open access

Vol 26 (2023): Continuous Publishing
Review paper
Submitted: 2023-08-18
Accepted: 2023-10-02
Published online: 2023-11-21
Get Citation

Prostate-specific membrane antigen expression in intracranial lesions — a review of the primary, metastatic, and nonneoplastic lesions

Kacper Pełka12, Aleksandra Bodys-Pełka3, Jolanta Kunikowska1
·
Pubmed: 37987378
·
Nucl. Med. Rev 2023;26:134-142.
Affiliations
  1. Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
  2. Laboratory of Center for Preclinical Research, Department of Methodology, Medical University of Warsaw, Warsaw, Poland
  3. Doctoral School, Medical University of Warsaw, Warsaw, Poland

open access

Vol 26 (2023): Continuous Publishing
Reviews
Submitted: 2023-08-18
Accepted: 2023-10-02
Published online: 2023-11-21

Abstract

Prostate-specific membrane antigen (PSMA) is a membrane protein originally discovered in prostate cancer cells. It is widely used at all stages of prostate cancer diagnosis. Several studies have highlighted its possible wide application in other cancers. This review discusses the potential use of positron emission tomography with labelled PSMA for the diagnosis or differentiation of intracranial lesions. Given the numerous reports on the usefulness of PSMA in the diagnosis of brain tumours of glial origin, the focus is on lesions of a different aetiology.

Abstract

Prostate-specific membrane antigen (PSMA) is a membrane protein originally discovered in prostate cancer cells. It is widely used at all stages of prostate cancer diagnosis. Several studies have highlighted its possible wide application in other cancers. This review discusses the potential use of positron emission tomography with labelled PSMA for the diagnosis or differentiation of intracranial lesions. Given the numerous reports on the usefulness of PSMA in the diagnosis of brain tumours of glial origin, the focus is on lesions of a different aetiology.

Get Citation

Keywords

PET/CT; PSMA; glial tumours; GBM; brain metastases; intracranial lesions

About this article
Title

Prostate-specific membrane antigen expression in intracranial lesions — a review of the primary, metastatic, and nonneoplastic lesions

Journal

Nuclear Medicine Review

Issue

Vol 26 (2023): Continuous Publishing

Article type

Review paper

Pages

134-142

Published online

2023-11-21

Page views

455

Article views/downloads

268

DOI

10.5603/nmr.97019

Pubmed

37987378

Bibliographic record

Nucl. Med. Rev 2023;26:134-142.

