#petct

High expression of PSMA in prostate cancer makes it an attractive target for imaging and therapy. The left image shows a Prostascint scan (indium-111-capromab, an anti-PSMA antibody) in a patient with metastatic prostate cancer (black arrow). The FDA recently approved 2 PET radiopharmaceuticals that bind the extracellular domain of PSMA (Ga-68-gozetotide and F-18-piflufolostat). The right image shows an F-18-piflufolostat scan. The superior signal-to-noise and resolution of PET allow for detection of the tiny metastatic nodes seen in the pelvis.

Image credit

Left: Bhargava et al. Am. Jour. Nucl. Med. Mol. Imag. 2012.

Clinical trials are also underway for PSMA-targeted therapy with alpha-emitting radionuclides. Alpha particles are much more energetic and thus cause more localized damage than beta particles. They do not travel as far in tissue, so they tend to have less toxicity. Image shows a patient with metastatic prostate cancer who had excellent response after 2 cycles of actinium-225-PSMA targeted alpha therapy (TAT). Reference: Zacherl et al. J. Nucl. Med. 2021, 62, 669-674.

#TeachingRounds#FOAMed#FOAMRad#Radiology#NuclearMedicine#PETCT

Our final PET tracers of the week are amyloid and tau PET tracers.

The FDA has approved 3 PET tracers for amyloid imaging: 18F-Florbetaben, 18F-Florbetapir, and 18F-Flutemetamol. Amyloid PET has greatest use in ruling out Alzheimer's dementia (AD; excellent NPV but poor PPV). The first image depicts a negative and positive amyloid PET. The key feature is loss of gray white differentiation in the positive scan. Image credit: UCSF Radiology.

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