Home
JournalsCollections
For Authors For Reviewers For Editorial Board Members
Article Processing Charges Open Access
Ethics Advertising Policy
Editorial Policy Resource Center
Company Information Contact Us
OPEN ACCESS

Impact of the 68Ga Prostate-Specific Membrane Antigen (68Ga-PSMA) PET/CT on the Management of Prostate Cancer

  • Surampalli Gurunath*,
  • Shreeya Salunke and
  • Sravan Komittishetty
Journal of Exploratory Research in Pharmacology   2020;5(3):42-46

doi: 10.14218/JERP.2020.00009

Received:

Revised:

Accepted:

Published online:

 Author information

Citation: Gurunath S, Salunke S, Komittishetty S. Impact of the 68Ga Prostate-Specific Membrane Antigen (68Ga-PSMA) PET/CT on the Management of Prostate Cancer. J Explor Res Pharmacol. 2020;5(3):42-46. doi: 10.14218/JERP.2020.00009.

Abstract

This review discusses the efficiency and sensitivity of 68Ga-labelled prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) imaging in comparison to other radiotracers and imaging techniques. It also conveys its impact on the treatment or management of prostate cancer patients. PSMA, observed in almost all prostate cancer cells, is used for staging and treatment, due to its high multiplication in this cancer when compared to normal tissues. PSMA PET/magnetic resonance imaging (MRI) has applications in the management of prostate cancer. Though PSMA PET/MRI has yielded preliminary results, it is still studied as an imaging biomarker for tumor responses. PSMA-PET/CT is known for its highly sensitive resolution, as it lights up only the parts harboring prostate cancer or tumor cells and not any other kind of lesion. Therefore, 68Ga-PSMA-PET imaging is chosen over other variants of 68Ga-PSMA-11, such as 177Lu-PSMA or 225Ac-PSMA, and it is used for its greater ability to detect metastatic sites in patients with biochemical recurrence and low serum prostate-specific antigens values. The efficacy of 68Ga-PSMA PET/CT also allows for estimation of oligometastases, as it supports the design of therapeutic trials in measuring long-term effects in patients. Finally, 68Ga-PSMA PET/CT is effective in identifying recurrence localization and, hence, permits the ability to choose the best therapeutic strategy as early as possible.

Keywords

Oligometastases, Metastatic sites, Nodal metastasis, Baseline staging

Introduction

Prostate cancer (PCa) holds the second position for most commonly occurring cancer and is a remarkable cause for the majority of death in men. According to research conducted in the UK, the incidence of PCa has increased by 44% since 1990.1 Every year in Australia and the UK, death of men due to PCa (3,306 deaths in Australia; 12,032 deaths in the UK) is more than the death of women due to breast cancer (3,058 deaths in Australia; 11,371 deaths in the UK).1,2 Twenty-sixty percent of patients treated for PCa fail primary therapy, and less than thirty percent of the patients having high-volume metastatic disease achieve 5-year survival.3

Imaging techniques like computed tomography (CT) or magnetic resonance imaging (MRI) are used for staging of cancer.4 In non-metastatic cancer patients, about 30–35% patients treated by radical prostatectomy (RP) or radiotherapy (RT) have a rise in the prostate-specific antigens (PSA) levels and biochemical recurrence (BCR) in the years following treatment.5 Increasing levels of PSA after RT or surgery indicate a higher risk of death in men. These high levels of PSA and the early PSA failure in patients indicates a greater need for 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/CT scanning.6 Treatment or management strategies differ for each patient depending on their risk, which usually increases after therapies like hormonal therapy, RT, chemotherapy or sometimes a combination of all these therapies.7

PSMA is a glycoprotein present on the outer surface of prostate cells, hyper-regulated during metastatic conditions and castrate-resistant PCa (CRPC).8 Though the exact functions of PSMA are yet to be defined, it is still used for staging and treatment due to its high multiplication in PCa.8,9 Many other malignancies, namely breast cancer, colorectal carcinoma, follicular lymphoma, etc., also express PSMA with 68Ga-PSMA avidness. Highly expressed PSMA (type-II-transmembrane glycoprotein) is also observed in almost all PCa cells, except the 5–10% of PCa cells without PSMA expression.9 In 2016, a study in Brazil estimated 61,200 new cases of PCa, which made it the second most prevailing neoplasia in men throughout the country and the third most common reason of death by cancer in men of Western countries.10 This review discusses the efficiency and sensitivity of 68Ga-PSMA PET/CT imaging in comparison to other radiotracers and imaging techniques. It also conveys its impact on the treatment or management of PCa patients.

