Simultaneous whole-body F-PSMA-1007-PET/MRI with integrated high-resolution multiparametric imaging of the prostatic fossa for comprehensive oncological staging of patients with prostate cancer: a pilot study.

Introduction: The aim of the present study was to explore the clinical feasibility and reproducibility of a comprehensive whole-body F-PSMA-1007-PET/MRI protocol for imaging prostate cancer (PC) patients.

Methods: Eight patients with high-risk biopsy-proven PC underwent a whole-body PET/MRI (3 h p.i.

11C-choline PET/CT and whole-body MRI including diffusion-weighted imaging for patients with recurrent prostate cancer.

Purpose: To compare the detection efficacy of 11C-choline positron emission tomography and computed tomography (PET/CT) with whole-body magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) in patients with suspected recurrent prostate cancer.

Materials And Methods: Fifty-seven patients (mean age 68, range 54-80 years) underwent 11C-choline PET/CT and MRI using T1-weighted (T1w), short-tau inversion recovery (STIR), and DWI. Two readers visually rated suspicious lesions on a 5-point scale in 20 different regions.

Prostate-specific membrane antigen-guided salvage lymph node dissection in recurrent prostate cancer: a novel technology to detect lymph node metastases.

Purpose Of Review: With Gallium (Ga)-prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) as emerging imaging technique offering superior detection rates in biochemical recurrent prostate cancer, salvage lymph node dissection has gained increasing interest in localized oligometastatic prostate cancer. Currently, PSMA-targeting small molecules cannot only be linked to positron-emitting isotopes for imaging but also be labelled with γ-radiation emitting isotopes. These modified PSMA agents are evaluated for intraoperative guidance for resection of metastatic lymph nodes.

[PSMA-radioguided surgery in localised recurrent prostate cancer].

Recently, prostate-specific membrane antigen radioguided surgery (PSMA-RGS) was introduced for targeted resection of localised prostate cancer recurrence. Preliminary results show that PSMA-RGS is very sensitive and specific in tracking suspicious lesions intraoperatively. Prerequisite for PSMA-RGS is a positive Ga-PSMA positron emission tomography (PET) scan with a preferably singular soft tissue or lymph node recurrence.

Prostate-Specific Membrane Antigen Ligands for Imaging and Therapy.

The prostate-specific membrane antigen (PSMA) is highly expressed on most prostate cancer (PC) cells. Therefore, the targeting of PSMA has become increasingly important over the last decade. Glu-urea-based PSMA ligands used for both imaging and radioligand therapy are the mainstays of the current success.

Prospective head-to-head comparison of C-choline-PET/MR and C-choline-PET/CT for restaging of biochemical recurrent prostate cancer.

Purpose: Whole-body integrated C-choline PET/MR might provide advantages compared to C-choline PET/CT for restaging of prostate cancer (PC) due to the high soft-tissue contrast and the use of multiparametric MRI, especially for detection of local recurrence and bone metastases.

Materials And Methods: Ninety-four patients with recurrent PC underwent a single-injection/dual-imaging protocol with contrast-enhanced PET/CT followed by fully diagnostic PET/MR. Imaging datasets were read separately by two reader teams (team 1 and 2) assessing the presence of local recurrence, lymph node and bone metastases in predefined regions using a five-point scale.

Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging.

Background: The rapidly expanding clinical adaptation of prostate-specific membrane antigen (PSMA)-targeted PET imaging in the evaluation of patients with prostate cancer has placed an increasing onus on understanding both the potential pearls of interpretation as well as limitations of this new technique. As with any new molecular imaging modality, accurate characterization of abnormalities on PSMA-targeted PET imaging can be accomplished only if one is aware of the normal distribution pattern, physiological variants of radiotracer uptake, and potential sources of false-positive and false-negative imaging findings. In recent years, a growing number of reports have come to light describing incidental non-prostatic benign or malignant pathologies with high uptake on PSMA-targeted PET imaging.

Imaging for Prostate Cancer Recurrence.

Context: Correct identification of metastatic sites in recurrent prostate cancer (PCa) is of crucial importance because it leads to further treatment decisions.

Objective: To provide an overview on current imaging procedures and their performance in recurrent PCa.

