Skeletal Scintigraphy in Assesing the Response of Prostate Cancer Metastases to Androgen Deprivation Therapy

Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone agonists is the basis for drug treatment in patients with metastatic prostate cancer (PC). An accurate assessment of the response of the tumor and its metastases is of primary importance for making a clinical decision regarding the continuation of treatment, changing the line of drugs or the nature of therapy. The presented clinical case illustrates the possibilities of 99mTc-pyrophosphate skeletal scintigraphy for monitoring the response of PC bone metastases to ADT. The efficiency of hormone therapy with Triptorelin has been confirmed by positive changes in the visual and quantitative scintigraphic signs that manifest the metabolic activity of bone tissue in the area of a metastatic lesion. This was manifested by a marked decrease in the intensity of 99mTc-pyrophosphate accumulation in the foci of bone pathology, by a reduction in the number of visualized hot foci, and by a gradual normalization of the scintigraphic pattern. This variant of the metabolic response of bone metastases to ADT correlated with the positive changes in laboratory parameters, as well as with the signs of reversal of the tumor and its metastases, as evidenced by magnetic resonance imaging.

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Enhancing PSMA-uptake with androgen deprivation therapy – a new way to detect prostate cancer metastases?

International braz j urol ◽

10.1590/s1677-5538.ibju.2018.0305 ◽

2019 ◽

Vol 45 (3) ◽

pp. 459-467 ◽

Cited By ~ 6

Author(s):

Conrad Leitsmann ◽

Paul Thelen ◽

Marianne Schmid ◽

Johannes Meller ◽

Carsten-Oliver Sahlmann ◽

...

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Androgen Deprivation ◽

Cancer Metastases ◽

Detect Prostate Cancer

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Prospective study on the effect of short-term androgen deprivation therapy on PSMA uptake evaluated with 68Ga-PSMA-11 PET/MRI in men with treatment-naïve prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-019-04635-7 ◽

2019 ◽

Vol 47 (3) ◽

pp. 665-673 ◽

Cited By ~ 5

Author(s):

Otto Ettala ◽

Simona Malaspina ◽

Terhi Tuokkola ◽

Pauliina Luoto ◽

Eliisa Löyttyniemi ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Metastases ◽

Androgen Deprivation Therapy ◽

Time Course ◽

Specific Antigen ◽

Androgen Deprivation ◽

Short Term ◽

Psma Pet ◽

Treatment Naïve

Abstract Purpose Based on in vitro studies, it is known that androgen deprivation therapy (ADT) increases prostate-specific membrane antigen (PSMA) expression. Therefore, we hypothesised that ADT improves the performance of PSMA-PET imaging in primary staging of prostate cancer. The purpose of the study was to demonstrate the time course effect of ADT on PSMA uptake in different types of metastatic lesions evaluated with 68Ga-PSMA-11 PET/MRI. Methods Nine men with treatment-naïve prostate cancer were enrolled to a prospective, registered (NCT03313726) clinical trial. A 68Ga-PSMA-11 PET/MRI was performed once before and 3 times post-ADT (degarelix, Firmagon). Change of maximum standardised uptake values (SUVmax) in prostate, lymph nodes, bone metastases, and physiologically PSMA-avid organs were evaluated in a time frame of 1–8 weeks. Results All patients reached castration levels within 10 days, and 50% decrease in prostate-specific antigen (PSA) concentration was observed 14 days post-ADT. A heterogeneous increase in PSMA uptake was observed 3 to 4 weeks post-ADT. This phenomenon was definitively more evident in bone metastases: 13 (57%) of the metastasis, with a mean (range) SUVmax increase of 77% (8–238%). In one patient, already having bone metastases at baseline, three new bone metastases were observed post-ADT. Of lesions with reduced SUVmax, none disappeared. Conclusions Both in patient and region level, increase in PSMA uptake post-ADT is heterogenous and is seen most evidently in bone metastases. Preliminary results on a small cohort of patients suggest the clinical impact of ADT on improving the performance of 68Ga-PSMA PET in staging seems to be minor. However, the optimal imaging time point might be 3 to 4 weeks post-ADT. Since none of the metastases with decreasing SUVmax disappeared, it seems that short-term usage of ADT does not interfere with the interpretation of 68Ga-PSMA PET. Trial registration NCT03313726, registered 18 October 2017; EUDRA-CT, 2017-002345-29.

