COMPARISON BETWEEN PET/CT WITH 18F-PSMA-1007 AND WITH 18F-FDG IN MUSCLE-INVASIVE BLADDER UROTHELIAL CARCINOMA

Abstract

Introduction/Justification: Muscle-invasive bladder cancer (MIBC) presents high rates of metastasis and recurrence, making its monitoring challenging. PET/CT with 18F-FDG is relevant in evaluating this disease, although its urinary excretion makes the analysis of some cases difficult, even when diuretics are used. Prostate-specific membrane antigen (PSMA) is also expressed in neoangiogenesis of MIBC, making it a potential disease marker. In particular, the radiotracer 18F-PSMA-1007, unlike other analogs of this molecule, is predominantly excreted through the biliary tract, thereby facilitating the evaluation of the urinary tract. Objectives: The aim of this study was to compare PET/CT with 18F-FDG and with 18F-PSMA-1007 in evaluating MIBC. Materials and Methods: Four male patients (ages 57-73 years) were prospectively studied, undergoing PET/CT 60 minutes after intravenous administration of 0.11 mCi/kg 18F-FDG and 5 and 90 minutes after intravenous injection of 18F-PSMA-1007. Additional late (2h) pelvic images were obtained with both tracers after intravenous furosemide injection. Images were analyzed by 2 experienced nuclear physicians and 1 radiologist. The maximum standardized uptake value (SUVmax) of each lesion was measured for both radiotracers. Results: 18F-PSMA-1007 uptake in bladder lesions and regional lymph nodes progressively increased between 5, 90 minutes and 2 hours. A total of 11 lesions were identified in the 4 patients using 18F-PSMA-1007 and 9 using 18F-FDG. Two patients had undergone transurethral resection and had no active macroscopic lesions in the bladder. 18F-PSMA-1007 detected bladder lesions in the other 2 patients (SUVmax = 9.8 and 23.4), while FDG detected only 1 (SUVmax = 30.0), with the other lesion indistinguishable from radioactive urine, even after diuretic administration. Both tracers detected lymph node metastases in 3 patients (SUVmax = 4.1 to 15.8, and 9.5 to 18.3, respectively, for 18F-PSMA-1007 and 18F-FDG), and bone metastasis in 1 patient (SUVmax = 11.1 and 10.1 for 18F-PSMA-1007 and 18F-FDG, respectively). Two patients had pulmonary inflammatory/infectious processes that were FDG-avid but not 18F-PSMA-1007-avid. Conclusion: PET/CTs with 18F-FDG and 18F-PSMA-1007 appear to have similar sensitivities for MIBC lesions. Due to lower uptake in inflammatory processes, 18F-PSMA-1007 appears to have higher specificity and, due to significantly lower urinary excretion than 18F-FDG, may be more favorable for evaluating the primary bladder lesion. The significant uptake of 18F-PSMA-1007 in MIBC lesions raises the possibility of theranostic approach in selected patients.

Keywords

• 18F-FDG PET/CT
• bladder cancer
• PSMA PET;