MR Ga68-PSMA prostate imaging brochure ART.indd

Ga-PSMA has been shown to be
highly effective in the detection of
prostate cancer cells in regional nodes
and distant metastatic sites as well
as early detection of site of relapse
following definitive treatment of
the disease.
68
References
1.Eiber et al. Evaluation of Hybrid 68Ga-PSMA ligand PET/CT
in 248 patients with biochemical recurrence after radical
prostatectomy. J Nucl Med 2015; 56:668-674.
2. Afshar-Oromieh et al. The diagnostic value of PET/CT imaging
with the 68Ga-labelled PSMA ligand HBED-CC in the diagnosis
of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2015;
42:197-209.
Lesions suspicious for metastatic
prostate cancer present with high
tumour to background contrast
resulting in superior detection rate
even when the level of PSA is low.
Prostate cancer staging with
Ga-PSMA
68
Gallium-labelled prostate-specific
membrane antigen ligand
(68Ga-PSMA), is a groundbreaking
PET scan which is rapidly gaining
popularity worldwide.
Dr Remy Lim, MB ChB (Auckland), FRANZCR
100 Mountain Rd, Epsom, Auckland
Specialising in: Nuclear, Oncologic and Cross Sectional Imaging
PO Box 9056, Newmarket, Auckland 1149
Nuclear Medicine and PET fellowship;
Body Oncology fellowship (Memorial Sloan-Kettering Cancer Center)
Tel 09 623 5862, Fax 09 623 5863
Email [email protected]
www.radiology.co.nz
Mercy PET-CT is now able to
offer this state of the art, fusion
examination as a superior
modality for staging and restaging
of prostate cancer patients.
Why choose 68Ga-PSMA for
prostate cancer staging?
PROSTATE
CANCER
Tumour specific
Prostate specific membrane antigen is
a cell surface protein over-expressed in
prostate cancer cells compared to benign
prostatic tissue.
Ga-PSMA detects presence of prostate
cancer cells directly, rather than indirect
indicators of disease such as increased bone
turnover (bone scan) or enlarged lymph node.
68
SMALL
LYMPH NODE
Figure 1a. CT study showing a small left pelvic lymph
node which would be considered normal if based purely
on size criteria.
High sensitivity and specificity
BLADDER
BLADDER
Superior tumour to background contrast
compared to other molecular tracers
(eg. 18F-Choline) allows for detection of disease
in small regional nodes and distant disease
in bones or visceral organs (see Figure 1).
SMALL
LYMPH NODE
Early detection of site of recurrence in
patients with low level PSA rise who have
had definitive therapy (see Table 1).
Concurrent diagnostic CT scan of the chest,
abdomen and pelvis allows anatomical
correlation to foci of abnormal PSMA
uptake, significantly increasing sensitivity
and specificity of the examination.
Fusion of PET images and MRI prostate can
be performed to increase confidence in MRI
interpretation of local disease extent (see Fig 2).
Comparable cost
Similar cost to patients when compared with
combined 18F-NaF or 99M-Tc MDP bone scan
and diagnostic CT of the chest, abdomen
and pelvis.
Figure 1b. Intense PSMA uptake in the normal-sized
pelvic lymph node due to disease involvement.
The high tumour-to-background contrast improves
sensitivity and specificity in detection of nodal disease.
Table 1. Early detection of site of recurrence in patients with
biochemical recurrence following radical prostatectomy*
PSA level
Detection rate
0.2-<0.5 ng/mL
57.9%
0.5-<1 ng/mL
72.7%
1-<2 ng/mL
93.1%
≥2 ng/mL
96.8%
* Eiber et al.
Figure 2a. T2 weighted MRI of the
prostate showing tumour in the
left prostate gland (red arrow).
PROSTATE
CANCER
Figure 2b. Intense uptake of PSMA in
the left prostate (red arrow) correlating
with the primary tumour on MRI.
Patient convenience
Imaging commences 45 minutes after
injection, acquisition phase of 20 minutes,
total appointment time of approx 90 minutes.
“One-stop staging examinations” with
prostate MRI performed on the same day as
68
Ga-PSMA to completely stage both local
and distant disease for patients with newly
diagnosed high-risk prostate cancer.