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Updated: Jun 29, 2025

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Optimizing PSMA scintigraphy for resource limited settings - a retrospective comparative study.

Olumayowa U Kolade1,2, Anita Brink3,4, Akinwale O Ayeni3,5,6

  • 1Division of Nuclear Medicine, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa. mayowakolade@gmail.com.

Cancer Imaging : the Official Publication of the International Cancer Imaging Society
|April 1, 2024
PubMed
Summary
This summary is machine-generated.

[99mTc]Tc-PSMA scintigraphy (PS) using planar or SPECT imaging is adequate for staging prostate cancer (PCa) in resource-limited settings. Limiting the field of view can optimize imaging time without missing metastatic lesions.

Keywords:
99mTc-PSMA scintigraphyDeveloping worldPlanarProstate CancerResource limitationSPECTSPECT/CT

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Area of Science:

  • Nuclear medicine
  • Oncology
  • Medical imaging

Background:

  • Prostate cancer (PCa) management relies on sensitive imaging, but PET/CT is often inaccessible in developing regions.
  • Technetium-99m-labeled PSMA scintigraphy (PS) offers a more accessible alternative using gamma cameras.
  • Resource constraints may necessitate simplified PS protocols, such as limited field of view (FOV) or omitting SPECT/CT.

Purpose of the Study:

  • To evaluate the adequacy of simplified [99mTc]Tc-PSMA scintigraphy (PS) protocols for prostate cancer (PCa) detection and staging.
  • To determine if planar-only or SPECT-only imaging with a limited FOV is sufficient in resource-limited settings.

Main Methods:

  • Retrospective review of PS scans from 95 histologically confirmed PCa patients.
  • Comparison of detection rates for primary tumor and metastases across planar, SPECT, and SPECT/CT imaging.
  • Assessment of inter-modality agreement for metastasis detection and TNM staging.
  • Evaluation of the impact of a limited FOV on imaging findings.

Main Results:

  • SPECT/CT detected pathological prostatic uptake in all evaluable cases; SPECT showed 90.3%, and planar images 15.1%.
  • Seminal vesicle involvement was identified on SPECT/CT but not on planar or SPECT alone in 11.7% of patients.
  • Agreement was moderate to good for nodal metastases (κ=0.41–0.61) and good for bone metastases (κ=0.73–0.77).
  • TNM staging agreement was good (κ=0.70–0.88), and no metastatic lesions were missed with a limited FOV.

Conclusions:

  • While SPECT/CT is recommended for [99mTc]Tc-PSMA scintigraphy (PS), planar and SPECT imaging are adequate for staging most prostate cancer (PCa) patients in resource-limited environments.
  • Simplified PS protocols, including limited FOV, can optimize imaging time without compromising staging accuracy.
  • The accessibility of PS makes it a valuable tool for PCa management where advanced imaging is unavailable.