68 Ga‐prostate‐specific membrane antigen (PSMA) PET/CT as a clinical decision‐making tool in biochemically recurrent prostate cancer

Background: The aim of this work was to assess the use of prostate-specific membrane antigen (PSMA)-labelled radiotracers in detecting the recurrence of prostate cancer. PSMA is thought to have higher detection rates when utilized in positron emission tomography (PET)/computed tomography (CT) scans, particularly at lower prostate-specific antigen (PSA) levels, compared with choline-based scans. Methods: A systematic review was conducted comparing choline and PSMA PET/CT scans in patients with recurrent prostate cancer following an initial curative attempt. The primary outcomes were overall detection rates, detection rates at low PSA thresholds, difference in detection rates and exclusive detection rates on a per-person analysis. Secondary outcome measures were total number of lesions, exclusive detection by each scan on a per-lesion basis and adverse side effects. Results: Overall detection rates were 79.8% for PSMA and 66.7% for choline. There was a statistically significant difference in detection rates favouring PSMA [OR (M–H, random, 95% confidence interval (CI)) 2.27 (1.06, 4.85), p = 0.04]. Direct comparison was limited to PSA < 2 ng/ml in two studies, with no statistically significant difference in detection rates between the scans [OR (M–H, random, 95% CI) 2.37 (0.61, 9.17) p = 0.21]. The difference in detection on the per-patient analysis was significantly higher in the PSMA scans ( p < 0.00001). All three studies reported higher lymph node, bone metastasis and locoregional recurrence rates in PSMA. Conclusions: PSMA PET/CT has a better performance compared with choline PET/CT in detecting recurrent disease both on per-patient and per-lesion analysis and should be the imaging modality of choice while deciding on salvage and nonsystematic metastasis-directed therapy strategies.

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Impact of 11C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-014-2872-x ◽

2014 ◽

Vol 41 (12) ◽

pp. 2222-2231 ◽

Cited By ~ 56

Author(s):

Francesco Ceci ◽

Ken Herrmann ◽

Paolo Castellucci ◽

Tiziano Graziani ◽

Christina Bluemel ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Recurrent Prostate Cancer ◽

Choline Pet ◽

Pet Ct

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MP18-09 INFLUENCE OF GA-PSMA PET/CT ON CLINICAL DECISION MAKING IN THE TREATMENT OF PATIENTS WITH PROSTATE CANCER.

The Journal of Urology ◽

10.1016/j.juro.2017.02.619 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Carlos Ferreira ◽

Liliana Violante ◽

Rui Freitas ◽

Isaac Braga ◽

Victor Silva ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Psma Pet ◽

Pet Ct

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The role of PSMA PET/CT imaging in the diagnosis, staging and restaging of prostate cancer

Future Oncology ◽

10.2217/fon-2020-1293 ◽

2021 ◽

Author(s):

Dominic Bagguley ◽

Sean Ong ◽

James P Buteau ◽

Sam Koschel ◽

Nattakorn Dhiantravan ◽

...

Keyword(s):

Prostate Cancer ◽

Imaging Technique ◽

Imaging Techniques ◽

Multiparametric Mri ◽

Prostate Specific Membrane Antigen ◽

Recurrent Prostate Cancer ◽

Psma Pet ◽

Pet Ct ◽

Specific Membrane

Prostate-specific membrane antigen (PSMA) PET/CT is a novel imaging technique for the detection and staging of either primary or recurrent prostate cancer. Early studies demonstrated its improved sensitivity and specificity over and in combination with other currently employed imaging techniques, such as multiparametric MRI, bone scan, PET and CT. However, the lack of strength and confidence in these studies has meant incorporation of PSMA PET/CT into clinical guidelines and practice has been limited to date. In response, a number of high-quality prospective studies have recently emerged and reflect exciting results seen in preceding publications. Here we recount some of the key earlier publications, report results from the latest studies and look to the future discussing some of the eagerly awaited ongoing clinical trials.

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Erratum to: Impact of 11C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-014-2913-5 ◽

2014 ◽

Vol 41 (12) ◽

pp. 2359-2359 ◽

Cited By ~ 2

Author(s):

Francesco Ceci ◽

Ken Herrmann ◽

Paolo Castellucci ◽

Tiziano Graziani ◽

Christina Bluemel ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Recurrent Prostate Cancer ◽

Choline Pet ◽

Pet Ct

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68-Ga prostate-specific membrane antigen-PET as a diagnostic and clinical decision making tool in biochemical recurrences post-radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.377 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 377-377

Author(s):

Janice Ser Huey Tan ◽

Charles Xian-Yang Goh ◽

Youquan Li ◽

Jeffrey Tuan ◽

Eu Tiong Chua ◽

...

