Arsalan Tariq1, Michael Kwok2, Adam Pearce3, Handoo Rhee4, Samuel Kyle5, Phillip Marsh6, Sheliyan Raveenthiran7, David Wong8, Rhiannon McBean8, Jurjen Westera1, Nigel Dunglison1, Rachel Esler9, Anojan Navaratnam1, John W Yaxley3, Paul Thomas10, David A Pattison10, Matthew J Roberts11. 1. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. 2. Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Urology, Redcliffe Hospital, Queensland, Australia. 3. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Wesley Urology Clinic, The Wesley Hospital, Brisbane, Queensland, Australia. 4. Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 5. Department of Diagnostic Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 6. Department of Diagnostic Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 7. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Department of Urology, Redcliffe Hospital, Queensland, Australia. 8. I-MED Radiology, The Wesley Hospital, Brisbane, Queensland, Australia. 9. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Wesley Urology Clinic, The Wesley Hospital, Brisbane, Queensland, Australia. 10. Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 11. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Urology, Redcliffe Hospital, Queensland, Australia; Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: m.roberts2@uq.edu.au.
Abstract
PURPOSE: The objective of this study was to perform an intra-individual dual tracer comparison of Fluorodeoxyglucose (FDG) and Prostate Specific Membrane Antigen (PSMA) computed tomography (CT)/Positron Emission Tomography (PET) against standard of care (SOC) imaging for the characterisation, staging and restaging of renal cell carcinoma (RCC). METHODS: A multicentre retrospective cohort study was performed at 3 major tertiary referral institutions in Brisbane, Australia between 2015 and 2020. All patients who underwent both PSMA and FDG PET/CT following SOC imaging for investigation of RCC were identified. Clinical details, imaging characteristics and histopathology were collected prior to univariate statistical analysis. RESULTS: Eleven patients who underwent dual tracer PET/CT were included. Mean age was 65.5 years (SD 8.8). Most patients were male (64%) with clear cell morphology (91%). The indication for dual tracer PET was staging (36%) and restaging after radical/partial nephrectomy (64%). Primary tumour assessment showed mixed avidity patterns (concordant 40%, discordant favouring PSMA 20%, and FDG 40%). Metastatic disease assessment showed concordant avidity in 6 patients (55%), concordant negative in 3 (27%), and discordant uptake favouring PSMA. PET outperformed SOC imaging for assessment of metastatic disease in 5 patients (45%) and equivalent for the remainder. A change in management was noted in three cases (27%). CONCLUSION: Dual tracer FDG and PSMA PET/CT for assessment of primary and metastatic RCC were mostly concordant. PET imaging outperformed conventional imaging and led to a change in management for 1 in 4 patients. Further studies with larger samples sizes are required to validate these findings and identify characteristics to guide patient selection for selective or dual tracer use.
PURPOSE: The objective of this study was to perform an intra-individual dual tracer comparison of Fluorodeoxyglucose (FDG) and Prostate Specific Membrane Antigen (PSMA) computed tomography (CT)/Positron Emission Tomography (PET) against standard of care (SOC) imaging for the characterisation, staging and restaging of renal cell carcinoma (RCC). METHODS: A multicentre retrospective cohort study was performed at 3 major tertiary referral institutions in Brisbane, Australia between 2015 and 2020. All patients who underwent both PSMA and FDG PET/CT following SOC imaging for investigation of RCC were identified. Clinical details, imaging characteristics and histopathology were collected prior to univariate statistical analysis. RESULTS: Eleven patients who underwent dual tracer PET/CT were included. Mean age was 65.5 years (SD 8.8). Most patients were male (64%) with clear cell morphology (91%). The indication for dual tracer PET was staging (36%) and restaging after radical/partial nephrectomy (64%). Primary tumour assessment showed mixed avidity patterns (concordant 40%, discordant favouring PSMA 20%, and FDG 40%). Metastatic disease assessment showed concordant avidity in 6 patients (55%), concordant negative in 3 (27%), and discordant uptake favouring PSMA. PET outperformed SOC imaging for assessment of metastatic disease in 5 patients (45%) and equivalent for the remainder. A change in management was noted in three cases (27%). CONCLUSION: Dual tracer FDG and PSMA PET/CT for assessment of primary and metastatic RCC were mostly concordant. PET imaging outperformed conventional imaging and led to a change in management for 1 in 4 patients. Further studies with larger samples sizes are required to validate these findings and identify characteristics to guide patient selection for selective or dual tracer use.
Authors: Stefanie Zschäbitz; Franziska Erlmeier; Christine Stöhr; Edwin Herrmann; Iris Polifka; Abbas Agaimy; Lutz Trojan; Philipp Ströbel; Frank Becker; Christian Wülfing; Peter Barth; Michael Stöckle; Michael Staehler; Christian Stief; Axel Haferkamp; Markus Hohenfellner; Stephan Macher-Göppinger; Bernd Wullich; Joachim Noldus; Walburgis Brenner; Frederik C Roos; Bernhard Walter; Wolfgang Otto; Maximilian Burger; Andres Jan Schrader; Yvonne Mondorf; Arndt Hartmann; Philipp Ivanyi; Sandra Steffens Journal: J Cancer Date: 2022-03-14 Impact factor: 4.207