Evidence Acquisition: Medline search via PubMed was performed with the keywords imaging, recurrent, and prostate cancer as well as more detailed searches including the keywords bone scan, bone scintigraphy, computed tomography, magnetic resonance imaging, positron emission tomography, PET, choline, FDG, prostate-specific membrane antigen, and PSMA, with emphasis on recent literature from 2010 to the present.

[PET-CT and PET-MRI of the prostate : From F-FDG to Ga-PSMA].

Clinical/methodical Issue: In the last few years nuclear medical diagnostics have experienced a unprecedented renaissance in the diagnostics of prostate cancer, due to the availability of hybrid imaging with positron emission tomography computed tomography (PET/CT), PET magnetic resonance imaging (PET/MRI) and single photon emission computed tomography (SPECT) CT as well as the development of prostate-specific radiopharmaceuticals.

Methodical Innovations: The use of fluorodeoxyglucose (FDG), which has been successfully implemented for many years in PET diagnostics, is only helpful in dedifferentiated tumors due to the biological characteristics of prostate cancer. New specific radiopharmaceuticals, such as choline-derivatives, which are incorporated into the prostate cancer cell and built into the cell membrane as well as the recently developed highly specific ligands for prostate-specific membrane antigen (PSMA) are revolutionizing prostate cancer imaging and (re-) staging.

PSMA Ligands for PET Imaging of Prostate Cancer.

Targeting the prostate-specific membrane antigen (PSMA) with Ga-labeled and F-labeled PET agents has become increasingly important in recent years. Imaging of biochemically recurrent prostate cancer has been established as a widely accepted clinical indication for PSMA ligand PET/CT in many parts of the world because of the results of multiple, primarily retrospective, studies that indicate superior detection efficacy compared with standard-of-care imaging. For high-risk primary prostate cancer, evidence is growing that this modality significantly aids in the detection of otherwise occult nodal and bone metastases.

Segmentation of Skeleton and Organs in Whole-Body CT Images via Iterative Trilateration.

Whole body oncological screening using CT images requires a good anatomical localisation of organs and the skeleton. While a number of algorithms for multi-organ localisation have been presented, developing algorithms for a dense anatomical annotation of the whole skeleton, however, has not been addressed until now. Only methods for specialised applications, e.

PSMA ligands in prostate cancer - Probe optimization and theranostic applications.

Due to its selective overexpression in prostate cancer (PCa), the prostate-specific membrane antigen (PSMA) has been recognized as a highly promising target for diagnostic and therapeutic applications. So far, various PSMA ligands have been developed for radiolabeling with radioisotopes such as Ga or F which can be used for specific visualization and diagnosis of PSMA-expressing PCa. In addition, PSMA ligands suitable for radiolabeling with I or Lu have become available to the clinics, allowing PSMA-based radioligand therapies.

Lu-PSMA Radioligand Therapy for Prostate Cancer.

Lu-prostate-specific membrane antigen (PSMA) radioligand therapy (RLT) using inhibitors of PSMA is a novel therapeutic option in patients with metastatic castration-resistant prostate cancer. The current literature suggests that this therapy is well tolerated and effective. On the basis of clinical need and current evidence, the therapy is being implemented in a growing number of centers worldwide.

Patterns of failure after radical prostatectomy in prostate cancer - implications for radiation therapy planning after Ga-PSMA-PET imaging.

Background: Salvage radiotherapy (SRT) after radical prostatectomy (RPE) and lymphadenectomy (LAE) is the appropriate radiotherapy option for patients with persistent/ recurrent prostate cancer (PC). Ga-PSMA-PET imaging has been shown to accurately detect PC lesions in a primary setting as well as for local recurrence or for lymph node (LN) metastases.

Objective: In this study we evaluated the patterns of recurrence after RPE in patients with PC, putting a highlight on the differentiation between sites that would have been covered by a standard radiation therapy (RT) field in consensus after the RTOG consensus and others that would have not.

Ga-PSMA PET/CT and Volumetric Morphology of PET-Positive Lymph Nodes Stratified by Tumor Differentiation of Prostate Cancer.

Ga-prostate-specific membrane antigen (PSMA) PET/CT is a new method to detect early nodal metastases in patients with biochemical relapse of prostate cancer. In this retrospective investigation, the dimensions, volume, localization, and SUV of nodes identified by Ga-PSMA were correlated to their Gleason score (GS) at diagnosis. All PET/CT images were acquired 60 ± 10 min after intravenous injection of Ga-PSMA (mean dose, 176 MBq).

