Gallium-68-Labeled Prostate-Specific Membrane Antigen-11 PET/CT of Prostate and Nonprostate Cancers

Abstract

OBJECTIVE. The purpose of this study is to provide a concise summary of the current experience with ⁶⁸Ga-labeled prostate-specific membrane antigen (PSMA)-11 imaging of prostate and nonprostate malignancies and benign conditions. CONCLUSION. PSMA is overexpressed in prostate cancer and in the neovasculature of many other malignancies. The relevance of PSMA as a biologic target, coupled with advances in the design, synthesis, and evaluation of PSMA-based radionuclides for imaging and therapy, is anticipated to play a major role in patient care.

Keywords: Ga-PSMA; PET; benign PSMA uptake; nonprostate malignancy; prostate cancer.

Fig. 1—

53-year-old man with newly diagnosed prostate cancer who underwent imaging for staging purposes. A and B, Gallium-68–labeled prostate-specific membrane antigen–11 PET/CT fusion (A) and CT (B) images show pelvic bone and nodal metastases (arrows). Note bone lesion in sacrum with no obvious changes on CT image.

Fig. 2—

80-year-old man with prostate cancer who had completed radiotherapy and androgen deprivation therapy 3 years before presenting with increasing prostate-specific antigen levels (from 0.8 to 2.2 ng/mL over 8 months). A, Gallium-68–labeled prostate-specific membrane antigen–11 PET/CT fusion image shows tracer-avid recurrence (arrow) in left lobe of prostate. B, CT image shows no obvious abnormality.

Fig. 3—

76-year-old man with history of prostate cancer who was receiving antiandrogen therapy with enzalutamide. A and B, Gallium-68–labeled prostate-specific membrane antigen (PSMA)–11 PET/CT fusion (A) and CT (B) images obtained at baseline show no pelvic, bone, or nodal metastases. C and D, Gallium-68–labeled PSMA-11 PET/CT fusion (C) and CT (D) images were acquired at follow-up 5 months after images shown in A and B and reveal new ⁶⁸Ga-PSMA-11–avid nodal and bone metastases (arrows, C) but no new abnormalities on CT (D). These findings indicate progression of disease that is only evident on ⁶⁸Ga-PSMA-11 PET/CT.

Fig. 4—

Uptake of ⁶⁸Ga-labeled prostate-specific membrane antigen (PSMA)–11 on PET/CT images of three patients with benign conditions. (Courtesy of Sohi JS [Northern California PET Imaging Center, Sacramento, CA] and Bengel FM and Derlin T [Hannover Medical School, Hannover, Germany]) A, 72-year-old man who underwent ⁶⁸Ga-PSMA-11 PET/CT for restaging of prostate cancer (PC) after completing ¹⁷⁷Lu-PSMA therapy. PET/CT image shows uptake in ganglion (arrow). B, 83-year-old man with biochemical recurrence of PC and radiopharmaceutical-avid atelectasis. Gallium-68–labeled PSMA-11 PET/CT image shows tracer uptake in pulmonary atelectasis consistent with known uptake in inflammation (arrow).

Fig. 4—

Uptake of ⁶⁸Ga-labeled prostate-specific membrane antigen (PSMA)–11 on PET/CT images of three patients with benign conditions. (Courtesy of Sohi JS [Northern California PET Imaging Center, Sacramento, CA] and Bengel FM and Derlin T [Hannover Medical School, Hannover, Germany]) A, 72-year-old man who underwent ⁶⁸Ga-PSMA-11 PET/CT for restaging of prostate cancer (PC) after completing ¹⁷⁷Lu-PSMA therapy. PET/CT image shows uptake in ganglion (arrow). B, 83-year-old man with biochemical recurrence of PC and radiopharmaceutical-avid atelectasis. Gallium-68–labeled PSMA-11 PET/CT image shows tracer uptake in pulmonary atelectasis consistent with known uptake in inflammation (arrow).

