The use of 68Ga-PET/CT PSMA in the staging of primary and suspected recurrent renal cell carcinoma

  • Sheliyan RaveenthiranEmail author
  • Rachel Esler
  • John Yaxley
  • Sam Kyle
Original Article
Part of the following topical collections:
  1. Oncology – Genitourinary



The role of 68Ga-PSMA PET/CT in the staging of prostate cancer is well known. PSMA is also overexpressed in the neovasculature of other tumours including renal cell carcinoma (RCC), suggesting there may be a role for the use of 68Ga-PSMA PET/CT. Thus far, there has been limited literature documenting the use of 68Ga-PSMA PET/CT in the investigation and management decisions of RCC.


This was a retrospective case series of patients who received a 68Ga-PSMA PET/CT scan for staging or restaging of RCC between July 2016 and December 2018. Primary outcome measure was to identify whether 68Ga-PSMA PET/CT changed management compared to standard diagnostic CT imaging. Analysis was based on four categories: (1) identification of new disease, (2) refuting disease on CT imaging, (3) identification of synchronous primaries, and (4) concordance with CT imaging.


38 68Ga-PSMA PET/CT scans met inclusion criteria. Primary staging scans were performed in 16 patients, of which 75% showed avid primary lesions, with the majority of clear cell subtype. Management was changed in 43.8% of patients. CT agreed with 68Ga-PSMA PET/CT in 37.5% of cases. Restaging scans were performed in 22 patients. 40.9% of patients had management changed by results of 68Ga- PSMA PET/CT. CT agreed with 68Ga- PSMA PET/CT in 36.4% of cases. Management was predominantly changed due to the identification of new sites of suspected metastases, as well as the detection of synchronous primaries.


68Ga-PSMA PET/CT directly changed management in 42.1% of cases. Strongest detection rates occurred in those patients with clear cell RCC. The results of this study suggest there may be merit in the use of the modality in the staging of RCC. Further analysis, both with respect to histological confirmation, efficacy and cost-benefit, is required to determine whether there is a role for routine 68Ga-PSMA PET/CT imaging.


68Ga-PSMA PET/CT Renal cell carcinoma cancer Staging Restaging 



The authors would like to thank Professor Srinivas Kondalsamy Chennakesavan from University of Queensland and Ricardo Maldonado from PowerStats Pty. Ltd. for their assistance regarding the statistical analysis for this manuscript.

Authors’ contributions

SR collected data and wrote the manuscript. RE and JY provided expert opinion regarding renal cell carcinoma. SK provided extensive information regarding 68Ga-PSMA PET/CT. All authors read and approved the final manuscript.

Compliance with ethical standards

Ethics approval and approval to publish

Ethics approval was obtained from the Royal Brisbane and Women’s Hospital Human Research Ethics Committee ref.: HREC/18/QRBW/395 (ERM: 42076).

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

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ESM 1 (DOCX 20 kb)
259_2019_4432_MOESM2_ESM.docx (24 kb)
ESM 2 (DOCX 23 kb)