PSMA-PET and PSMA-PET/CT Technique

PSMA-PET increases its positivity with an increase in the grade and stage of the tumor, level of PSA, and time. PSMA expression is linked directly to the status of disease (PCa) and therapeutic effects, indicating a parallel relationship with PSA values in treatment techniques like RT, chemotherapy and radionuclide therapies (with 177Lu/225Ac-PSMA or 223Ra).11 PSMA-PET has a specific molecular imaging target for tumors expressing PSMA. Each imaging modality has a specific capability of identifying the sites of the tumor that would otherwise be neglected or considered negative by the other techniques. Hence, PSMA-PET is emerging as the most favorable imaging tool and a potential prognostic biomarker. PET scanning by using various tracers poorly detects early BCR with low levels of PSA. Only 68Ga-PSMA-PET imaging is used due to its precise detection of metastatic sites in patients having BCR with low serum PSA values.10,12,13

PSMA-PET/CT has a highly sensitive resolution to detect tumors as small as 3 mm, across the lymph nodes.8 It is highly specific, as it lights up only the parts having PCa or any tumor tissue and not any kind of lesion which may look like PCa. Also, PSMA-based imaging shows improved detection in those patients having primary PCa (intermediate to high risk) when compared to CT or multi-parametric (mp-)MRI, making bone scintigraphy or additional cross-sectional imaging unnecessary.14

68Ga-PSMA PET/CT-11

68Ga-PSMA PET/CT-11 is a PSMA tracer, wherein Ga-68 is a radioactive carrier and PSMA-11 is a small molecule that binds to the receptor. An automated synthesis system usually synthesizes Ga-68 of high efficiency and purity. PSMA radiotracers are given in micrograms so that no side-effects or adverse effects are perceived. These tracers are now widely used in PET and CT, due to their higher efficacy and precision in PCa scans when compared to bone scanning or MRI. PSMA radiotracers, given to hundreds of thousands of patients globally, have no reported side effects.8 Presently, using 68Ga, the physiological biodistribution of radiolabeled PSMA includes various glands, like salivary and lacrimal, other organs, like liver and spleen, and low-level uptake in the prostate tissue.15,16 The specificity and sensitivity of 68Ga-PSMA PET/CT estimates the detection of PCa as it supports the design of therapeutic trials in measuring long-term effects in patients. Hence, 68Ga-PSMA PET/CT is a novel imaging technique that detects BCR with greater sensitivity and is effective in identifying recurrence localization and permitting the choice for the best therapeutic strategy as early as possible.

Variants of 68GA-PSMA-11

177Lu-PSMA, a variant of 68Ga-PSMA-11, is also used for PET/CT imaging. Lutetium-177 is a short-path length beta emitter, having a crossfire effect of targeting all cells in 1 mm radius by supplying effective radiation only to the tumor, reducing the damage to other normal cells/tissues around it. The single-center, single-arm phase-2 trial, is the only trial showing that 177Lu-PSMA radioligand therapy (RLT) has a favorable anti-tumor activity and toxicity profile, depicting a significant improvement in the mCRPC patients with disease progression though treated with standard options/procedures.17177Lu-PSMA RLT is administered after considering all traditional therapies, though its exact sequence remains uncertain in the treatment procedure.

