. 2023 Apr;50(5):1466-1486.

doi: 10.1007/s00259-022-06089-w. Epub 2023 Jan 5.

PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0

Wolfgang P Fendler^{1

2}, Matthias Eiber³, Mohsen Beheshti⁴, Jamshed Bomanji⁵, Jeremie Calais⁶, Francesco Ceci^{7

8}, Steve Y Cho⁹, Stefano Fanti¹⁰, Frederik L Giesel¹¹, Karolien Goffin¹², Uwe Haberkorn¹³, Heather Jacene¹⁴, Phillip J Koo¹⁵, Klaus Kopka^{16

17

18}, Bernd J Krause¹⁹, Liza Lindenberg²⁰, Charles Marcus²¹, Felix M Mottaghy^{22

23}, Daniela E Oprea-Lager²⁴, Joseph R Osborne²⁵, Morand Piert²⁶, Steven P Rowe²⁷, Heiko Schöder²⁸, Simon Wan⁵, Hans-Jürgen Wester²⁹, Thomas A Hope³⁰, Ken Herrmann³¹

Affiliations

¹ Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
² PET Committee of the German Society of Nuclear Medicine, Marburg, Germany.
³ Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany.
⁴ Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
⁵ Institute of Nuclear Medicine, UCLH NHS Foundation Trust, London, UK.
⁶ Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA.
⁷ Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology, IRCCS, Milan, Italy.
⁸ Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
⁹ Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
¹⁰ IRCCS, AOU Bologna, Bologna, Italy.
¹¹ Department of Nuclear Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.
¹² Department of Nuclear Medicine, Division of Nuclear Medicine and Molecular Imaging, University Hospital Leuven, KU Leuven, Louvain, Belgium.
¹³ Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.
¹⁴ Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, USA.
¹⁵ Banner MD Anderson Cancer Center, Phoenix, AZ, USA.
¹⁶ Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.
¹⁷ School of Science, Faculty of Chemistry and Food Chemistry, Technical University Dresden, Dresden, Germany.
¹⁸ German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany.
¹⁹ Department of Nuclear Medicine, University Medical Center, University of Rostock, Rostock, Germany.
²⁰ Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA.
²¹ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA.
²² Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany.
²³ Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
²⁴ Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
²⁵ Department of Radiology, Division of Molecular Imaging and Therapeutics, Weill Cornell Medicine, New York, NY, USA.
²⁶ Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Michigan, Ann Arbor, MI, USA.
²⁷ Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁸ Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
²⁹ Pharmaceutical Radiochemistry, Technische Universität München, Walther-Meißner-Str. 3, 85748, Garching, Germany.
³⁰ Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
³¹ Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany. ken.herrmann@uk-essen.de.

PMID: 36604326
PMCID: PMC10027805
DOI: 10.1007/s00259-022-06089-w

PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0

Wolfgang P Fendler et al. Eur J Nucl Med Mol Imaging. 2023 Apr.

. 2023 Apr;50(5):1466-1486.

doi: 10.1007/s00259-022-06089-w. Epub 2023 Jan 5.

Authors

Affiliations

¹ Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
² PET Committee of the German Society of Nuclear Medicine, Marburg, Germany.
³ Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany.
⁴ Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
⁵ Institute of Nuclear Medicine, UCLH NHS Foundation Trust, London, UK.
⁶ Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA.
⁷ Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology, IRCCS, Milan, Italy.
⁸ Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
⁹ Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
¹⁰ IRCCS, AOU Bologna, Bologna, Italy.
¹¹ Department of Nuclear Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University and Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.
¹² Department of Nuclear Medicine, Division of Nuclear Medicine and Molecular Imaging, University Hospital Leuven, KU Leuven, Louvain, Belgium.
¹³ Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.
¹⁴ Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, USA.
¹⁵ Banner MD Anderson Cancer Center, Phoenix, AZ, USA.
¹⁶ Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.
¹⁷ School of Science, Faculty of Chemistry and Food Chemistry, Technical University Dresden, Dresden, Germany.
¹⁸ German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany.
¹⁹ Department of Nuclear Medicine, University Medical Center, University of Rostock, Rostock, Germany.
²⁰ Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA.
²¹ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA.
²² Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany.
²³ Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
²⁴ Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
²⁵ Department of Radiology, Division of Molecular Imaging and Therapeutics, Weill Cornell Medicine, New York, NY, USA.
²⁶ Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Michigan, Ann Arbor, MI, USA.
²⁷ Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁸ Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
²⁹ Pharmaceutical Radiochemistry, Technische Universität München, Walther-Meißner-Str. 3, 85748, Garching, Germany.
³⁰ Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
³¹ Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany. ken.herrmann@uk-essen.de.

PMID: 36604326
PMCID: PMC10027805
DOI: 10.1007/s00259-022-06089-w

Abstract

Here we aim to provide updated guidance and standards for the indication, acquisition, and interpretation of PSMA PET/CT for prostate cancer imaging. Procedures and characteristics are reported for a variety of available PSMA small radioligands. Different scenarios for the clinical use of PSMA-ligand PET/CT are discussed. This document provides clinicians and technicians with the best available evidence, to support the implementation of PSMA PET/CT imaging in research and routine practice.

