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A prospective comparative study of [68Ga]Ga-RM26 and [68Ga]Ga-PSMA-617 PET/CT imaging in suspicious prostate cancer

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Abstract

Purpose

Prostate-specific membrane antigen (PSMA)–based PET/CT imaging has limitations in the diagnosis of prostate cancer (PCa). We recruited 207 participants with suspicious PCa to perform PET/CT imaging with radiolabeled gastrin-releasing peptide receptor (GRPR) antagonist, [68Ga]Ga-RM26, and compare with [68Ga]Ga-PSMA-617 and histopathology.

Methods

Every participant with suspicious PCa was scanned with both [68Ga]Ga-RM26 and [68Ga]Ga-PSMA-617 PET/CT. PET/CT imaging was compared using pathologic specimens as a reference standard.

Results

Of the 207 participants analyzed, 125 had cancer, and 82 were diagnosed with benign prostatic hyperplasia (BPH). The sensitivity and specificity of [68Ga]Ga-RM26 and [68Ga]Ga-PSMA-617 PET/CT imaging differed significantly for detecting clinically significant PCa. The area under the ROC curve (AUC) was 0.54 for [68Ga]Ga-RM26 PET/CT and 0.91 for [68Ga]Ga-PSMA-617 PET/CT in detecting PCa. For clinically significant PCa imaging, the AUCs were 0.51 vs. 0.93, respectively. [68Ga]Ga-RM26 PET/CT imaging had higher sensitivity for PCa with Gleason score (GS) = 6 (p = 0.03) than [68Ga]Ga-PSMA-617 PET/CT but poor specificity (20.73%). In the group with PSA < 10 ng/mL, the sensitivity, specificity, and AUC of [68Ga]Ga-RM26 PET/CT were lower than [68Ga]Ga-PSMA-617 PET/CT (60.00% vs. 80.30%, p = 0.12, 23.26% vs. 88.37%, p = 0.000, and 0.524 vs. 0.822, p = 0.000, respectively). [68Ga]Ga-RM26 PET/CT exhibited significantly higher SUVmax in specimens with GS = 6 (p = 0.04) and in the low-risk group (p = 0.01), and its uptake did not increase with PSA level, GS, or clinical stage.

Conclusion

This prospective study provided evidence for the superior accuracy of [68Ga]Ga-PSMA-617 PET/CT over [68Ga]Ga-RM26 PET/CT in detecting more clinically significant PCa. [68Ga]Ga-RM26 PET/CT showed an advantage for imaging low-risk PCa.

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Data availability

The study protocol and individual participant data reported in this article (text, tables, figures, and appendices) will all be available between 9 and 36 months after article publication. All related data are shared with researchers who provided an approved proposal. Requests for data should be directed by email to Yi Cai. Data requestors will need to sign a data access agreement.

Abbreviations

GRPR:

Gastrin-releasing peptide receptor

PSMA:

Prostate-specific membrane antigen

PSA:

Prostate-specific antigen

GS:

Gleason score

PCa:

Prostate cancer

BPH:

Benign prostatic hyperplasia

PET/CT:

Positron emission tomography/computed tomography

SUVmax:

Maximum standard uptake value

AUC:

Area under the ROC curve

HE:

Hematoxylin and eosin

IHC:

Immunohistochemistry

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Funding

This work was supported in part by funding from the National Natural Science Foundation of China (91859207, 81771873, 82003130, 81800590, and 81801740), the Science and Technology Innovation Program of Hunan Province (2021RC4056), the Key Research and Development Program of Hunan Province (2021SK2014), the Natural Science Foundation of Hunan Province (2021JJ40983, 2020JJ5882, and 2020JJ5922), and the Clinical Research Fund Project of National Geriatric Disease Clinical Research Center (2020LNJJ01).

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Author notes

  1. Xiaomei Gao and Yongxiang Tang contributed equally to this work.

Authors and Affiliations

  1. Department of Pathology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan Province, No.87 Xiangya Road, Changsha City, 410008, People’s Republic of China

    Xiaomei Gao & Hongling Yin

  2. Department of Nuclear Medicine, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan Province, No.87 Xiangya Road, Changsha City, 410008, People’s Republic of China

    Yongxiang Tang, Jian Li & Shuo Hu

  3. Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan Province, No.87 Xiangya Road, Changsha City, 410008, People’s Republic of China

    Minfeng Chen, Yu Gan, Xiongbin Zu & Yi Cai

  4. Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Hunan Province, No.87 Xiangya Road, Changsha City, 410008, People’s Republic of China

    Shuo Hu

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  1. Xiaomei Gao
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Contributions

YC, MFC, and XBZ enrolled the participants. HLY and XMG contributed to pathological data. YXT and JL conducted the imaging analysis from PET/CT. MFC, XBZ, and SH verified the raw data. XMG, YXT, and YC conceived the study, analyzed the data, and prepared the manuscript. All authors critically reviewed and approved the final manuscript for publication.

Corresponding authors

Correspondence to Xiongbin Zu, Yi Cai or Shuo Hu.

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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. The study was approved by the local ethics committee.

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

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Gao, X., Tang, Y., Chen, M. et al. A prospective comparative study of [68Ga]Ga-RM26 and [68Ga]Ga-PSMA-617 PET/CT imaging in suspicious prostate cancer. Eur J Nucl Med Mol Imaging 50, 2177–2187 (2023). https://doi.org/10.1007/s00259-023-06142-2

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