[18F]AlF-PSMA-11 PET in diagnosing prostate cancer: a head-to-head comparison with [68Ga]Ga-PSMA-11 PET and an exploration of dual-phase scanning

Abstract

Purpose

To evaluate the physiological distribution and tumour detection ability of [¹⁸F]AlF-PSMA-11 positron emission tomography (PET) dual-phase scans in patients with prostate cancer (PCa).

Methods

As a retrospective study, clinical and PET data of PCa patients who underwent dual-phase [¹⁸F]AlF-PSMA-11 PET of routine scan (45–50 min) and delayed scan (120 min) from November 2020 to June 2021 were collected, and physiological and pathological regions of interest were quantified to determine the time-dependent maximum standardized uptake value (SUV_max) of [¹⁸F]AlF-PSMA-11. Part of the above subjects who underwent [⁶⁸Ga]Ga-PSMA-11 PET in the following 6 months were included in a head-to-head comparison. The difference with a p-value < 0.05 was defined as statistical significance. Diagnosis accuracy of primary and metastatic lesions was measured referring to the surgical findings, pathology, and follow-up imaging.

Results

[⁶⁸Ga]Ga-PSMA-11 and [¹⁸F]AlF-PSMA-11 were of the comparable uptake in glands in head, but the latter was of a significant lower distribution in liver and spleen. For the 25 patients initially diagnosed with prostate cancer and 3 patients with biochemical recurrence after radical surgery, the SUV_max of the primary lesions, lacrimal glands, parotid glands and submandibular glands was higher at 120 min compared to that at 45–50 min, but not a significant difference. SUV_max of the liver, spleen and bladder decreased significantly at 120 min, but the bladder SUV_max remained higher than that of primary lesions. SUV_max of the kidneys and centrum was the same in dual-phase scans. For the 31 primary lesions detected in [¹⁸F]AlF-PSMA-11 PET, both the SUV_max of the two phases kept the positive correlation with PSA, Gleason score and initial risk stratification. For the 39 distant metastatic lesions, 94.87% accuracy of routine scan and 100% accuracy of delayed scan were acquired, and 7.14% patients (2/28) benefited from the dual-phase [¹⁸F]AlF-PSMA-11 scans that revealed novel information on metastatic lesions compared to the routine scan.

Conclusion

[¹⁸F]AlF-PSMA-11 PET expanded the time window and further decreased metabolic background of [⁶⁸Ga]Ga-PSMA-11 PET. The dual-phase scan of [¹⁸F]AlF-PSMA-11 PET can benefit prostate cancer diagnosis via providing more PSMA-specific information.