Diagnostic value of 68 ga-labeled prostate- specific membrane antigen ligand pet/ct in assessment and post therapeutic follow up in prostatic cancer : by Asmaa Sayed Eissa Farrag ; supervised by Prof. Dr. Manal Halim Wahba, Prof. Dr. Alaa ElDin Wafik Meshref, Prof. Dr. Tamer Wahid Kassem.

Thesis (Ph.D)-Cairo University, 2023.

Bibliography: pages 84-93.

• Prostate cancer is the second most frequent cancer in men and the sixth leading cause of death from cancer worldwide. Its incidence is expected to double by 2030 because of the aging global population. So, early detection and accurate staging are important for proper management and to improve the clinical outcome. Also, early detection of BCR increases the life expectancy.
• The conventional imaging modalities could miss small morphologically normal yet possibly neoplastic lesions. So, the whole body anatomical and functional imaging modality by PET/CT becomes a must.
• Prostate Specific Membrane Antigen is a transmembrane protein that is expressed at the cell surface of prostatic cells. Immuno-histochemical studies have shown that PSMA expression increases in case of de-differentiated, metastatic, or hormone-refractory disease. Initially reported in 2012, the most widely studied type of PSMA based PET/CT is 68Ga-labeled on the small molecular inhibitor PSMA-11 (also known as PSMA HBED-CC).
• At present, the best utilization of 68 Ga-PSMA-PET/CT appears to be in
biochemical recurrence. 68 Ga-PSMA-PET/CT has high diagnostic accuracy for lymph node metastases and has been shown to have superior detection rates to conventional imaging especially at low PSA levels.
• The purpose of our study is to assess the diagnostic value of 68Ga-PSMA PET/CT in prostatic cancer patients referred for initial and post therapeutic assessment. We studied 73 patients with prostate cancer, referred for evaluation by 68Ga-PSMA PET/CT. Thirty eight patients were referred for initial assessment and metastatic work-up and thirty five patients were referred for post therapeutic follow up to detect the possibility of disease recurrence in the post-prostatectomy patients and to evaluate the disease course after different types of therapies. Eighteen patients had underwent a limited complementary MRI study (axial T2WIs & diffusion) fused with the PET/CT findings.
• We found that 68Ga-PSMA PET/CT is a superior modality of higher sensitivity than conventional CT imaging for evaluation of the primary and metastatic prostate cancer and near compatible with mpMRI in evaluation of the local disease. Furthermore, the conventional CT has limited sensitivity and specificity as compared to 68Ga-PSMA PET/CT. Also, we noticed that the increased PSMA tracer uptake on PET/CT scans following initiation of hormone therapy for prostate cancer does not necessarily represents disease progression. Our study also revealed that the likelihood of a pathogenic 68Ga-PSMA PET/CT scan appears to be high in detection of disease recurrence with high PSA levels >2ng/ml and less at PSA levels <2 ng/ml.

يعد سرطان البروستاتا ثاني أكثر أنواع السرطانات شيوعًا بين الرجال وسادس سبب رئيسي للوفاة من السرطان في جميع أنحاء العالم. مع الاستخدام الواسع لفحص مستضد البروستاتا النوعي (PSA)، يزداد معدل تشخيص الإصابة بسرطان البروستاتا.
مستضد غشاء البروستاتا النوعي (PSMA) هو واحد من أنجح أهداف التصوير والعلاج النووي. مستضد غشاء البروستات المحدد (PSMA) هو بروتين عبر الغشاء مع تعبير مرتفع بشكل ملحوظ في خلايا سرطان البروستاتا مقارنة بأنسجة البروستاتا الحميدة. حتى عندما تكون مستويات المستضد البروستاتي النوعي منخفضة ، فقد لوحظ تعبير PSMA في معظم سرطانات البروستاتا.
فإن التنظيم الـعالي ل PSMA في الخلايا البروستاتا السرطانية معروفة جيدًا وتستخدم كعامل فعال كعلامة تشخيصية لوجود السرطان. أكثر من هذا- التعبير موجود في أكثر من 90٪ من خلايا البروستاتا السرطانية، مما يجعل PSMA يعد علامة حيوية موثوقة للأنسجة للتصوير الوظيفي لـسرطان البروستاتا.

Issues also as CD.

Text in English and abstract in Arabic & English.