In mCRPC patients who previously failed in treatments like chemotherapy, 177Lu-PSMA RLT has been shown to increase the progression-free survival in 40–70% of patients by decreasing the levels of PSA, tumor volume, and activity.18–24 This treatment is well-tolerated due to its minimal or moderate side-effects. In smaller studies, targeted alpha therapy using 225Ac-PSMA showed decreased levels of PSA, tumor volumes and activity in patients who failed the 177Lu-PSMA therapy. 225Ac-PSMA therapy also showed a noticeable effect on the function of the salivary gland. Though, the long-term toxicities of these therapies, if any, are yet to be studied.25

18F-Labeled PSMA Tracers

18F-labeled compounds are also being preferred over 68Ga radionuclide due to various factors, such as low positron energy resulting in short positron range in tissues, the long half-life, and potential to be shipped through existing distribution networks (decreasing the cost).26 Due to low positron energy, 18F has more greatly improved resolution than 68Ga. 18F can be produced in larger quantities, as it is obtained from the cyclotron, unlike 68Ga. Therefore, all these factors have increased the need to develop 18F-labelled PSMA compounds.27 One such compound is 18F-PSMA-1007, which quickly clears from blood but has a decreased clearance through the urinary tract.28 A study reported that 18F-PSMA-1007 PET/CT is better than other PSMA PET agents as its detection ability is efficient and highly sensitive, even in patients with low PSA level (0.2–0.5 ng/mL), in comparison to 68Ga-PSMA-11.29,30 The management was improved in these patients due to the precise identification of recurrence sites by 18F-PSMA-1007 PET/CT.

18F-Fluorodeoxyglucose (FDG) PET/CT is a tracer used in many tumors, but its results in PCa are not promising, due to the decreased metabolic activity of PCa cells and increased excretion of 18F in the urine.31,32 Its effectiveness, however, is observed in hormone-resistant weakly differentiated cell types found in PCa patients.33–35 As the use of 18F-FDG is limited, other radiotracers for PCa have been developed. One such class of PET tracer encompasses the choline derivatives, which have been examined abundantly over the past few years. Membranes of the prostate cell consist of choline, which is imaged with choline radiotracers such as 18F-fluorocholine (FCH). Soyka et al.36 reported that 48% (75/156) of patients showed management changes (RT or salvage therapy, or both) based on the results of 18F-FCH PET/CT. Therefore, concluding that 18F-FCH PET/CT has a huge impact on the therapeutic strategies of PCa patients. Though 18F-FCH PET/CT had a high detection rate, there are no studies yet to prove its usefulness in diagnosing and evaluating the extent of localized tumors in PCa patients.

Impact of the 68Ga-PSMA PET/CT on Management Changes

68Ga-PSMA PET/CT has been reported to be of greater clinical importance to stage primary PCa. Roach et al.37 reported that management changes after PCa detection using 68Ga-PSMA PET/CT accounted for one-fifth of all the patients imaged. The management changes were suggested as a change from hormonal and radical therapy to surgery (namely prostatectomy, regional lymph node detection), radiation treatment, systemic therapy, additional biopsies, and imaging. Replanning the treatment due to the prognostic implication in these patients is substantia. Bluemel et al.38 showed management changes in about 40% of the patients due to 68Ga-PSMA PET/CT. Salvage RT in the presence of BCR or PSA was suggested as a management change after prior radical therapy.

Müller et al.39 reported that the overall management changes of 68Ga-PSMA PET/CT were 60% (122/203). The use of metastasis-targeted treatment increased with a decrease in systemic treatment due to management changes, like targeted RT with and without hormonal therapy, based on the 68Ga-PSMA PET/CT scan. A meta-analysis reported management changes in 54% (628/1,163) of its patients.40 An increase was seen in RT, surgery and multimodal treatment, with a decrease in systemic treatment referred as management changed due to the 68Ga-PSMA PET/CT scan findings. Calais et al.41 showed that, when changes based only on scans with positive findings were considered, 114 of 152 patients (75%) had management changes. The changes in management due to the impact of 68Ga-PSMA PET/CT findings were measured as the fraction of patients who had a change in treatment plan after the scan. However, the intended management changes early after 68Ga-PSMA PET/CT is usually different from implemented management changes. Post 68Ga-PSMA PET, the number of systemic treatments decreased with increased local treatments.

