%0 Journal Article
%A Seifert, Robert
%A Telli, Tugce
%A Hadaschik, Boris
%A Fendler, Wolfgang P
%A Kuo, Phillip H
%A Herrmann, Ken
%T Is 18F-FDG PET Needed to Assess 177Lu-PSMA Therapy Eligibility? A VISION-like, Single-Center Analysis.
%J Journal of nuclear medicine
%V 64
%N 5
%@ 0097-9058
%C New York, NY
%I Soc.
%M DKFZ-2023-00860
%P 731 - 737
%D 2023
%X 18F-FDG and prostate-specific membrane antigen (PSMA) PET have been used to assess eligibility for PSMA-targeted therapy by some centers. However, it remains unclear whether both examinations are needed as a part of workup in the clinical practice or whether PSMA PET alone, as was done in the positive phase 3 VISION trial, is sufficient to identify suitable candidates. The aim was to reanalyze all patients who underwent both 18F-FDG and PSMA PET for PSMA-targeted therapy eligibility assessment using the VISION trial criteria. Methods: Eighty-nine men with metastatic castration-resistant prostate cancer referred to 177Lu-PSMA therapy from June 2019 to October 2021 who underwent both 18F-FDG and PSMA PET (using either 68Ga-PSMA-11 or 18F-PSMA-1007) examinations within 2 wk were included in this analysis. Eligibility status was determined in accordance with either knowledge of both 18F-FDG and PSMA PET (clinical routine) or VISION criteria with PSMA PET-only (study reassessment, done twice with liver only for PSMA-11 and liver/spleen as reference for PSMA-1007). A metastasis seen on 18F-FDG PET or CT but not on PSMA PET was denoted as a mismatch finding and led to exclusion from 177Lu-PSMA therapy. On the basis of clinical assessment, 52 patients received 177Lu-PSMA therapy, and 37 did not; all patients were reassessed. Results: Patients treated with 177Lu-PSMA therapy had significantly longer overall survival than those not treated (12.4 vs. 6.8 mo, P < 0.01). PSMA-only analysis (spleen/liver reference) and 18F-FDG/PSMA mismatch reads had substantial agreement (Cohen κ = 0.73). Eighteen percent (n = 16/89) of patients had a mismatch finding based on 18F-FDG/PSMA PET. With the liver/spleen reference, a minor fraction of patients who had no mismatch finding (and were therefore treated) would have been withheld from therapy by PSMA-only analysis (3
%K Male
%K Humans
%K Fluorodeoxyglucose F18
%K Radiopharmaceuticals: therapeutic use
%K Dipeptides: therapeutic use
%K Prostate-Specific Antigen
%K Prostatic Neoplasms, Castration-Resistant: diagnostic imaging
%K Prostatic Neoplasms, Castration-Resistant: radiotherapy
%K Prostatic Neoplasms, Castration-Resistant: drug therapy
%K Positron Emission Tomography Computed Tomography
%K Lutetium: therapeutic use
%K Heterocyclic Compounds, 1-Ring: therapeutic use
%K Treatment Outcome
%K PET (Other)
%K PSMA therapy (Other)
%K PSMA-1007 (Other)
%K PSMA-11 (Other)
%K prostate cancer (Other)
%K Fluorodeoxyglucose F18 (NLM Chemicals)
%K Radiopharmaceuticals (NLM Chemicals)
%K Dipeptides (NLM Chemicals)
%K Prostate-Specific Antigen (NLM Chemicals)
%K Lutetium (NLM Chemicals)
%K Heterocyclic Compounds, 1-Ring (NLM Chemicals)
%F PUB:(DE-HGF)16
%9 Journal Article
%$ pmid:36522186
%R 10.2967/jnumed.122.264741
%U https://inrepo02.dkfz.de/record/275761