PET/CT with ¹⁸F-PSMA-1007 in Diagnostics of Metastatic Lesions of Clear-Cell Renal Cell Carcinoma in Comparison with ¹⁸F-FDG: Prospective Study

Purpose: To demonstrate the capabilities of PET/CT with ¹⁸F-PSMA-1007 in comparison with ¹⁸F-FDG in the diagnostics of metastatic ccRCC.

Material and methods: Ninety-seven patients with metastatic ccRCC were included in the study. Biopsy results of the primary tumor were available in all patients. Metastatic foci were confirmed by biopsy, follow-up and other diagnostic methods. All patients under went PET/CT with ¹⁸F-PSMA-1007 and ¹⁸F FDG.

Results: A total of 1247 metastases were identified in 97 patients: 1002 — PSMA-positive, 245 — PSMA-negative, 694 — FDG-positive, and 553 — FDG-negative. The largest number of foci was found in the lungs (601 in 43 patients), bones (220 in 46 patients), and lymph nodes (166 in 34 patients).

Sixty-two patients had more PSMA-positive foci compared with ¹⁸FDG, 32 had an equal number of foci, and 3 had more foci according to PET/CT with ¹⁸FDG.

The sensitivity and specificity of ¹⁸F-PSMA-1007 in the diagnostics of ccRCC metastases were 80 % and 72 %, positive and negative predictive value were 87 % and 61 %, respectively.

The sensitivity and specificity of ¹⁸F-FDG in the diagnostics of ccRCC metastases were 55 % and 54 %, positive and negative predictive value were 69 % and 41 %, respectively.

The mean SUV_max difference between ¹⁸F-PSMA-1007 and ¹⁸FDG was 5.32, and the mean TBR difference was 5.66. Lung foci demonstrated significantly lower SUV_max and TBR for both RPs compared to other metastases.

Discussion and conclusions. Data analysis demonstrates higher efficiency of ¹⁸F-PSMA-1007 compared to ¹⁸F-FDG in the diagnostics of ccRCC metastases. PET/CT with ¹⁸F-PSMA-1007 revealed a higher number of metastases, SUV_max and TBR in studies with ¹⁸F-PSMA-1007 are on average significantly higher than those with ¹⁸F FDG.

PET/CT with ¹⁸F-PSMA-1007 demonstrates the lowest efficiency in the diagnosis of foci in the lungs up to 1 cm. It is feasible to analyze pulmonary foci and other metastases separately to exclude the influence of a large number of low-active and false-negative foci on statistical parameters.

PET/CT with ¹⁸F-PSMA-1007 can be recommended for use in patients with suspected metastatic ccRCC as an alternative to routine diagnostic methods and PET/CT with ¹⁸F-FDG. The potential of ¹⁸F-PSMA-1007 in assessing the efficacy of systemic therapy requires further investigation.

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