Comparison of 18F-based PSMA radiotracers with [68Ga]Ga-PSMA-11 in PET/CT imaging of prostate cancer-a systematic review and meta-analysis

Siyu Huang; Sean Ong; Dean McKenzie; Adam Mirabelli; David C Chen; Thilakavathi Chengodu; Declan G Murphy; Michael S Hofman; Nathan Lawrentschuk; Marlon Perera

doi:10.1038/s41391-023-00755-2

Comparison of ¹⁸F-based PSMA radiotracers with [⁶⁸Ga]Ga-PSMA-11 in PET/CT imaging of prostate cancer-a systematic review and meta-analysis

Prostate Cancer Prostatic Dis. 2023 Nov 28. doi: 10.1038/s41391-023-00755-2. Online ahead of print.

Authors

Siyu Huang¹, Sean Ong^{2

3}, Dean McKenzie^{4

5}, Adam Mirabelli², David C Chen^{6

7

8}, Thilakavathi Chengodu³, Declan G Murphy^{7

9}, Michael S Hofman^{6

7}, Nathan Lawrentschuk^{2

3

10}, Marlon Perera^{9

11}

Affiliations

¹ Department of Surgery, University of Melbourne, Parkville, VIC, Australia. huangsiyu1998@gmail.com.
² Department of Surgery, University of Melbourne, Parkville, VIC, Australia.
³ EJ Whitten Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, VIC, Australia.
⁴ Research Development & Governance Unit, Epworth HealthCare, Melbourne, VIC, Australia.
⁵ Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, VIC, Australia.
⁶ Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
⁷ Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
⁸ Young Urology Researchers Organisation (YURO), Melbourne, VIC, Australia.
⁹ Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
¹⁰ Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia.
¹¹ Department of Surgery, Austin Health, The University of Melbourne, Melbourne, VIC, Australia.

PMID: 38017295
DOI: 10.1038/s41391-023-00755-2

Abstract

Background: Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) has become an increasingly established imaging modality in the staging of prostate cancer (PCa). Numerous PSMA-based tracers are currently available, however, there is a lack of consensus on the optimal radiotracer(s) for PSMA PET/CT. This study aims to investigate whether Fluorine-18 (¹⁸F)-labelled PSMA PET/CT is significantly different from Gallium-68 (⁶⁸Ga) in primary diagnosis and/or secondary staging of prostate cancer following biochemical recurrence.

Methods: A critical review of MEDLINE, EMBASE, PubMed and Web of Science databases was performed in May 2023 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Studies that directly compared ¹⁸F-based PSMA radiotracers and [⁶⁸Ga]Ga-PSMA-11 in terms of the normal organ SUV or the lesion SUV or the detection rate were assessed. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).

Results: Twenty-four studies were analysed. [¹⁸F]DCFPyL and [¹⁸F]PSMA-1007 were the two most commonly studied ¹⁸F based PSMA tracers. [¹⁸F]JK-PSMA-7, [¹⁸F]rhPSMA-7, [¹⁸F]AlF-PSMA-11 were the new tracers evaluated in a limited number of studies. Overall, [¹⁸F]DCFPyL was observed to have a similar lesion detection rate to [⁶⁸Ga]Ga-PSMA-11 with no increase in false positive rates. [¹⁸F]PSMA-1007 was found to have a greater local lesion detection rate because of its predominant hepatobiliary excretory route. However, [⁶⁸Ga]Ga-PSMA-11 was observed to have a similar local lesion detection rate in studies that administer patients with furosemide prior to the scan. In addition, [¹⁸F]PSMA-1007 was found to have a significant number of benign bone uptakes.

Conclusions: [¹⁸F]DCFPyL was observed to be similar to [⁶⁸Ga]Ga-PSMA-11. [¹⁸F]PSMA-1007 was observed to be less preferrable to [⁶⁸Ga]Ga-PSMA-11 due to its high benign bone uptakes. Overall, there was not enough evidence in differentiating the radiotracers based on their clinical impacts.

Publication types

Review