18: PSMA-PET-Based Response Assessment of Metastatic Prostate Cancer Response to Radiotherapy: A Case Series

2021 ◽  
Vol 163 ◽  
pp. S11
Author(s):  
Aruz Mesci ◽  
Mohammad Gouran-Savadkoohi ◽  
Jeffrey Greenspoon ◽  
Anil Kapoor ◽  
Himanshu Lukka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Case Series ◽  
Response Assessment ◽  
Psma Pet

68Ga-PSMA PET/CT for response assessment and outcome prediction in metastatic prostate cancer patients treated with taxane-based chemotherapy

2021 ◽  
pp. jnumed.121.263006
Author(s):  
Qaid Ahmed Shagera ◽  
Carlos Artigas ◽  
Ioannis Karfis ◽  
Gabriela Critchi ◽  
Nieves Martinez Chanza ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Metastatic Prostate Cancer ◽  
Outcome Prediction ◽  
Response Assessment ◽  
Psma Pet ◽  
Pet Ct

68Ga-PSMA expression changes on PET/CT for response assessment during taxane-based chemotherapy in metastatic prostate cancer patients.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 35-35
Author(s):  
Qaid Shagera ◽  
Carlos Artigas ◽  
Patrick Flamen
Keyword(s):  
Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Response Assessment ◽  
Biological Data ◽  
Psma Pet ◽  
Pet Ct ◽  
Psa Response ◽  
The Mean ◽  
Mean Time ◽  
Psma Expression

35 Background: Imaging-based response to systemic therapies in metastatic prostate cancer is still challenging. The aim of this study was to retrospectively investigate the association between Prostate-Specific Membrane Antigen (PSMA) expression changes on 68Ga PSMA PET/CT and the response to treatment following the start of taxane-based chemotherapies (docetaxel or cabazitaxel) in both metastatic hormonosensitive (mHSPC) and castration-resistant prostate cancer (mCRPC) patients. Methods: We retrospectively reviewed all 68Ga-PSMA-11 PET/CT scans performed at our institution from November 2014 to June 2020. We included mHSPC and mCRPC patients with a baseline 68Ga-PSMA PET/CT performed < 2 months before, and a second 68Ga-PSMA PET/CT performed < 3 months after docetaxel or cabazitaxel (with no modification in therapy between scans). The biological data was used to distinguish PSA-non-responders (increasing PSA or decreasing PSA by < 50% from pretherapy level) and PSA-responders (decreasing PSA > 50% following the start of therapy or the peak thereafter). The PSMA PET/CT response was assessed visually by two independent nuclear medicine physicians blinded to clinical data and patient outcomes. Patients were classified as PSMA-non-responders (≥1 new PSMA-expressing metastases, majority of PSMA-expressing metastases increasing in intensity, or stable PSMA-expression of the disease) or PSMA-responders (complete disappearance of pathologic PSMA uptake, or majority of PSMA-expressing metastases decreasing in intensity). Majority of lesions was defined as > 50% of registered lesions. Descriptive statistics and measures of associations (two-sided Fisher’s exact test and Phi coefficient) were calculated. Results: A total of 37 patients were included (8 mHSPC and 29 mCRPC), 21 patients under docetaxel and 16 cabazitaxel. All patients received at least 3 cycles [median 6 (range 3-10)]. The mean time (±standard deviation) between the first 68Ga-PSMA PET/CT and the start of therapy was 22±16 days. The mean time between the the last cycleand the second 68Ga-PSMA PET/CT was 36±27 days. PSA-response and PSMA-response were concordant in 95% of cases with 18 patients PSA/PSMA-non-responders and 17 PSA/PSMA-responders (Phi = 0.90, p = 0.0001). Two discordant patients presented with PSMA-response but PSA-non-response. No isolated PSMA flare was observed, as PSA-response was always associated with a decrease in PSMA-expression on the second PET/CT. Conclusions: This retrospective study suggests PSMA expression changes on PET/CT at least after 3 cycles of chemotherapy (docetaxel or cabazitaxel) are strongly associated with PSA response. No flare phenomenon was found at this evaluation. Prospective studies are needed to better define the potential role of PSMA-PET/CT in response assessment.

scholarly journals Radiotherapy of oligometastatic prostate cancer: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Paul Rogowski ◽  
Mack Roach ◽  
Nina-Sophie Schmidt-Hegemann ◽  
Christian Trapp ◽  
Rieke von Bestenbostel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Predictive Factors ◽  
Therapeutic Potential ◽  
Case Series ◽  
Current Evidence ◽  
Oligometastatic Disease ◽  
Psma Pet ◽  
Oligometastatic Prostate Cancer ◽  
Prognostic And Predictive Factors

