E2605. 18F-PSMA PET/CT Utility in Prostate Cancer: A Comprehensive Review
Authors
Yuzhou Liu;
University of Arizona
Gabriel Duhancioglu;
University of Arizona
Conner Reynolds;
University of Arizona
Devdutta Warhadpande;
University of Arizona
Bital Savir-Baruch;
University of Arizona
Background
In the United States, prostate cancer is the second leading cause of cancer-related death among men, with a prediction of 268,490 new cases and approximately 34,500 deaths by the end of 2022. Accurate staging is the key to accurate therapy selection. Over the last 10 years, the use of molecular PET/CT for the evaluation of prostate cancer has increased. This led to the early detection of disease despite negative findings on conventional image modalities such as MRI, CT, and bone scans. In 2016, the FDA approved 18F-fluciclovine PET/CT scans for patients with recurrent disease, improving patient outcomes. In 2022, 68Ga/18F prostate-specific membrane antigen (PSMA) PET tracers were approved by the FDA. PSMA is upregulated in prostate cancer cells.
Educational Goals / Teaching Points
Describe 18F-PSMA PET/CT imaging technique, PSMA mechanism of uptake, physiological and pathological distribution, and image interpretation. Understand the role of 18F-PSMA PET/CT in diagnosing primary prostate cancer and early detection of recurrent prostate cancer, as outlined in the NCCN guidelines. Understand the role of 18F-PSMA PET/CT in the selection of patients with metastatic castration-resistant prostate cancers (mCRPC) for radioligand therapy.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
18F-PSMA PET/CT was added to the NCCN guidelines as the first line imaging modality for evaluating patients with prostate cancer for primary staging and restaging in biochemical recurrence. To allow accurate interpretation, education of the radiologist on the normal and abnormal distribution of PSMA is essential. We will discuss the 18F-PSMA PET/CT imaging technique, PSMA mechanism of uptake, physiological and pathological distribution, and image interpretation. We will discuss the role of 18F-PSMA PET/CT in evaluating eligibility for radioligand therapy (177Lu-PSMA-617/Pluvito) for mCRPC. Pluvicto is proven to improve overall survival in patients who progressed on hormonal and chemotherapy (VISION trial).
Conclusion
18F-PSMA PET tracers were recently FDA approved and demonstrated higher sensitivity for detecting primary and recurrent prostate cancer and serves as a screening tool for assessing radioligand therapy eligibility.
