A Practical Guide to PSMA PET Radiopharmaceuticals for Prostate Cancer Imaging, From the AJR Special Series on...

Area of Science:

• Nuclear medicine
• Radiopharmaceutical chemistry
• Oncology imaging

Background:

• Prostate-specific membrane antigen (PSMA)-targeted PET/CT is standard for prostate cancer imaging.
• FDA approvals include [68Ga]Ga-PSMA-11, [18F]DCFPyl, and [18F]rhPSMA-7.3.
• These agents share a PSMA-binding domain but differ in radioisotope, ligand structure, and clearance.

Purpose of the Study:

• To compare clinically relevant similarities and differences among PSMA-targeted PET radiopharmaceuticals.
• To guide radiologists in selecting the appropriate agent for clinical use.
• To address confusion regarding the development and application of multiple PSMA agents.

Main Methods:

• Review of existing literature on PSMA-targeted radiopharmaceuticals.
• Analysis of imaging characteristics, including synthesis, distribution, and clearance.
• Comparison of operational considerations and supply logistics.

Main Results:

• Radiopharmaceuticals differ in radioisotope properties and ligand structure, impacting synthesis and distribution.
• Renal versus hepatic clearance affects lesion detection near organs.
• Current evidence shows no single agent is diagnostically superior; intrapatient comparisons are limited.

Conclusions:

• Understanding the distinct properties of PSMA agents is crucial for clinical decision-making.
• Variations in clearance and imaging characteristics necessitate careful selection based on clinical context.
• Further research and direct comparisons are needed to optimize the use of these agents in prostate cancer management.