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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Diagnostic performance of 99mTc-PSMA SPECT/CT in primary prostate carcinoma
Kanhaiyalal Agrawal, P Sai Sradha Patro, Tejasvini Singhal, Drishty Satpati, Prasant Nayak, Swarnendu Mandal, Navneet Kumar, Biswa Mohan Padhy, Mukund Sable, Bikash Ranjan Meher
Kanhaiyalal Agrawal, P Sai Sradha Patro, Tejasvini Singhal, Navneet Kumar, Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneshwar 751019, Odisha, India
Drishty Satpati, Radiation Sources & Irradiation Services Section, Radiopharmaceuticals Division, Bhabha Atomic Research Center, Mumbai 400085, Mahārāshtra, India
Prasant Nayak, Swarnendu Mandal, Department of Urology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneshwar 751019, Odisha, India
Biswa Mohan Padhy, Bikash Ranjan Meher, Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneshwar 751019, Odisha, India
Mukund Sable, Department of Pathology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar 751019, Odisha, India
Author contributions: Agrawal K conceptualised the study; Agrawal K, Patro PSS, and Singhal T contributed to the design, content, literature search, data interpretation and analysis, and drafting and editing the manuscript; Satpati D and Nayak P contributed to the study concept, design, and analysis; Mandal S and Kumar N helped in the data collection and analysis; Padhy BM, Sable MN, and Meher BR contributed to the design, content, and data analysis; all authors have reviewed and edited the manuscript for confirmation and final approval.
Institutional review board statement: The study was reviewed and approved by the institutional ethics committee of All India Institute of Medical Sciences Bhubaneswar with Reference Number T/IM-F/18-19/39.
Informed consent statement: All patients enrolled in study gave written informed consent.
Conflict-of-interest statement: All authors declare that they have no competing interests to disclose.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Kanhaiyalal Agrawal, MD, Additional Professor and HOD, Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Dumuduma, Bhubaneshwar 751019, Odisha, India.
nucmed_kanhaiyalal@aiimsbhubaneswar.edu.in
Received: March 26, 2025
Revised: April 17, 2025
Accepted: May 13, 2025
Published online: August 26, 2025
Processing time: 82 Days and 18.7 Hours
BACKGROUND
68Ga (gallium)-PSMA PET-CT (prostate-specific membrane antigen-directed Positron emission tomography-computed tomography) has established its role in prostate cancer management as targeted molecular imaging. However, limited studies are available on the diagnostic accuracy of 99mTc (Technetium)-PSMA-SPECT/CT. Due to its cost effectiveness and better feasibility, it needs to be explored more extensively for its incorporation into routine clinical practice.
AIM
To analyse the diagnostic accuracy of 99mTc-PSMA-SPECT/CT for detection of primary prostate carcinoma.
METHODS
As a prospective study in a tertiary hospital, 99mTc-PSMA-SPECT/CT was performed in 29 outpatients with suspected prostate cancer, with a median age of 66 (range: 50-82) years. The findings were compared to histopathology as the gold standard.
RESULTS
Nineteen of twenty-nine patients were positive on 99mTc-PSMA-SPECT/CT, of which 16 (84.2%) had prostate cancer on histopathology, while the remaining ten were negative on imaging, of which three had prostate cancer, leading to an overall sensitivity, specificity, and accuracy of 84.2%, 70%, and 79.3%, respectively, on visual analysis. Prostate:background and prostate:liver ratios were 37.18 ± 48.85 and 5.35 ± 7.35 in the malignant group, while 6.65 ± 5.17 and 1.14 ± 0.56 in the benign group, respectively. The area under the curve values for prostate:background and prostate:liver ratios were 0.833 (95% confidence interval [CI]: 0.677-0.990, P = 0.005) and 0.767 (95%CI: 0.596-0.937, P = 0.024), respectively, on receiver operator curve analysis. A cut-off value > 10.45 for prostate:background ratio (sensitivity 85% and specificity 88.9%), and > 1.15 for prostate:liver ratio (sensitivity 75% and specificity of 77.8% respectively) was found to be pertinent to differentiate between the malignant vs benign groups.
CONCLUSION
99mTc-PSMA-SPECT/CT shows a promising role in the diagnosis of primary prostate cancer.
Core Tip: 99mTc-PSMA-SPECT/CT has good diagnostic accuracy in the detection of primary prostate cancer and the results are comparable with those of its 68Ga-PSMA positron emission tomography/computed tomography counterpart. The former is more cost-effective, feasible, and accessible, and thus can be incorporated in routine clinical practice in remote places or facilities with only gamma camera.