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O12 Salvage stereotactic body radiotherapy for patients with limited prostate cancer metastases: Deferring androgen deprivation therapy

European Urology Supplements ◽

10.1016/s1569-9056(13)60381-4 ◽

2012 ◽

Vol 11 (5) ◽

pp. 189 ◽

Cited By ~ 1

Author(s):

P. Berkovic ◽

G. De Meerleer ◽

L. Delrue ◽

B. Lambert ◽

V. Fonteyne ◽

...

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Stereotactic Body Radiotherapy ◽

Androgen Deprivation ◽

Cancer Metastases

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Castration resistance and risk of bone metastases among men with nonmetastatic prostate cancer on androgen-deprivation therapy: A population-based cohort study from the Henry Ford Health System (HFHS) in Detroit, Michigan.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.163 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 163-163

Author(s):

Jennifer Beebe-Dimmer ◽

Karynsa Cetin ◽

Cecilia Yee ◽

Scott Stryker ◽

Lois Lamerato ◽

...

Keyword(s):

Prostate Cancer ◽

Cohort Study ◽

High Risk ◽

Bone Metastases ◽

Androgen Deprivation Therapy ◽

Population Based ◽

Androgen Deprivation ◽

Castration Resistant Prostate Cancer ◽

Castration Resistant ◽

Increased Risk

163 Background: Androgen deprivation therapy (ADT) is the cornerstone treatment of metastatic prostate cancer (PC), but is frequently used in the non-metastatic (M0) setting. After a variable period of hormone sensitivity, most patients develop castration-resistant prostate cancer (CRPC). These men are at increased risk of developing bone metastases (BM), particularly in those with higher serum PSA and shorter PSA doubling time (DT). The epidemiology and natural history of M0 CRPC has not been well studied in a population-based setting. Methods: Using HFHS patient records, a retrospective cohort study was conducted among 723 men diagnosed with M0 PC between 1996 and 2005 (with follow-up [f/u] for outcomes through 12/31/2008), who received ADT, including 613 men with serial PSA measurements for CRPC determination. CRPC was defined as 2 consecutive PSA rises, with “high-risk” defined as PSA ≥ 8 ng/mL or PSA DT ≤ 10 months (mos) after the development of CRPC. The risk of subsequent BM was estimated for the overall cohort and for the CRPC and non-CRPC subsets. Results: The median age among patients in the study was 73 years, 48% were African American, and median f/u time after ADT initiation was 58 mos. 15% (n=93) met criteria for CRPC during f/u (with a median of 23 mos between ADT initiation and establishment of CRPC), with the majority considered being at high risk (n=81). Among the entire cohort, 74 men (10%) developed BM during f/u. The rate of BM was 4 times higher among CRPC patients compared to non-CRPC patients (p<0.001), with a median of 6 mos between CRPC and subsequent BM. No racial difference was observed with either the incidence of CRPC or BM. Conclusions: The HFHS resource allowed for investigation of disease progression in a racially diverse population. A substantial proportion of M0 PC patients on ADT will eventually develop CRPC and once castration-resistant, risk of BM is high.

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Salvage Stereotactic Body Radiotherapy for Patients With Limited Prostate Cancer Metastases: Deferring Androgen Deprivation Therapy

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2012.08.003 ◽

2013 ◽

Vol 11 (1) ◽

pp. 27-32 ◽

Cited By ~ 123

Author(s):

Patrick Berkovic ◽

Gert De Meerleer ◽

Louke Delrue ◽

Bieke Lambert ◽

Valérie Fonteyne ◽

...

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Stereotactic Body Radiotherapy ◽

Androgen Deprivation ◽

Cancer Metastases

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Natural History of Rising Serum Prostate-Specific Antigen in Men With Castrate Nonmetastatic Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.01.529 ◽

2005 ◽

Vol 23 (13) ◽

pp. 2918-2925 ◽

Cited By ~ 306

Author(s):

Matthew R. Smith ◽

Fairooz Kabbinavar ◽

Fred Saad ◽

Arif Hussain ◽

Marc C. Gittelman ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Metastasis ◽