Fig. 5—

76-year-old man with known Paget disease with biochemical recurrence of prostate cancer imaged with ⁶⁸Ga-labeled prostate-specific membrane antigen (PSMA)–11 PET/CT. (Courtesy of Sohi JS [Northern California PET Imaging Center, Sacramento, CA] and Bengel FM and Derlin T [Hannover Medical School, Hannover, Germany]) A, CT image from PET/CT shows osteoblastic cortical thickening in left humerus (arrow), which can be seen with Paget disease. B, Gallium-68–labeled PSMA-11 fusion PET/CT image shows radiopharmaceutical uptake in area of CT changes (arrow) suggestive of Paget disease. C, Gallium-68–labeled PSMA-11 PET/CT maximum-intensity-projection image shows patchy extensive radiopharmaceutical distribution in left humerus (arrow) typical for Paget disease. H = head.

Fig. 6—

Hepatocellular carcinoma. (Adapted with permission from research originally published in JNM. Kesler M, Levine C, Hershkovitz D, et al. ⁶⁸Ga-PSMA is a novel PET-CT tracer for imaging of hepatocellular carcinoma: a prospective pilot study. A–C, CT image (A), ⁶⁸Ga-labeled prostate-specific membrane antigen (PSMA)–11 PET/CT image (B), and ¹⁸F-FDG PET/CT image (C). CT image (A) shows arterially enhancing hepatocellular carcinoma (arrow) and left portal vein tumor thrombus (arrowhead) with increased uptake of ⁶⁸Ga-PSMA-11 (B) in both areas but no significant ¹⁸F-FDG uptake (C).

Fig. 7—

60-year-old man who initially underwent left nephrectomy and left lung lower lobectomy for synchronous presentation of solitary metastasis of Fuhrman grade 3 clear cell carcinoma. (Adapted with permission from Siva S, Callahan J, Pryor D, Martin J, Lawrentschuk N, Hofman MS. Utility of ⁶⁸Ga prostate specific membrane antigen positron emission tomography in diagnosis and response assessment of recurrent renal cell carcinoma. A and B, Fluorine-18–labeled FDG PET image (A) and ⁶⁸Ga-labeled prostate-specific membrane antigen (PSMA)–11 PET image (B), obtained 18 months after nephrectomy and lobectomy, show left adrenal metastasis (arrows) that was mildly FDG avid (A) and intensely ⁶⁸Ga-PSMA-11 avid (B).

Fig. 8—

55-year-old man with incidental ⁶⁸Ga-labeled prostate-specific membrane antigen (PSMA)–11–avid squamous cell carcinoma. (Adapted with permission from research originally published in JNM. Osman MM, Iravani A, Hicks RJ, Hofman MS. Detection of synchronous primary malignancies with ⁶⁸Ga-labeled prostate-specific membrane antigen PET/CT in patients with prostate cancer: frequency in 764 patients. A and B, Gallium-68–labeled PSMA-11 PET/CT images show incidental abnormal uptake in squamous cell carcinoma of right tonsillar pillar (arrow, A) and also in ipsilateral mildly enlarged level II neck node (arrow, B).

Fig. 9—

72-year-old man with prostate cancer. (Adapted with permission from research originally published in JNM. Sager S, Vatankulu B, Uslu L, Sönmezoglu K. Incidental detection of follicular thyroid carcinoma in ⁶⁸Ga-PSMA PET/CT imaging. A and B, Gallium-68–labeled prostate-specific membrane antigen (PSMA)–11 PET/CT fusion (A) and CT (B) images show ⁶⁸Ga-PSMA-11–avid malignant thyroid nodule (arrows). On CT, there is lobulated heterogeneous nodule. On PET, nodule has small area of central necrosis with peripheral abnormal increased uptake.

Fig. 10—

69-year-old man with prostate cancer. Axial PET/CT fusion image shows focal ⁶⁸Ga-labeled prostate-specific membrane antigen–11 uptake (arrow) in incidentally detected spiculated right-sided lung nodule found to be synchronous lung adenocarcinoma. (Adapted with permission from research originally published in JNM. Osman MM, Iravani A, Hicks RJ, Hofman MS. Detection of synchronous primary malignancies with ⁶⁸Ga-labeled prostate-specific membrane antigen PET/CT in patients with prostate cancer: frequency in 764 patients.