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. 2022 Dec 15;14(24):6209.
doi: 10.3390/cancers14246209.

Prostate-Specific Membrane Antigen Targeted Pet/CT Imaging in Patients with Colon, Gastric and Pancreatic Cancer

Floris A Vuijk  1 , Fleur Kleiburg  2   3 , Wyanne A Noortman  2   3 , Linda Heijmen  2 , Shirin Feshtali Shahbazi  4 , Floris H P van Velden  2 , Victor M Baart  1 , Shadhvi S Bhairosingh  1 , Bert D Windhorst  5 , Lukas J A C Hawinkels  6 , Petra Dibbets-Schneider  2 , Neanke Bouwman  7 , Stijn A L P Crobach  8 , Arantza Fariña-Sarasqueta  9 , Andreas W K S Marinelli  10 , Daniela E Oprea-Lager  5 , Rutger-Jan Swijnenburg  11 , Frits Smit  12 , Alexander L Vahrmeijer  1 , Lioe-Fee de Geus-Oei  2   3 , Denise E Hilling  1   13 , Marije Slingerland  14
Affiliations

Prostate-Specific Membrane Antigen Targeted Pet/CT Imaging in Patients with Colon, Gastric and Pancreatic Cancer

Floris A Vuijk et al. Cancers (Basel). .

Abstract

Current imaging modalities frequently misjudge disease stage in colorectal, gastric and pancreatic cancer. As treatment decisions are dependent on disease stage, incorrect staging has serious consequences. Previous preclinical research and case reports indicate that prostate-specific membrane antigen (PSMA)-targeted PET/CT imaging might provide a solution to some of these challenges. This prospective clinical study aims to assess the feasibility of [18F]DCFPyL PET/CT imaging to target and visualize primary colon, gastric and pancreatic cancer. In this prospective clinical trial, patients with colon, gastric and pancreatic cancer were included and underwent both [18F]DCFPyL and [18F]FDG PET/CT scans prior to surgical resection or (for gastric cancer) neoadjuvant therapy. Semiquantitative analysis of immunohistochemical PSMA staining was performed on the surgical resection specimens, and the results were correlated to imaging parameters. The results of this study demonstrate detection of the primary tumor by [18F]DCFPyL PET/CT in 7 out of 10 patients with colon, gastric and pancreatic cancer, with a mean tumor-to-blood pool ratio (TBR) of 3.3 and mean SUVmax of 3.6. However, due to the high surrounding uptake, visual distinction of these tumors was difficult, and the SUVmax and TBR on [18F]FDG PET/CT were significantly higher than on [18F]DCFPyL PET/CT. In addition, no correlation between PSMA expression in the resection specimen and SUVmax on [18F]DCFPyL PET/CT was found. In conclusion, the detection of several gastrointestinal cancers using [18F]DCFPyL PET/CT is feasible. However, low tumor expression and high uptake physiologically in organs/background hamper the clear distinction of the tumor. As a result, [18F]FDG PET/CT was superior in detecting colon, gastric and pancreatic cancers.

Keywords: PET/CT; PSMA; colon cancer; gastric cancer; pancreatic cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overview of imaging modalities of a patient with pT3N0M0 colon carcinoma (patient 1). The arrows indicate (upper row) a lesion with intense [18F]DCFPyL expression with an SUVmax of 9.9 and (bottom row) a lesion with [18F]FDG uptake with an SUVmax of 45.5. From left to right: low-dose CT (A,E), fused PET/CT (B,F), PET (C,G), and the maximal intensity projection (MIP, (D,H)). Image scale SUV 0-5.
Figure 2
Figure 2
Overview of imaging modalities of a patient with cT4N1M0 tubular gastric carcinoma (patient 6). The arrows indicate (upper row) a lesion with light [18F]DCFPyL expression with an SUVmax of 2.5 and (bottom row) a lesion with [18F]FDG uptake with an SUVmax of 7.8. From left to right: low-dose CT (A,E), fused PET/CT (B,F), PET (C,G), and the maximal intensity projection (MIP, (D,H)). Image scale SUV 0-5.
Figure 3
Figure 3
Overview of imaging modalities of a patient with pT2N2M0 pancreatic ductal adenocarcinoma (patient 10). The arrows indicate (upper row) a lesion with moderate to intense [18F]DCFPyL expression with an SUVmax of 5.1 and (bottom row) a lesion with [18F]FDG uptake with an SUVmax of 10.1. From left to right: low-dose CT (A,E), fused PET/CT (B,F), PET (C,G), and the maximal intensity projection (MIP, (D,H)). Image scale SUV 0-5.
Figure 4
Figure 4
Maximum Intensity Projection (MIP) PET images of all included patients. The arrows indicate the location of the primary tumor. In the MIP PET images with an asterisk the primary tumor was not visible. [18F]FDG PET/CT of patient 5 was not performed as this was not the standard of care due to his cT2-3 gastric tumor. Patient numbers are identical to Table 1.
Figure 5
Figure 5
Scatterplot of [18F]DCFPyL SUVmax values with associated H scores. Abbreviations: SUVmax, maximal standardized uptake value.
Figure 6
Figure 6
Overview of immunohistochemical stainings. This figure displays Hematoxylin and Eosin (HE), endoglin and PSMA staining of, respectively, colon ((A–C), H-score 120), gastric ((D–F), H-score 150) and pancreatic cancer ((G–I), H-score 0). As a positive control, the PSMA staining was performed on prostate cancer tissue ((J), H-score 300). Overview images were made at 1–2× magnification, zoom images at 10× magnification.
See this image and copyright information in PMC

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