Prostate-Specific Membrane Antigen (PSMA)-Targeted PET Imaging of Prostate Cancer: An Update on Important Pitfalls

Sheikhbahaei, Sara; Werner, Rudolf A.; Solnes, Lilja B.; Pienta, Kenneth J.; Pomper, Martin G.; Gorin, Michael A.; Rowe, Steven P.

doi:10.1053/j.semnuclmed.2019.02.006

Cited by 84 publications

(65 citation statements)

References 153 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…53 A common false positive is uptake in the cervical, celiac, and sacral ganglia. 53,54 PSMA expression has also been observed in a variety of nonprostate solid tumors by PSMA PET imaging. 61,62 Biopsy of some of the lesions that were 18 F-PSMAnegative/ 18 F-NaF-positive confirmed the presence of cancer in some cases.…”

Section: False Negatives and False Positives With Psma Pet Imagingmentioning

confidence: 99%

Meeting report from the Prostate Cancer Foundation PSMA theranostics state of the science meeting

et al. 2020

Self Cite

View full text Add to dashboard Cite

Introduction The Prostate Cancer Foundation (PCF) convened a PCF prostate‐specific membrane antigen (PSMA) Theranostics State of the Science Meeting on 18 November 2019, at Weill Cornell Medicine, New York, NY. Methods The meeting was attended by 22 basic, translational, and clinical researchers from around the globe, with expertise in PSMA biology, development and use of PSMA theranostics agents, and clinical trials. The goal of this meeting was to discuss the current state of knowledge, the most important biological and clinical questions, and critical next steps for the clinical development of PSMA positron emission tomography (PET) imaging agents and PSMA‐targeted radionuclide agents for patients with prostate cancer. Results Several major topic areas were discussed including the biology of PSMA, the role of PSMA‐targeted PET imaging in prostate cancer, the physics and performance of different PSMA‐targeted PET imaging agents, the current state of clinical development of PSMA‐targeted radionuclide therapy (RNT) agents, the role of dosimetry in PSMA RNT treatment planning, barriers and challenges in PSMA RNT clinical development, optimization of patient selection for PSMA RNT trials, and promising combination treatment approaches with PSMA RNT. Discussion This article summarizes the presentations from the meeting for the purpose of globally disseminating this knowledge to advance the use of PSMA‐targeted theranostic agents for imaging and treatment of patients with prostate cancer.

show abstract

Section: False Negatives and False Positives With Psma Pet Imagingmentioning

confidence: 99%

Meeting report from the Prostate Cancer Foundation PSMA theranostics state of the science meeting

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Further complicating biodistribution, the novel 18 F-labeled PSMA radiotracer 18 F-PSMA-1007 displayed lower renal excretion; the resultant nonurinary excretion may prove valuable for delineation of local recurrence or small pelvic lymph node metastases (especially in close proximity to the ureters) [26]. Apart from physiological uptake pattern, recognition of potential sources of erroneous findings (either false-positive or false-negative) is essential for accurate interpretation of SSTR- and PSMA-PET/CTs [27].…”

Section: Common Pitfalls On Sstr- and Psma-pet/ctmentioning

confidence: 99%

“…Like SSTR-PET, manifold pitfalls have been described for PSMA-PET imaging, including a broad spectrum of either benign or malignant diseases associated with exaggerated uptake [27]. Several benign PSMA-avid pathologies can be misinterpreted as: (I) lymph node involvement (minimum one sympathetic ganglion demonstrating discernible radiotracer uptake in >97%) [23]; (II) bone lesions (bone remodeling, reparative processes including healing of fractures, Paget’s disease) [45,46,47]; (III) benign tumors of neurogenic origin (schwannoma, meningioma, paraganglioma, neurofibromas) [48,49,50]; (IV) benign vascular tumors (hepatic or subcutaneous capillary hemangioma) and tumor neovasculature [51,52]; (V) soft tissue lesions (gynecomastia, desmoid tumors, intramuscular myxoma, and pseudo-angiomatous stromal hyperplasia) [53,54,55,56]; or (VI) pulmonary involvement (granulomatous diseases (sarcoidosis, tuberculosis), anthracosilicosis, or chronic beryllium lung disease) [27,57,58,59,60]. However, non-prostatic malignant entities may also demonstrate relevant PSMA uptake, e.g., in the thyroid (medullary thyroid cancer), breast (triple-negative bilateral breast cancer), brain (glioblastoma multiform), lung (primary lung cancer) or in metastatic renal cell carcinoma [27,61,62,63,64].…”