Natural History ◽

Bone Metastases ◽

Androgen Deprivation Therapy ◽

Specific Antigen ◽

Androgen Deprivation ◽

History Of ◽

Psa Velocity ◽

Baseline Psa

Purpose To describe the natural history of nonmetastatic prostate cancer and rising prostate-specific antigen (PSA) despite androgen deprivation therapy. Patients and Methods: The 201 patients in this report were the placebo control group from an aborted randomized controlled trial to evaluate the effects of zoledronic acid on time to first bone metastasis in men with prostate cancer, no bone metastases, and rising PSA despite androgen deprivation therapy. Relationships between baseline covariates and clinical outcomes were assessed by Cox proportional hazard analyses. Covariates in the model were baseline PSA, Gleason sum, history of bilateral orchiectomies, regional lymph node metastases at diagnosis, prior prostatectomy, time from androgen deprivation therapy to random assignment, time from diagnosis to random assignment, and PSA velocity. Results At 2 years, 33% of patients had developed bone metastases. Median bone metastasis–free survival was 30 months. Median time to first bone metastases and overall survival were not reached. Baseline PSA level greater than 10 ng/mL (relative risk, 3.18; 95% CI, 1.74 to 5.80; P < .001) and PSA velocity (4.34 for each 0.01 increase in PSA velocity; 95% CI, 2.30 to 8.21; P < .001) independently predicted shorter time to first bone metastasis. Baseline PSA and PSA velocity also independently predicted overall survival and metastasis-free survival. Other covariates did not consistently predict clinical outcomes. Conclusion Men with nonmetastatic prostate cancer and rising PSA despite androgen deprivation therapy have a relatively indolent natural history. Baseline PSA and PSA velocity independently predict time to first bone metastasis and survival.

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68Ga-PSMA-11 PET/CT Follow-Up of Patients with Prostate Cancer with Bone Metastases Who Had Reduced Bone Density after Androgen Deprivation Therapy

Diagnostics ◽

10.3390/diagnostics11020277 ◽

2021 ◽

Vol 11 (2) ◽

pp. 277

Author(s):

Mikhail Kesler ◽

Ido Druckmann ◽

Charles Levine ◽

Jonathan Kuten ◽

Ofer Yossepowitch ◽

...

Keyword(s):

Prostate Cancer ◽

Computed Tomography ◽

Bone Density ◽

Bone Metastases ◽

Androgen Deprivation Therapy ◽

Androgen Deprivation ◽

Response To Therapy ◽

Ct Scans ◽

Pet Ct

Bone metastases from prostate cancer (PCa) often show an increase in density on computed tomography (CT) after successful androgen deprivation therapy (ADT). Density may be reduced, however, as the disease progresses or, contrarily, when disease is no longer active. The current study investigated the role of 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) in differentiating between these two conditions. Methods: The study cohort included 15 PCa patients with sclerotic/blastic bone metastasis in whom reduction in bone density of metastasis was noted on follow-up 68Ga-PSMA-11 PET/CT after ADT. Each patient had two PET/CT scans. Prior to the first scan, six patients were castration naïve and nine patients were already treated. All patients had ADT between the two PET/CT scans. PET parameters (SUVmax and tumor-to-background ratio), and CT parameters (HUmax) were determined and compared for each lesion on both scans. Patient’s response was based on prostate-specific antigen (PSA) levels and appearance of new lesions. The Kolmogorov–Smirnov test was used to evaluate normal distribution of the continuous variables. Results: Post-ADT reduction in bone density was identified in 37 lesions. The mean HUmax was 883.9 ± 175.1 on the first scan and 395.6 ± 157.1 on the second scan (p < 0.001). Twenty-one of the 37 lesions showed no increased tracer uptake on the second PET/CT scan raising the likelihood of a response. The other 16 lesions were associated with increased uptake suggestive of an active resistant disease. Bone density was not different in lesions that no longer showed an increased uptake as compared with those that did. Seven of the study patients responded to therapy, and none of the 16 lesions found in these patients showed increased 68Ga-PSMA-11 uptake. In eight patients with progressive disease, all 12 lesions in five of them showed increased 68Ga-PSMA-11 uptake, there was mixed response in two patients (having two lesions with increased uptake and one without) and although all three lesions no longer showed an increased uptake, new lesions were detected in the eighth patient. Conclusion: A decrease in density of bone lesions may reflect clinical progression, or contrarily, a response to therapy in patients with PCa and skeletal involvement treated with ADT. Uptake of 68Ga-PSMA-11 may separate between these two vastly opposing conditions.

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