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Research ArticleClinical Investigation
Open Access

Eligibility for 177Lu-PSMA Therapy Depends on the Choice of Companion Diagnostic Tracer: A Comparison of 68Ga-PSMA-11 and 99mTc-MIP-1404 in Metastatic Castration-Resistant Prostate Cancer

Gary J.R. Cook, Wai-Lup Wong, Bal Sanghera, Stephen Mangar, Amarnath Challapalli, Amit Bahl, Paul Bassett, Darren Leaning and Christian Schmidkonz
Journal of Nuclear Medicine February 2023, 64 (2) 227-231; DOI: https://doi.org/10.2967/jnumed.122.264296
Gary J.R. Cook
1Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom;
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Wai-Lup Wong
2Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Northwood, United Kingdom;
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Bal Sanghera
2Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Northwood, United Kingdom;
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Stephen Mangar
3Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom;
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Amarnath Challapalli
4Department of Clinical Oncology, Bristol Cancer Institute, Bristol, United Kingdom;
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Amit Bahl
4Department of Clinical Oncology, Bristol Cancer Institute, Bristol, United Kingdom;
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Paul Bassett
5Statsconsultancy Ltd, Amersham, United Kingdom;
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Darren Leaning
6Department of Clinical Oncology, James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom;
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Christian Schmidkonz
7Department of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany; and
8Department of Industrial Engineering and Health, Technical University of Applied Sciences Amberg-Weiden, Weiden, Germany
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    FIGURE 1.

    Box plots of 99mTc-MIP-1404 and 68Ga-PSMA-11 liver SUVmax (P = 0.002) (A) and lesion-to-liver SUVmax ratios (P = 0.009) (B) in patients with mCRPC. median = central line; mean = X; box = interquartile range (IQR); whiskers = maximum and minimum values; O = outliers > 1.5 IQR.

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    TABLE 1.

    Characteristics in 99mTc-MIP-1404 and 68Ga-PSMA-11 Groups

    Characteristic99mTc-MIP-140468Ga-PSMA-11
    Median age (y)72 (range, 62–91)71 (range, 54–84)
    Median Gleason score9 (SD, 8–9)9 (SD, 7–9)
    Mean PSA413.6 (SD, 581.6)415.6 (SD, 1,101.7)
    Prior ADT2425
    Current ADT68
    Prior prostatectomy144
    Prior prostate radiotherapy1313
    Prior chemotherapy2015
    miTNM
     Prostate710
     N1813
     M1a88
     M1b2323
     M1c34
    • ADT = androgen deprivation therapy; miTNM = molecular imaging tumor, node and metastasis staging.

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    TABLE 2.

    Lesion, Normal-Organ (Liver, Spleen, Parotid Gland, MBP), and Lesion–to–Normal-Organ Ratios Between 99mTc-MIP-1404 and 68Ga-PSMA-11 mCRPC Patients

    99mTc-MIP-140468Ga-PSMA-11
    ParameterMedianMean ± SDMedianMean ± SDP
    Lesion SUVmax18.2 (4.1–52.1)17.3 (3.4–128.0)0.93
    Liver SUVmax8.5 (4.7–13.9)5.8 (3.9–9.0)0.002
    Lesion-to-liver SUVmax ratio2.5 (0.6–10.0)3.7 (0.8–17.1)0.009
    Parotid gland SUVmax13.4 ± 7.116.8 ± 6.40.23
    Lesion–to–parotid gland SUVmax ratio1.8 (0.3–6.4)1.4 (0.3–7.0)0.5
    Spleen SUVmax11.5 (5.4–22.5)9.3 (4.9–16.0)0.072
    Lesion-to-spleen SUVmax ratio1.4 (0.3–6.1)2.0 (0.4–14.9)0.034
    MBP SUVmax1.1 ± 0.31.6 ± 0.30.003
    Lesion-to-MBP SUVmax ratio19.9 (3.8–114.5)13.5 (2.7–57.6)0.011
    • Data in parentheses are ranges.

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Journal of Nuclear Medicine: 64 (2)
Journal of Nuclear Medicine
Vol. 64, Issue 2
February 1, 2023
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Eligibility for 177Lu-PSMA Therapy Depends on the Choice of Companion Diagnostic Tracer: A Comparison of 68Ga-PSMA-11 and 99mTc-MIP-1404 in Metastatic Castration-Resistant Prostate Cancer
Gary J.R. Cook, Wai-Lup Wong, Bal Sanghera, Stephen Mangar, Amarnath Challapalli, Amit Bahl, Paul Bassett, Darren Leaning, Christian Schmidkonz
Journal of Nuclear Medicine Feb 2023, 64 (2) 227-231; DOI: 10.2967/jnumed.122.264296

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Eligibility for 177Lu-PSMA Therapy Depends on the Choice of Companion Diagnostic Tracer: A Comparison of 68Ga-PSMA-11 and 99mTc-MIP-1404 in Metastatic Castration-Resistant Prostate Cancer
Gary J.R. Cook, Wai-Lup Wong, Bal Sanghera, Stephen Mangar, Amarnath Challapalli, Amit Bahl, Paul Bassett, Darren Leaning, Christian Schmidkonz
Journal of Nuclear Medicine Feb 2023, 64 (2) 227-231; DOI: 10.2967/jnumed.122.264296
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Keywords

  • 177Lu-PSMA-617
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