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Journal of Nuclear Medicine

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Research ArticleTheranostics

The Effects of Monosodium Glutamate on PSMA Radiotracer Uptake in Men with Recurrent Prostate Cancer: A Prospective, Randomized, Double-Blind, Placebo-Controlled Intraindividual Imaging Study

Sara Harsini, Heather Saprunoff, Tina Alden, Behnoud Mohammadi, Don Wilson and François Bénard
Journal of Nuclear Medicine January 2021, 62 (1) 81-87; DOI: https://doi.org/10.2967/jnumed.120.246983
Sara Harsini
1BC Cancer, Vancouver, British Columbia, Canada; and
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Heather Saprunoff
1BC Cancer, Vancouver, British Columbia, Canada; and
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Tina Alden
1BC Cancer, Vancouver, British Columbia, Canada; and
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Behnoud Mohammadi
1BC Cancer, Vancouver, British Columbia, Canada; and
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Don Wilson
1BC Cancer, Vancouver, British Columbia, Canada; and
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François Bénard
1BC Cancer, Vancouver, British Columbia, Canada; and
2Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract

The prostate-specific membrane antigen (PSMA) is an excellent target for theranostic applications in prostate cancer. However, PSMA-targeted radioligand therapy can cause undesirable effects due to high accumulation of PSMA radiotracers in salivary glands and kidneys. This study assessed orally administered monosodium glutamate (MSG) as a potential means of reducing kidney and salivary gland radiation exposure using a PSMA-targeting radiotracer. Methods: This prospective, double-blind, placebo-controlled study enrolled 10 patients with biochemically recurrent prostate cancer. Each subject served as his own control. PET/CT imaging sessions using 2-(3-{1-carboxy-5-[(6-18F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) were performed 3–7 d apart, after oral administration of either 12.7 g of MSG or placebo. Data from the 2 sets of images were analyzed by placing regions of interest on lacrimal, parotid, and submandibular glands; left ventricle; liver; spleen; kidneys; bowel; urinary bladder; gluteus muscle; and malignant lesions. The results from MSG and placebo scans were compared by paired analysis of the region-of-interest data. Results: In total, 142 pathologic lesions along with normal tissues were analyzed. As hypothesized a priori, there was a significant decrease in SUVmax corrected for lean body mass (SULmax) on images obtained after MSG administration in the parotids (24% ± 14%, P = 0.001), submandibular glands (35% ± 11%, P < 0.001), and kidneys (23% ± 26%, P = 0.014). Significant decreases were also observed in the lacrimal glands (49% ± 13%, P < 0.001), liver (15% ± 6%, P < 0.001), spleen (28% ± 13%, P = 0.001), and bowel (44% ± 13%, P < 0.001). A mildly lower blood pool SULmean was observed after MSG administration (decrease of 11% ± 13%, P = 0.021). However, significantly lower radiotracer uptake in terms of SULmean, SULpeak, and SULmax was observed in malignant lesions on scans performed after MSG administration than on the placebo studies (SULmax median decrease, 33%; range, −1% to 75%; P < 0.001). No significant adverse events occurred after placebo or MSG administration, and vital signs were stable. Conclusion: Orally administered MSG significantly decreased salivary gland, kidney, and other normal-organ PSMA radiotracer uptake in human subjects, using 18F-DCFPyL as an exemplar. However, MSG caused a corresponding reduction in tumor uptake, which may limit the benefits of this approach for diagnostic and therapeutic applications.

  • monosodium glutamate
  • PSMA
  • prostate-specific membrane antigen
  • salivary glands
  • kidney

Footnotes

  • Published online May 8, 2020.

  • © 2021 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 62 (1)
Journal of Nuclear Medicine
Vol. 62, Issue 1
January 1, 2021
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The Effects of Monosodium Glutamate on PSMA Radiotracer Uptake in Men with Recurrent Prostate Cancer: A Prospective, Randomized, Double-Blind, Placebo-Controlled Intraindividual Imaging Study
Sara Harsini, Heather Saprunoff, Tina Alden, Behnoud Mohammadi, Don Wilson, François Bénard
Journal of Nuclear Medicine Jan 2021, 62 (1) 81-87; DOI: 10.2967/jnumed.120.246983

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The Effects of Monosodium Glutamate on PSMA Radiotracer Uptake in Men with Recurrent Prostate Cancer: A Prospective, Randomized, Double-Blind, Placebo-Controlled Intraindividual Imaging Study
Sara Harsini, Heather Saprunoff, Tina Alden, Behnoud Mohammadi, Don Wilson, François Bénard
Journal of Nuclear Medicine Jan 2021, 62 (1) 81-87; DOI: 10.2967/jnumed.120.246983
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Keywords

  • Monosodium glutamate
  • PSMA
  • prostate-specific membrane antigen
  • salivary glands
  • kidney
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