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Prospective intra-individual blinded comparison of [18F]PSMA-1007 and [68 Ga]Ga-PSMA-11 PET/CT imaging in patients with confirmed prostate cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

A Correction to this article was published on 03 November 2021

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Abstract

Introduction

[18F]PSMA-1007 has potential advantages over [68 Ga]Ga-PSMA-11, although limited prospective data evaluating diagnostic performance exist. The aims of this study are to describe the concordance of [18FPSMA-1007 and [68 Ga]Ga-PSMA-11 for TNM with the American Joint Committee on Cancer (AJCC) prognostic stage and assess differences in tracer uptake.

Methods

Fifty men (mean age 71.8) were imaged with [68 Ga]Ga-PSMA-11 and [18F]PSMA-1007 < 4 weeks apart. Images were independently reported according to TNM by two experienced nuclear medicine specialists blinded to the other scan and prior imaging. Discordant results were resolved by a third independent nuclear medicine specialist. Quantitative analysis of lesion uptake and physiologic tissue for each tracer was performed by one experienced reader.

Results

Scan indications were initial staging (n = 12), biochemical recurrence (n = 27) and metastatic disease evaluation (n = 11). Most patients had ISUP grade group 3 or higher. Median PSA value was 2.7 ng/ml (IQR 0.7–12.0), and a minority of patients (28%) were currently treated with androgen deprivation therapy. [18F]PSMA-1007 uptake was significantly higher than [68Ga]Ga-PSMA-11 in local recurrence, nodal and distant metastases and most physiologic sites (including bone) except for urinary bladder which was significantly lower. [18F]PSMA-1007 upstaged local prostate staging in 5/17 patients, local recurrence in 3/33 patients, regional nodal disease in 3/50 patients and 1 distant metastasis (bladder). [68Ga]Ga-PSMA-11 upstaged regional nodal disease in 1/50 patients and distant metastasis in one patient (right adrenal). Overall AJCC prognostic stage was concordant in 46/50 (92%) patients, with two patients upstaged for both [18F]PSMA-1007 and [68Ga]Ga-PSMA-11. [18F]PSMA-1007 had more equivocal results (one regional node; six equivocal bone lesions, one of which was subsequently confirmed metastatic) than [68Ga]Ga-PSMA-11 (one equivocal local recurrence).

Conclusion

Overall AJCC prognostic stage was similar (92%) between [18F]PSMA-1007 and [68Ga]Ga-PSMA-11. [18F]PSMA-1007 demonstrates higher uptake within involved nodes and distant metastases and most physiologic sites except urinary bladder which aided [18F]PSMA-1007 local staging of the prostate primary/local recurrence and regional nodal disease adjacent ureters. However, [18F]PSMA-1007 liver uptake obscured a solitary right adrenal metastasis, and more equivocal bone lesions were identified.

Trial registration

The study was registered with Australia New Zealand Clinical Trials Registry (ACTRN12618000665235) on 24 April 2018.

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Acknowledgements

We would like to acknowledge the effort of nuclear medicine technologists, nursing and medical staff at Royal Brisbane and Women’s Hospital and Q-TRaCE (QLD—The Radiopharmaceutical Centre of Excellence) radiochemistry staff who supported and contributed to the running of this trial, in addition to the enthusiastic participation of our patients. We are also grateful to Marita Prior for assistance with trial administration.

Funding

No funding was received for conducting this study. Matthew J Roberts is supported by a Clinician Research Fellowship from the Metro North Office of Research, Queensland Health, and a Doctor in Training Research Scholarship from Avant Mutual Group Pty Ltd.

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Authors and Affiliations

  1. Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women’s Hospital, Brisbane, QLD, 2006, Australia

    David A. Pattison, Evyn G. Arnfield, Peter L. Garcia, Melissa J. Latter, Stuart C. Ramsay & Paul A. Thomas

  2. School of Medicine, University of Queensland, Brisbane, Australia

    David A. Pattison, Melissa J. Latter, Charles Y. Lin & Paul A. Thomas

  3. Department of Medical Imaging, Royal Brisbane & Women’s Hospital, Brisbane, Australia

    Maciej Debowski & Brook Gulhane

  4. Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia

    Anita M. Pelecanos

  5. Department of Radiation Oncology, Royal Brisbane & Women’s Hospital, Brisbane, Australia

    Charles Y. Lin

  6. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Matthew J. Roberts

  7. Department of Urology, Redcliffe Hospital, Redcliffe, Australia

    Matthew J. Roberts

  8. Centre for Clinical Research, The University of Queensland, Brisbane, Australia

    Matthew J. Roberts

  9. School of Medicine, James Cook University, Townsville, Australia

    Stuart C. Ramsay

Authors
  1. David A. Pattison
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Contributions

All authors contributed to the study conception and design, or acquiring data, or analysing and interpreting data. Material preparation, data collection and analysis were performed by Maciej Debowski, Brook Gulhane, Evyn Arnfield, David Pattison, Stuart Ramsay and Paul Thomas. The first draft of the manuscript was written by David Pattison, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to David A. Pattison.

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Ethics approval and consent to participate

This trial was approved by the institutional review board of the Royal Brisbane and Women’s Hospital Human Research Ethics Committee and was conducted in accordance with 1964 Helsinki Declaration. Written informed consent for participation and publication was provided.

Conflict of interest

The authors declare no competing interests.

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This article is part of the Topical Collection on Oncology–Genitourinary

Stuart C. Ramsay and Paul A. Thomas contributed equally to this work

The original online version of this article was revised: The authors regret that the figure legends in the original article are correct but the images for Figure 5 and Figure 6 need to be swapped.

The original article has been corrected.

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Pattison, D.A., Debowski, M., Gulhane, B. et al. Prospective intra-individual blinded comparison of [18F]PSMA-1007 and [68 Ga]Ga-PSMA-11 PET/CT imaging in patients with confirmed prostate cancer. Eur J Nucl Med Mol Imaging 49, 763–776 (2022). https://doi.org/10.1007/s00259-021-05520-y

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  • DOI: https://doi.org/10.1007/s00259-021-05520-y

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