Diagnostic Performance of [18F]Fluorocholine and [68Ga]Ga-PSMA PET/CT in Prostate Cancer: A Comparative Study

Abstract

The current study endeavored to closely compare the detection rate of 68-Gallium labelled prostate-specific membrane antigen ([68Ga]Ga-PSMA) versus [18F]Fluorocholine in men with prostate cancer (PC), to investigate the benefits and pitfalls of each modality in the setting of various patient characteristics. We retrospectively analyzed 29 biopsy-proven PC patients in two categories, staging and restaging, who underwent both scans within a maximum of 30 days of each other. Variables including patient demographics, prostate specific antigen (PSA) level, Gleason score, clinical course, and following treatments were recorded. The number and location of suspicious lesions as well as uptake values were noted. A total of 148 suspicious lesions were detected, of which 70.9% (105/148) were concordantly visualized in both imaging modalities. [68Ga]Ga-PSMA positron emission tomography/computed tomography (PET/CT) revealed a higher number of metastatic lesions per patients (91% vs 78%). The mean of maximum standardized uptake value (SUV max) in concordant lesions was significantly higher in [68Ga]Ga-PSMA compared to [18F]Fluorocholine PET/CT (14.6 ± 8.44 vs. 6.9 ± 3.4, p = 0.001). Discordant lesions were detected by both modalities, but more frequently by [68Ga]Ga-PSMA PET/CT (20.3% in [68Ga]Ga-PSMA versus 8.8% by [18F]Fluorocholine PET/CT). In patients with PSA levels below 1.0 ng/mL and <2.0 ng/mL, [18F]Fluorocholine PET/CT detection rate was half (57% and 55%, respectively) that of [68Ga]Ga-PSMA PET/CT. Tumor, nodes and metastases (TNM) staging, and subsequently patient management, was only influenced in 4/29 patients (14%), particularly by [68Ga]Ga-PSMA PET/CT with PSA values under 0.5 ng/mL. [68Ga]Ga-PSMA PET/CT revealed superior diagnostic performance to [18F]Fluorocholine PET/CT in staging and restaging of PC patients, especially in cases with low PSA levels. However, in a few hormone resistant high-risk PC patients, [18F]Fluorocholine PET/CT may improve overall diagnostic accuracy.

PSMA radioligand therapy for solid tumors other than prostate cancer: background, opportunities, challenges, and first clinical reports

“…Second, SUVmax values in other solid cancers are generally lower than the SUVmax (> 15-40) values in prostate cancer [121,122]. This suggests that lower radiation doses in the tumor could be reached, likely leading to a lower fraction of patients responding to PSMA-RLT compared to prostate cancer patients.…”

Stereotactic Re-Irradiation for Local Recurrence after Radical Prostatectomy and Radiation Therapy: A Retrospective Multicenter Study

“…Unfortunately, we have no sufficient follow-up to analyze these elements. The heterogeneity of next-generation imaging prescriptions (PSMA PET-CT and choline PET-CT) is another limitation for determining the best candidates for this treatment modality, given the greater sensitivity and specificity of PSMA PET-CT compared with choline PET-CT [26][27][28]. We could not compare the results using imaging modality because of the small number of patients and the many confounding factors, such as ADT prescription, that can influence the imaging results.…”

18F-DCFPyL PET versus 18F-PSMA-1007 PET for the Detection of Prostate Cancer Biochemical Recurrence: A Systematic Review and Meta-Analysis

“…The novel PSMA radiotracers are showing encouraging diagnostic performance in detecting BCR compared with the conventional radiotracers (11,12). Many radioisotopes are currently available for the labeling of the PSMA ligands, such as gallium-68 (68Ga) and uorine-18 (18F), of which 68Ga-PSMA targets agents are widely used in clinical practice (13)(14)(15). Although 18F-PSMA has a similar diagnostic performance to 68Ga-PSMA, it has the additional advantages of having a longer half-life and better quality images (16,17).…”