Diagnosis and Treatment of Prostate Cancer: What Americans Can Learn From International Oncologists.

The three main sections in this article illustrate a number of facets of European health care. The first section looks at the influence of NICE on treatment of metastatic castration-resistant prostate cancer. The second section explores the impact of molecular imaging on diagnosis and treatment, in particular the development and clinical implementation of Ga PET imaging in prostate cancer.

Establishing Lu-PSMA-617 Radioligand Therapy in a Syngeneic Model of Murine Prostate Cancer.

Clinical Lu-PSMA-617 radioligand therapy (RLT) is applied in advanced-stage prostate cancer. However, to the best of our knowledge murine models to study the biologic effects of various activity levels have not been established. The aim of this study was to optimize specific and total activity for Lu-PSMA-617 RLT in a syngeneic model of murine prostate cancer.

Exploring New Multimodal Quantitative Imaging Indices for the Assessment of Osseous Tumor Burden in Prostate Cancer Using Ga-PSMA PET/CT.

PET combined with CT and prostate-specific membrane antigen (PSMA) ligands has gained significant interest for staging prostate cancer (PC). In this study, we propose 2 multimodal quantitative indices as imaging biomarkers for the assessment of osseous tumor burden using Ga-PSMA PET/CT and present preliminary clinical data. We defined 2 bone PET indices (BPIs) that incorporate anatomic information from CT and functional information from Ga-PSMA PET: BPI is the percentage of bone volume affected by tumor and BPI additionally considers the level of PSMA expression.

Development of standardized image interpretation for 68Ga-PSMA PET/CT to detect prostate cancer recurrent lesions.

Methods: After primary treatment, biochemical relapse (BCR) occurs in a substantial number of patients with prostate cancer (PCa). PET/CT imaging with prostate-specific membrane antigen based tracers (68Ga-PSMA) has shown promising results for BCR patients. However, a standardized image interpretation methodology has yet to be properly agreed.

Oligometastases from prostate cancer: local treatment with stereotactic body radiotherapy (SBRT).

Background: The impact of local tumor ablative therapy in oligometastasized prostate cancer (PC) is still under debate. To gain data for this approach, we evaluated oligometastasized PC patients receiving stereotactic body radiotherapy (SBRT) to bone metastases.

Methods: In this retrospective study, 15 oligometastasized PC patients with a total of 20 bone metastases were evaluated regarding biochemical progression-free survival (PSA-PFS), time to initiation of ADT, and local control rate (LCR).

[PSMA-Radioguided Surgery for Salvage Lymphadenectomy in Recurrent Prostate Cancer].

Recently, the use of In-labeled PSMA-I&T-based radioguided surgery (In-PSMARGS) for salvage surgery using intraoperative ex-vivo γ-probe measurements has been described by our group as a promising new and individual treatment concept in patients with localised recurrent prostate cancer (PC). In-PSMA-RGS allowed for the intraoperative identification of metastatic lesions with a sensitivity, specificity and accuracy of 92.3, 93.

[Significance and Value of PSMA Ligands in Prostate Cancer].

In recent years, PSMA-targeting PET tracers such as Ga-PSMA-11 have shown promising results, thus contributing to a better management of prostate cancer patients. At the present time, Ga-PSMA-11 is most frequently used for diagnostic evaluation in the setting of biochemical recurrence of prostate cancer. In this context, the Ga-PSMA-11 PET/CT delivers superior detection rates compared to conventional imaging, especially for the detection of small, unsuspicious lesions or lesions in the presence of low PSA values.

Most of the Intended Management Changes After Ga-DOTATATE PET/CT Are Implemented.

In this prospective referring-physician-based survey, we investigated the definite clinical impact of Ga-DOTATATE PET/CT on managing patients with neuroendocrine tumors (NETs). We prospectively studied 130 patients with Ga-DOTATATE PET/CT referred for initial or subsequent management decisions (NCT02174679). Referring physicians completed one questionnaire before the scan (Q1) to indicate the treatment plan without PET/CT information, one immediately after review of the imaging report to denote intended management changes (Q2), and one 6 mo later (Q3) to verify whether intended changes were in fact implemented.