Radiation Dosimetry of <sup>99m</sup>Tc-PSMA I&S: A Single-Center Prospective Study
Szabolcs Urbán, Catherine Meyer, Magnus Dahlbom, István Farkas, Gábor Sipka, Zsuzsanna Besenyi, Johannes Czernin, Jérémie Calais, László Pávics
Abstract
<sup>99m</sup>Tc-PSMA I&S is a prostate-specific membrane antigen (PSMA) tracer that can be used for planar and SPECT/CT γ-imaging and radioguided surgery. The primary aim of this study was to estimate the dosimetry of <sup>99m</sup>Tc-PSMA I&S using a hybrid method (sequential γ-planar imaging and 1 single SPECT/CT) in healthy volunteers. The secondary aim was to depict the tracer biodistribution and tumor-to-background ratios (TBRs) in patients with prostate cancer (PCa). <b>Methods:</b> Dosimetry of <sup>99m</sup>Tc-PSMA I&S was investigated in 4 healthy volunteers. Whole-body planar imaging was acquired at 1, 2, 3, 6, and 24 h and SPECT/CT at 6 h after tracer injection. Contours of organs were drawn on all acquisitions to determine organ activity at each time point. Absorbed dose was estimated using 2 methods: independent curve-fitting manual method (Levenberg-Marquardt–based algorithm using dose factors from RAdiation Dose Assessment Resource [RADAR] website) and OLINDA/EXM software (version 2.0; HERMES Medical Solutions). Biodistribution of <sup>99m</sup>Tc-PSMA I&S was assessed in 10 patients with PCa on SPECT/CT images at 6 h. Tumor uptake (SUV<sub>max</sub>), and TBR (tumor SUV<sub>max</sub>/background organ SUV<sub>mean</sub>) using muscle (T/M), bladder (T/B), and intestine (T/I) as background organs were determined. <b>Results:</b> The mean injected activity of <sup>99m</sup>Tc-PSMA I&S was 717 MBq (range: 562–828 MBq). No adverse events related to the injection of <sup>99m</sup>Tc-PSMA I&S were reported. The average radiation effective dose was 0.0055 mSv/MBq with the RADAR manual method and 0.0052 mSv/MBq with OLINDA/EXM. Total body effective dose ranged between 3.33–4.42 and 3.11–4.23 mSv, respectively. All PCa patients showed high tracer uptake in primary and metastatic lesions with T/M, T/B, and T/I ranging from 5.29–110, 0.11–7.02, and 0.96–16.30, respectively. <b>Conclusion:</b> Effective doses of <sup>99m</sup>Tc-PSMA I&S were comparable to those known for most of the <sup>99m</sup>Tc tracers and was lower than for the <sup>68</sup>Ga-labeled and <sup>18</sup>F-labeled agents. <sup>99m</sup>Tc-PSMA I&S SPECT/CT showed high TBR in PCa patients. This study can provide required data for translation and approval of <sup>99m</sup>Tc-PSMA I&S by regulatory agencies.