High detection rate (74%) of 68Ga-PSMA-11 PET, which was nearly 50% even in the patients with low PSA values, formed the basis for the changes in patient management. These detection rates were observed to be consistent, even in larger retrospective studies.30 Androgen deprivation treatment alters both PSMA status and PSMA PET. In a study by Müller et al.,39 15.6% (33/223) of patients received androgen deprivation treatment at some point prior to the scan, with rise in PSA levels. Higher detection rate was observed in this subgroup compared to other groups (88% vs. 74%), with a positive scan in 31/35 patients. The high detection rate of recurrent PCa with 68Ga-PSMA PET changed management in 60% of the patients. The patients were suggested to undergo salvage surgery, chemotherapy, radical therapy, or secondary hormonal therapy as management changes after the 68Ga-PSMA-PET/CT scan.42 Moreover, this cohort (60%) showed a slightly high impact on management when compared to the management changes found by Afaq et al.43 (39% of patients) and Sterzing et al.44 (51% of patients).

The accuracy of 68Ga-PSMA PET/CT scan has paved its way for future personalized treatment of PCa, as it has already replaced the conventional scans, like CT. This precise scanning may also aid in the development of various drugs to increase the precision or localization of the metastases.

Hypothesis

The changes in management due to 68Ga-PSMA PET/CT (Table 1) not only showed a clinical benefit in PCa patients with very low PSA values and BCR but also a benefit to the PCa patients with a higher risk even after the planned curative treatment. The sensitivity and specificity of this imaging technique decreased the possibility of unsatisfactory post-operative outcomes, while increasing the survival rate with better outcomes compared to the conventional treatments planned before the scan. 68Ga-PSMA PET/CT could be advised in the routine check-up of PCa patients due to its effectiveness in the identification of metastasis followed by increased PSA levels, which are usually seen after the primary treatment. Another advantage of this type of scanning is that it can stage and image only the tumors and not any lesions. This precise scanning may also aid in the development of various drugs to increase the precision or localization of the metastases.

Table 1

Change of intended treatment options after 68Ga-PSMA PET/CT imaging

CategoryTreatment options41
Primary treatmentSalvage surgery
Salvage radiotherapy
Metastasis-directed ablative radiation therapy (stereotactic body radiation therapy)
Androgen deprivation therapy
Chemotherapy
PSMA radionuclide therapy
Other systemic treatment (vaccine therapy, immunotherapy)
Active surveillance
Management changes chosen post-68Ga PSMA PET/CT imagingConversion to focal treatment
Conversion to new focal treatment
Conversion to systemic treatment
Changed systemic treatment (addition or removal of systemic treatment)
Conversion to active surveillance

Conclusions

68Ga-PSMA PET/CT is effective in identifying recurrence localization and hence permits choosing the best therapeutic strategy as early as possible. 68Ga-PSMA PET/CT shows a significant impact on the management changes in PCa patients.

Abbreviations

BCR: 

biochemical recurrence

CRPC: 

castration-resistant prostate cancer

CT: 

computed tomography

FCH: 

fluorocholine

FDG: 

fluorodeoxyglucose

MRI: 

magnetic resonance imaging

mp-MRI: 

multi-parametric magnetic resonance imaging

PCa: 

prostate cancer

PET: 

positron emission tomography

PSA: 

prostate-specific antigens

PSMA: 

prostate-specific membrane antigen

RLT: 

radioligand therapy

RP: 

radical prostatectomy

RT: 

radiotherapy

Declarations

Acknowledgement

The authors thank Sri Ch. Venugopal Reddy, Chairman, Bharat Institutions, for his timely support in the accomplishment of this paper.

Funding

Our study has not received any funding or grants, or any financial support

Conflict of interest

The authors declare no conflict of interests.