  1. 1.
    Rossi SH, Prezzi D, Kelly-Morland C, Goh V. Imaging for the diagnosis and response assessment of renal tumours. World J Urol. 2018;36:1927–42. Scholar
  2. 2.
    Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N. Imaging renal cell carcinoma with ultrasonography, CT and MRI. Nat Rev Urol. 2010;7:311–25. Scholar
  3. 3.
    Campbell SP, Baras AS, Ball MW, Kates M, Hahn NM, Bivalacqua TJ, et al. Low levels of PSMA expression limit the utility of F-18-DCFPyL PET/CT for imaging urothelial carcinoma. Ann Nucl Med. 2018;32:69–74. Scholar
  4. 4.
    Baccala A, Sercia L, Li J, Heston W, Zhou M. Expression of prostate-specific membrane antigen in tumor-associated neovasculature of renal neoplasms. Urology. 2007;70:385–90.CrossRefPubMedGoogle Scholar
  5. 5.
    Evangelista L, Basso U, Maruzzo M, Novara G. The role of radiolabeled prostate-specific membrane antigen positron emission tomography/computed tomography for the evaluation of renal cancer. Eur Urol Focus. 2018.
  6. 6.
    Hoffmann MA, Miederer M, Wieler HJ, Ruf C, Jakobs FM, Schreckenberger M. Diagnostic performance of 68Gallium-PSMA-11 PET/CT to detect significant prostate cancer and comparison with 18FEC PET/CT. Oncotarget. 2017;8:111073–83. Scholar
  7. 7.
    Zukotynski K, Lewis A, O'Regan K, Jacene H, Sakellis C, Krajewski K, et al. PET/CT and renal pathology: a blind spot for radiologists? Part 1, primary pathology. AJR Am J Roentgenol. 2012;199:W163–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Demirci E, Ocak M, Kabasakal L, Decristoforo C, Talat Z, Halac M, et al. Ga-68-PSMA PET/CT imaging of metastatic clear cell renal cell carcinoma. Eur J Nucl Med Mol Imaging. 2014;41:1461–2. Scholar
  9. 9.
    Einspieler I, Tauber R, Maurer T, Schwaiger M, Eiber M. Ga-68 prostate-specific membrane antigen uptake in renal cell cancer lymph node metastases. Clin Nucl Med. 2016;41:E261–E2. Scholar
  10. 10.
    Saadat S, Tie B, Wood S, Vela I, Rhee H. Imaging tumour thrombus of clear cell renal cell carcinoma: FDG PET or PSMA PET? Direct in vivo comparison of two technologies. Urology Case Reports. 2018;16:4–5. Scholar
  11. 11.
    Sasikumar A, Joy A, Nanabala R, Unni M, Tk P. Complimentary pattern of uptake in 18F-FDG PET/CT and 68Ga-prostate-specific membrane antigen PET/CT in a case of metastatic clear cell renal carcinoma. Clin Nucl Med. 2016;41:e517–e9.CrossRefPubMedGoogle Scholar
  12. 12.
    Evangelista L, Cuppari L. 18F-FDG or 68Ga/18F-PSMA PET/CT in recurrent renal cancer? Clinical and Translational Imaging. 2018;6:329–30. Scholar
  13. 13.
    Siva S, Callahan J, Pryor D, Martin J, Lawrentschuk N, Hofman MS. Utility of 68Ga prostate specific membrane antigen – positron emission tomography in diagnosis and response assessment of recurrent renal cell carcinoma. J Med Imaging Radiat Oncol. 2017;61:372–8. Scholar
  14. 14.
    Takahashi M, Kume H, Koyama K, Nakagawa T, Fujimura T, Morikawa T, et al. Preoperative evaluation of renal cell carcinoma by using 18F-FDG PET/CT. Clin Nucl Med. 2015;40:936–40.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Pinthus JH, Whelan KF, Gallino D, Lu J-P, Rothschild N. Metabolic features of clear-cell renal cell carcinoma: mechanisms and clinical implications. Can Urol Assoc J. 2011;5:274–82. Scholar
  16. 16.
    Rhee H, Tham CM, Blazak J, Ng KL, Thomas P, Vela I, et al. Staging advanced and metastatic clear cell renal cell carcinoma with 68-gallium PSMA PET for treatment planning. Asia Pac J Clin Oncol. 2016;12:48.CrossRefGoogle Scholar
  17. 17.
    Chang SS, Reuter VE, Heston WD, et al. Metastatic renal cell carcinoma neovasculature expresses prostate-specific membrane antigen. Urology. 2001;57:801.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Li G, Lambert C, Gentil-Perret A, et al. Molecular and cytometric analysis of renal cell carcinoma cells. Concepts, techniques and prospects. Prog Urol. 2003;13:1.PubMedGoogle Scholar
  19. 19.
    Al-Ahmadie HA, Olgac S, Gregor PD, et al. Expression of prostate-specific membrane antigen in renal cortical tumors. Mod Pathol. 2008;21:727.CrossRefPubMedGoogle Scholar
  20. 20.
    Sawicki LM, Buchbender C, Boos J, Giessing M, Ermert J, Antke C, et al. Diagnostic potential of PET/CT using a 68Ga-labelled prostate-specific membrane antigen ligand in whole-body staging of renal cell carcinoma: initial experience. Eur J Nucl Med Mol Imaging. 2017;44:102–7. Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Royal Brisbane & Women’s HospitalBrisbaneAustralia
  2. 2.Wesley Urology ClinicBrisbaneAustralia
  3. 3.Department of MedicineUniversity of QueenslandBrisbaneAustralia

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