Recurrent Prostate Cancer Diagnostics with 18F-PSMA-1007 PET/CT: A Systematic Review of the Current State

Abstract

Background: Early diagnosis of recurrent prostate cancer is a cornerstone for further adequate therapy planning. Therefore, clinical practice and research still focuses on diagnostic tools that can detect prostate cancer in early recurrence when it is undetectable in conventional diagnostic imaging. ¹⁸F-PSMA-1007 PET/CT is a novel method to evaluate patients with biochemical recurrent PCa. The aim of this review was to evaluate the role of ¹⁸F-PSMA-1007 PET/CT in prostate cancer local recurrence, lymph node metastases and bone metastases detection.

Methods: Original studies, reviews and five meta-analyses were included in this article. A total of 70 studies were retrieved, 31 were included in the study.

Results: All patients described in the studies underwent ¹⁸F-PSMA-1007 PET/CT. The administered ¹⁸F-PSMA-1007 individual dose ranged from 159 ± 31 MBq to 363.93 ± 69.40 MBq. Results showed that ¹⁸F-PSMA-1007 PET/CT demonstrates a good detection rate in recurrent prostate cancer.

Conclusions: ¹⁸F-PSMA-1007 PET/CT appears to achieve reliable performance in detecting recurrent prostate cancer. The high detection rate of ¹⁸F-PSMA-1007 PET/CT in recurrent prostate cancer was confirmed, especially in local recurrence and small lymph nodes with non-specific characteristics on conventional diagnostic imaging methods. However, several authors emphasize some limitations for this tracer-for example, non-specific uptake in bone lesions that can mimic bone metastases.

Keywords: F-PSMA; PET/CT; biochemical relapse; bone metastases; local recurrence; lymph nodes; prostate cancer.

Figure 1

(A)—¹⁸F-PSMA-1007 PET/CT examination of a patient (74 years old) after radical prostatectomy eight years before, Gleason Score 7(3 + 4), current PSA level 0.29 ng/mL. ¹⁸F-PSMA-1007 focal uptake in right side tissues adjacent to the prostate bed, in the level under seminal vesicle, pararectaly with SUVmax = 6.9 was detected, confirming local recurrence. (B) this lesion cannot be seen on the corresponding MRI examination (Images from Riga Stradins University Radiology research laboratory archive).

Figure 2

(A)—¹⁸F-PSMA-1007 PET/CT examination of a patient (74 years old) after radical prostatectomy ten years before, Gleason Score 6 (3 + 3), current PSA level 4.77 ng/mL. ¹⁸F-PSMA-1007 uptake in an 8 mm in size obturatory right side lymph node with SUVmax = 13.7 was detected. (B) an 8 mm in size round shaped obturatory right side lymph node in corresponding computed tomography image in axial plane (Images from Riga Stradins University Radiology research laboratory archive).

Figure 3

(A)—¹⁸F-PSMA-1007 PET/CT examination of a patient (69 years old) after radical prostatectomy seven years before, current PSA level 3.9 ng/mL. ¹⁸F-PSMA-1007 uptake in the right femur with SUVmax = 5.7 was detected to approve metastatic activity. (B) in computed tomography mild, local sclerotic lesion in the right femoral neck was inconclusive (Images from Riga Stradins University Radiology research laboratory archive).