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Combination of [18F]FDG and [18F]PSMA-1007 PET/CT predicts tumour aggressiveness at staging and biochemical failure postoperatively in patients with prostate cancer

Authors
 Jisu Kim  ;  Seunghwan Lee  ;  Dongwoo Kim  ;  Hyun Jeong Kim  ;  Kyeong Taek Oh  ;  Sun Jung Kim  ;  Young Deuk Choi  ;  Frederik L Giesel  ;  Klaus Kopka  ;  Alexander Hoepping  ;  Misu Lee  ;  Mijin Yun 
Citation
 EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, Vol.51(6) : 1763-1772, 2024-05 
Journal Title
EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
ISSN
 1619-7070 
Issue Date
2024-05
MeSH
Aged ; Fluorodeoxyglucose F18* ; Humans ; Male ; Middle Aged ; Neoplasm Staging* ; Niacinamide / analogs & derivatives* ; Oligopeptides / chemistry ; Positron Emission Tomography Computed Tomography* ; Postoperative Period ; Prospective Studies ; Prostatic Neoplasms* / diagnostic imaging ; Prostatic Neoplasms* / pathology ; Prostatic Neoplasms* / surgery ; Radiopharmaceuticals
Keywords
Biochemical failure ; Cancer metabolism ; Cancer staging ; Prostate ; [18F]FDG ; [18F]PSMA-1007 PET/CT
Abstract
Purpose: [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has limitations in prostate cancer (PCa) detection owing to low glycolysis in the primary tumour. Recently, prostate-specific membrane antigen (PSMA) PET/CT has been useful for biochemical failure detection and radioligand therapy (RLT) guidance. However, few studies have evaluated its use in primary prostate tumours using PSMA and [18F]FDG PET/CT. This study aimed to evaluate [18F]PSMA-1007 and [18F]FDG PET/CT for primary tumour detection and understand the association of metabolic heterogeneity with clinicopathological characteristics at staging and postoperatively.

Method: This prospective study included 42 index tumours (27 acinar and 15 ductal-dominant) in 42 patients who underwent [18F]PSMA-1007 and [18F]FDG PET/CT and subsequent radical prostatectomy. All patients were followed for a median of 26 mo, and serum prostate-specific antigen levels were measured every 3 mo to evaluate biochemical failure. One-way analysis of variance, Tukey's multiple comparison test, and Fisher's exact test were performed.

Results: All 42 index tumours were detected on [18F]PSMA-1007 PET/CT, whereas only 15 were detected on [18F]FDG PET/CT (62.3% vs. 37.7%, p < 0.0001). A high SUVmax for [18F]PSMA-1007 was observed in tumours with high Gleason scores (GS 6-7 vs. GS 8-10; 12.1 vs. 20.1, p < 0.05). Tumours with [18F]FDG uptake were mostly ductal dominant (acinar-dominant 4/27; ductal-dominant; 11/15, p < 0.001), with lower [18F]PSMA-1007 uptake than tumours without [18F]FDG uptake (SUVmax 16.58 vs. 11.19, p < 0.001). There were 16.6% (7/42) of patients with pStage IV in whom the primary tumours were [18F]FDG positive. Biochemical failure was observed in 14.8% (4/27) of patients with [18F]FDG negative tumours but in 53.3% (8/15) of patients with [18F]FDG positive tumours (p = 0.013).

Conclusions: [18F]PSMA-1007 PET/CT was superior to [18F]FDG PET/CT in detecting primary PCa. In contrast, tumours with [18F]FDG uptake are associated with larger size, a ductal-dominant type, and likely to undergo metastasis at staging and biochemical failure postoperatively.
Full Text
https://link.springer.com/article/10.1007/s00259-023-06585-7
DOI
10.1007/s00259-023-06585-7
Appears in Collections:
1. College of Medicine (의과대학) > BioMedical Science Institute (의생명과학부) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ji Su(김지수)
Kim, Hyun Jeong(김현정) ORCID logo https://orcid.org/0000-0002-3116-8848
Yun, Mijin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Lee, Misu(이미수)
Lee, Seung Hwan(이승환) ORCID logo https://orcid.org/0000-0001-7358-8544
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/200218
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