Authors’ contributions

Design, analysis and critical revisions of the manuscript (SG); design, coordination and drafting of the manuscript (SS, SK). All authors read and approved the final manuscript.

References

  1. Cancer Research UK. Prostate cancer statistics. 2017. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer. Accessed April 20, 2020 View Article PubMed/NCBI
  2. Cancer Australia. Prostate cancer in Australia. 2017. Available from: http://edcan.org.au/edcan-learning-resources/case-based-learning-resources/prostate-cancer/reduce-risk/australian-context. Accessed April 20, 2020 View Article PubMed/NCBI
  3. Dong L, Zieren RC, Xue W, de Reijke TM, Pienta KJ. Metastatic prostate cancer remains incurable, why?. Asian J Urol 2019;6:26-41 View Article PubMed/NCBI
  4. Sarioglu FC, Salman M, Guleryuz H, Ozer E, Cecen E, Ince D. Radiological staging in neuroblastoma: computed tomography or magnetic resonance imaging?. Pol J Radiol 2019;84:e46-e53 View Article PubMed/NCBI
  5. Paller CJ, Antonarakis ES. Management of biochemically recurrent prostate cancer after local therapy: evolving standards of care and new directions. Clin Adv Hematol Oncol 2013;11:14-23 View Article PubMed/NCBI
  6. Yuminaga Y, Rothe C, Kam J, Beattie K, Arianayagam M, Bui C. 68Ga-PSMA PET/CT versus CT and bone scan for investigation of PSA failure post radical prostatectomy. Asian J Urol 2020 View Article PubMed/NCBI
  7. Cancer.Net Editorial Board. Breast Cancer: Types of Treatment. 2019. Available from: https://www.cancer.net/cancer-types/breast-cancer/types-treatment. Accessed April 20, 2020 View Article PubMed/NCBI
  8. Hofman M. PSMA PET/CT for staging and treatment of prostate cancer. Clin Adv Hematol Oncol 2019;17:370-373 View Article PubMed/NCBI
  9. Barbosa FG, Queiroz MA, Nunes RF, Marin JFG, Buchpiguel CA, Cerri GG. Clinical perspectives of PSMA PET/MRI for prostate cancer. Clinics (Sao Paulo) ;2018:e586s View Article PubMed/NCBI
  10. Maurer T, Eiber M, Schwaiger M, Gschwend JE. Current use of PSMA-PET in prostate cancer management. Nat Rev Urol 2016;13:226-235 View Article PubMed/NCBI
  11. Kratochwil C, Bruchertseifer F, Giesel FL, Weis M, Verburg FA, Mottaghy F. 225Ac-PSMA-617 for PSMA-Targeted α-Radiation Therapy of Metastatic Castration-Resistant Prostate Cancer. J Nucl Med 2016;57:1941-1944 View Article PubMed/NCBI
  12. Tan JSH, Goh CXY, Koh YS, Li Y, Tuan JKL, Chua ET. 68Gallium-labelled PSMA-PET/CT as a diagnostic and clinical decision-making tool in Asian prostate cancer patients following prostatectomy. Cancer Biol Med 2019;16:157-166 View Article PubMed/NCBI
  13. Fitzpatrick C, Lynch O, Marignol L. 68Ga-PSMA-PET/CT Has a Role in Detecting Prostate Cancer Lesions in Patients with Recurrent Disease. Anticancer Res 2017;37:2753-2760 View Article PubMed/NCBI
  14. Mottet N, Cornford P, van den Bergh RCN, Briers E, De Santis M, Fanti S. Prostate Cancer. EAU Guidelines Office, The Netherlands, 2020. Available from: http://uroweb.org/guideline/prostate-cancer/. Accessed April 20, 2020 View Article PubMed/NCBI
  15. Demirci E, Sahin OE, Ocak M, Akovali B, Nematyazar J, Kabasakal L. Normal distribution pattern and physiological variants of 68Ga-PSMA-11 PET/CT imaging. Nucl Med Commun 2016;37:1169-1179 View Article PubMed/NCBI
  16. Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging 2013;40:486-495 View Article PubMed/NCBI
