The value of intravenous contrast medium in PSMA PET/CT imaging in patients with biochemical recurrence of prostate cancer

208 Background: It is estimated that within ten years of primary treatment for prostate cancer up to 40% of patients post radical prostatectomy, and up to 50% of patients post radiotherapy will develop disease recurrence. While monitoring of PSA levels is informative of biochemical recurrence, it may precede radiologically detectable recurrence by months to years, and cannot differentiate local/regional recurrence from systemic disease. This represents a management dilemma for treating physicians. The incorporation of PET probes targeting prostate-specific membrane antigen (PSMA) for prostate cancer shows promise for improving the management of patients with prostate cancer, when used alongside existing imaging techniques, like CT, MRI and bone scans. Methods: Retrospective review of all patients referred from our institution for PSMA imaging was carried out. Baseline clinical features were determined and we analyzed impact of PSMA imaging on management outcomes and survival data. Results: 33 patients referred for 68Ga-PSMA-PET imaging were identified. Median age at diagnosis was 65 years (51 -75). The indication for referral in all patients was biochemical recurrence in the absence of radiological evidence of disease by CT imaging and bone scan. Median PSA at time of referral for PSMA scan was 7.3ug/L (1.4ug/L to 87.7ug/L). 100% of patients (n = 33) were upstaged following PSMA imaging, and 30% (n = 10) had more than one site of metastatic disease identified. Most common sites of metastasis were lymph node and bone. Median number of sites of metastatic disease identified by PSMA imaging was one. These results led to a change in management for 96% patients (n = 32). All patients at the time of this review are alive with a median follow up of 13 months, and median progression-free survival of 11 months. Conclusions: PSMA PET-CT directly led to an alteration in the treatment of the majority of patients in this study. This real world data reflects the growing role of PSMA imaging in influencing clinical decisions for prostate cancer patients with biochemical recurrence. Prospective data from randomized studies are awaited to further validate the role of PSMA PET-CT in this patient cohort.

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A Prospective Study on 18F-DCFPyL PSMA PET/CT Imaging in Biochemical Recurrence of Prostate Cancer

Journal of Nuclear Medicine ◽

10.2967/jnumed.119.226381 ◽

2019 ◽

Vol 60 (11) ◽

pp. 1587-1593 ◽

Cited By ~ 14

Author(s):

Etienne Rousseau ◽

Don Wilson ◽

Frédéric Lacroix-Poisson ◽

Andra Krauze ◽

Kim Chi ◽

...

Keyword(s):

Prostate Cancer ◽

Prospective Study ◽

Biochemical Recurrence ◽

Ct Imaging ◽

Psma Pet ◽

Pet Ct ◽

A Prospective Study

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Assessment of volumetric parameters derived from 68Ga-PSMA PET/CT in prostate cancer patients with biochemical recurrence

Nuclear Medicine Communications ◽

10.1097/mnm.0000000000001459 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Berna Okudan ◽

Nazim Coşkun ◽

Bedri Seven ◽

Merve Ağcioğlu Atalay ◽

Aslihan Yildirim ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Biochemical Recurrence ◽

Psma Pet ◽

Pet Ct

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Oligometastatic Disease Detection with 68Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact

Cancers ◽

10.3390/cancers13194982 ◽

2021 ◽

Vol 13 (19) ◽

pp. 4982

Author(s):

Carlos Artigas ◽

Romain Diamand ◽

Qaid Ahmed Shagera ◽

Nicolas Plouznikoff ◽

Fabrice Fokoue ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Predictive Factors ◽

