Analysis of Pros and Cons in Using [68Ga]Ga-PSMA-11 and [18F]PSMA-1007: Production, Costs, and PET/CT Applications in Patients with Prostate Cancer

Abstract

The aim of this work is to compare [68Ga]Ga-PSMA-11 and [18F]PSMA-1007 PET/CT as imaging agents in patients with prostate cancer (PCa). Comparisons were made by evaluating times and costs of the radiolabeling process, imaging features including pharmacokinetics, and impact on patient management. The analysis of advantages and drawbacks of both radioligands might help to make a better choice based on firm data. For [68Ga]Ga-PSMA-11, the radiochemical yield (RCY) using a low starting activity (L, average activity of 596.55 ± 37.97 MBq) was of 80.98 ± 0.05%, while using a high one (H, average activity of 1436.27 ± 68.68 MBq), the RCY was 71.48 ± 0.04%. Thus, increased starting activities of [68Ga]-chloride negatively influenced the RCY. A similar scenario occurred for [18F]PSMA-1007. The rate of detection of PCa lesions by Positron Emission Tomography/Computed Tomography (PET/CT) was similar for both radioligands, while their distribution in normal organs significantly differed. Furthermore, similar patterns of biodistribution were found among [18F]PSMA-1007, [68Ga]Ga-PSMA-11, and [177Lu]Lu-PSMA-617, the most used agent for RLT. Moreover, the analysis of economical aspects for each single batch of production corrected for the number of allowed PET/CT examinations suggested major advantages of [18F]PSMA-1007 compared with [68Ga]Ga-PSMA-11. Data from this study should support the proper choice in the selection of the PSMA PET radioligand to use on the basis of the cases to study.

[18F]FAPI-42 PET/CT in differentiated thyroid cancer: Diagnostic performance, uptake values and comparison with 2-[18F]FDG PET/CT

“…This nding is consistent with that of previous studies investigating the diagnostic performance of [ 68 Ga]Ga-FAPI PET/CT in thyroid cancer [11,15]. In addition to an excellent rate of detection, other advantages of FAPI radioligands based on 18 F include long half-life, greater imaging quality, economic convenience, greater availability and consequent higher number of PET/CT examinations performed, which are promising alternatives and more practical to FAPI radioligands based on 68 Ga in clinical practice [21,22]. Furthermore, with the development of theranostics based on FAPI [13], [ 18 F]FAPI-42 PET/CT provides an opportunity for diagnostic imaging to evaluate the therapeutic feasibility and bene ts of FAPI-based targeted therapy.…”

Prostate-Specific Membrane Antigen PET-CT Imaging for the Staging of Prostate Cancer in Canada

“…25 Many clinical guidelines identify PSMA-PET as an emerging imaging modality that is rapidly becoming part of standard practice. 33,34 Anticipated Future Use of PET-CT…”

“…60 As well, the production yield of cyclotron-produced 18F is higher than that of a 68Ga generator, 6 allowing for around 25 PET-CT exams a day. 34 While centralized production of PSMA radiopharmaceuticals using cyclotrons may provide greater production efficiency and cost-effectiveness when compared to generator-produced radiopharmaceuticals, 61 for provinces with PET-CT that rely on a single cyclotron (which is the case in 6 provinces), unplanned downtime due to technical problems or unanticipated maintenance can create a "single point of failure," which results in the cancellation of patient appointments. 18 Generators allow sites that do not have access to cyclotrons to have a supply of 68Ga PSMA.…”

[18F]-PSMA-1007 PET imaging optimization and inter-rater reliability – a comparison of three different reconstructions read by four radiologists

“…The European Association of Nuclear Medicine (EANM) recommendations have only recently been widened to include fluor-18 labeled PSMA tracers [3]. Fluorine-18 as a radionuclide has several advantages compared to gallium-68 [4,5]. Notably, it has a longer half-life, enabling transportation to imaging centers further away from the site of radiolabelling; it is easier to manufacture in large quantities; and the emitted positron has a lower energy which in turn means that the positron range is shorter for fluorine-18 compared to gallium-68.…”