Intra-Individual Comparison of 18F-PSMA-1007 and 18F-FDG PET/CT in the Evaluation of Patients With Prostate Cancer

Xing Zhou; YingChun Li; Xiao Jiang; XiaoXiong Wang; ShiRong Chen; TaiPeng Shen; JinHui You; Hao Lu; Hong Liao; Zeng Li; ZhuZhong Cheng

doi:10.3389/fonc.2020.585213

Intra-Individual Comparison of 18F-PSMA-1007 and 18F-FDG PET/CT in the Evaluation of Patients With Prostate Cancer

Front Oncol. 2021 Feb 1:10:585213. doi: 10.3389/fonc.2020.585213. eCollection 2020.

Authors

Xing Zhou^{1

2}, YingChun Li³, Xiao Jiang¹, XiaoXiong Wang¹, ShiRong Chen¹, TaiPeng Shen¹, JinHui You², Hao Lu¹, Hong Liao⁴, Zeng Li⁴, ZhuZhong Cheng^{1

2}

Affiliations

¹ Radiation Oncology Key Laboratory of Sichuan Province, PET/CT Centre, Sichuan Cancer Hospital, Chengdu, China.
² Department of Nuclear Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
³ Department of Nuclear Medicine & Radiotherapy, Air Force Hospital of Western Theater Command, Chengdu, China.
⁴ Radiation Oncology Key Laboratory of Sichuan Province, Department of Urology, Sichuan Cancer Hospital, Chengdu, China.

Abstract

Purpose: 18F labelled PSMA-1007 presents promising results in detecting prostate cancer (PC), while some pitfalls exists meanwhile. An intra-individual comparison of 18F-FDG and 18F-PSMA-1007 in patients with prostate cancer were aimed to be performed in the present study. Then, the pitfalls of 18F-PSMA-1007 PET/CT in imaging of patients with prostate cancer were analyzed.

Methods and material: 21 prostate cancer patients underwent 18F-PSMA-1007 PET/CT as well as 18F-FDG PET/CT before treatment. All positive lesions were noticed in both 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT, then differentiated PC metastasis from benign lesions. the SUVmax, SUVmean and TBR of lesions, up to 10 metastases and 10 benign lesions per patients were recorded (5 for bone, 5 for soft tissue metastasis ). The distribution of positive lesions were analyzed for two imaging. Detection rates, SUVmax, SUVmean and TBR in 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT were compared, respectively. The optimal cut-off values of SUVmax, SUVmean for metastases vs. benign lesions was found through areas under ROC in 18F-PSMA-1007.

Results: The detection rates of primary lesions in 18F-PSMA-1007 PET/CT was higher than that of 18F-FDG PET/CT(100% (21/21) vs. 67%(14/21)). For extra- prostatic lesions, 18F-PSMA-1007 PET/CT revealed 124 positive lesions, 49(49/124, 40%) attributed to a benign origin; 18F-FDG PET/CT revealed 68 positive lesions, 14(14/68, 21%) attributed to a benign origin. The SUVmax, SUVmean, TBR of primary tumor in 18F-PSMA-1007 PET/CT was higher than that in 18F-FDG PET/CT (15.20 vs. 4.20 for SUVmax; 8.70 vs. 2.80 for SUVmean; 24.92 vs. 4.82 for TBR, respectively); The SUVmax, SUVmean, TBR of metastases in 18F-PSMA-1007 PET/CT was higher than that in 18F-FDG PET/CT (10.72 vs. 4.42 for SUVmax; 6.67 vs. 2.59 for SUVmean; The TBR of metastases was 13.3 vs. 7.91). For 18F-FDG PET/CT, the SUVmax, SUVmean in metastases was higher than that in benign lesions (4.42 vs. 3.04 for SUVmax, 2.59 vs. 1.75 for SUVmean, respectively). Similarly, for 18F-PSMA-1007 PET/CT, the SUVmax, SUVmean in metastases was significantly higher than that in benign lesions(10.72 vs. 3.14 for SUVmax, 6.67 vs. 1.91 for SUVmean, respectively), ROC suggested that SUVmax=7.71, SUVmean=5.35 might be the optimal cut-off values for metastases vs. benign lesions.

Conclusion: The pilot study suggested that 18F-PSMA-1007 showed superiority over 18F-FDG because its high detecting rate of PC lesions and excellent tumor uptake. While non-tumor uptake in 18F-PSMA-1007 may lead to misdiagnosis, recognizing these pitfalls and careful analysis can improve the accuracy of diagnosis.

Keywords: 18F-FDG; 18F-PSMA-1007; PET/CT; pitfalls; prostate cancer.