Clinical Management ◽

Biochemical Recurrence ◽

Oligometastatic Disease ◽

Psma Pet ◽

Pet Ct ◽

Hormone Sensitive

Metastasis-directed therapy (MDT) in oligometastatic prostate cancer has the potential of delaying the start of androgen deprivation therapy (ADT) and disease progression. We aimed to analyze the efficacy of PSMA-PET/CT in detecting oligometastatic disease (OMD), to look for predictive factors of OMD, and to evaluate the impact of PSMA-PET/CT findings on clinical management. We retrospectively analyzed a homogeneous population of 196 hormone-sensitive prostate cancer patients (HSPC), considered potential candidates for MDT, with a PSMA-PET/CT performed at biochemical recurrence (BCR) after radical prostatectomy (RP). Multivariable logistic regression analysis was performed based on several clinico-pathological factors. Changes in clinical management before and after PSMA-PET/CT were analyzed. The OMD detection rate was 44% for a total positivity rate of 60%. PSMA-PET/CT positivity was independently related to PSA (OR (95%CI), p) (1.7 (1.3–2.3), p < 0.0001) and PSAdt (0.4 (0.2–0.8), p = 0.013), and OMD detection was independently related to PSA (1.6 (1.2–2.2), p = 0.001) and no previous salvage therapy (0.3 (0.1–0.9), p = 0.038). A treatment change was observed in 58% of patients, mostly to perform MDT after OMD detection (60% of changes). This study showed that PSMA-PET/CT is an excellent imaging technique to detect OMD early in HSPC patients with BCR after RP, changing therapeutic management mostly into MDT.

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The Impact of 18F-DCFPyL PSMA PET-CT in the Management of Prostate Cancer Biochemical Recurrence

Open Journal of Urology ◽

10.4236/oju.2021.1111038 ◽

2021 ◽

Vol 11 (11) ◽

pp. 393-403

Author(s):

Raquel García ◽

Virginia Morillo ◽

Pablo Sopena ◽

Miguel R. Soler ◽

María Rodríguez ◽

...

Keyword(s):

Prostate Cancer ◽

Biochemical Recurrence ◽

Psma Pet ◽

Pet Ct ◽

The Impact

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[68Ga]Ga-PSMA-11 PET-CT: Local preliminary experience in prostate cancer biochemical recurrence patients

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2021.1.21 ◽

2021 ◽

Vol 93 (1) ◽

pp. 21-25

Author(s):

João Carvalho ◽

Pedro Nunes ◽

Edgar Tavares Da Silva ◽

Rodolfo Silva ◽

João Lima ◽

...

Keyword(s):

Prostate Cancer ◽

Complete Remission ◽

Biochemical Recurrence ◽

Detection Rate ◽

Salvage Treatment ◽

Clinical Approach ◽

Curative Intent ◽

Psma Pet ◽

Pet Ct ◽

Pelvic Relapse

Objectives: Clinical approach of prostate cancer (PCa) biochemical recurrence (BCR) is an ever-changing topic. Prostate-specific membrane antigen positron emission tomography ([68Ga]Ga-PSMA-11 PET-CTPSMA PET-CT) has shown good potential in this field. The aim is to evaluate PSMA PET-CT detection rate in PCa BCR and assess its impact on clinical outcome. Material and methods: Out of 319 patients with PCa who underwent PSMA PET-CT between October 2015 and June 2019, 70 had developed BCR after treatment with curative intent. Two groups were created: one with BCR after surgery (RP group) (N: 48; 68.6%) and other with BCR after radiotherapy (RT group) (N: 22; 31.4%). Clinical, analytical, pathological and PSMA PET-CT results were evaluated. Results: Initial age was different between groups (p = 0.008). RP patients were mainly at intermediate risk (85.1% vs 42.9%, p = 0.001) while RT patients were at low risk of recurrence (8.5% vs 47.6%, p = 0.001). In RP and RT groups, PSMA PETCT detected, respectively, pelvic relapse in 31.3% and 63.6%, and extrapelvic relapse in 18.8% and 31.8%. Salvage treatment was performed in 61.9% (n = 26) of RP patients and in 15% (n = 3) of RT patients, p < 0.001. Of RP patients submitted to salvage treatment, 59.1% achieved complete remission. Concerning these patients, local radiotherapy led to complete remission in 68.4% (n = 13). Of RT patients submitted to salvage treatment, two had complete remission and one had partial remission.Concerning detection rate, PSMA PET-CT was positive for pelvic relapse when pre-PET PSA ≥ 0.8 ng/mL (RP) or ≥ 2.3 ng/mL (RT) and for extrapelvic relapse when PSA ≥ 0.4 ng/mL (RP) or ≥ 3.5 ng/mL (RT), p > 0.05. Conclusions: Biochemical persistence rate after salvage therapy was similar (30-40%). The cut-off PSA values for pelvic relapse detected on PSMA PET-CT were ≥ 0.8 ng/mL (RP) and ≥ 2.3 ng/mL (RT).

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