Federica Matteucci1, Emilio Mezzenga2, Paola Caroli1, Valentina Di Iorio3, Anna Sarnelli2, Monica Celli1, Lorenzo Fantini1, Andrea Moretti4, Riccardo Galassi4, Ugo De Giorgi5, Giovanni Paganelli6. 1. Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 2. Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 3. Oncology Pharmacy, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 4. Nuclear Medicine Unit, AUSL Romagna, Forlì, Italy. 5. Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 6. Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. giovanni.paganelli@irst.emr.it.
Abstract
PURPOSE: Urea-based prostate-specific membrane antigen (PSMA) ligands labelled with 68Ga or 177Lu are new tracers with great potential for theranostic approaches in prostate cancer. However, clinical studies have shown that the kidneys are one of the off-target organs along with the salivary and lacrimal glands. In the kidneys, PSMA is physiologically expressed in the apical epithelium of the proximal tubules, and mannitol acts as an osmotic diuretic in these tubules. We investigated the potential of mannitol to reduce renal uptake of 68Ga-PSMA. METHODS: Kidney uptake (SUVmax) was calculated in nine patients undergoing 68Ga-PSMA PET/CT at baseline (b-PET/CT) and after intravenous infusion of 500 ml of 10% mannitol (m-PET/CT). Two different infusion schemes for mannitol were used: (1) 500 ml mannitol was infused over 40 min after 68Ga-PSMA administration (A-infusion) and (2) 250 ml mannitol was infused over 15 min before and again after 68Ga-PSMA administration (B-infusion). RESULTS: In patients receiving the A-infusion, mean SUVmax increased by 11.9% and 7.4% in the right and left kidney, respectively. In patients receiving the B-infusion, mean SUVmax decreased by 24.3% and 22.4% in the right and left kidney, respectively. CONCLUSION: Our preliminary findings indicate that mannitol may play a role in reducing off-target 68Ga-PSMA renal uptake. Administration of the osmotic diuretic should be rapid and start before 68Ga-PSMA injection. These results warrant dosimetric studies in patients treated with 177Lu-PSMA to find the best scheme for mannitol administration.
PURPOSE:Urea-based prostate-specific membrane antigen (PSMA) ligands labelled with 68Ga or 177Lu are new tracers with great potential for theranostic approaches in prostate cancer. However, clinical studies have shown that the kidneys are one of the off-target organs along with the salivary and lacrimal glands. In the kidneys, PSMA is physiologically expressed in the apical epithelium of the proximal tubules, and mannitol acts as an osmotic diuretic in these tubules. We investigated the potential of mannitol to reduce renal uptake of 68Ga-PSMA. METHODS: Kidney uptake (SUVmax) was calculated in nine patients undergoing 68Ga-PSMA PET/CT at baseline (b-PET/CT) and after intravenous infusion of 500 ml of 10% mannitol (m-PET/CT). Two different infusion schemes for mannitol were used: (1) 500 ml mannitol was infused over 40 min after 68Ga-PSMA administration (A-infusion) and (2) 250 ml mannitol was infused over 15 min before and again after 68Ga-PSMA administration (B-infusion). RESULTS: In patients receiving the A-infusion, mean SUVmax increased by 11.9% and 7.4% in the right and left kidney, respectively. In patients receiving the B-infusion, mean SUVmax decreased by 24.3% and 22.4% in the right and left kidney, respectively. CONCLUSION: Our preliminary findings indicate that mannitol may play a role in reducing off-target 68Ga-PSMA renal uptake. Administration of the osmotic diuretic should be rapid and start before 68Ga-PSMA injection. These results warrant dosimetric studies in patients treated with 177Lu-PSMA to find the best scheme for mannitol administration.
