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@ARTICLE{Dietlein:910154,
      author       = {Dietlein, Felix and Kobe, Carsten and Vázquez, Sergio
                      Muñoz and Fischer, Thomas and Endepols, Heike and Hohberg,
                      Melanie and Reifegerst, Manuel and Neumaier, Bernd and
                      Schomäcker, Klaus and Drzezga, Alexander E. and Dietlein,
                      Markus},
      title        = {{A}n 89{Z}r-{L}abeled {PSMA} {T}racer for {PET}/{CT}
                      {I}maging of {P}rostate {C}ancer {P}atients},
      journal      = {Journal of nuclear medicine},
      volume       = {63},
      number       = {4},
      issn         = {0022-3123},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {FZJ-2022-03641},
      pages        = {573 - 583},
      year         = {2022},
      abstract     = {The short half-life of existing
                      prostate-specificmembraneantigen (PSMA) tracers limits their
                      time for internalization into tumor cells after injection,
                      which is an essential prerequisite for robust detection of
                      tumor lesions with low PSMA expression on PET/CT scans.
                      Because of its longer half-life, the 89Zr-labeled ligand
                      89Zr-PSMA-DFO allows acquisition of PET scans up to 6 d
                      after injection, thereby overcoming the above limitation. We
                      investigated whether 89Zr-PSMA-DFO allowed more sensitive
                      detection of weak PSMA-positive prostate cancer lesions.
                      Methods: We selected 14 prostate cancer patients with
                      biochemical recurrence who exhibited no PSMA-positive
                      lesions on a PET scan acquired with existing PSMA tracers
                      (68Ga-PSMA-11, 18F-JK-PSMA-7). Within 5 wk after the
                      negative scan result, we obtained a second PSMA PET scan
                      using 89Zr-PSMA-DFO (117 6 16 MBq, PET acquisition within 6
                      d of injection). Results: 89Zr-PSMADFO detected 15
                      PSMA-positive lesions in 8 of 14 patients, who had a
                      PET-negative reading of their initial PET scans with
                      existing tracers. In these 8 patients, the new scans
                      revealed localized recurrence of disease (3/8), metastases
                      in lymph nodes (3/8), or lesions at distant sites (2/8). On
                      the basis of these results, patients received lesiontargeted
                      radiotherapies (5/8), androgen deprivation therapies (2/8),
                      or no therapy (1/8). The plausibility of 14 of 15 lesions
                      was supported by histology, clinical follow-up after
                      radiotherapy, or subsequent imaging. Furthermore, comparison
                      of the 15 89Zr-PSMA-DFO–positive lesions with their
                      correlates on the original PET scan revealed that
                      established tracers exhibited mild accumulation in 7 of 15
                      lesions; however, contrast-to-noise ratios were too low for
                      robust detection of these lesions (contrast-to-noise ratios,
                      2.4 6 3.7 for established tracers vs. 10.2 6 8.5
                      for89Zr-PSMA-DFO, P 5 0.0014). The SUVmax of the 15
                      89ZrPSMA-DFO–positive lesions (11.5 6 5.8) was
                      significantly higher than the SUVmax on the original PET
                      scans (4.7 6 2.8, P5 0.0001). Kidneys were the most exposed
                      organ, with doses of 3.3 6 0.7 mGy/MBq. The effective dose
                      was 0.15 6 0.04 mSv/MBq. Conclusion: In patients with weak
                      PSMA expression, a longer period of time might be needed for
                      ligand internalization than that offered by existing PSMA
                      tracers to make lesions visible on PET/CT scans. Hence,
                      89ZrPSMA-DFO might be of significant benefit to patients in
                      whom the search for weak PSMA-positive lesions is
                      challenging. Radiation exposure should be weighed against
                      the potential benefitof metastasis-directed therapy or
                      salvage radiotherapy, which weinitiated in $36\%$ (5/14) of
                      our patients based on their 89Zr-PSMA-DFO PET scans.},
      cin          = {INM-5 / INM-2},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-5-20090406 / I:(DE-Juel1)INM-2-20090406},
      pnm          = {5253 - Neuroimaging (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5253},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {34326129},
      UT           = {WOS:000796182700014},
      doi          = {10.2967/jnumed.121.262290},
      url          = {https://juser.fz-juelich.de/record/910154},
}