Escolar Documentos
Profissional Documentos
Cultura Documentos
Received for publication June 29, 2015; revision accepted September 12, 2015.
From the Departments of *Nuclear Medicine and Radiation Oncology, Ankara
University Medical Faculty, Ankara, Turkey.
Conflicts of interest and sources of funding: none declared.
Correspondence to: Cigdem Soydal, MD, Department of Nuclear Medicine,
Ankara University Medical Faculty, 06590, Cebeci, Ankara, Turkey. E-mail:
csoydal@yahoo.com.
Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0363-9762/15/00000000
DOI: 10.1097/RLU.0000000000001058
REFERENCES
1. Sweat SD, Pacelli A, Murphy GP, et al. Prostate-specific membrane antigen
expression is greatest in prostate adenocarcinoma and lymph node metastases.
Urology. 1998;52:637640.
2. Mannweiler S, Amersdorfer P, Trajanoski S, et al. Heterogeneity of prostatespecific membrane antigen (PSMA) expression in prostate carcinoma with
distant metastasis. Pathol Oncol Res. 2009;15:167172.
3. Baur B, Solbach C, Andreolli E, et al. Synthesis, radiolabelling and in vitro
characterization of the gallium-68, yttrium-90 and lutetium-177labelled
PSMA ligand, CHX-A-DTPA-DUPA-Pep. Pharmaceuticals (Basel). 2014;7:
517529.
4. Eder M, Schfer M, Bauder-Wst U, et al. 68Ga-complex lipophilicity and the
targeting property of a urea-based PSMA inhibitor for PET imaging.
Bioconjug Chem. 2012;23:688697.
5. Giesel FL, Fiedler H, Stefanova M, et al. PSMA PET/CT with Glu-urea-Lys(Ahx)-[68Ga(HBED-CC)] versus 3D CT volumetric lymph node assessment
in recurrent prostate cancer [published online ahead of print July 11, 2015].
Eur J Nucl Med Mol Imaging. 2015.
6. Ganguly T, Dannoon S, Hopkins MR, et al. A high-affinity [(18)F]-labeled
phosphoramidate peptidomimetic PSMA-targeted inhibitor for PET imaging
of prostate cancer. Nucl Med Biol. 2015;42:780787.
7. Behe M, Alt K, Deininger F, et al. In vivo testing of 177Lu-labelled anti-PSMA
antibody as a new radioimmunotherapeutic agent against prostate cancer.
In Vivo. 2011;25:5559.
8. Kratochwil C, Giesel FL, Eder M, et al. [177Lu]lutetium-labelled PSMA
ligand-induced remission in a patient with metastatic prostate cancer. Eur J
Nucl Med Mol Imaging. 2015;42:987988.
www.nuclearmed.com
Copyright 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
This paper can be cited using the date of access and the unique DOI number which can be found in the footnotes.
Soydal et al
FIGURE 2. The patient underwent 4 cycles of 7400-MBq 177Lu-PSMA treatment within the dates of January 29, 2015, and
June 25, 2015, between 6-week periods. Twenty-four hours after each treatment, whole-body planar scintigraphic images
were obtained with GE Millenium dual-headed SPECT camera with matrix size of 256 1024 and speed of 6.0 min/m.
In posttreatment scan of the first cycle, intense uptakes in the cranium, vertebral column, costae, pelvic bones, each scapula,
humerus, femur, and mediastinal lymph nodes were confirmed (A). At that time, serum prostate-specific antigen (PSA) level
was measured as 988.2 ng/mL. Interestingly, whole-body scan after the second dose (B) revealed an increase in number and
intensity of pathological uptake areas in axial skeleton and femurs with elevation of serum PSA level (1770 ng/mL). The number
of pathological uptake areas in skeleton dramatically decreased in the third (PSA = 55.95 ng/mL) cycle, and uptake in mediastinal
lymph nodes disappeared (C). After the fourth (PSA = 14.86 ng/mL) cycle, patient bone lesions were almost absent except a few
areas in the costae and thoracic vertebrae (D). Interestingly, the patient experienced gastrointestinal symptoms such as vomiting
and stomachache during the third and fourth cycles. In both whole-body images (C and D), increase in gastrointestinal uptake was
observed. Prostate-specific membrane antigen is a transmembrane cell surface protein expressed in prostate cancer tissue as well
as kidney, salivary glands, and intestinal system.1,2 Prostate-specific membrane antigen has been a subject of interest to bind
different radionuclides for imaging and treatment of metastatic prostatic carcinoma.36 For this reason, second-generation
antibodies have been developed to bind the extracellular domain of PSMA. Radionuclide treatment with 90Y- or 177Lu-labeled
PSMA is a potential method to treat metastatic prostatic carcinoma.7,8 Because the method has recently been developed,
experience on its potential efficacy and adverse effects have not been well known yet. In this case, we noticed there might be a
flair-like effect of treatment that might be a predictor for good response. In addition, decrease in pathological lesions might
be accompanied with increase in gastrointestinal uptake and related adverse effects.
2
www.nuclearmed.com
Copyright 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
This paper can be cited using the date of access and the unique DOI number which can be found in the footnotes.