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OtherClinical Investigations (Human)

Early injection of furosemide increases detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for 68Ga-PSMA-11 PET/CT.

Christian Uprimny, Steffen Bayerschmidt, Alexander Stephan Kroiss, Josef Fritz, Bernhard Nilica, Hanna Svirydenka, Clemens Decristoforo, Elisabeth von Guggenberg, Wolfgang Horninger and Irene Johanna Virgolini
Journal of Nuclear Medicine March 2021, jnumed.120.261866; DOI: https://doi.org/10.2967/jnumed.120.261866
Christian Uprimny
1 Department of Nuclear Medicine, Medical University Innsbruck, Austria;
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Steffen Bayerschmidt
1 Department of Nuclear Medicine, Medical University Innsbruck, Austria;
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Alexander Stephan Kroiss
1 Department of Nuclear Medicine, Medical University Innsbruck, Austria;
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Josef Fritz
2 Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Austria;
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Bernhard Nilica
1 Department of Nuclear Medicine, Medical University Innsbruck, Austria;
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Hanna Svirydenka
1 Department of Nuclear Medicine, Medical University Innsbruck, Austria;
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Clemens Decristoforo
1 Department of Nuclear Medicine, Medical University Innsbruck, Austria;
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Elisabeth von Guggenberg
1 Department of Nuclear Medicine, Medical University Innsbruck, Austria;
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Wolfgang Horninger
3 Department of Urology, Medical University Innsbruck, Austria
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Irene Johanna Virgolini
1 Department of Nuclear Medicine, Medical University Innsbruck, Austria;
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Abstract

Purpose: The aim of this study was to assess a) the impact of forced diuresis with early furosemide injection on the detection rate of local recurrence (LR) in prostate cancer (PC) patients with biochemical recurrence (BR) referred for 68Ga-labelled Glu-NH-CO-NH-Lys(Ahx)-HBED-CC (68Ga-PSMA-11) Positron Emission Tomography/Computed Tomography (PET/CT) and b) whether intravenous administration of furosemide shortly after tracer injection increases renal wash-out of 68Ga-PSMA-11 before it binds to the PSMA-receptor with possible influence on biodistribution and intensity of tracer uptake in organs with physiologic tracer accumulation. Materials and Methods: In a retrospective analysis two different groups with 220 prostate cancer patients each, referred for 68Ga-PSMA-11 PET/CT because of biochemical recurrence after primary therapy, were compared: patients of group one (median prostate specific antigen (PSA): 1.30 ng/ml) receiving no preparation prior to imaging, whereas patients in group two (median PSA: 0.82 ng/ml) were injected with 20 mg furosemide and 500 ml sodium chloride (NaCl 0.9%) immediately after tracer injection. Presence of local recurrence was assessed visually. In addition, intensity of tracer accumulation in organs with physiologic tracer uptake was evaluated standardized uptake value. Results: The detection rate of lesions judged positive for local recurrence was significantly higher in patients receiving furosemide compared to patients without preparation: 56 cases (25.5%) vs 38 cases (17.3%), respectively (P = 0.048). Median maximum standardized uptake values (SUVmax) of organs with physiologic uptake of 68Ga-PSMA-11 in group one and two were: urinary bladder (63.0 vs 8.9), kidney (55.6 vs 54.5), liver (9.9 vs 9.4), spleen (11.2 vs 11.9), small bowel (16.2 vs 17.1), parotid gland (19.2 vs 19.6), lacrimal gland (8.9 vs 10.9), blood pool activity (2.2 vs 2.3), muscle (1.0 vs 1.1) and bone (1.6 vs 1.6). Apart from bladder activity, no significant reduction of tracer accumulation was found in the patient group receiving furosemide. Conclusion: Injection of 20 mg furosemide at the timepoint of radiotracer administration significantly increases the detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for 68Ga-PSMA-11 PET/CT. As intensity of 68Ga-PSMA-11-uptake in organs with physiologic uptake is not significantly reduced, a negative impact of early furosemide injection on targeting properties and biodistribution of 68Ga-PSMA-11 seems unlikely.

  • Genitourinary
  • Oncology: GU
  • PET/CT
  • PET/CT
  • PSMA
  • biochemical recurrence
  • furosemide
  • prostate cancer
  • Copyright © 2021 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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Journal of Nuclear Medicine: 62 (4)
Journal of Nuclear Medicine
Vol. 62, Issue 4
April 1, 2021
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Early injection of furosemide increases detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for 68Ga-PSMA-11 PET/CT.
Christian Uprimny, Steffen Bayerschmidt, Alexander Stephan Kroiss, Josef Fritz, Bernhard Nilica, Hanna Svirydenka, Clemens Decristoforo, Elisabeth von Guggenberg, Wolfgang Horninger, Irene Johanna Virgolini
Journal of Nuclear Medicine Mar 2021, jnumed.120.261866; DOI: 10.2967/jnumed.120.261866

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Early injection of furosemide increases detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for 68Ga-PSMA-11 PET/CT.
Christian Uprimny, Steffen Bayerschmidt, Alexander Stephan Kroiss, Josef Fritz, Bernhard Nilica, Hanna Svirydenka, Clemens Decristoforo, Elisabeth von Guggenberg, Wolfgang Horninger, Irene Johanna Virgolini
Journal of Nuclear Medicine Mar 2021, jnumed.120.261866; DOI: 10.2967/jnumed.120.261866
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Keywords

  • Genitourinary
  • Oncology: GU
  • PET/CT
  • PSMA
  • biochemical recurrence
  • furosemide
  • prostate cancer
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