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Review
. 2024 Nov;54(6):941-950.
doi: 10.1053/j.semnuclmed.2024.10.004. Epub 2024 Oct 28.

Update on PSMA-based Prostate Cancer Imaging

Esther Mena  1 , Liza Lindenberg  2 , Peter L Choyke  2
Affiliations
Review

Update on PSMA-based Prostate Cancer Imaging

Esther Mena et al. Semin Nucl Med. 2024 Nov.

Abstract

The increased use of prostate-specific membrane antigen (PSMA) based PET imaging for prostate cancer (Pca) detection has revolutionized the clinical management of Pca, with higher diagnostic sensitivity for extraprostatic disease and increasing clinical utility across different stages of the disease. The integration of PSMA PET imaging into clinical guidelines and consensus documents reflects its growing importance in the personalized management of Pca. This review of recent literature highlights the rapid evolution of PSMA PET into the mainstream of staging and restaging and the decreasing reliance on conventional imaging modalities. This comprehensive review serves as a resource for clinicians and researchers involved in the domains of Pca diagnosis and management.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1:
Figure 1:
A 76-year-old man with unfavorable intermediate risk prostate cancer (T1c, Gleason 4+4, PSA 5.6 ng/mL). 18F-DCFPyL PET (1A), fused PET/CT (1B) and MRI (1C) detect malignancy in two intraprostatic lesions in a 1.9 cm right apical transition zone (PIRADS 5, SUVmax 12.4) and in a 0.9 cm right apical peripheral zone (PIRADS 4, SUVmax 14.3) of the prostate gland.
Figure 2:
Figure 2:
65-year-old man newly diagnosed with high risk Pca (Gleason 4+4, PSA 10.1 ng/mL). 18F-DCFPyL PET (1A) and fused PET/CT (1B) detect malignancy in the left mid peripheral zone of the prostate gland with PSMA overexpression (SUVmax 38.9), which corresponds to the 2.5 cm PIRADS 5 lesion seen on MRI (1C). An additional 1.4 cm intraprostatic lesion is seen on MRI (PIRADS 5) that does not express PSMA.
Figure 3:
Figure 3:
66-year-old man with high volume, Gleason 4+5 Pca, PSA 37.4 ng/mL. 18F-DCFPyL PET/CT detects malignancy involving the entire bilateral peripheral zone of the prostate gland (A1) matching a large PIRADS 5 lesion with EPE on MRI (B1). Both modalities are able to identify bilateral seminal vesicles (A2, B2), left side predominant (A3, B3).
Figure 4:
Figure 4:
63-year-old man with newly diagnosed high-risk Pca, Gleason score 5+5, PSA=16.5 ng/mL. 18F-DCFPyL PET/CT including maximum intensity projection (MIP (A1) and axial PET and fused PET/CT images demonstrate PSMA overexpression in almost the entire bilateral prostate gland (A2, A3), and in very small 2–3 mm bilateral pelvic lymph nodes (arrows, A4, A5).
Figure 5:
Figure 5:
73-year-old man with history of Pca (Gleason 4+4, pT3b pN1 M0) status post prostatectomy, salvage radiation and androgen deprivation therapy. PSA continued to be detectable at 1.4 ng/mL, with negative CT, bone scan and prostate MRI. 18F-DCFPyL PET/CT including maximum intensity projection (A1) and axial fused PET/CT images demonstrate PSMA overexpression in two sub-centimeter retroperitoneal nodes (B1, B2) compatible with nodal metastases.
See this image and copyright information in PMC

References

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