Comparison of F-based PSMA radiotracers with [Ga]Ga-PSMA-11 in PET/CT imaging of prostate cancer-a systematic review and meta-analysis.

Siyu Huang, Sean Ong, Dean McKenzie, Adam Mirabelli, David C Chen, Thilakavathi Chengodu, Declan G Murphy, Michael S Hofman, Nathan Lawrentschuk, Marlon Perera

Journal: Prostate cancer and prostatic diseases 2024;27(4):654-664

PMID: 38017295

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Abstract

BACKGROUND

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) has become an increasingly established imaging modality in the staging of prostate cancer (PCa). Numerous PSMA-based tracers are currently available, however, there is a lack of consensus on the optimal radiotracer(s) for PSMA PET/CT. This study aims to investigate whether Fluorine-18 (F)-labelled PSMA PET/CT is significantly different from Gallium-68 (Ga) in primary diagnosis and/or secondary staging of prostate cancer following biochemical recurrence.

METHODS

A critical review of MEDLINE, EMBASE, PubMed and Web of Science databases was performed in May 2023 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Studies that directly compared F-based PSMA radiotracers and [Ga]Ga-PSMA-11 in terms of the normal organ SUV or the lesion SUV or the detection rate were assessed. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).

RESULTS

Twenty-four studies were analysed. [F]DCFPyL and [F]PSMA-1007 were the two most commonly studied F based PSMA tracers. [F]JK-PSMA-7, [F]rhPSMA-7, [F]AlF-PSMA-11 were the new tracers evaluated in a limited number of studies. Overall, [F]DCFPyL was observed to have a similar lesion detection rate to [Ga]Ga-PSMA-11 with no increase in false positive rates. [F]PSMA-1007 was found to have a greater local lesion detection rate because of its predominant hepatobiliary excretory route. However, [Ga]Ga-PSMA-11 was observed to have a similar local lesion detection rate in studies that administer patients with furosemide prior to the scan. In addition, [F]PSMA-1007 was found to have a significant number of benign bone uptakes.

CONCLUSIONS

[F]DCFPyL was observed to be similar to [Ga]Ga-PSMA-11. [F]PSMA-1007 was observed to be less preferrable to [Ga]Ga-PSMA-11 due to its high benign bone uptakes. Overall, there was not enough evidence in differentiating the radiotracers based on their clinical impacts.

Address: Department of Surgery, University of Melbourne, Parkville, VIC, Australia. [email protected].; Department of Surgery, University of Melbourne, Parkville, VIC, Australia.; EJ Whitten Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, VIC, Australia.; Research Development & Governance Unit, Epworth HealthCare, Melbourne, VIC, Australia.; Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, VIC, Australia.; Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.; Young Urology Researchers Organisation (YURO), Melbourne, VIC, Australia.; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.; Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia.; Department of Surgery, Austin Health, The University of Melbourne, Melbourne, VIC, Australia.

DOI: 10.1038/s41391-023-00755-2