The aim of this study was twofold. First, we aimed to assess the impact of forced diuresis with early furosemide injection on the detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for ⁶⁸Ga-labeled Glu-NH-CO-NH-Lys(Ahx)-HBED-CC (⁶⁸Ga-PSMA-11) PET/CT. Second, we determined whether intravenous administration of furosemide shortly after tracer injection increases renal washout of ⁶⁸Ga-PSMA-11 before it binds to the PSMA receptor with possible influence on biodistribution and intensity of tracer uptake in organs with physiologic tracer accumulation. Methods: In a retrospective analysis, 2 different groups with 220 prostate cancer patients each, referred for ⁶⁸Ga-PSMA-11 PET/CT because of biochemical recurrence after primary therapy, were compared: patients in group 1 (median prostate-specific antigen, 1.30 ng/mL) received no preparation before imaging, whereas patients in group 2 (median prostate-specific antigen, 0.82 ng/mL) were injected with 20 mg of furosemide and 500 mL of sodium chloride (NaCl 0.9%) immediately after tracer injection. The presence of local recurrence was assessed visually. In addition, the intensity of tracer accumulation in organs with physiologic tracer uptake was evaluated. Results: The detection rate of lesions judged positive for local recurrence was significantly higher in patients receiving furosemide than in patients without preparation: 56 cases (25.5%) versus 38 cases (17.3%), respectively (P = 0.048). Median maximum SUVs (SUV_max) of organs with physiologic uptake of ⁶⁸Ga-PSMA-11 in groups 1 and 2 were urinary bladder (63.0 vs. 8.9), kidney (55.6 vs. 54.5), liver (9.9 vs. 9.4), spleen (11.2 vs. 11.9), small bowel (16.2 vs. 17.1), parotid gland (19.2 vs. 19.6), lacrimal gland (8.9 vs. 10.9), blood-pool activity (2.2 vs. 2.3), muscle (1.0 vs. 1.1), and bone (1.6 vs. 1.6). Apart from bladder activity, no significant reduction of tracer accumulation was found in the patient group receiving furosemide. Conclusion: Injection of 20 mg of furosemide at the time point of radiotracer administration significantly increases the detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for ⁶⁸Ga-PSMA-11 PET/CT. As intensity of ⁶⁸Ga-PSMA-11 uptake in organs with physiologic uptake is not significantly reduced, a negative impact of early furosemide injection on targeting properties and biodistribution of ⁶⁸Ga-PSMA-11 seems unlikely.

这项研究的目的是双重的。首先，我们的目的是评估早期注射速尿强制利尿对生化复发前列腺癌患者局部复发检出率的影响，该患者转诊为⁶⁸ Ga 标记的 Glu-NH-CO-NH-Lys(Ahx)-HBED- CC ( ⁶⁸ Ga-PSMA-11) PET/CT。其次，我们确定示踪剂注射后不久静脉注射呋塞米是否会增加⁶⁸ Ga-PSMA-11 在与 PSMA 受体结合之前的肾脏冲洗，并可能影响具有生理示踪剂积累的器官中示踪剂摄取的生物分布和强度。方法：在回顾性分析中，对 2 个不同组各 220 名前列腺癌患者进行比较，这些患者因初次治疗后生化复发而转诊接受⁶⁸ Ga-PSMA-11 PET/CT：第 1 组患者（中位前列腺特异性抗原， 1.30 ng/mL）成像前未进行任何准备，而第 2 组患者（中位前列腺特异性抗原，0.82 ng/mL）在示踪剂注射后立即注射 20 mg 呋塞米和 500 mL 氯化钠（NaCl 0.9%） 。目视评估局部复发的存在。此外，还评估了具有生理示踪剂摄取的器官中示踪剂积累的强度。结果：接受呋塞米治疗的患者局部复发阳性病灶检出率显着高于未准备患者：分别为56例（25.5%）和38例（17.3%）（ P =0.048）。第 1 组和第 2 组中生理摄取⁶⁸ Ga-PSMA-11 的器官的中位最大 SUV (SUV _max ) 是膀胱（63.0 vs. 8.9)、肾脏(55.6 vs. 54.5)、肝脏(9.9 vs. 9.4)、脾脏(11.2 vs. 11.9)、小肠(16.2 vs. 17.1)、腮腺(19.2 vs. 19.6)、泪腺(8.9 vs. 19.6) . 10.9）、血池活动（2.2 vs. 2.3）、肌肉（1.0 vs. 1.1）和骨骼（1.6 vs. 1.6）。除了膀胱活动外，接受呋塞米治疗的患者组中未发现示踪剂积累显着减少。结论：在放射示踪剂给药时间点注射 20 mg 呋塞米显着提高了⁶⁸ Ga-PSMA-11 PET/CT 生化复发的前列腺癌患者局部复发的检出率。由于具有生理摄取的器官中⁶⁸ Ga-PSMA-11 的摄取强度并未显着降低，因此早期注射速尿对⁶⁸ Ga-PSMA-11 的靶向特性和生物分布产生负面影响似乎不太可能。