Abstract Background Due to improved imaging sensitivity, the term “oligometastatic” prostate cancer disease is diagnosed more often, leading to an increasing interest in metastasis-directed therapy (MDT). There are two types of radiation based MDT applied when treating oligometastatic disease: (1) stereotactic body radiation therapy (SBRT) generally used for bone metastases; or (2) SBRT for isolated nodal oligometastases combined with prophylactic elective nodal radiotherapy. This review aims to summarize current evidence data, which may shed light on the optimal management of this heterogeneous group of patients. Methods A systematic review of the Medline database through PubMed was performed according to PRISMA guidelines. All relevant studies published up to November 2020 were identified and screened. Fifty-six titles were included. Besides outcome parameters, different prognostic and predictive factors were assessed, including site of metastases, time between primary treatment and MDT, use of systemic therapies, hormone sensitivity, as well as pattern of recurrence. Findings Evidence consists largely of retrospective case series and no consistent precise definition of oligometastasis exists, however, most investigators seem to acknowledge the need to distinguish between patients presenting with what is frequently called “synchronous” versus “metachronous” oligometastatic disease. Available data on radiotherapy as MDT demonstrate high local control rates and a small but relevant proportion of patients without progressive disease after 2 years. This holds true for both hormone sensitive and castration resistant prostate cancer diseases. The use of 68Ga-PSMA PET/CT for staging increased dramatically. Radiation doses and field sizes varied considerably among the studies. The search for relevant prognostic and predictive factors is ongoing. Conclusions To our best knowledge this review on oligometastatic prostate cancer included the largest number of original articles. It demonstrates the therapeutic potential and challenges of MDT for oligometastatic prostate cancer. Prospective studies are under way and will provide further high-level evidence.

scholarly journals Surgical Castration in Hormone-Refractory Metastatic Prostate Cancer Patients Can Be an Alternative for Medical Castration

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Masayoshi Zaitsu ◽  
Mariko Yamanoi ◽  
Koji Mikami ◽  
Yuta Takeshima ◽  
Naohiko Okamoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Metastatic Prostate Cancer ◽  
Reduction Rate ◽  
Case Series ◽  
Total Testosterone ◽  
Lhrh Agonist ◽  
Hormone Refractory Prostate Cancer ◽  
Testosterone Levels ◽  
Hormone Refractory

Background. Most patients with metastatic prostate cancer are endocrinologically treated with LHRH agonist, but finally castration-refractory and hormone-refractory cancers occur. Serum testosterone levels get low to “the castration level” by LHRH agonists but may not get low enough against castration-refractory prostate cancer.Methods. As case series, twelve patients suffering from hormone-refractory prostate cancer continuously on LHRH agonist underwent surgical castration. Additionally, one hundred and thirty-nine prostate cancer patients on LHRH agonist or surgical castration were tested for serum total testosterone levels.Results. Surgical castration caused decrease in serum PSA in one out of 12 hormone-refractory prostate cancer patients with PSA reduction rate 74%. Serum total testosterone levels were below the sensitivity threshold (0.05 ng/mL) in 40 of 89 (44.9%) medically castrated patients and 33 of 50 (66.0%) surgically castrated patients (P=.20).Conclusion. Even hormone-refractory prostate cancer patients are candidates for surgical castration because of endocrinological, oncological, and economical reasons.

scholarly journals Prostate-specific Membrane Antigen PET: Therapy Response Assessment in Metastatic Prostate Cancer

Radiographics ◽  
2020 ◽  
Vol 40 (5) ◽  
pp. 1412-1430 ◽  
Author(s):  
Felipe G. Barbosa ◽  
Marcelo A. Queiroz ◽  
Daniela A. Ferraro ◽  
Rafael F. Nunes ◽  
Priscilla R. Dreyer ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Therapy Response ◽  
Response Assessment ◽  
Pet Therapy ◽  
Prostate Specific Membrane Antigen ◽  
Therapy Response Assessment ◽  
Specific Membrane

scholarly journals Prior PSMA PET-CT Imaging and Hounsfield Unit Impact on Tumor Yield and Success of Molecular Analyses from Bone Biopsies in Metastatic Prostate Cancer

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3756
Author(s):  
Minke Smits ◽  
Kamer Ekici ◽  
Samhita Pamidimarri Naga ◽  
Inge M. van Oort ◽  
Michiel J. P. Sedelaar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Molecular Characterization ◽  
Metastatic Prostate Cancer ◽  
Ct Imaging ◽  
Ct Guidance ◽  
Prediction Tool ◽  
Psma Pet ◽  
Pet Ct ◽  
Bone Biopsies ◽  
Tumor Yield

Developing and optimizing targeted therapies in metastatic castration-resistant prostate cancer (mCRPC) necessitates molecular characterization. Obtaining sufficient tumor material for molecular characterization has been challenging. We aimed to identify clinical and imaging variables of imaging-guided bone biopsies in metastatic prostate cancer patients that associate with tumor yield and success in obtaining molecular results, and to design a predictive model: Clinical and imaging data were collected retrospectively from patients with prostate cancer who underwent a bone biopsy for histological and molecular characterization. Clinical characteristics, imaging modalities and imaging variables, were associated with successful biopsy results. In our study, we included a total of 110 bone biopsies. Histological conformation was possible in 84 of all biopsies, of which, in 73 of the 84, successful molecular characterization was performed. Prior use of PSMA PET-CT resulted in higher success rates in histological and molecular successful biopsies compared to CT or MRI. Evaluation of spine biopsies showed more often successful results compared to other locations for both histological and molecular biopsies (p = 0.027 and p = 0.012, respectively). Low Hounsfield units (HUs) and deviation (Dev), taken at CT-guidance, were associated with histological successful biopsies (p = 0.025 and p = 0.023, respectively) and with molecular successful biopsies (p = 0.010 and p = 0.006, respectively). A prediction tool combining low HUs and low Dev resulted in significantly more successful biopsies, histological and molecular (p = 0.023 and p = 0.007, respectively). Based on these results, we concluded that site selection for metastatic tissue biopsies with prior PSMA PET-CT imaging improves the chance of a successful biopsy. Further optimization can be achieved at CT-guidance, by selection of low HU and low Dev lesions. A prediction tool is provided to increase the success rate of bone biopsies in mCRPC patients, which can easily be implemented in daily practice.

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