Digital PET and detection of recurrent prostate cancer: what have we gained, and what is still missing?

ABSTRACT

Defined by the TIME magazine ‘medical invention of the year 2000,’ positron emission computed tomography (PET/CT) has experienced impressive improvements in technology and clinical applications over time. In recent years, silicon photomultipliers (SiPMs) detectors, characterized by excellent intrinsic time resolution and high photon-detection efficiency, have been introduced as an alternative to the classic photomultiplier tubes (PMTs), thus moving the field of PET technology forward and leading to the so-called digital PET/CT (dPET/CT). On the other side, the radiopharmaceutical ⁶⁸Ga-PSMA-11, approved by the Food and Drug Administration in December 2020, proved to strongly impact prostate cancer (PCa) diagnosis and management. In the study under evaluation, Alberts et al. retrospectively compared the performance of dPET/CT and PMTs-based PET/CT, namely analogue PET/CT (aPET/CT), in two cohorts, each one including 65 patients undergoing PET/CT with ⁶⁸Ga-PSMA-11 for suspected recurrent PCa. The authors found that dPET/CT presented a higher detection rate of pathological lesions with respect to aPET/CT. Of note, dPET/CT’s higher sensitivity results are associated with an increased true-positive rate and high inter-reader agreement. This report underscores how innovative PET/CT instrumentation, by utilizing novel radiopharmaceuticals targeting specific metabolic/molecular signatures expressed by PCa, may represent a successful weapon in uro-oncology.

KEYWORDS:

• PET/CT
• nuclear medicine
• digital PET/CT
• precision medicine
• oncology
• 18f-fluciclovine
• prostate cancer

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One peer reviewer has previously received personal fees from Esmit and Springer. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.