Section: Common Pitfalls On Sstr- and Psma-pet/ctmentioning

confidence: 99%

Recent Updates on Molecular Imaging Reporting and Data Systems (MI-RADS) for Theranostic Radiotracers—Navigating Pitfalls of SSTR- and PSMA-Targeted PET/CT

Werner

Thackeray

Pomper

et al. 2019

JCM

Self Cite

View full text Add to dashboard Cite

The theranostic concept represents a paradigmatic example of personalized treatment. It is based on the use of radiolabeled compounds which can be applied for both diagnostic molecular imaging and subsequent treatment, using different radionuclides for labelling. Clinically relevant examples include somatostatin receptor (SSTR)-targeted imaging and therapy for the treatment of neuroendocrine tumors (NET), as well as prostate-specific membrane antigen (PSMA)-targeted imaging and therapy for the treatment of prostate cancer (PC). As such, both classes of radiotracers can be used to triage patients for theranostic endoradiotherapy using positron emission tomography (PET). While interpreting PSMA- or SSTR-targeted PET/computed tomography scans, the reader has to navigate certain pitfalls, including (I.) varying normal biodistribution between different PSMA- and SSTR-targeting PET radiotracers, (II.) varying radiotracer uptake in numerous kinds of both benign and malignant lesions, and (III.) resulting false-positive and false-negative findings. Thus, two novel reporting and data system (RADS) classifications for PSMA- and SSTR-targeted PET imaging (PSMA- and SSTR-RADS) have been recently introduced under the umbrella term molecular imaging reporting and data systems (MI-RADS). Notably, PSMA- and SSTR-RADS are structured in a reciprocal fashion, i.e., if the reader is familiar with one system, the other system can readily be applied. Learning objectives of the present case-based review are as follows: (I.) the theranostic concept for the treatment of NET and PC will be briefly introduced, (II.) the most common pitfalls on PSMA- and SSTR-targeted PET/CT will be identified, (III.) the novel framework system for theranostic radiotracers (MI-RADS) will be explained, applied to complex clinical cases and recent studies in the field will be highlighted. Finally, current treatment strategies based on MI-RADS will be proposed, which will demonstrate how such a generalizable framework system truly paves the way for clinically meaningful molecular imaging-guided treatment of either PC or NET. Thus, beyond an introduction of MI-RADS, the present review aims to provide an update of recently published studies which have further validated the concept of structured reporting systems in the field of theranostics.

show abstract

“…However, 18 F-FDG is nonspecific and accumulates in tissues with increased metabolic activity regardless of the underlying pathology (i.e., cancer, inflammation, infection). Therefore, target-specific PET probes for cancer are being developed to allow for a more specific diagnosis (11). In drug development, molecular PET imaging is particularly useful in target validation, whole-body target expression and heterogeneity, whole-body drug distribution, pharmacokinetics (PK) (e.g., drug penetration into privileged sites such as the central nervous system [CNS] penetration), and pharmacodynamic (PD) effects (12).…”

Section: Introductionmentioning

confidence: 99%

Molecular Imaging: a Novel Tool To Visualize Pathogenesis of Infections In Situ

Gordon

Ruiz-Bedoya

Ordoñez

et al. 2019

mBio

View full text Add to dashboard Cite

show abstract

Prostate-Specific Membrane Antigen (PSMA)-Targeted PET Imaging of Prostate Cancer: An Update on Important Pitfalls

Cited by 84 publications

References 153 publications

Meeting report from the Prostate Cancer Foundation PSMA theranostics state of the science meeting

Meeting report from the Prostate Cancer Foundation PSMA theranostics state of the science meeting

Recent Updates on Molecular Imaging Reporting and Data Systems (MI-RADS) for Theranostic Radiotracers—Navigating Pitfalls of SSTR- and PSMA-Targeted PET/CT

Molecular Imaging: a Novel Tool To Visualize Pathogenesis of Infections In Situ

Contact Info

Product

Resources

About