False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA Levels
BackgroundPET-CT using prostate-specific membrane antigen (PSMA)-targeting radiopharmaceuticals labeled with 68Ga or 18F has emerged as the most sensitive staging tool in prostate cancer (PC). Nonetheless, the occurrence of false positive (FP) findings presents a major concern of this approach. In t...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.943760/full |
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| author | Marina Orevi Simona Ben-Haim Simona Ben-Haim Galith Abourbeh Alexandre Chicheportiche Eyal Mishani Vladimir Yutkin Ofer N. Gofrit |
| author_facet | Marina Orevi Simona Ben-Haim Simona Ben-Haim Galith Abourbeh Alexandre Chicheportiche Eyal Mishani Vladimir Yutkin Ofer N. Gofrit |
| author_sort | Marina Orevi |
| collection | DOAJ |
| description | BackgroundPET-CT using prostate-specific membrane antigen (PSMA)-targeting radiopharmaceuticals labeled with 68Ga or 18F has emerged as the most sensitive staging tool in prostate cancer (PC). Nonetheless, the occurrence of false positive (FP) findings presents a major concern of this approach. In this prospective study, we investigated the frequency and pattern of false-positive findings of [18F]PSMA-1007 PET/CT in patients after radical prostatectomy with undetectable serum PSA levels. Any discrete non-physiological accumulation of [18F]PSMA-1007 in this population is by definition FP.MethodsSeventeen men after radical prostatectomy, whose serum PSA levels were <0.05 ng/mL at 2–24 months after surgery were prospectively recruited. PET/CT was acquired at both 1 and 2 h after injection of [18F]PSMA-1007.FindingsThree studies (18%) were interpreted as completely normal. Thirty-five foci of “non-physiological” uptake were observed in the remaining 14 (82%) patients, including a single skeletal focus in four patients, multiple skeletal foci in five patients and soft tissue uptake in eight, including in a desmoid tumor and in pelvic lymphocele. The SUVmax of all lesions was in the range of 1–7, except for the desmoid tumor which measured 12.7. All foci were visible in both the 1- and the 2 h studies, presenting a minor (<10%), statistically insignificant increase of SUVmax during this time-interval.InterpretationFP [18F]PSMA-1007-avid foci are found in about 80% of patients with undetectable serum PSA levels. Thus, focal uptake of [18F]PSMA-1007 outside its physiological distribution is not a categorical sign of metastasis and can arise from non-specific uptake of the ligand. The interpretation of [18F]PSMA-1007 PET/CT studies should always consider the clinical context, and lesions with SUVmax < 7 are suspicious for FP. |
| first_indexed | 2024-12-12T15:13:12Z |
| format | Article |
| id | doaj.art-875ff6da2da54eb9bc75955d8c1ce59d |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-12T15:13:12Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj.art-875ff6da2da54eb9bc75955d8c1ce59d2022-12-22T00:20:33ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-06-01910.3389/fsurg.2022.943760943760False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA LevelsMarina Orevi0Simona Ben-Haim1Simona Ben-Haim2Galith Abourbeh3Alexandre Chicheportiche4Eyal Mishani5Vladimir Yutkin6Ofer N. Gofrit7Department of Nuclear Medicine and Medical Biophysics, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, IsraelDepartment of Nuclear Medicine and Medical Biophysics, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, IsraelUniversity College London and UCL Hospitals, NHS Trust, London, United KingdomCyclotron/Radiochemistry Unit, Hadassah Medical Center, Jerusalem, IsraelCyclotron/Radiochemistry Unit, Hadassah Medical Center, Jerusalem, IsraelCyclotron/Radiochemistry Unit, Hadassah Medical Center, Jerusalem, IsraelDepartment of Urology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, IsraelDepartment of Urology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, IsraelBackgroundPET-CT using prostate-specific membrane antigen (PSMA)-targeting radiopharmaceuticals labeled with 68Ga or 18F has emerged as the most sensitive staging tool in prostate cancer (PC). Nonetheless, the occurrence of false positive (FP) findings presents a major concern of this approach. In this prospective study, we investigated the frequency and pattern of false-positive findings of [18F]PSMA-1007 PET/CT in patients after radical prostatectomy with undetectable serum PSA levels. Any discrete non-physiological accumulation of [18F]PSMA-1007 in this population is by definition FP.MethodsSeventeen men after radical prostatectomy, whose serum PSA levels were <0.05 ng/mL at 2–24 months after surgery were prospectively recruited. PET/CT was acquired at both 1 and 2 h after injection of [18F]PSMA-1007.FindingsThree studies (18%) were interpreted as completely normal. Thirty-five foci of “non-physiological” uptake were observed in the remaining 14 (82%) patients, including a single skeletal focus in four patients, multiple skeletal foci in five patients and soft tissue uptake in eight, including in a desmoid tumor and in pelvic lymphocele. The SUVmax of all lesions was in the range of 1–7, except for the desmoid tumor which measured 12.7. All foci were visible in both the 1- and the 2 h studies, presenting a minor (<10%), statistically insignificant increase of SUVmax during this time-interval.InterpretationFP [18F]PSMA-1007-avid foci are found in about 80% of patients with undetectable serum PSA levels. Thus, focal uptake of [18F]PSMA-1007 outside its physiological distribution is not a categorical sign of metastasis and can arise from non-specific uptake of the ligand. The interpretation of [18F]PSMA-1007 PET/CT studies should always consider the clinical context, and lesions with SUVmax < 7 are suspicious for FP.https://www.frontiersin.org/articles/10.3389/fsurg.2022.943760/fullprostate cancer[18F]PSMA-1007 PET/CTundetectable serum PSA levelsfalse positivecancer |
| spellingShingle | Marina Orevi Simona Ben-Haim Simona Ben-Haim Galith Abourbeh Alexandre Chicheportiche Eyal Mishani Vladimir Yutkin Ofer N. Gofrit False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA Levels Frontiers in Surgery prostate cancer [18F]PSMA-1007 PET/CT undetectable serum PSA levels false positive cancer |
| title | False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA Levels |
| title_full | False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA Levels |
| title_fullStr | False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA Levels |
| title_full_unstemmed | False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA Levels |
| title_short | False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA Levels |
| title_sort | false positive findings of 18f psma 1007 pet ct in patients after radical prostatectomy with undetectable serum psa levels |
| topic | prostate cancer [18F]PSMA-1007 PET/CT undetectable serum PSA levels false positive cancer |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.943760/full |
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