Keywords

PET/CT
PSMA
glial tumours
GBM
brain metastases
intracranial lesions

Authors

Kacper Pełka
Aleksandra Bodys-Pełka
Jolanta Kunikowska

References (97)
  1. Godefroy O, Duhamel A, Leclerc X, et al. Brain-behaviour relationships. Some models and related statistical procedures for the study of brain-damaged patients. Brain. 1998; 121 ( Pt 8): 1545–1556.
  2. Goldman L, Siddiqui EM, Khan A, et al. Understanding acquired brain injury: a review. Biomedicines. 2022; 10(9): 2167.
  3. Shooli H, Dadgar H, Wáng YXJ, et al. An update on PET-based molecular imaging in neuro-oncology: challenges and implementation for a precision medicine approach in cancer care. Quant Imaging Med Surg. 2019; 9(9): 1597–1610.
  4. Lowery FJ, Yu D. Brain metastasis: unique challenges and open opportunities. Biochim Biophys Acta Rev Cancer. 2017; 1867(1): 49–57.
  5. Fink KR, Fink JR. Imaging of brain metastases. Surg Neurol Int. 2013; 4(Suppl 4): S209–S219.
  6. Galldiks N, Langen KJ, Albert NL, et al. Investigational PET tracers in neuro-oncology – What's on the horizon? A report of the PET/RANO group. Neuro Oncol. 2022; 24(11): 1815–1826.
  7. Schroeder H, Hall L. Molecular imaging of brain metastases with PET. Metastasis. 2022: 1–16.
  8. Israeli RS, Powell CT, Fair WR, et al. Molecular cloning of a complementary DNA encoding a prostate-specific membrane antigen. Cancer Res. 1993; 53(2): 227–230.
  9. Farolfi A, Calderoni L, Mattana F, et al. Current and emerging clinical applications of PSMA PET diagnostic imaging for prostate cancer. J Nucl Med. 2021; 62(5): 596–604.
  10. Malik D, Kumar R, Mittal BR, et al. 68Ga-Labeled PSMA uptake in nonprostatic malignancies: has the time come to remove "PS" from PSMA? Clin Nucl Med. 2018; 43(7): 529–532.
  11. Evangelista L, Maurer T, Poel Hv, et al. [68Ga]Ga-PSMA versus [18F]PSMA positron emission tomography/computed tomography in the staging of primary and recurrent prostate cancer. A systematic review of the literature. Eur Urol Oncol. 2022; 5(3): 273–282.
  12. Maurin M, Wyczółkowska M, Sawicka A, et al. [Tc]Tc-PSMA-T4-Novel SPECT tracer for metastatic pca: from bench to clinic. Molecules. 2022; 27(21).
  13. Privé B, Derks Y, Rosar F, et al. 89Zr-labeled PSMA ligands for pharmacokinetic PET imaging and dosimetry of PSMA-617 and PSMA-I&T: a preclinical evaluation and first in man. Eur J Nucl Med Mol Imaging. 2022; 49(6): 2064–2076.
  14. Goodenberger ML, Jenkins RB. Genetics of adult glioma. Cancer Genet. 2012; 205(12): 613–621.
  15. Komori T. Grading of adult diffuse gliomas according to the 2021 WHO classification of tumors of the central nervous system. Lab Invest. 2022; 102(2): 126–133.
  16. Maher EA, Furnari FB, Bachoo RM, et al. Malignant glioma: genetics and biology of a grave matter. Genes Dev. 2001; 15(11): 1311–1333.
  17. Lah TT, Novak M, Breznik B. Brain malignancies: Glioblastoma and brain metastases. Semin Cancer Biol. 2020; 60: 262–273.
  18. Zhou Q, Xue C, Ke X, et al. Treatment response and prognosis evaluation in high-grade glioma: an imaging review based on MRI. J Magn Reson Imaging. 2022; 56(2): 325–340.
  19. Bertagna F, Albano D, Cerudelli E, et al. Potential of radiolabeled PSMA PET/CT or PET/MRI diagnostic procedures in gliomas/glioblastomas. Curr Radiopharm. 2020; 13(2): 94–98.
  20. Stopa BM, Crowley J, Juhász C, et al. Prostate-Specific membrane antigen as target for neuroimaging of central nervous system tumors. Mol Imaging. 2022: 5358545.
  21. Muoio B, Albano D, Dondi F, et al. Diagnostic accuracy of PET/CT or PET/MRI using psma-targeting radiopharmaceuticals in high-grade gliomas: a systematic review and a bivariate meta-analysis. Diagnostics (Basel). 2022; 12(7): 1665.
