DGN-Handlungsempfehlung (S1-Leitlinie) - PSMA-Liganden-PET/CT in der Diagnostik des Prostatakarzinoms - Stand: 01/2022 - AWMF-Registernummer: 031-055

Translated title of the contribution: Procedure Guideline for Prostate Cancer Imaging with PSMA-ligand PET/CT

Ali Afshar-Oromieh, Matthias Eiber, Wolfgang Fendler, Matthias Schmidt, Kambiz Rahbar, Hojjat Ahmadzadehfar, Lale Umutlu, Boris Hadaschik, Oliver W. Hakenberg, Paolo Fornara, Jens Kurth, O. Neels, Hans Jürgen Wester, Markus Schwaiger, Klaus Kopka, Uwe Haberkorn, Ken Herrmann, Bernd J. Krause

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

PSMA-PET/CT for imaging prostate cancer (PC) has spread worldwide since its clinical introduction in 2011. The majority of experiences have been collected for PSMA-PET-imaging of recurrent PC. Data for primary staging of high-risk PC are highly promising. Meanwhile, a plethora of PSMA-ligands are available for clinical use (e.g. 68 Ga-PSMA-11, 68 Ga-PSMA-I&T, 68 Ga-PSMA-617, 18 F-DCFBC, 18 F-DCFPyL, 18 F-PSMA-1007, 18 F-rhPSMA-7 and 18 F-JK-PSMA-7). However, an official approval is available only for 68 Ga-PSMA-11 (approved by the US FDA in 2020) and 18 F-DCFPyL (approved by the US FDA in 2021). Recommendations for acquisition times vary from 1-2h p.i. It has been shown that for the majority of tumour lesions, the contrast in PSMA-PET/CT increases with time. Therefore, additional late imaging can help to clarify unclear findings. PSMA-PET/CT should be performed prior to commencing an androgen deprivation therapy (ADT) since (long term) ADT reduces the visibility of PC lesions. Following injection of PSMA-ligands, hydration and forced diuresis are recommended for PSMA-ligands with primarily excretion via the kidneys in order to increase the visibility of tumour lesions adjacent to the urinary bladder. PSMA-ligands are physiologically taken up in multiple normal organs. For some 18 F-labelled PSMA-ligands, presence of unspecific focal bone uptake has been reported. When using these tracers, focal bone uptake without CT-correlate should be interpreted with great caution. Besides prostate cancer, practically all solid tumors express PSMA in their neovasculature thereby taking up PSMA-ligands, although usually at a lower extent compared to PC. Also multiple benign lesions and inflammatory processes (e.g. lymph nodes) take up PSMA-ligands, also usually at lower extent compared to PC.

Translated title of the contributionProcedure Guideline for Prostate Cancer Imaging with PSMA-ligand PET/CT
Original languageGerman
Pages (from-to)5-19
Number of pages15
JournalNuklearMedizin
Volume62
Issue number1
DOIs
StatePublished - Feb 2023

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