Información del artículo
Resumen
La tomografía por emisión de positrones/tomografía computarizada (PET/TC) con 68Ga-PSMA es una técnica de imagen no invasiva para el estudio del cáncer de próstata con incremento de la expresión del antígeno prostático específico de membrana (prostate-specific membrane antigen, PSMA). El PSMA es una proteína transmembrana presente en todos los tejidos prostáticos. El incremento de la expresión de PSMA está presente en varios tumores, aunque su concentración es más elevada en el cáncer de próstata. Casi todos los adenocarcinomas de próstata muestran expresión de PSMA en la mayoría de las lesiones, tanto primarias como metastásicas. Estudios inmunohistoquímicos han demostrado que la expresión de PSMA está incrementada en pacientes con tumores desdiferenciados, metastásicos u hormonorrefractarios. Más aún, el nivel de expresión del PSMA tiene un valor pronóstico para la evolución de la enfermedad. La tomografía por emisión de positrones proporciona una medida de la distribución tridimensional del 68Ga-PSMA, obteniendo imágenes semicuantitativas que permiten valorar de forma no invasiva la expresión de PSMA.
Palabras clave:
PSMA
PET/TC
Cáncer de próstata
Recidiva
Pronóstico
PSA
Abstract
Positron emission tomography/computed tomography (PET/CT) with 68Ga-PSMA is a non-invasive diagnostic technique to image prostate cancer with increased prostate-specific membrane antigen (PSMA) expression. PSMA is a transmembrane protein present in all prostatic tissues. Increased PSMA expression is seen in several malignancies, although prostate cancer is the tumour where it presents higher concentrations. Almost all prostate adenocarcinomas show PSMA expression in most of lesions, primary and metastatic. Immunohistochemistry has demonstrated that the expression of PSMA increases in patients with de-differentiated, metastatic or hormone-refractory tumours. Moreover, the expression level of PSMA has a prognostic value for disease outcome. PET measures the three-dimensional distribution of 68Ga-PSMA, producing semi-quantitative images that allow for non-invasive assessment of PSMA expression.
Keywords:
PSMA
PET/CT
Prostate cancer
Relapse
Prognosis
PSA
Artículo
Opciones para acceder a los textos completos de la publicación Revista Española de Medicina Nuclear e Imagen Molecular
Suscriptor
Comprar
Contactar
Teléfono para suscripciones e incidencias
De lunes a viernes de 9h a 18h (GMT+1) excepto los meses de julio y agosto que será de 9 a 15h
Llamadas desde España
932 415 960
Llamadas desde fuera de España
+34 932 415 960
E-mail
Bibliografía
[1]
M. Dietlein, C. Kobe, G. Kuhnert, S. Stockter, T. Fischer, K. Schomäcker, et al.
Comparison of 18F-DCFPyL and 68Ga-PSMA-HBED-CC for PSMA-PET imaging in patients with relapsed prostate cancer.
Mol Imaging Biol., 17 (2015), pp. 575-584
[2]
F. Dietlein, C. Kobe, S. Neubauer, M. Schmidt, S. Stockter, T. Fischer, et al.
PSA-stratified performance of 18F and 68Ga-labeled tracers in PSMA-PET imaging of patients with biochemical recurrence of prostate cancer.
J Nucl Med., 58 (2017), pp. 947-952
[3]
K.P. Zhernosekov, D.B. Filosofov, R.P. Baum, P. Aschoff, H. Bihl, A.A. Razbash, et al.
Processing of generator-produced 68Ga for medical application.
J Nucl Med., 48 (2007), pp. 1741-1748
[4]
C.O. Sahlmann, B. Meller, C. Bouter, C.O. Ritter, P. Ströbel, J. Lotz, et al.
Biphasic 68Ga-PSMA-HBED-CC-PET/CT in patients with recurrent and high-risk prostate carcinoma.
Eur J Nucl Med Mol Imaging., 43 (2016), pp. 898-905
[5]
M. Eder, O. Neels, M. Muller, U. Bauder-Wust, Y. Remde, M. Scharfer, et al.
Novel preclinical and radiopharmaceuticals aspects of 68Ga-PSMA-HBED-CC: A new PET tracer for imaging of prostate cancer.
Pharmaceuticals., 7 (2014), pp. 779-796
[6]
M. Eder, M. Eisenhut, J. Babich, U. Haberkorn.
PSMA as a target for radiolabelled small molecules.
Eur J Nucl Med Mol Imaging., 40 (2013), pp. 819-823
[7]
A. Afshar-Oromich, A. Malcher, M. Eder, M. Eisenhyt, H.G. Linhart, B.A. Hadaschik, et al.
PET imaging with a 68Ga-labelled PSMA ligand for the diagnosis of prostate cancer: Biodistribution in human and first evaluation or tumour lesions.
