The CHAPPP study: Changing care with PSMA-PET for prostate cancer—A retrospective study of the role of PSMA imaging in altering treatment pathways.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 13-13
Author(s):  
Andrew Schmidt ◽  
Jeffrey C. Goh ◽  
Manoj Bhatt ◽  
Paul Thomas ◽  
Aneta Suder
Keyword(s):  
Prostate Cancer ◽  
Retrospective Study ◽  
Ct Scan ◽  
Local Treatment ◽  
Primary Treatment ◽  
Treatment Pathways ◽  
Additional Information ◽  
Psma Pet ◽  
Pet Ct ◽  
Work Up

13 Background: The low sensitivity of standard imaging (SI) techniques in detecting metastases (Ms) may lead to unnecessary local treatment for patients (Pts) with newly diagnosed or recurrent prostate cancer (PC). Ga-68-PSMA (Prostate Specific Membrane Antigen)-PET-CT is a novel imaging technique with increased sensitivity in detection of PC especially at low PSA values and may change the decision to pursue primary local or salvage treatment. This study quantified changes in definitive local treatment secondary to occult Ms detected on Ga-68-PSMA not visualized on SI. Methods: A retrospective study was performed of 509 consecutive PSMA scans (and 481 Pts) at our tertiary cancer centre, the Royal Brisbane and Women’s Hospital between Sept 2014 and Dec 2015. PSMA imaging was compared with a CT scan and bone scan to determine whether PSMA results altered the decision to pursue local treatment. Results: 81 (16%) Pts had PSMA-PET-CT scan and no Ms on SI, 40 prior to definitive local treatment and 41 as work up for recurrence. 9/40 Pts (23%) undergoing primary work-up had PSMA-identified Ms not visible on SI and altered these patients treatment pathway (mean PSA 20.5 ng/mL). Because of PSMA-diagnosed Ms, 3 did not receive local treatment. 4 had pelvic nodal involvement and received definitive radiotherapy (RT) including nodal fields. 2 Pts proceeded to radical prostatectomy with the addition of lymph node dissection. 41 Pts investigated for recurrence following local treatment had SI for comparison, (mean PSA 4.7, range 0.11 – 35 ng/mL). 11/41 (27%) were found to have distant or nodal Ms not visualized on SI. 7/11 with prior surgery did not proceed to salvage RT and the remaining Pts who had Ms were referred for an earlier medical oncology opinion. In total 20/81 (25%) of Pts had a direct change in treatment due to the additional information conferred by PSMA imaging. Conclusions: PSMA is more sensitive in the detection of prostate cancer Ms for patients being evaluated for primary treatment or looking for recurrence following local treatment. These results show clinically meaningful changes in management with avoidance of local treatment because of enhanced detection of metastases.

False-Positive Findings on Bone Scintigraphy After MRI-Guided Stereotactic Ablative Radiotherapy for Osseous Oligometastasis.

2021 ◽  
Author(s):  
Yukihiro Hama ◽  
Etsuko Tate
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Radiation Therapy ◽  
Ct Scan ◽  
False Positive ◽  
Psma Pet ◽  
Pet Ct ◽  
Bone Spect ◽  
Radical Radiation ◽  
Pet Ct Scan

Abstract Radical radiation therapy for oligorecurrent prostate cancer is considered to improve both overall and disease-specific survival. Therefore, accurate diagnosis by imaging is important when considering the indications for radiation therapy. We present a case of marginal recurrence of bone metastases from castration-resistant prostate cancer previously treated with radical radiation therapy, which could not be detected by bone single photon emission computed tomography/computed tomography (SPECT/CT) but could be diagnosed by 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT). Bone SPECT/CT showed false-positive tracer uptake in the lesion previously irradiated. 68Ga-PSMA PET/CT scan showed no abnormal uptake in the previously irradiated lesion, but showed intense uptake in the newly developed metastasis near the irradiated site. 68Ga-PSMA PET/CT scan may be able to diagnose marginal recurrence after radiation therapy more accurately than bone SPECT/CT.

scholarly journals Can SUVmax values of Ga-68-PSMA PET/CT scan predict the clinically significant prostate cancer?

2019 ◽  
Vol 40 (1) ◽  
pp. 86-91 ◽  
Author(s):  
Emre Demirci ◽  
Levent Kabasakal ◽  
Onur E. Şahin ◽  
Elife Akgün ◽  
Mehmet Hamza Gültekin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Ct Scan ◽  
Psma Pet ◽  
Pet Ct ◽  
Clinically Significant ◽  
Pet Ct Scan

Randomized prospective phase 3 trial of 68Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT].

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS5101-TPS5101
Author(s):  
Jeremie Calais ◽  
Johannes Czernin ◽  
Wolfgang P Fendler ◽  
David Elashoff ◽  
Nicholas George Nickols
Keyword(s):  
Prostate Cancer ◽  
Molecular Imaging ◽  
Ct Scan ◽  
Radiation Oncologist ◽  
Phase 3 ◽  
Prostate Bed ◽  
Psma Pet ◽  
Pet Ct ◽  
Biochemical Progression ◽  
Pet Ct Scan

TPS5101 Background: Salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence after prostatectomy offers long-term biochemical control in about 50–60% of patients. SRT is commonly initiated in patients with serum PSA levels < 1 ng/mL, a threshold at which standard-of-care imaging is insensitive for detecting recurrence. As such, SRT target volumes are usually drawn in the absence of radiographically visible disease. 68Ga-PSMA-11 (PSMA) PET/CT molecular imaging is highly sensitive and may offer anatomic localization of PCa biochemical recurrence. However, it is unclear if incorporation of PSMA PET/CT imaging into the planning of SRT could improve its likelihood of success. The purpose of this trial is to evaluate the success rate of SRT for recurrence of PCa after prostatectomy with and without planning based on PSMA PET/CT. Methods: We will randomize 193 patients to proceed with standard SRT (control arm 1, n = 90) or undergo a PSMA PET/CT scan (free of charge for patients) prior to SRT planning (investigational arm 2, n = 103). The primary endpoint is the success rate of SRT measured as biochemical progression-free survival (BPFS) after initiation of SRT. Biochemical progression is defined by PSA ≥ 0.2 ng/mL and rising. The randomization ratio of 1:1.13 is based on the assumption that approximately 13% of subjects randomized to Arm 2 will not be treated with SRT because of PSMA-positive extra-pelvic metastases. These patients will not be included in the primary endpoint analysis but will still be followed. The choice of treating the prostate bed alone vs prostate bed and pelvic lymph nodes, with or without androgen deprivation therapy (ADT), is selected by the treating radiation oncologist. The radiation oncologist may change the radiation plan depending on the findings of the PSMA PET/CT scan. Any other imaging is allowed for SRT planning in both arms if done per routine care. Patients will be followed until either one of the following conditions occur: 5 years after the date of initiation of randomization, biochemical progression, diagnosis of metastatic disease, initiation of any additional salvage therapy, death. Discussion: This is the first randomized phase 3 prospective trial designed to determine whether PSMA PET/CT molecular imaging can improve outcomes in patients with PCa early BCR following radical prostatectomy. Clinical trial information: NCT03582774.

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