From the Departments of Radiology and Biomedical Imaging (R.K., X.W., T.A.H.), Urology (H.G.N., M.R.C., P.R.C.), and Pathology (T.C.), University of California San Francisco, 505 Parnassus Ave, M361, San Francisco, CA 94143.
Radiology. 2024 Aug;312(2):e232544. doi: 10.1148/radiol.232544.
Background Intravenous prostate-specific membrane antigen (PSMA)-targeted radioligand therapy improves survival in men with metastatic castration-resistant prostate cancer. Yet, the impact of selective prostatic arterial administration on primary tumor uptake is unclear. Purpose To compare gallium 68 (Ga)-PSMA-11 uptake using dynamic PET/CT in prostatic tumoral volumes of interest (VOIs) during intravenous and selective prostatic arterial infusions for individuals with untreated, high-risk prostate cancer. Materials and Methods In this prospective, intraindividual comparative study conducted at an academic medical center, five men aged 58, 61, 64, 66, and 68 years with treatment-naive prostate cancer were enrolled between January 2022 and February 2023 and underwent two dynamic Ga-PSMA-11 PET/CT examinations 1 week apart. During the first examination, the radiotracer was administered intravenously. During the second administration, the radiotracer was delivered into either the right or left prostatic artery through an angiographically placed microcatheter. The primary outcome was maximum standardized uptake value (SUV) in prostatic tumoral VOIs. The secondary outcomes included mean SUV (SUV) in prostatic tumoral VOIs and area under the SUV curves (AUC). Longitudinal mixed-effects models were used to compare dynamic SUV and SUV time-activity curves (TACs), and paired tests were used for the remaining data. Results The mean SUV within tumoral VOIs was 14 (range, 3-43) for venous sessions and 938 (range, 460-1436) for arterial sessions ( = .008). The SUV within VOIs was greater during arterial sessions ( < .001) overall and 46-fold and 19-fold greater at peak uptake and final time points, respectively. The mean AUC was greater on arterial TACs than on venous TACs at 14600 SUV × min (range, 8353-20025 SUV × min) and 240 SUV × min (range, 69-622 SUV × min), respectively ( = .002). Conclusion Selective prostatic arterial infusion resulted in greater Ga-PSMA-11 tumoral SUV than intravenous infusion. Further study of local-regional, intra-arterial delivery of a PSMA-targeted theranostic agent is warranted in high-risk prostate cancer. ClinicalTrials.gov identifier: NCT04976257 © RSNA, 2024 See also the editorial by Civelek in this issue.
背景 静脉内前列腺特异性膜抗原 (PSMA)-靶向放射性配体疗法可提高转移性去势抵抗性前列腺癌男性的生存率。然而，选择性前列腺动脉给药对原发性肿瘤摄取的影响尚不清楚。目的 比较未经治疗的高危前列腺癌患者静脉内和选择性前列腺动脉内输注时，使用动态 PET/CT 在前列腺肿瘤感兴趣区 (VOI) 中测量镓 68 (Ga)-PSMA-11 的摄取。材料与方法 本项在学术医疗中心进行的前瞻性、个体内比较研究纳入了 5 名年龄 58、61、64、66 和 68 岁、患有未经治疗的前列腺癌的男性，他们在 2022 年 1 月至 2023 年 2 月期间入组，并在 1 周内接受了两次 Ga-PSMA-11 动态 PET/CT 检查。第一次检查时，放射性示踪剂经静脉内给药。在第二次给药时，通过血管造影放置的微导管将放射性示踪剂输送到右侧或左侧前列腺动脉中。主要结局为前列腺肿瘤 VOI 中的最大标准化摄取值 (SUV)。次要结局包括前列腺肿瘤 VOI 中的平均 SUV (SUV) 和 SUV 曲线下面积 (AUC)。使用纵向混合效应模型比较动态 SUV 和 SUV 时间-活性曲线 (TAC)，并对其余数据进行配对 t 检验。结果 静脉内给药时肿瘤 VOI 内的平均 SUV 为 14(范围，3-43)，动脉内给药时为 938(范围，460-1436)( =.008)。总体而言，动脉内给药时 VOI 内 SUV 更高( <.001)，在峰值摄取和终末时间点分别高 46 倍和 19 倍。动脉 TAC 的平均 AUC 大于静脉 TAC，分别为 14600 SUV×min(范围，8353-20025 SUV×min)和 240 SUV×min(范围，69-622 SUV×min)( =.002)。结论 与静脉内给药相比，选择性前列腺动脉内给药可使 Ga-PSMA-11 肿瘤摄取 SUV 更高。在高危前列腺癌中，有必要进一步研究局部区域性、动脉内给予 PSMA 靶向治疗药物。ClinicalTrials.gov 标识符：NCT04976257 参见本期 Civelek 编辑的社论。