  22. Holzgreve A, Biczok A, Ruf VC, et al. PSMA expression in glioblastoma as a basis for theranostic approaches: a retrospective, correlational panel study including immunohistochemistry, clinical parameters and PET imaging. Front Oncol. 2021; 11: 646387.
  23. Wernicke AG, Edgar MA, Lavi E, et al. Prostate-specific membrane antigen as a potential novel vascular target for treatment of glioblastoma multiforme. Arch Pathol Lab Med. 2011; 135(11): 1486–1489.
  24. Mahzouni P, Shavakhi M. Prostate-Specific membrane antigen expression in neovasculature of glioblastoma multiforme. Adv Biomed Res. 2019; 8: 18.
  25. Yuile A, Lee A, Moon EA, et al. PSMA expression correlates with improved overall survival and VEGF expression in glioblastoma. Biomedicines. 2023; 11(4).
  26. Saffar H, Noohi M, Tavangar SM, et al. Expression of prostate-specific membrane antigen (PSMA) in brain glioma and its correlation with tumor grade. Iran J Pathol. 2018; 13(1): 45–53.
  27. Schwenck J, Tabatabai G, Skardelly M, et al. In vivo visualization of prostate-specific membrane antigen in glioblastoma. Eur J Nucl Med Mol Imaging. 2015; 42(1): 170–171.
  28. Moreau A, Febvey O, Mognetti T, et al. Contribution of different positron emission tomography tracers in glioma management: focus on glioblastoma. Front Oncol. 2019; 9: 1134.
  29. Akgun E, Akgun M, Selçuk H, et al. 68Ga PSMA PET/MR in the differentiation of low and high grade gliomas: Is 68Ga PSMA PET/MRI useful to detect brain gliomas? Eur J Radiol. 2020; 130: 109199.
  30. Verma P, Malhotra G, Goel A, et al. Differential uptake of 68Ga-PSMA-HBED-CC (PSMA-11) in low-grade versus high-grade gliomas in treatment-naive patients. Clin Nucl Med. 2019; 44(5): e318–e322.
  31. Vallejo-Armenta P, Soto-Andonaegui J, Villanueva-Pérez RM, et al. [Tc]Tc-iPSMA SPECT brain imaging as a potential specific diagnosis of metastatic brain tumors and high-grade gliomas. Nucl Med Biol. 2021; 96-97: 1–8.
  32. Salas Fragomeni RA, Menke JR, Holdhoff M, et al. Prostate-specific membrane antigen-targeted imaging with [18F]DCFPyL in high-grade gliomas. Clin Nucl Med. 2017; 42(10): e433–e435.
  33. Ninatti G, Pini C, Gelardi F, et al. The role of PET imaging in the differential diagnosis between radiation necrosis and recurrent disease in irradiated adult-type diffuse gliomas: a systematic review. Cancers (Basel). 2023; 15(2).
  34. Kumar A, ArunRaj ST, Bhullar K, et al. Ga-68 PSMA PET/CT in recurrent high-grade gliomas: evaluating PSMA expression in vivo. Neuroradiology. 2022; 64(5): 969–979.
  35. Kunikowska J, Czepczyński R, Pawlak D, et al. Expression of glutamate carboxypeptidase II in the glial tumor recurrence evaluated in vivo using radionuclide imaging. Sci Rep. 2022; 12(1): 652.
  36. Kunikowska J, Kuliński R, Muylle K, et al. 68Ga-Prostate-Specific membrane antigen-11 PET/CT: a new imaging option for recurrent glioblastoma multiforme? Clin Nucl Med. 2020; 45(1): 11–18.
  37. Sasikumar A, Joy A, Pillai MRA, et al. Diagnostic value of 68Ga PSMA-11 PET/CT imaging of brain tumors-preliminary analysis. Clin Nucl Med. 2017; 42(1): e41–e48.
  38. Marafi F, Sasikumar A, Fathallah W, et al. 18F-PSMA 1007 brain PET/CT imaging in glioma recurrence. Clin Nucl Med. 2020; 45(1): e61–e62.
  39. Matsuda M, Ishikawa E, Yamamoto T, et al. Potential use of prostate specific membrane antigen (PSMA) for detecting the tumor neovasculature of brain tumors by PET imaging with Zr-Df-IAB2M anti-PSMA minibody. J Neurooncol. 2018; 138(3): 581–589.