Eur J Nucl Med Mol Imaging., 40 (2013), pp. 486-495
[8]
K. Herrmann, C. Bluemel, M. Weineisen, M. Schottelius, H.J. Wester, J. Czernin, et al.
Biodistribution and radiation dosimetry for a probe targetin prostate-specific membrane antigen for imaging and theraphy.
J Nucl Med., 56 (2015), pp. 855-861
[9]
C. Uprimny, A.S. Kroiss, C. Decristoforo, J. Fritz, B. Warwitz, L. Scarpa, et al.
Early dynamic imaging in 68Ga- PSMA-11 PET/CT allows discrimination of urinary bladder activity and prostate cancer lesions.
Eur J Nucl Med Mol Imaging., 44 (2017), pp. 765-775
[10]
C. Sachpekidis, K. Kopka, M. Eder, B.A. Hadaschik, M.T. Freitag, L. Pan, et al.
68Ga-PSMA-11 dynamic PET/CT imaging in primary prostate cancer.
Clin Nucl Med., 41 (2016), pp. e473-e479
[11]
W.P. Fendler, M. Eiber, M. Beheshti, J. Bomanji, F. Ceci, S. Cho, et al.
68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0.
Eur J Nucl Med Mol Imaging., 44 (2017), pp. 1014-1024
[12]
M. Perera, N. Papa, D. Christidis, D. Wetherell, M.S. Hofman, D.G. Murphy, et al.
Sensitivity, specificity, and predictors of positive 68Ga-Prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: A systematic review and meta-analysis.
Eur Urol, 70 (2016), pp. 926-937
[13]
A.M. García Vicente, A. Núñez García, A.M. Soriano Castrejón, G.A. Jiménez Londoño, J.M. Cordero García, A. Palomar Muñoz.
Pitfalls with 18F-Choline PET/CT in patients with prostate cancer.
Rev Esp Med Nucl Imagen Mol., 32 (2013), pp. 37-39
[14]
W.P. Fendler, D.F. Schmidt, V. Wenter, K.M. Thierfelder, C. Zach, C. Stief, et al.
68Ga-PSMA PET/CT detects the location and extent of primary prostate cancer.
J Nucl Med., 57 (2016), pp. 1720-1725
[15]
K. Rahbar, M. Weckesser, S. Huss, A. Semjonow, H.J. Breyholz, A.J. Schrader, et al.
Correlation of intraprostatic tumor extent with 68Ga-PSMA distribution in patients with prostate cancer.
J Nucl Med., 57 (2016), pp. 563-567
[16]
H. Rhee, P. Thomas, B. Shepherd, S. Greenslade, I. Vela, P.J. Russell, et al.
PSMA PET may improve the diagnostic accuracy of mpMRI in localised prostate cancer as confirmed by whole-mount histopathology.
J Urol., 196 (2016), pp. 1261-1267
[17]
M. Eiber, G. Weirich, K. Holzapfel, M. Souvatzoglou, B. Haller, I. Rauscher, et al.
Simultaneous 68Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer.
Eur Urol., 70 (2016), pp. 829-836
[18]
C. Uprimny, A.S. Kroiss, C. Decristoforo, J. Fritz, E. von Guggenberg, D. Kendler, et al.
68Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour.
Eur J Nucl Med Mol Imaging., 44 (2017), pp. 1647-1655
[19]
A. D’Amico, M. Altschuler, R. Whittington, G. Kao, S.B. Malkowicz, A. Wein.
The use of clinical parameters in an interactive statistical package to predict pathological features associated with local failure after radical prostatectomy for prostate cancer.
Clin Perform Qual Health Care., 1 (1993), pp. 219-222
[20]
J.R. García, M. Cozar, M. Soler, P. Bassa, E. Riera, J. Ferrer.
Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using 11C-choline PET/CT.
Rev Esp Med Nucl Imagen Mol., 35 (2016), pp. 238-245
[21]
L. Budäus, S.R. Leyh-Bannurah, G. Salomon, U. Michl, H. Heinzer, H. Huland, et al.
Initial experience of 68Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy.
Eur Urol., 69 (2016), pp. 393-396
[22]
P.J. Van Leeuwen, L. Emmett, B. Ho, W. Delprado, F. Ting, Q. Nguyen, et al.
Prospective evaluation of 68Gallium-PSMA positron emission tomography/computerized tomography for preoperative lymph node staging in prostate cancer.
BJU Int., 119 (2017), pp. 209-215
[23]
T. Maurer, J.E. Gschwend, I. Rauscher, M. Souvatzoglou, B. Haller, G. Weirich, et al.
Diagnostic efficacy of 68Gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer.
J Urol., 195 (2016), pp. 1436-1443
[24]
L. Kabasakal, E. Demirci, M. Ocak, R. Akyel, J. Nematyazar, A. Aygun, et al.
Evaluation of PSMA PET/CT imaging using a 68Ga-HBED-CC ligand in patients with prostate cancer and the value of early pelvic imaging.
