Early Injection of Furosemide Increases Detection Rate of Local Recurrence in Prostate Cancer Patients with Biochemical Recurrence Referred for 68 Ga-PSMA-11 PET/CT.

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  • Additional Information
    • Source:
      Publisher: Society of Nuclear Medicine Country of Publication: United States NLM ID: 0217410 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1535-5667 (Electronic) Linking ISSN: 01615505 NLM ISO Abbreviation: J Nucl Med
    • Publication Information:
      Publication: Reston, VA : Society of Nuclear Medicine
      Original Publication: [Chicago, Ill.] : S.N. Turiel & Assoc.
    • Subject Terms:
      Prostatic Neoplasms*/diagnostic imaging ; Prostatic Neoplasms*/metabolism ; Positron Emission Tomography Computed Tomography* ; Furosemide*/pharmacokinetics ; Furosemide*/administration & dosage ; Gallium Radioisotopes* ; Gallium Isotopes* ; Edetic Acid*/analogs & derivatives ; Oligopeptides*/pharmacokinetics ; Neoplasm Recurrence, Local*/diagnostic imaging; Humans ; Male ; Aged ; Retrospective Studies ; Middle Aged ; Aged, 80 and over ; Radiopharmaceuticals/pharmacokinetics ; Tissue Distribution
    • Abstract:
      The aim of this study was twofold. First, we aimed to assess the impact of forced diuresis with early furosemide injection on the detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for 68 Ga-labeled Glu-NH-CO-NH-Lys(Ahx)-HBED-CC ( 68 Ga-PSMA-11) PET/CT. Second, we determined whether intravenous administration of furosemide shortly after tracer injection increases renal washout of 68 Ga-PSMA-11 before it binds to the PSMA receptor with possible influence on biodistribution and intensity of tracer uptake in organs with physiologic tracer accumulation. Methods: In a retrospective analysis, 2 different groups with 220 prostate cancer patients each, referred for 68 Ga-PSMA-11 PET/CT because of biochemical recurrence after primary therapy, were compared: patients in group 1 (median prostate-specific antigen, 1.30 ng/mL) received no preparation before imaging, whereas patients in group 2 (median prostate-specific antigen, 0.82 ng/mL) were injected with 20 mg of furosemide and 500 mL of sodium chloride (NaCl 0.9%) immediately after tracer injection. The presence of local recurrence was assessed visually. In addition, the intensity of tracer accumulation in organs with physiologic tracer uptake was evaluated. Results: The detection rate of lesions judged positive for local recurrence was significantly higher in patients receiving furosemide than in patients without preparation: 56 cases (25.5%) versus 38 cases (17.3%), respectively ( P = 0.048). Median maximum SUVs (SUV max ) of organs with physiologic uptake of 68 Ga-PSMA-11 in groups 1 and 2 were urinary bladder (63.0 vs. 8.9), kidney (55.6 vs. 54.5), liver (9.9 vs. 9.4), spleen (11.2 vs. 11.9), small bowel (16.2 vs. 17.1), parotid gland (19.2 vs. 19.6), lacrimal gland (8.9 vs. 10.9), blood-pool activity (2.2 vs. 2.3), muscle (1.0 vs. 1.1), and bone (1.6 vs. 1.6). Apart from bladder activity, no significant reduction of tracer accumulation was found in the patient group receiving furosemide. Conclusion: Injection of 20 mg of furosemide at the time point of radiotracer administration significantly increases the detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for 68 Ga-PSMA-11 PET/CT. As intensity of 68 Ga-PSMA-11 uptake in organs with physiologic uptake is not significantly reduced, a negative impact of early furosemide injection on targeting properties and biodistribution of 68 Ga-PSMA-11 seems unlikely.
      (© 2021 by the Society of Nuclear Medicine and Molecular Imaging.)
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    • Contributed Indexing:
      Keywords: 68Ga-PSMA-11; PET; PET/CT; biochemical recurrence; forced diuresis; furosemide; local recurrence; prostate cancer; prostate specific membrane antigen
    • Accession Number:
      7LXU5N7ZO5 (Furosemide)
      0 (Gallium Radioisotopes)
      0 (gallium 68 PSMA-11)
      0 (Gallium Isotopes)
      9G34HU7RV0 (Edetic Acid)
      0 (Oligopeptides)
      0 (Radiopharmaceuticals)
    • Publication Date:
      Date Created: 20210313 Date Completed: 20240724 Latest Revision: 20240724
    • Publication Date:
      20240726
    • Accession Number:
      PMC8612314
    • Accession Number:
      10.2967/jnumed.120.261866
    • Accession Number:
      33712533