  40. Unterrainer M, Niyazi M, Ruf V, et al. The endothelial prostate-specific membrane antigen is highly expressed in gliosarcoma and visualized by [68Ga]-PSMA-11 PET: a theranostic outlook for brain tumor patients? Neuro Oncol. 2017; 19(12): 1698–1699.
  41. Pernthaler B, Nazerani Hooshmand T, Igrec J, et al. Oligodendroglioma in 68Ga-PSMA-11 and 18F-Fluciclovine PET/CT. Clin Nucl Med. 2021; 46(4): e231–e232.
  42. Gupta M, Choudhury PS, Gairola M, et al. Pseudoprogression on 68Ga-prostate-specific membrane antigen-11 PET/CT in a treated glioblastoma. Clin Nucl Med. 2020; 45(8): 621–622.
  43. Hatzoglou V, Patel GV, Morris MJ, et al. Brain metastases from prostate cancer: an 11-year analysis in the MRI era with emphasis on imaging characteristics, incidence, and prognosis. J Neuroimaging. 2014; 24(2): 161–166.
  44. McBean R, Tatkovic A, Wong DC. Intracranial metastasis from prostate cancer: investigation, incidence, and imaging findings in a large cohort of Australian men. J Clin Imaging Sci. 2021; 11: 24.
  45. McLaughlin LA, Yildirim O, Rosenblum MK, et al. Identification of incidental brain tumors in prostate cancer patients via PSMA PET/CT. J Neurooncol. 2023; 163(2): 455–462.
  46. Dureja S, Thakral P, Pant V, et al. Rare sites of metastases in prostate cancer detected on ga-68 PSMA PET/CT scan-a case series. Indian J Nucl Med. 2017; 32(1): 13–15.
  47. Mütevelizade G, Sezgin C, Gümüşer G, et al. Unexpected metastatic localizations of prostate cancer determined by ga PSMA PET/CT: series of four cases. Mol Imaging Radionucl Ther. 2022; 31(3): 223–226.
  48. Ross MI, Bird N, Mendichovszky IA, et al. Neurologically asymptomatic cerebral oligometastatic prostate carcinoma metastasis identified on [Ga]Ga-THP-PSMA PET/CT. EJNMMI Res. 2020; 10(1): 108.
  49. Viglialoro R, Esposito E, Zanca R, et al. What to trust, PSA or [Ga]Ga-PSMA-11: learn from experience. Res Rep Urol. 2021; 13: 597–601.
  50. Nellaiappan HS, Rajaraman V, Halanaik D, et al. Incidental detection of asymptomatic brain metastases due to carcinoma prostate in Ga-68 PSMA HBED-CC positron emission tomography-computed tomography: reiterating its superiority in assessing disease status. Indian J Nucl Med. 2022; 37(1): 99–100.
  51. Chakraborty PS, Kumar R, Tripathi M, et al. Detection of brain metastasis with 68Ga-labeled PSMA ligand PET/CT: a novel radiotracer for imaging of prostate carcinoma. Clin Nucl Med. 2015; 40(4): 328–329.
  52. Yin C, Ho B, Chan L, et al. Asymptomatic prostate cancer brain metastases on 68Ga-PSMA PET/CT. Clin Nucl Med. 2019; 44(6): e382–e384.
  53. Chan M, Hsiao E, Turner J. Cerebellar metastases from prostate cancer on 68Ga-PSMA PET/CT. Clin Nucl Med. 2017; 42(3): 193–194.
  54. Ajit N, Tejonath G, Pratyusha B, et al. Rare isolated cerebellar metastases in prostate cancer: a case report with review of literature. World J Nucl Med. 2023; 22(2): 140–143.
  55. Kulkarni M, Vare A, Shetkar S, et al. 68Ga-Prostate-Specific membrane antigen PET/CT findings in extra-axial metastasis from prostate carcinoma. Clin Nucl Med. 2020; 45(2): e85–e87.
  56. Parihar SA, Chandekar KR, Singh H, et al. Orbital and brain metastases on 68Ga-PSMA PET/CT in a patient with prostate carcinoma refractory to 177Lu-PSMA and 225Ac-PSMA therapy. Asia Ocean J Nucl Med Biol. 2021; 9(1): 67–70.
  57. Rayamajhi SJ, Ponisio MR, Siegel B. Use of 18 F-PSMA PET to distinguish cerebral radiation necrosis from tumor recurrence. Clin Nucl Med. 2023; 48(10): e483–e484.
  58. Sathekge MM, Bruchertseifer F, Lawal IO, et al. Treatment of brain metastases of castration-resistant prostate cancer with Ac-PSMA-617. Eur J Nucl Med Mol Imaging. 2019; 46(8): 1756–1757.
