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Comparison of PSMA-HBED and PSMA-I&T as diagnostic agents in prostate carcinoma

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

Abstract

Purpose

Gallium(68)-labelled prostate-specific membrane antigen (PSMA) radiopharmaceuticals can be used to detect prostate cancer (PCa) cells due the their over expression of PSMA. The 68Ga HBED-PSMA (PSMA-HBED) ligand has been most widely used and can be considered the current gold standard agent. Further PSMA ligands based on the DOTAGA and DOTA conjugates have more recently been developed. These agents (PSMA-I&T and PSMA-617) have potential theranostic capabilities as they can be conjugated with therapeutic radioisotopes. In this study, we examine whether PSMA-I&T has comparative efficacy, such that it could replace PSMA-HBED as a diagnostic agent in prostate carcinoma.

Methods

19 patients with PCa referred for 68Ga-PSMA imaging were imaged with PSMA-HBED and PSMA-I&T PET-CT imaging within a 2-week period. The two pharmaceuticals were synthesised using click chemistry. Imaging was performed using the same standardised methodology on a Siemens Biograph mCT. All sites of PSMA binding thought to represent PCa (probable or definite) were included in a lesion analysis that examined lesion concordance and lesional binding efficiency (SUVpeak) between the two radiopharmaceuticals. For each patient, SUVmean of the LV cavity blood pool, bone, muscle and liver were determined as image background measures.

Results

Across all patients, PSMA uptake was observed in 47 lesions (10 bone lesions, 19 nodal lesions, 18 high-grade intraprostatic binding). Lesions were concordant between the agents in all except for two small (<4 mm) nodal lesions which were not visualised with PSMA-I&T. SUVpeak assessment showed significantly greater overall lesion binding with HBED (paired t test, p = 0.0001). LV blood pool and bone marrow SUVmean were significantly higher for I&T than HBED (paired t test, blood pool p < 1 × 10–5, bone marrow p < 0.005).

Conclusion

Intra-patient comparative imaging demonstrates higher lesional PSMA-HBED binding than PSMA-I&T and that the HBED agent is likely to have better lesion contrast. While there was concordance in 96% of lesions, 2 small nodal lesions were appreciated with PSMA-HBED imaging while considered normal with PSMA-I&T. These findings suggest that HBED-PSMA has a slightly higher diagnostic accuracy in comparison to PSMA-I&T.

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Acknowledgements

We would like to acknowledge all involved departmental staff and clinical referrers for their input for this article and patient referral.

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Authors and Affiliations

  1. Molecular Imaging and Therapy Service (Nuclear Medicine), Fiona Stanley Hospital, Perth, Australia

    Michael McCarthy, Tiffany Langton, Divesh Kumar & Andrew Campbell

  2. Molecular Imaging and Therapy Service (Nuclear Medicine), Royal Perth Hospital, Perth, Australia

    Michael McCarthy, Tiffany Langton, Divesh Kumar & Andrew Campbell

  3. Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia

    Andrew Campbell

Authors
  1. Michael McCarthy
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  2. Tiffany Langton
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  3. Divesh Kumar
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  4. Andrew Campbell
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Correspondence to Michael McCarthy.

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Internal funding by institution.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

Table 4 SUVpeak values and location details for all lesions
Full size table
Table 5 Mean SUV values for blood pool, liver, bone and muscle for all subjects
Full size table

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McCarthy, M., Langton, T., Kumar, D. et al. Comparison of PSMA-HBED and PSMA-I&T as diagnostic agents in prostate carcinoma. Eur J Nucl Med Mol Imaging 44, 1455–1462 (2017). https://doi.org/10.1007/s00259-017-3699-z

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  • DOI: https://doi.org/10.1007/s00259-017-3699-z

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