Gallium-68 or Fluorine-18 for prostate cancer imaging?

The introduction of prostate specific membrane antigen (PSMA)-positron emission tomography (PET) using (68)Ga revolutionized prostate cancer imaging. Outperforming standard imaging, it allows complete staging of the local tumor and possible lymph nodes, visceral or bone metastases with high accuracy in only one examination (1,2). Sensitivities of 66% and specificities of 99% were observed for primary lymph node staging. Moreover, it has become an excellent staging tool for recurrent prostate cancer even at early stage and low PSA levels. PSMA-positive detection rates of 50%-58% were reported for serum PSA values less than <0.5 ng/mL, 58%-73% for PSA values of 0.5-<1ng/mL and up to >90% at higher PSA values. Considering the high incidence of prostate cancer worldwide, the possibility of large scale batch production capacity of the novel (18)F-labelled PSMA-tracers(18)F-PSMA-1007 and (18)F-DCFPyL offers a promising advantage. Furthermore, the nuclear decay characteristics of (18)F, such as optimal positron energy and a half-life enabling delayed PET-acquisition, may also translate into refined imaging quality.

Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2017 Apr 13 [Epub ahead of print]

Claudia Kesch, Clemens Kratochwil, Walter Mier, Klaus Kopka, Frederik L Giesel

University Hospital Heidelberg, Germany., German Cancer Research Center (DKFZ) Heidelberg, Germany.