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Positron Emission Tomography

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Positron emission tomography (PET) is a medical imaging technique involving radiopharmaceuticals — substances that emit short-lived radiation. Although the first PET scanner was introduced in 1961, it took 15 more years before radiopharmaceuticals were combined with the technique and revolutionized its potential.
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A Whole Body Dosimetry Protocol for Peptide-Receptor Radionuclide Therapy (PRRT): 2D Planar Image and Hybrid 2D+3D SPECT/CT Image Methods

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PSMA-PET-Guided Intraprostatic Boost in Prostate SBRT (PROBE): A Phase 2 Trial.

Maneesh Singh¹, Aparna Katdare², Suchismita Ghosh³

¹Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Mumbai, India.

International Journal of Radiation Oncology, Biology, Physics

|March 30, 2025

Summary

Gallium68-prostate-specific membrane antigen (PSMA)-PET/CT combined with MRI for prostate SBRT boost planning showed volumetric similarity but poor spatial concordance. This PSMA-PET guided boost appears safe for dose escalation, with low acute toxicity.

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Area of Science:

Oncology
Radiotherapy
Medical Imaging

Background:

Prostate stereotactic radiation therapy (SBRT) utilizes dose escalation for improved outcomes.
Accurate delineation of dominant intraprostatic lesions (DIL) is crucial for effective boost planning.
Combined imaging modalities like ⁶⁸Ga-PSMA-PET/CT and mpMRI offer complementary information for DIL targeting.

Purpose of the Study:

To evaluate the safety and concordance of combined ⁶⁸Ga-PSMA-PET/CT and mpMRI for planning DIL boost in prostate SBRT.
To assess the feasibility of using PSMA-PET/CT for dose escalation in prostate cancer radiotherapy.

Main Methods:

Phase 2 trial involving patients with intermediate- to high-risk prostate adenocarcinoma.
Fusion of ⁶⁸Ga-PSMA-PET/CT and mpMRI for gross tumor volume (GTV) delineation.
Semiautomatic contouring of DIL using %SUV_max thresholds and concordance metrics for GTV selection.
5-fraction SBRT plan incorporating prostate, pelvic nodes, GTV_union, and GTV_overlap with ADT.

Main Results:

Strong volumetric correlation (ρ = 0.817) between GTV_MRI and GTV_PET.
Median Dice similarity coefficient of 0.56 and Jaccard index of 0.37 indicated poor spatial concordance.
Median %SUV_max threshold for GTV_PET contouring was 48%, inversely correlated with DIL SUV_max.
Low rates of acute grade 2 urinary (13.3%) and GI (6.6%) toxicity, with no grade ≥3 events.

Conclusions:

⁶⁸Ga-PSMA-PET/CT and mpMRI-based boost volumes are volumetrically similar but spatially discordant.
A median %SUV_max of 48% is identified for PSMA-PET GTV contouring.
PSMA-PET guided intraprostatic boost is a safe approach for dose escalation in prostate SBRT, supported by a favorable toxicity profile.