  59. Wei X, Schlenkhoff C, Schwarz B, et al. Combination of 177Lu-PSMA-617 and external radiotherapy for the treatment of cerebral metastases in patients with castration-resistant metastatic prostate cancer. Clin Nucl Med. 2017; 42(9): 704–706.
  60. Filizoglu N, Oksuzoglu K, Ozguven S. Distinguishing meningioma from metastasis of prostate cancer on 68Ga-PSMA PET/CT. Clin Nucl Med. 2021; 46(11): e553–e555.
  61. Pirayesh E, Tavakoli M. Metachronous brain tumor in 177Lu-PSMA scan in a patient with metastatic castration resistant prostate cancer mimicking disease progression. Mol Imaging Radionucl Ther. 2023; 32(1): 54–56.
  62. Cagney DN, Martin AM, Catalano PJ, et al. Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol. 2017; 19(11): 1511–1521.
  63. Pei Y, Liu C, Feng M, et al. The clinical application of Ga-PSMA PET/CT and regulating mechanism of PSMA expression in patients with brain metastases of lung cancer. Transl Oncol. 2023; 28: 101616.
  64. Dall'Armellina S, Cauda S, Duca S, et al. Can PSMA-Targeting PET/CT be a valuable instrument to assess the presence of brain metastases in lung cancer patients?: A case report. Clin Nucl Med. 2023; 48(6): e304–e306.
  65. Xia C, Dong X, Li He, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl). 2022; 135(5): 584–590.
  66. Gori S, Rimondini S, De Angelis V, et al. Central nervous system metastases in HER-2 positive metastatic breast cancer patients treated with trastuzumab: incidence, survival, and risk factors. Oncologist. 2007; 12(7): 766–773.
  67. Wernicke AG, Varma S, Greenwood EA, et al. Prostate-specific membrane antigen expression in tumor-associated vasculature of breast cancers. APMIS. 2014; 122(6): 482–489.
  68. Nomura N, Pastorino S, Jiang P, et al. Prostate specific membrane antigen (PSMA) expression in primary gliomas and breast cancer brain metastases. Cancer Cell Int. 2014; 14(1): 26.
  69. Kasoha M, Unger C, Solomayer EF, et al. Prostate-specific membrane antigen (PSMA) expression in breast cancer and its metastases. Clin Exp Metastasis. 2017; 34(8): 479–490.
  70. Medina-Ornelas SS, García-Pérez FO, Medel-Gamez C, et al. A single brain metastasis seen on 68Ga-PSMA PET/CT in recurrent breast cancer. Rev Esp Med Nucl Imagen Mol (Engl Ed). 2018; 37(1): 61–62.
  71. Marafi F, Sasikumar A, Alfeeli M, et al. 18F-PSMA 1007 uptake in brain metastases from breast cancer. Clin Nucl Med. 2020; 45(2): e77–e79.
  72. Arslan E, Ergül N, Karagöz Y, et al. Recurrent brain metastasis of triple negative breast cancer with high uptake in 68Ga-PSMA-11 PET/CT. Clin Nucl Med. 2021; 46(2): e106–e108.
  73. Hod N, Lantsberg S, Benkovich E, et al. Incidental detection of malignant melanoma brain recurrence on 68Ga-prostate-specific membrane antigen PET/CT. Clin Nucl Med. 2020; 45(11): 896–899.
  74. Fitzmaurice C, Allen C, Barber RM. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol. 2017; 3(4): 524–548.
  75. Rowe SP, Gorin MA, Hammers JH, et al. Imaging of metastatic clear cell renal cell carcinoma with PSMA-targeted ¹⁸F-DCFPyL PET/CT. Ann Nucl Med. 2015; 29(10): 877–882.
  76. Sadeq A, Usmani S, Esmail AA, et al. Incremental value of 18F-PSMA-1007 PET/CT in detection of metastatic renal cell carcinoma to the brain. Clin Nucl Med. 2022; 47(7): 627–628.
  77. Filizoglu N, Cetin IA, Kissa TN, et al. 68Ga-PSMA PET/CT to distinguish brain metastasis of renal cell carcinoma from radiation necrosis after stereotactic radiosurgery. Clin Nucl Med. 2021; 46(11): 913–914.
  78. Yin Y, Campbell SP, Markowski MC, et al. Inconsistent detection of sites of metastatic non-clear cell renal cell carcinoma with psma-targeted [(18)F]DCFPyL PET/CT. Mol Imaging Biol. 2019; 21(3): 567–573.
