[68 Ga]Ga-Prostate-Specific Membrane Antigen PET/CT: a novel method for imaging patients with hepatocellular carcinoma

• Published in: European journal of nuclear medicine and molecular imaging 2021-03, Vol.48 (3), p.883-892
• Main Authors: Kunikowska, Jolanta, Cieślak, Bartosz, Gierej, Beata, Patkowski, Waldemar, Kraj, Leszek, Kotulski, Marcin, Zieniewicz, Krzysztof, Królicki, Leszek
• Format: Article
• Language: English
• Subjects: Adverse events; Angiogenesis; Antigens; Cardiology; Computed tomography; Hepatocellular carcinoma; Heterogeneity; Imaging; Liver cancer; Magnetic resonance imaging; Medical imaging; Medicine; Medicine & Public Health; Membranes; Nuclear Medicine; Oncology; Oncology – Digestive tract; Original; Original Article; Orthopedics; Patients; Pharmaceuticals; Positron emission; Prostate; Prostate cancer; Radiochemistry; Radioisotopes; Radiology; Statistical analysis; Tomography; Tumor markers; Tumors
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-020-05017-0

Purpose Prostate-specific membrane antigen (PSMA) is not only highly expressed on the surface prostate cancer cells but is also elevated during angiogenesis in other cancer cell types, including hepatocellular carcinoma (HCC). This study aimed to evaluate the feasibility of using PET/CT imaging with [ 68 Ga]Ga-PSMA-11 in HCC and its impact on patient management. Methods Fifteen patients (13 men and two women; aged 55.6 ± 18.2 years) with HCC were enrolled in this prospective, single-institution study. All patients underwent contrast-enhanced MRI/CT, [ 68 Ga]Ga-PSMA-11 PET/CT, and histopathological verification of lesions. Results No radiopharmaceutical-related adverse events were noted. Visual interpretation showed increased accumulation of [ 68 Ga]Ga-PSMA-11 in all HCC patients. The tumor-to-liver ratio (TLR) was 3.6 ± 2.1, and the maximal standardized uptake value (SUV max ) was 13.5 ± 7.1. There were no significant differences in the SUVs or TLR between newly diagnosed and recurrent patients. No statistically significant relationship was found between serum concentration of tumor markers (i.e., AFP, CA 19-9, CEA) and PET parameters. Results of the [ 68 Ga]Ga-PSMA-11 PET/CT changed the treatment strategy in five (33%) patients. PSMA staining showed visible heterogeneity in terms of intensity and distribution: the reaction was weak and only observed in a few vessels in pseudoglandular patterns of HCC, while it was homogeneously strong, with some hot spots, in trabecular patterns of HCC. Conclusion [ 68 Ga]Ga-PSMA-11 PET/CT can detect PSMA expression in vivo in patients with HCC and is useful for guiding treatment strategies. Further investigation of the clinical utility of this method in HCC is warranted.