, cranial enhancement of CXCR4 radiolabel may serve as a surrogate marker indicating focal association with improved progression-free survival. The data of this study advocate preservation and further exploitation of these cranioencephalic units for the clinical care of glioblastoma., (© 2024. The Author(s).)

Background: Prostate cancer (PCa) is the most common malignancy in men and the second most common tumor-associated cause of death in the male population in Germany. Prostate-specific membrane antigen (PSMA)-targeted hybrid imaging using positron emission tomography (PET) in combination with CT or MRI represents a comparably new method that gained increasing importance in the diagnostic process of PCa in recent years., Method: Current applications of PSMA hybrid imaging were summarized according to the German and European guidelines on PCa. New developments were elaborated based on a literature review of PubMed conducted in 10/22., Results: PSMA-PET/CT demonstrated higher detection rates for metastases in high-risk PCa and recurrent PCa after primary therapy than established imaging methods (CT, MRI, and bone scan). Despite promising results from prospective trials in both scenarios and substantial influence on clinical decision making, data regarding the influence of PSMA-PET on PCa-specific and overall survival are still lacking. Hence, PSMA PET/CT is recommended with a "weak" strength rating in most situations. However, its importance in new treatment options like metastasis-directed therapy or PSMA-radioligand therapy expands the scope of PSMA-PET in the clinical routine., Conclusion: PSMA-targeting hybrid imaging represents the most sensitive diagnostic test in several stages of PCa and allows the development of new treatment strategies. Prospective studies are needed to evaluate the influence of PSMA-PET on patient survival., Key Points: · PSMA-PET/CT is superior to conventional imaging in the primary staging of high-risk prostate cancer.. · PSMA hybrid imaging can detect metastases in patients with biochemical recurrence at low PSA values.. · Clinical decision making is frequently influenced by results of PSMA-PET/CT.., Citation Format: · Koehler D, Berliner C, Shenas F et al. PSMA hybrid imaging in prostate cancer - current applications and perspectives. Fortschr Röntgenstr 2023; 195: 1001 - 1008., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Our objective was to compare the ability to detect histopathologically confirmed lymph node metastases by early and delayed [ 99m Tc]Tc-PSMA-I&S SPECT/CT in early biochemically recurrent prostate cancer. Methods: We retrospectively analyzed 222 patients selected for radioguided surgery using [ 99m Tc]Tc-PSMA-I&S SPECT/CT at different time points after injection (≤4 h and >15 h). In total, 386 prostate-specific membrane antigen (PSMA) PET predetermined lesions were analyzed on SPECT/CT using a 4-point scale, and the results were compared between early and late imaging groups, with uni- and multivariate analyses performed including prostate-specific antigen, injected [ 99m Tc]Tc-PSMA-I&S activity, Gleason grade group, initial TNM stage, and, stratified by size, PSMA PET/CT-positive lymph nodes. PSMA PET/CT findings served as the standard of reference. Results: [ 99m Tc]Tc-PSMA-I&S SPECT/CT had a significantly higher positivity rate for detecting lesions in the late than the early imaging group (79%, n  = 140/178, vs. 27%, n  = 12/44 [ P  < 0.05] on a patient basis; 60%, n  = 195/324, vs. 21%, n  = 13/62 [ P  < 0.05] on a lesion basis). Similar positivity rates were found when lesions were stratified by size. Multivariate analysis found that SUV max on PSMA PET/CT and the uptake time of [ 99m Tc]Tc-PSMA-I&S were independent predictors for lesion detectability on SPECT/CT. Conclusion: Late imaging (>15 h after injection) should be preferred when [ 99m Tc]Tc-PSMA-I&S SPECT/CT is used for lesion detection in early biochemical recurrence of prostate cancer. However, the performance of PSMA SPECT/CT is clearly inferior to that of PSMA PET/CT., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

18 F-PSMA-1007 PET is used in the management of patients with prostate cancer. However, recent reports indicate a high rate of unspecific bone uptake (UBU) with 18 F-PSMA-1007, which may lead to a false-positive diagnosis. UBU has not been evaluated thoroughly. Here, we evaluate the frequency of UBU and bone metastases separately for 18 F-PSMA-1007 and 68 Ga-PSMA-11 in biochemical recurrence (interindividual comparison). Additionally, we investigate UBU seen in 18 F-PSMA-1007 through follow-up examinations (intraindividual comparison) using 68 Ga-PSMA-11 PET, bone scintigraphy, and MRI. Methods: First, all patients ( n = 383) who underwent 68 Ga-PSMA-11 PET between January 2020 and December 2020 and all patients ( n = 409) who underwent 18 F-PSMA-1007 PET between January 2020 and November 2021 due to biochemical recurrence were included for an interindividual comparison of bone metastases and UBU rate. In a second approach, we regarded all patients with UBU in 18 F-PSMA-1007, characterized by focal bone uptake with an SUV max > 4 and prostate-specific antigen (PSA) ≤ 5 ng/mL, who underwent additional 68 Ga-PSMA-11 PET ( n = 17) (interindividual comparison). Of these, 12 patients also had bone scintigraphy and whole-body MRI within a 1- to 5-wk interval. Bone uptake seen on 18 F-PSMA-1007 but not on any of the other 4 modalities (CT, MRI [ n = 1], bone scanning, and 68 Ga-PSMA-11 PET) was recorded as false-positive. Results: Patients scanned with 18 F-PSMA-1007 PET had a significantly higher rate of UBU than those scanned with 68 Ga-PSMA-11 (140 vs. 64; P < 0.001); however, the rate of bone metastases was not significantly different (72 vs. 64; P = 0.7). In the intraindividual comparison group, workup by CT, MRI, bone scanning, and 68 Ga-PSMA-11 PET resulted in a positive predictive value for 18 F-PSMA-1007 focal bone uptake (mean SUV max , 6.1 ± 2.9) per patient and per lesion of 8.3% and 3.6%, respectively. Conclusion: In patients with PSA ≤ 5 ng/mL and SUV > 4 at biochemical recurrence, most 18 F-PSMA-1007 focal bone uptake is likely to be false-positive and therefore due to UBU. In the case of low clinical likelihood of metastatic disease, 18 F-PSMA-1007 bone uptake without morphologic surrogate should be assessed carefully with regard to localization and clinical context. However, the rate of bone metastases was not higher with 18 F-PSMA-1007 in the clinical routine, indicating that experienced reporting physicians adjust for UBU findings., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

PSMA PET/CT has unprecedented accuracy for localization of initial or recurrent prostate cancer (PC), which can be applied in a metastasis-directed therapy approach. PSMA PET/CT (PET) also has a role in the selection of patients for metastasis-directed therapy or radioligand therapy and therapy assessment in CRPC patients. The purpose of this multicenter retrospective study was to determine the incidence of bone-only metastasis in CRPC patients who underwent PSMA PET/CT for restaging, as well as identifying potential predictors of bone-only PET positivity. The study analyzed data from 179 patients from two centers in Essen and Bologna. Results showed that 20.1% of the patients had PSMA uptake only in the bone, with the most frequent lesions located in the vertebrae, ribs, and hip bone. Half half of the patients showed oligo disease in bone and may benefit from a bone-metastasis-directed therapy. Initial positive nodal status and solitary ADT were shown to be negative predictors of osseous metastasis. The role of PSMA PET/TC in this patient population needs to be further explored in terms of its role in the evaluation and adoption of bone-specific therapies.