  79. Taywade SK, Damle NA, Bal C. PSMA expression in papillary thyroid carcinoma: opening a new horizon in management of thyroid cancer? Clin Nucl Med. 2016; 41(5): e263–e265.
  80. Kesim S, Oksuzoglu K. 68Ga-PSMA uptake in brain metastasis of gastric carcinoma. Clin Nucl Med. 2022; 47(9): e585–e586.
  81. Hod N, Levin D, Novoa R, et al. Incidental detection of radiotracer uptake in intracranial dermoid cyst on 18F-prostate-specific membrane antigen PET/CT during staging for prostate carcinoma. Clin Nucl Med. 2021; 46(5): e273–e275.
  82. Watts J, Box G, Galvin A, et al. Magnetic resonance imaging of meningiomas: a pictorial review. Insights Imaging. 2014; 5(1): 113–122.
  83. Gupta N, Verma R, Belho ES. Prostate-Specific membrane antigen-avid meningioma detected in 68Ga-prostate-specific membrane antigen PET/CT. Clin Nucl Med. 2020; 45(9): 692–693.
  84. Jiang JY, Liang Yip JW, Kang C, et al. Incidental prostate-specific membrane antigen-avid meningioma detected on Ga-prostate-specific membrane antigen PET/CT. Radiol Case Rep. 2021; 16(11): 3422–3425.
  85. Bilgin R, Ergül N, Çermik TF. Incidental meningioma mimicking metastasis of prostate adenocarcinoma in 68Ga-Labeled PSMA ligand PET/CT. Clin Nucl Med. 2016; 41(12): 956–958.
  86. Junqueira MZ, Rocha NH, Sapienza MT. 68Ga-prostate-specific membrane antigen PET/CT uptake in intraventricular meningioma in the choroid plexus. Clin Nucl Med. 2021; 46(1): 58–59.
  87. Jain TK, Jois AGS, Kumar V S, et al. Incidental detection of tracer avidity in meningioma in Ga-PSMA PET/CT during initial staging for prostate cancer. Rev Esp Med Nucl Imagen Mol. 2017; 36(2): 133–134.
  88. Sakthivel P, Thakar A, Prashanth A, et al. Prostate-Specific membrane antigen expression in primary juvenile nasal angiofibroma-a pilot study. Clin Nucl Med. 2020; 45(3): 195–199.
  89. Sakthivel P, Prashanth A, Thakar A, et al. Juvenile nasal angiofibroma on 68Ga-PSMA PET/CT: opening new frontiers. Clin Nucl Med. 2019; 44(2): e118–e119.
  90. Chandran A, Verma H, Bhalla AS, et al. Negative 68Ga-prostate-specific membrane antigen PET/CT scan on a recurrent juvenile nasopharyngeal angiofibroma. Clin Nucl Med. 2022; 47(3): e268–e270.
  91. Klein Nulent TJW, van Es RJJ, Krijger GC, et al. Prostate-specific membrane antigen PET imaging and immunohistochemistry in adenoid cystic carcinoma-a preliminary analysis. Eur J Nucl Med Mol Imaging. 2017; 44(10): 1614–1621.
  92. Datta Gupta S, Arora G, Kumar D, et al. Rare brain metastasis in parotid adenoid cystic carcinoma detected on 68Ga-PSMA PET/CT. Clin Nucl Med. 2021; 46(11): e561–e562.
  93. Chan M, Hsiao E. Subacute cortical infarct showing uptake on 68Ga-PSMA PET/CT. Clin Nucl Med. 2017; 42(2): 110–111.
  94. Noto B, Vrachimis A, Schäfers M, et al. Subacute stroke mimicking cerebral metastasis in 68Ga-PSMA-HBED-CC PET/CT. Clin Nucl Med. 2016; 41(10): e449–e451.
  95. Oh G, Miles K. Subacute cerebellar infarction with uptake on 68Ga-prostate-specific membrane antigen PET/CT. Clin Nucl Med. 2018; 43(2): 134–135.
  96. Vadi SK, Kumar R, Singh H, et al. 68Ga-prostate-specific membrane antigen expression in neurocysticercosis lesions in a patient with prostate carcinoma. Clin Nucl Med. 2018; 43(4): e122–e124.
  97. Wong VC, Shen L, Nasser E, et al. 68Ga-prostate-specific membrane antigen uptake in cerebral tuberculosis. Clin Nucl Med. 2020; 45(3): 238–240.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

phone: +48 58 320 94 94, fax: +48 58 320 94 60, e-mail: viamedica@viamedica.pl