68Ga-PSMA-11 PET/CT in patients with recurrent prostate cancer—a modified protocol compared with the common protocol

Fabian Haupt, Lotte Dijkstra, Ian Alberts, Christos Sachpekidis, Viktor Fech, Silvan Boxler, Tobias Gross, Tim Holland-Letz, Helle D. Zacho, Uwe Haberkorn, Kambiz Rahbar, Axel Rominger, Ali Afshar-Oromieh

Research output: Contribution to journalArticle


Purpose: 68Ga-PSMA-11 PET/CT is commonly performed at 1 h post injection (p.i.). However, various publications have demonstrated that most prostate cancer (PC) lesions exhibit higher contrast at later imaging. The aim of this study was to compare the “common” protocol of 68Ga-PSMA-11 PET/CT with a modified protocol. Methods: In 2017, we used the following scanning protocol for 68Ga-PSMA-11 PET/CT in patients with recurrent PC: acquisition at 1 h p.i. without further preparations. From 2018, all scans were conducted at 1.5 h p.i. In addition, patients were orally hydrated with 1 L of water 0.5 h p.i. and were injected with 20 mg of furosemide 1 h p.i. Both protocols including 112 patients (2017) and 156 (modified protocol in 2018) were retrospectively compared. Rates of pathologic scans, maximum standardized uptake values (SUVmax), and tumor contrast (ratio lesion-SUVmax/background-SUVmean) as well as average standardized uptake values (SUVmean) of urinary bladder were analyzed. Results: Both tumor contrast and tracer uptake were significantly (p < 0.001) higher in the novel protocol. Although statistically not significant, the rates of pathologic scans were also higher in the modified protocol: 76.3% vs. 68.8% for all PSA values including 38.9% vs. 25.0% for PSA < 0.5 ng/ml and 60.0% vs. 56.7% for PSA > 0.5–≤ 2.0 ng/ml. Average SUVmean of the urinary bladder was significantly (p < 0.001) lower with the modified protocol. Conclusions: The modified protocol, which includes a combination of delayed image acquisition at 1.5 h p.i., hydration, and furosemide resulted in higher tumor contrast and seems to have the potential to increase the rates of pathological scans, especially at low PSA levels.

Original languageEnglish (US)
Pages (from-to)624-631
Number of pages8
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number3
Publication statusPublished - Mar 1 2020



  • Furosemide
  • Ga-PSMA-11
  • Hydration
  • PET/CT
  • PSMA
  • Prostate cancer
  • Prostate-specific membrane antigen
  • Protocol

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this