Keyword(s):

Decision Making ◽

Radical Prostatectomy ◽

Clinical Decision Making ◽

Systemic Disease ◽

False Negative ◽

Clinical Decision ◽

Prostate Specific Membrane Antigen ◽

Detection Rates ◽

Psma Pet ◽

Specific Membrane

377 Background: In patients with biochemical relapse (BCR) following radical prostatectomy (RadP), risk stratification by clinical indices alone is suboptimal for identifying subgroups likely to benefit from salvage radiotherapy (RT). It is also recommended that combination hormonal therapy (HT)-RT improves rates of salvage and survival, hence the need for a clinical tool to better stratify patients for RT and HT-RT; the latter approach for patients at risk of occult metastases. Herein, we investigated the role of 68Ga-Prostate-specific Membrane Antigen (PSMA)-PET in the detection of regional and distal recurrences, and for clinical decision making in a prospective cohort of patients with BCR post-RadP. Methods: 68Ga-PSMA-PET and CT were performed in a cohort of 50 RadP patients with BCR. Radiological interpretation was independently performed by two assessors, who were blinded to the patient identifiers. PSMA+ lesions were considered as true positives; negative-PSMA in the presence of continued PSA rise defined false negative. Impact on clinical decision making was reviewed by comparison of PSMA-PET and CT findings in the post-RadP PSA 0.5-2.0 ng/ml subgroup. Results: Overall detection rate for 68Ga-PSMA/PET was 74% (37 of 50) in our cohort with a median post-RadP PSA level of 2.19 (IQR = 0.45-4.26). Detection rates were significantly increased at a PSA cut-off > 1.0; 96% (25 of 26) at > 2.0 and 100% (5 of 5) at 1.0-2.0 compared to 67% (4 of 6) at 0.5-1.0, and 23% (3 of 13) at < 0.5 (P < 0.001). In 0.5-2.0 PSA subgroup, 3 regional nodes and 11 distal (6 nodes, 4 bones, 1 lung) lesions were detected. This altered treatment in 5 of the 11 (46%) cases; 3 N+ cases would have been recommended for HT-RT and pelvic nodal RT, while RT would be omitted in 2 patients due to low volume systemic disease. Conclusions: Our findings support the existing data for PSMA-PET as a sensitive diagnostic tool for clinical recurrences post-RadP. Additionally, the detection of small volume nodal and distal lesions at post-RadP PSA levels of < 2.0 ng/ml highlights the potential utility of PSMA-PET for selecting patients to treatment intensification with HT-RT or omission of RT in cases of distal relapse.

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P063 Staging of biochemical recurrent prostate cancer after radical prostatectomy using 68Gallium-labelled ligand of prostate-specific membrane antigen PET/CT and PET/MRI

European Urology Supplements ◽

10.1016/s1569-9056(14)61286-0 ◽

2014 ◽

Vol 13 (5) ◽

pp. 132

Author(s):

T. Maurer ◽

V. Beck ◽

A.J. Beer ◽

M. Souvatzoglou ◽

K. Holzapfel ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Prostate Specific Membrane Antigen ◽

Recurrent Prostate Cancer ◽

Pet Ct ◽

Specific Membrane

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Prostate-specific membrane antigen (PSMA) PET-CT guided radiotherapy in oligometastatic prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.213 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 213-213

Author(s):

Benedikt Engels ◽

Ozan Cem Guler ◽

Cem Onal ◽

Mark De Ridder

Keyword(s):

Prostate Cancer ◽

Lymph Nodes ◽

Pelvic Bone ◽

Prostate Specific Membrane Antigen ◽

Ct Guided ◽

Castration Resistant ◽

Psma Pet ◽

Pet Ct ◽

Oligometastatic Prostate Cancer ◽

Specific Membrane

213 Background: Metastases-directed therapy by metastasectomy or radiotherapy (RT) might delay disease progression and postpone systemic treatment in patients with oligometastatic prostate cancer. Here, we evaluated retrospectively the efficacy and toxicity of 68Ga prostate-specific membrane antigen (PSMA) PET-CT guided radiotherapy (RT) in the treatment of oligometastatic prostate cancer. Methods: A total of 23 prostate cancer patients with biochemical relapse, of which 13 castration-sensitive and 10 castration-resistant, were treated with intensity-modulated and image-guided RT (IMRT-IGRT) on ≤ 3 metastases detected by 68Ga PSMA PET-CT. Androgen deprivation therapy was continued in castration-resistant patients. Local control (LC), progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method. Results: A total of 38 metastases were treated. Involved sites were pelvic bone (n = 16), pelvic lymph nodes (n = 11), para-aortic lymph nodes (n = 6), ribs (n = 3) and vertebral body (n = 2). The median PSA prior to RT was 1.06 ng/ml (range 0.10 – 29.0 ng/ml). A median dose of 43.5 Gy (range, 30-64 Gy) was delivered by IMRT-IGRT in 12-27 fractions. At a median follow-up of 7 months (range, 2-17 months), 19 patients (83%) are in remission. Four patients (17%) developed distant recurrence. The actuarial 1-year LC, PFS and OS rates were 100%, 51% (95% CI 8-83%) and 100%. Castration-sensitive patients displayed a statistically significantly superior PFS on univariate analysis as compared to castration-resistant patients (1-year PFS 67% vs 0%, p < 0.01). One patient experienced grade 2 acute gastro-intestinal toxicity. No grade 3 or more toxic events were observed. Conclusions: By providing optimal LC, low toxicity and a promising PFS in castration-sensitive patients, the current retrospective study illustrated that 68Ga PSMA PET-CT guided RT may be an attractive treatment option in patients with oligometastatic prostate cancer. Validation by randomized trials is eagerly awaited.

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