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. 2024 Oct 7;24(1):132.
doi: 10.1186/s40644-024-00778-5.

Outstanding increase in tumor-to-background ratio over time allows tumor localization by [89Zr]Zr-PSMA-617 PET/CT in early biochemical recurrence of prostate cancer

Caroline Burgard #  1   2 , Florian Rosar #  3   4 , Elena Larsen  3   4 , Fadi Khreish  3   5 , Johannes Linxweiler  6   4 , Robert J Marlowe  7 , Andrea Schaefer-Schuler  3   4 , Stephan Maus  3   4 , Sven Petto  3   4 , Mark Bartholomä  3   4 , Samer Ezziddin  3   4
Affiliations

Outstanding increase in tumor-to-background ratio over time allows tumor localization by [89Zr]Zr-PSMA-617 PET/CT in early biochemical recurrence of prostate cancer

Caroline Burgard et al. Cancer Imaging. .

Abstract

Background: Positron emission tomography/computed tomography (PET/CT) using prostate-specific membrane antigen (PSMA)-targeted radiotracers labeled with zirconium-89 (89Zr; half-life ~ 78.41 h) showed promise in localizing biochemical recurrence of prostate cancer (BCR) in pilot studies.

Methods: Retrospective analysis of 38 consecutive men with BCR (median [minimum-maximum] prostate-specific antigen 0.52 (0.12-2.50 ng/mL) undergoing [89Zr]Zr-PSMA-617 PET/CT post-negative [68Ga]Ga-PSMA-11 PET/CT. PET/CT acquisition 1-h, 24-h, and 48-h post-injection of a median (minimum-maximum) [89Zr]Zr-PSMA-617 tracer activity of 123 (84-166) MBq.

Results: [89Zr]Zr-PSMA-617 PET/CT detected altogether 57 lesions: 18 local recurrences, 33 lymph node metastases, 6 bone metastases in 30/38 men with BCR (78%) and prior negative conventional PSMA PET/CT. Lesion uptake significantly increased from 1-h to 24-h and, in a majority of cases, from 24-h to 48-h. Tumor-to-background ratios significantly increased over time, with absolute increases of 100 or more. No side effects were noted. After [89Zr]Zr-PSMA-617 PET/CT-based treatment, prostate-specific antigen concentration decreased in all patients, becoming undetectable in a third of patients.

Limitations: retrospective, single center design; infrequent histopathological and imaging verification.

Conclusion: This large series provides further evidence that [89Zr]Zr-PSMA-617 PET/CT is a beneficial imaging modality to localize early BCR. A remarkable increase in tumor-to-background ratio over time allows localization of tumor unidentified on conventional PSMA PET/CT.

Keywords: Biochemical recurrence; Localization; Positron emission tomography/Computed tomography (PET/CT); Prostate cancer; Prostate-specific membrane antigen (PSMA); Zirconium-89 (89Zr).

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Maximum intensity projection (MIP) and transversal slices from a 48-h post-injection (p.i.) [89Zr]Zr-PSMA-617 PET/CT scan of a BCR patient (PSA level 0.28 ng/mL; gleason score 7a) that was positive for a suspicious lesion in the right former prostate bed (blue arrow), compared with corresponding prior negative 1-h p.i. [68Ga]Ga-PSMA-11 PET/CT images (PSA level 0.20 ng/mL; 82 days between both PET/CT). The patient received a [89Zr]Zr-PSMA-617-guided radiotherapy with a follow-up PSA level becoming undetectable (< 0.07 ng/mL)
Fig. 2
Fig. 2
Maximum intensity projection (MIP) and transversal slices from a 48-h p.i. [89Zr]Zr-PSMA-617 PET/CT scan of a BCR patient (PSA level 2.50 ng/mL; gleason score 7a) that was positive for a suspicious lymph node lesion (red arrow), compared with corresponding prior negative 1-h p.i. [68Ga]Ga-PSMA-11 PET/CT images (PSA level 2.49 ng/mL; 13 days between both PET/CT). The patient received a [89Zr]Zr-PSMA-617-guided radiotherapy with a follow-up PSA level of 0.19 ng/mL
Fig. 3
Fig. 3
MIP and transversal slices from a 48-h p.i. [89Zr]Zr-PSMA-617 PET/CT scan of a BCR patient (PSA level 0.85 ng/mL; gleason score 9) that was positive for a suspicious bone lesion (green arrow), compared with corresponding prior negative 1-h p.i. [68Ga]Ga-PSMA-11 PET/CT images (PSA level 0.72 ng/mL; 34 days between both PET/CT). Subsequent magnet resonance imaging confirmed the suspicious bone lesion. The patient received a [89Zr]Zr-PSMA-617-guided radiotherapy with a follow-up PSA level becoming undetectable (< 0.07 ng/mL)
Fig. 4
Fig. 4
SUVmax (mean ± SD) of (A) all suspicious lesions, referred as (B) local recurrence (C) lymph node metastasis, and (D) bone metastasis by scan type and scan time
Fig. 5
Fig. 5
Mean lesion contrast, i.e., (A) TMR, (B) TLR, (C) TCR, and (D) TBR by scan type, scan time, and lesion type
Fig. 6
Fig. 6
A, B Transversal slices from a 48-h p.i. [89Zr]Zr-PSMA-617 PET/CT scan that was positive for local recurrence (blue arrow), compared with a 48-h p.i. [89Zr]Zr-PSMA-617 PET/CT follow-up scan after radiation therapy, respectively. C Transversal slice from a 48-h p.i. [89Zr]Zr-PSMA-617 PET/CT scan that was positive for a suspicious lymph node lesion (red arrow), with post-surgical histological work-up with H.E.- and PSA staining confirming prostate cancer metastasis
See this image and copyright information in PMC

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