  17. Yadav MP, Ballal S, Sahoo RK, Dwivedi SN, Bal C. Radioligand Therapy With 177Lu-PSMA for Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2019;213:275-285 View Article PubMed/NCBI
  18. Fendler WP, Rahbar K, Herrmann K, Kratochwil C, Eiber M. 177Lu-PSMA Radioligand Therapy for Prostate Cancer. J Nucl Med 2017;58:1196-1200 View Article PubMed/NCBI
  19. Boegemann M, Schrader AJ, Rahbar K. 177Lu-PSMA therapy: current evidence for use in the treatment of patients with metastatic prostate cancer (in German). Urologe A 2017;56:1440-1444 View Article PubMed/NCBI
  20. Calopedos RJS, Chalasani V, Asher R, Emmett L, Woo HH. Lutetium-177-labelled anti-prostate-specific membrane antigen antibody and ligands for the treatment of metastatic castrate-resistant prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2017;20:352-360 View Article PubMed/NCBI
  21. Emmett L, Willowson K, Violet J, Shin J, Blanksby A, Lee J. Lutetium 177 PSMA radionuclide therapy for men with prostate cancer: A review of the current literature and discussion of practical aspects of therapy. J Med Radiat Sci 2017;64:52-60 View Article PubMed/NCBI
  22. Fendler WP, Kratochwil C, Ahmadzadehfar H, Rahbar K, Baum RP, Schmidt M. 177Lu-PSMA-617 therapy dosimetry and follow-up in patients with metastatic castration-resistant prostate cancer (in German). Nuklearmedizin 2016;55:123-128 View Article PubMed/NCBI
  23. Weineisen M, Schottelius M, Simecek J, Baum RP, Yildiz A, Beykan S. 68Ga- and 177Lu-Labeled PSMA I&T: Optimization of a PSMA-Targeted Theranostic Concept and First Proof-of-Concept Human Studies. J Nucl Med 2015;56:1169-1176 View Article PubMed/NCBI
  24. Kesavan M, Turner JH, Meyrick D, Yeo S, Cardaci G, Lenzo NP. Salvage Radiopeptide Therapy of Advanced Castrate Resistant Prostate Cancer with Lutetium-177 labelled Prostate Specific Membrane Antigen (177Lu-PSMA): Efficacy and safety in Routine Practice. Cancer Biother Radiopharm 2018;33:274-281 View Article PubMed/NCBI
  25. Lenzo NP, Meyrick D, Turner JH. Review of Gallium-68 PSMA PET/CT Imaging in the Management of Prostate Cancer. Diagnostics (Basel) 2018;8:16 View Article PubMed/NCBI
  26. Werner RA, Chen X, Rowe SP, Lapa C, Javadi MS, Higuchi T. Moving Into the Next Era of PET Myocardial Perfusion Imaging: Introduction of Novel 18F-labeled Tracers. Int J Cardiovasc Imaging 2019;35:569-577 View Article PubMed/NCBI
  27. Cho SY, Gage KL, Mease RC, Senthamizhchelvan S, Holt DP, Jeffrey-Kwanisai A. Biodistribution, tumor detection, and radiation dosimetry of 18F-DCFBC, a low-molecular-weight inhibitor of prostate-specific membrane antigen, in patients with metastatic prostate cancer. J Nucl Med 2012;53:1883-1891 View Article PubMed/NCBI
  28. Giesel FL, Hadaschik B, Cardinale J, Radtke J, Vinsensia M, Lehnert W. F-18 labelled PSMA-1007: biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. Eur J Nucl Med Mol Imaging 2017;44:678-688 View Article PubMed/NCBI
  29. Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M. The diagnostic value of PET/CT imaging with the 68Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2015;42:197-209 View Article PubMed/NCBI
  30. Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B. Evaluation of hybrid 68Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med 2015;56:668-674 View Article PubMed/NCBI
