Prognostic implications of dual tracer PET/CT: PSMA ligand and [ 18 F]FDG PET/CT in patients undergoing [ 177 Lu]PSMA ra
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ORIGINAL ARTICLE
Prognostic implications of dual tracer PET/CT: PSMA ligand and [18F] FDG PET/CT in patients undergoing [177Lu]PSMA radioligand therapy Kerstin Michalski 1 & Juri Ruf 1 & Christian Goetz 1 & Anna Katharina Seitz 2 & Andreas K. Buck 3 & Constantin Lapa 4 & Philipp E. Hartrampf 3 Received: 28 August 2020 / Accepted: 8 December 2020 # The Author(s) 2020
Abstract Background Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) with 177Lu-labeled PSMA ligands has achieved remarkable results in advanced disease stages of metastatic castration-resistant prostate cancer (mCRPC). However, not all patients benefit from this therapy. Different treatment responses could be explained by tumor heterogeneity triggered by progression and the number of prior treatments. PSMA-negative lesions can be missed on PSMA ligand PET/CT, which subsequently results in an underestimation of tumor burden. Conversely, high FDG uptake may also be an indicator of tumor aggressiveness and thus a poor prognostic marker for response to RLT and overall survival (OS). The aim of this analysis was to investigate the prognostic value of combined PSMA ligand PET/CT and [18F]fluorodeoxyglucose (FDG) PET/CT for outcome prediction in patients undergoing RLT. Materials and methods This bicentric analysis included 54 patients with mCRPC who underwent both FDG and PSMA ligand PET/CT imaging before RLT. In all patients, the pattern of PSMA ligand and FDG uptake was visually assessed. Patients with at least one FDG-positive, but PSMA-negative (FDG+/PSMA−) lesions were compared to patients without any FDG+/PSMA− lesions. A log-rank analysis was used to assess the difference in OS between subgroups. Results Median OS was 11 ± 1.8 months (95% CI 7.4–14.6). A significantly lower OS (p < 0.001) was found in patients with at least one FDG+/PSMA− lesion at baseline PET/CTs (n = 18) with a median OS of 6.0 ± 0.5 months (95% CI: 5.0–7.0 months). In comparison, patients without any FDG+/PSMA− lesions (n = 36) had a median OS of 16.0 ± 2.5 months (95% CI: 11.2– 20.8 months). Conclusion FDG+/PSMA− lesions are a negative predictor of overall survival in patients with mCRPC undergoing RLT. However, it remains to be determined if patients with FDG+/PSMA− lesions should be excluded from PSMA RLT. Keywords PSMA . FDG . PET/CT . Prostate cancer . Radioligand therapy
This article is part of the Topical Collection on Oncology - Genitourinary * Philipp E. Hartrampf [email protected] Kerstin Michalski [email protected] Juri Ruf [email protected]
Constantin Lapa [email protected] 1
Department of Nuclear Medicine, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
2
Department of Urology and Paediatric Urology, University Hospital Würzburg, Würzburg, Germany
3
Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
4
Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
Christian Goetz christian.goetz@uniklinik-frei
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