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Current Medical Imaging

Author(s): Emine Acar*, Recep Bekiş and Berna Polack

DOI: 10.2174/1573405615666190225155254

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Comparison of Bone Uptake in Bone Scan and Ga-68 PSMA PET/CT Images in Patients with Prostate Cancer

Page: [589 - 594] Pages: 6

  • * (Excluding Mailing and Handling)

Abstract

Objective: The aim of this study was to compare images from Tc-99m MDP bone scan (BS) and Ga-68 PSMA PET/CT of patients with prostate cancer in terms of bone metastases.

Methods: Overall, 34 patients exhibited a mean age of 66 ± 9.5 (50-88) years, mean PSA of 51 ± 159ng/ml (0-912), and mean Gleason score of 8 (6-9). BS and Ga-68 PSMA PET/CT were applied to 34 patients within 30 days, and the results were evaluated, retrospectively. In both tests, radiopharmaceutical uptake in bones were compared.

Results: In 7 patients (20.5%), uptake was not significant on BS and Ga-68 PSMA PET / CT images, which is related to metastasis. In 14 (41%) patients, bone metastases were observed in both examinations. However, more metastatic lesions were observed in the Ga-68 PSMA PET/CT of 3 patients and in the bone scintigraphy of 2 patients. PSMA expression was not observed on Ga-68 PSMA PET / CT in 13 (38%) patients with increased activity in bone scintigraphy. Two (6%) of these patients were thought to be metastatic, 2 (6%) were suspicious for metastasis, and 9 (26%) had no metastasis. When a lesion-based evaluation was performed, a total of 480 activities were evaluated: increased activity uptake was found in 305 BS, and 427 PSMA expression activity was detected. Furthermore, 435 of these activities were evaluated as metastatic.

Conclusion: Ga-68 PSMA PET/CT provides an additional contribution to the BS evaluation of activity areas because of the presence of PSMA expression and anatomical lesions. In 6% of the patients, activity on BS and metastatic appearance in CT images were observed and the presence of lesions in the absence of PSMA was determined. This suggests that bone metastases without PSMA expression may also be present.

Keywords: Prostate cancer, bone scan, metastasis, Ga-68 PSMA PET / CT, patients, lesions.

Graphical Abstract

[1]
Attard G, Parker C, Eeles RA, et al. Prostate cancer. Lancet 2016; 387(10013): 70-82.
[2]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65(1): 5-29.
[3]
Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2014; 65(1): 124-37.
[4]
Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol 2017; 71(4): 618-29.
[5]
KandaSwamy GV, Bennett A, Narahari K, Hughes O, Rees J, Kynaston H. Establishing the pathways and indications for performing isotope bone scans in newly diagnosed intermediate-risk localised prostate cancer - results from a large contemporaneous cohort. BJU Int 2017; 120(5B): E59-63.
[6]
Kosuri S, Akhtar NH, Smith M, Osborne JR, Tagawa ST. Review of salvage therapy for biochemically recurrent Prostate Cancer: the role of imaging and rationale for systemic salvage targeted anti-prostate-specific membrane antigen radioimmunotherapy. Adv Urol 2012; 2012921674
[7]
Andriole GL, Crawford ED, Grubb RL III, et al. Mortality results from a randomized Prostate-Cancer screening trial. N Engl J Med 2009; 360(13): 1310-9.
[8]
Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res 1997; 3(1): 81-5.
[9]
Wright GL Jr, Haley C, Beckett ML, Schellhammer PF. Expression of prostate-specific membrane antigen in normal, benign, and malignant prostate tissues. Urol Oncol 1995; 1(1): 18-28.
[10]
Sweat SD, Pacelli A, Murphy GP, Bostwick DG. Prostate-specific membrane antigen expression is greatest in prostate adenocarcinoma and lymph node metastases. Urology 1998; 52(4): 637-40.
[11]
Kularatne SA, Zhou Z, Yang J, Post CB, Low PS. Design, synthesis, and preclinical evaluation of prostate-specific membrane antigen targeted (99m)Tc-radioimaging agents. Mol Pharm 2009; 6(3): 790-800.
[12]
Chen Y, Pullambhatla M, Foss CA, et al. 2-(3-1-Carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl-ureido)-pentanedioic acid, [18F]DCFPyL, a PSMA-based PET imaging agent for prostate cancer. Clin Cancer Res 2011; 17(24): 7645-53.
[13]
Hillier SM, Maresca KP, Femia FJ, et al. Preclinical evaluation of novel glutamate-urea-lysine analogues that target prostate-specific membrane antigen as molecular imaging pharmaceuticals for prostate cancer. Cancer Res 2009; 69(17): 6932-40.
[14]
Ghosh A, Heston WD. Tumor target prostate specific membrane antigen (PSMA) and its regulation in prostate cancer. J Cell Biochem 2004; 91(3): 528-39.
[15]
Bander NH. Technology insight: monoclonal antibody imaging of prostate cancer. Nat Clin Pract Urol 2006; 3(4): 216-25.
[16]
Banerjee SR, Foss CA, Castanares M, et al. Synthesis and evaluation of technetium-99m- and rhenium-labeled inhibitors of the prostate-specific membrane antigen (PSMA). J Med Chem 2008; 51(15): 4504-17.
[17]
Eder M, Schäfer M, Bauder-Wüst U, et al. 68Ga-complex lipophilicity and the targeting property of a Urea-Based PSMA inhibitor for PET imaging. Bioconjug Chem 2012; 23(4): 688-97.
[18]
Schreiter V, Gericke M, Heimann U, et al. Comparison of [68Ga]Ga-PSMA-HBED-CC PET versus whole-body bone scintigraphy for the detection of bone metastases in patients with prostate cancer. J Nucl Med Radiat Ther 2016; 7(5): 1-6.
[19]
Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med 2006; 47(2): 287-97.
[20]
Rowe SP, Mana-Ay M, Javadi MS, et al. PSMA-based detection of prostate cancer bone lesions with 18F-DCFPyL PET/CT: A sensitive alternative to (99m)Tc-MDP bone scan and Na18F PET/CT? Clin Genitourin Cancer 2016; 14(1): e115-8.
[21]
Lavalaye J, Kaldeway P, van Melick HH. Diffuse bone metastases on (68)Ga-PSMA PET-CT in a patient with prostate cancer and normal bone scan. Eur J Nucl Med Mol Imaging 2016; 43(8): 1563-4.
[22]
Freitag MT, Radtke JP, Hadaschik BA, et al. Comparison of hybrid (68)Ga-PSMA PET/MRI and (68)Ga-PSMA PET/CT in the evaluation of lymph node and bone metastases of prostate cancer. Eur J Nucl Med Mol Imaging 2016; 43(1): 70-83.
[23]
Pyka T, Okamoto S, Dahlbender M, et al. Comparison of bone scintigraphy and 68Ga-PSMA PET for skeletal staging in prostate cancer. Eur J Nucl Med Mol Imaging 2016; 43(12): 2114-21.