Keywords: Guideline; PET; PSMA; Prostate cancer; Restaging; Staging.

PubMed Disclaimer

Conflict of interest statement

W.P.F. reports fees from SOFIE Bioscience (research funding), Janssen (consultant, speakers bureau), Calyx (consultant), Bayer (consultant, speakers bureau, research funding), Parexel (image review), Novartis/AAA (speakers bureau), and Telix (speakers bureau).

S.F. reports fees from Amgen (research funding), AAA, Astellas, Astra Zeneca, Bayer, GE, Janssen, Novartis, Sofie, and Telix (consultant, speaker).

M.E. reports fees from Blue Earth Diagnostics Ltd. (consultant, research funding), Novartis/AAA (consultant), Telix (consultant), Bayer (consultant, research funding), RayzeBio (consultant), Point Biopharma (consultant) and Janssen Pharmaceuticals (consultant, speakers bureau), Parexel (image review) and Bioclinica (image review), and a patent application for rhPSMA.

M.B. reports fees from Telix (research funding) and Novartis (advisory board) outside of the submitted work.

K.G. reports fees from Bayer (consultant, speakers bureau, research funding), GE healthcare (speakers bureau), Janssen (research funding), Lightpoint (consultant), and Telix (consultant).

U.H. reports fees from SOFIE Bioscience/iTheranostics (patent fees) outside of the submitted work.

K.K. is a member of the scientific advisory board of Telix Pharmaceuticals and coinventor of the PSMA-ligands PSMA-617, PSMA-914, and PSMA-1007.

D.E.O.-L. reports unrestricted grants from Janssen for Consensus meetings attendance outside the submitted work.

S.Y.C. reports fees from Voximetry, Inc. (research consultant), AIQ Solutions (research consultant), GE Healthcare (consultant), Focus-X Therapeutics (consultant), Haymarket Media Group (one time speaker), Advanced Accelerator Applications/Novartis (consultant), and Bristol Myers Squibb (consultant).

B.J.K. reports fees from Novartis (speakers bureau, travel, research funding, consultant), Janssen (speakers bureau, consultant), Bayer (speakers bureau, consultant), AMGEN (research funding), Eisai (research funding), Terumo (consultant), Rotop (consultant), PSI CRO (consultant), and ITM (consultant) outside of the submitted work.

T.H. reports fees from Clovis Oncology (research funding), Philips (research funding), GE Healthcare (research funding), Lantheus (research funding), the Prostate Cancer Foundation (research funding), the National Cancer Institute (research funding; R01CA235741 and R01CA212148), Ipsen (advisory board), Bayer (advisory board), BlueEarth Diagnostics (advisory board), RayzeBio (consultant and equity interest), and Curium (consultant and equity interest).

P.K. reports Merck (consultant), Novartis (consultant), Blue Earth (consultant), Telix (consultant and speaker), GE (image review), Janssen (consultant), Lantheus (consultant), Bayer (consultant), Astellas (speaker), and ConcertAI (consultant).

F.C. reports Novartis (consultant, advisory board), Telix (consultant, advisory board), Janssen Oncology (speaker fees), Bayer (speaker fees), Radmetrix (image review), Lightpoint medical (consultant), and Curium Pharma (consultant).

M.P. reports research funding by Novartis, Progenics, and Blue Earth Diagnostics.

K.H. reports personal fees from Bayer, personal fees and other from Sofie Biosciences, personal fees from SIRTEX, non-financial support from ABX, personal fees from Adacap, personal fees from Curium, personal fees from Endocyte, grants and personal fees from BTG, personal fees from IPSEN, personal fees from Siemens Healthineers, personal fees from GE Healthcare, personal fees from Amgen, personal fees from Novartis, personal fees from ymabs, personal fees from Aktis Oncology, personal fees from Theragnostics, and personal fees from Pharma15.

Figures

**Fig. 1**
Normal body distribution of PSMA-ligands. [⁶⁸ Ga]Ga-PSMA-11, [⁶⁸ Ga]Ga-PSMA-I&T, [¹⁸F]F-DCFPyL, and [¹⁸F]F-rhPSMA-7.3 applications lead to notable kidney uptake. Bladder retention is high for [⁶⁸ Ga]Ga-PSMA-11, [⁶⁸ Ga]Ga-PSMA-I&T, and [¹⁸F]F-DCFPyL and lower for [¹⁸F]F-rhPSMA-7.3. Reference organs for ligands with kidney-dominant excretion are liver and parotid gland. [¹⁸F]F-PSMA-1007 leads to high liver uptake due to hepatic excretion. Reference organs for ligands with liver excretion are spleen and parotid gland. Focal uptake in the pelvic bone is noted on the [¹⁸F]F-rhPSMA-7.3 PET corresponding to metastatic disease. [⁶⁸ Ga]Ga-PSMA-I&T subpart was modified with permission from [130]

See this image and copyright information in PMC

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PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0

Affiliations

PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0

Authors

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Abstract

Conflict of interest statement

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