Nucl Med Commun., 36 (2015), pp. 582-587
[25]
V. Prasad, I.G. Steffen, G. Diederichs, M.R. Makowski, P. Wust, W. Brenner.
Biodistribution of 68Ga-PSMA-HBED-CC in patients with prostate cancer: Characterization of uptake in normal organs and tumour lesions.
Mol Imaging Biol., 18 (2016), pp. 428-436
[26]
S. Dewes, K. Schiller, K. Sauter, M. Eiber, T. Maurer, M. Schwaiger, et al.
Integration of (68)Ga-PSMA-PET imaging in planning of primary definitive radiotherapy in prostate cancer: a retrospective study.
Radiat Oncol., 26 (2016), pp. 11-73
[27]
J.R. Garcia, C. Moreno, E. Valls, P. Cozar, P. Bassa, M. Soler, et al.
Diagnostic performance of bone scintigraphy and 11C-Choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer.
Rev Esp Med Nucl Imagen Mol., 34 (2015), pp. 155-156
[28]
R. Schiavina, E. Brunocilla, M. Borghesi, V. Vagnoni, P. Castellucci, C. Nanni, et al.
Diagnostic imaging work-up for disease relapse after radical treatment for prostate cancer: how to differentiate local from systemic disease? The urologist point of view.
Rev Esp Med Nucl Imagen Mol., 32 (2013), pp. 310-3113
[29]
J.R. García, M. Soler, M.A. Blanch, I. Ramírez, E. Riera, P. Lozano, et al.
PET/CT with 11C-Choline and 18F-FDG in patients with elevated PSA after radical treatment of a prostate cancer.
Rev Esp Med Nucl., 28 (2009), pp. 95-100
[30]
A. Afshar-Oromieh, H. Hetzheim, C. Kratochwil, M. Benesova, M. Eder, O.C. Neels, et al.
The theranostic PSMA ligand PSMA-617 in the diagnosis of prostate cancer by PET/CT: Biodistribution in humans, radiation dosimetry, and first evaluation of tumour lesions.
J Nucl Med., 56 (2015), pp. 1697-1705
[31]
A. Afshar-Oromieh, C.M. Zechmann, A. Malcher, M. Eder, M. Eisenhut, H.G. Linhart, et al.
Comparison of PET imaging with a 68Ga-labelled PSMA ligand and 18F-Choline-based PET/CT for the diagnosis of recurrent prostate cancer.
Eur J Nucl Med Mol Imaging., 41 (2014), pp. 11-20
[32]
D. Pfister, D. Porres, A. Heidenreich, I. Heidegger, R. Knuechel, F. Steib, et al.
Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with 68Ga-PSMA-HBED-CC than with 18F-Fluoroethylcholine PET/CT.
Eur J Nucl Med Mol Imaging., 43 (2016), pp. 1410-1417
[33]
I. Rauscher, T. Maurer, A.J. Beer, F.P. Graner, B. Haller, G. Weirich, et al.
Value of 68Ga-PSMA HBED-CC PET for the assessment of lymph node metastases in prostate cancer patients with biochemical recurrence: Comparison with histopathology after salvage lymphadenectomy.
J Nucl Med., 57 (2016), pp. 1713-1719
[34]
T. Pyka, S. Okamoto, M. Dahlbender, R. Tauber, M. Retz, M. Heck, et al.
Comparison of bone scintigraphy and 68Ga-PSMA PET for skeletal staging in prostate cancer.
Eur J Nucl Med Mol Imaging., 43 (2016), pp. 2114-2121
[35]
J.J. Morigi, P.D. Stricker, P.J. van Leeuwen, R. Tang, B. Ho, Q. Nguyen, et al.
Prospective comparison of 18F-Fluoromethylcholine versus 68Ga-PSMA PET/CT in prostate cancer patients who have rising PSA after curative treatment and are being considered for targeted therapy.
J Nucl Med., 56 (2015), pp. 1185-1190
[36]
F. Ceci, C. Uprimny, B. Nilica, L.L. Geraldo, D. Kendler, A. Kroiss.
68Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate.
Eur J Nucl Med Mol Imaging., 42 (2015), pp. 1284-1294
[37]
C. Bluemel, F. Linke, K. Herrmann, I. Simunovic, M. Eiber, C. Kestler, et al.
Impact of 68Ga-PSMA PET/CT on salvage radiotherapy planning in patients with prostate cancer and persisting PSA values or biochemical relapse after prostatectomy.
EJNMMI Res., 6 (2016), pp. 78
[38]
S. Lütje, S. Blex, B. Gomez, B.M. Schaarschmidt, L. Umutlu, M. Forsting, et al.
Optimization of acquisition time of 68Ga-PSMA-Ligand PET/MRI in patients with local and metastatic prostate cancer.
PLoS One., 18 (2016), pp. 11
[39]
G. Hruby, T. Eade, A. Kneebone, L. Emmett, L. Guo, B. Ho, et al.
Delineating biochemical failure with 68Ga-PSMA-PET following definitive external beam radiation treatment for prostate cancer.
Radiother Oncol., 122 (2017), pp. 99-102