  31. Morris MJ, Akhurst T, Osman I, Nunez R, Macapinlac H, Siedlecki K. Fluorinated deoxyglucose positron emission tomography imaging in progressive metastatic prostate cancer. Urology 2002;59:913-918 View Article PubMed/NCBI
  32. Sanz G, Robles JE, Gimenez M, Arocena J, Sanchez D, Rodriguez-Rubio F. Positron emission tomography with 18fluorine-labelled deoxyglucose: utility in localized and advanced prostate cancer. BJU Int 1999;84:1028-1031 View Article PubMed/NCBI
  33. Minamimoto R, Uemura H, Sano F, Terao H, Nagashima Y, Yamanaka S. The potential of FDG-PET/CT for detecting prostate cancer in patients with an elevated serum PSA level. Ann Nucl Med 2011;25:21-27 View Article PubMed/NCBI
  34. Shiiba M, Ishihara K, Kimura G, Kuwako T, Yoshihara H, Sato H. Evaluation of primary prostate cancer using 11C-methionine-PET/CT and 18F-FDG-PET/CT. Ann Nucl Med 2012;26:138-145 View Article PubMed/NCBI
  35. Effert P, Beniers AJ, Tamimi Y, Handt S, Jakse G. Expression of glucose transporter 1 (Glut-1) in cell lines and clinical specimens from human prostate adenocarcinoma. Anticancer Res 2004;24:3057-3063 View Article PubMed/NCBI
  36. Soyka JD, Muster MA, Schmid DT, Seifert B, Schick U, Miralbell R. Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2012;39:936-943 View Article PubMed/NCBI
  37. Roach PJ, Francis R, Emmett L, Hsiao E, Kneebone A, Hruby G. The impact of 68Ga-PSMA PET/CT on management intent in prostate cancer: results of an Australian prospective multicenter study. J Nucl Med 2018;59:82-88 View Article PubMed/NCBI
  38. Bluemel C, Linke F, Herrmann K, Simunovic I, Eiber M, Kestler C. Impact of 68Ga-PSMA PET/CT on salvage radiotherapy planning in patients with prostate cancer and persisting PSA values or biochemical relapse after prostatectomy. EJNMMI Res 2016;6:78 View Article PubMed/NCBI
  39. Müller J, Ferraro DA, Muehlematter UJ, Schüler HIG, Kedzia S, Eberli D. Clinical impact of 68Ga-PSMA-11 PET on patient management and outcome, including all patients referred for an increase in PSA level during the first year after its clinical introduction. Eur J Nucl Med Mol Imaging 2019;46:889-900 View Article PubMed/NCBI
  40. Han S, Woo S, Kim YJ, Suh CH. Impact of 68Ga-PSMA PET on the management of patients with prostate cancer: a systematic review and meta-analysis. Eur Urol 2018;74:179-190 View Article PubMed/NCBI
  41. Calais J, Fendler WP, Eiber M, Gartmann J, Chu FI, Nickols NG. Impact of 68Ga-PSMA-11 PET/CT on the management of prostate cancer patients with biochemical recurrence. J Nucl Med 2018;59:434-441 View Article PubMed/NCBI
  42. Mattiolli AB, Santos A, Vicente A, Queiroz M, Bastos D, Herchenhorn D. Impact of 68GA-PSMA PET/CT on treatment of patients with recurrent/metastatic high risk prostate cancer - a multicenter study. Int Braz J Urol 2018;44:892-899 View Article PubMed/NCBI
  43. Afaq A, Alahmed S, Chen SH, Lengana T, Haroon A, Payne H. Impact of 68Ga-prostate-specific membrane antigen PET/CT on prostate cancer management. J Nucl Med 2018;59:89-92 View Article PubMed/NCBI
  44. Sterzing F, Kratochwil C, Fiedler H, Katayama S, Habl G, Kopka K. (68)Ga-PSMA-11 PET/CT: a new technique with high potential for the radiotherapeutic management of prostate cancer patients. Eur J Nucl Med Mol Imaging 2016;43:34-41 View Article PubMed/NCBI