Entities:
Keywords:
Dosimetry; Mannitol; PET/CT; Prostate cancer
Authors: Wolfgang P Fendler; Matthias Eiber; Mohsen Beheshti; Jamshed Bomanji; Francesco Ceci; Steven Cho; Frederik Giesel; Uwe Haberkorn; Thomas A Hope; Klaus Kopka; Bernd J Krause; Felix M Mottaghy; Heiko Schöder; John Sunderland; Simon Wan; Hans-Jürgen Wester; Stefano Fanti; Ken Herrmann Journal: Eur J Nucl Med Mol Imaging Date: 2017-06 Impact factor: 9.236
Authors: Matthias Eiber; Tobias Maurer; Michael Souvatzoglou; Ambros J Beer; Alexander Ruffani; Bernhard Haller; Frank-Philipp Graner; Hubert Kübler; Uwe Haberkorn; Michael Eisenhut; Hans-Jürgen Wester; Jürgen E Gschwend; Markus Schwaiger Journal: J Nucl Med Date: 2015-03-19 Impact factor: 10.057
Authors: Clemens Kratochwil; Frederik L Giesel; Karin Leotta; Matthias Eder; Torsten Hoppe-Tich; Hagop Youssoufian; Klaus Kopka; John W Babich; Uwe Haberkorn Journal: J Nucl Med Date: 2015-01-22 Impact factor: 10.057
Authors: Shozo Okamoto; Anne Thieme; Jakob Allmann; Calogero D'Alessandria; Tobias Maurer; Margitta Retz; Robert Tauber; Matthias M Heck; Hans-Juergen Wester; Nagara Tamaki; Wolfgang P Fendler; Ken Herrmann; Christian H Pfob; Klemens Scheidhauer; Markus Schwaiger; Sibylle Ziegler; Matthias Eiber Journal: J Nucl Med Date: 2016-09-22 Impact factor: 10.057
Authors: Ali Afshar-Oromieh; Henrik Hetzheim; Wolfgang Kübler; Clemens Kratochwil; Frederik L Giesel; Thomas A Hope; Matthias Eder; Michael Eisenhut; Klaus Kopka; Uwe Haberkorn Journal: Eur J Nucl Med Mol Imaging Date: 2016-06-03 Impact factor: 9.236
Authors: Kristell L S Chatalic; Sandra Heskamp; Mark Konijnenberg; Janneke D M Molkenboer-Kuenen; Gerben M Franssen; Marian C Clahsen-van Groningen; Margret Schottelius; Hans-Jürgen Wester; Wytske M van Weerden; Otto C Boerman; Marion de Jong Journal: Theranostics Date: 2016-04-12 Impact factor: 11.556
Authors: Ganesan Vaidyanathan; Choong Mo Kang; Darryl McDougald; Il Minn; Mary Brummet; Martin G Pomper; Michael R Zalutsky Journal: Nucl Med Biol Date: 2018-05-05 Impact factor: 2.408
Authors: Simona Malaspina; Ugo De Giorgi; Jukka Kemppainen; Angelo Del Sole; Giovanni Paganelli Journal: Radiol Med Date: 2018-08-16 Impact factor: 3.469
Authors: Clemens Kratochwil; Wolfgang Peter Fendler; Matthias Eiber; Richard Baum; Murat Fani Bozkurt; Johannes Czernin; Roberto C Delgado Bolton; Samer Ezziddin; Flavio Forrer; Rodney J Hicks; Thomas A Hope; Levant Kabasakal; Mark Konijnenberg; Klaus Kopka; Michael Lassmann; Felix M Mottaghy; Wim Oyen; Kambiz Rahbar; Heiko Schöder; Irene Virgolini; Hans-Jürgen Wester; Lisa Bodei; Stefano Fanti; Uwe Haberkorn; Ken Herrmann Journal: Eur J Nucl Med Mol Imaging Date: 2019-08-22 Impact factor: 9.236
Authors: Amanda Kristiansson; Anders Örbom; Jonas Ahlstedt; Helena Karlsson; Wahed Zedan; Magnus Gram; Bo Åkerström; Sven-Erik Strand; Mohamed Altai; Joanna Strand; Oskar Vilhelmsson Timmermand Journal: Biomolecules Date: 2021-02-10