Role of 18F-Fluciclovine and Prostate-Specific Membrane Antigen PET/CT in Guiding Oligometastatic Prostate Cancer Management: AJR Expert Panel Narrative Review

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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Prostate-specific membrane antigen (PSMA) PET-CT imaging in the investigation and management of biochemical recurrence in prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.208 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 208-208 ◽

Cited By ~ 1

Author(s):

Fergus Keane ◽

Yasser Ged ◽

Megan Greally ◽

Michael A. Maher ◽

Kieran O'Malley ◽

...

Keyword(s):

Prostate Cancer ◽

Metastatic Disease ◽

Biochemical Recurrence ◽

Systemic Disease ◽

Ct Imaging ◽

Prostate Specific Membrane Antigen ◽

Psma Pet ◽

Pet Ct ◽

Specific Membrane

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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The feasibility of prostate-specific membrane antigen positron emission tomography(PSMA PET/CT)-guided radiotherapy in oligometastatic prostate cancer patients

Clinical & Translational Oncology ◽

10.1007/s12094-017-1736-9 ◽

2017 ◽

Vol 20 (4) ◽

pp. 484-490 ◽

Cited By ~ 20

Author(s):

O. C. Guler ◽

B. Engels ◽

C. Onal ◽

H. Everaert ◽

R. Van den Begin ◽

...

Keyword(s):

Prostate Cancer ◽

Positron Emission Tomography ◽

Emission Tomography ◽

Prostate Specific Membrane Antigen ◽

Ct Guided ◽

Positron Emission ◽

Psma Pet ◽

Pet Ct ◽

Oligometastatic Prostate Cancer ◽

Specific Membrane

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The emerging role of prostate-specific membrane antigen (PSMA) PET-CT in patients with high-risk prostate cancer: moving the bar in high-risk prostate cancer

Asian Journal of Andrology ◽

10.4103/aja.aja_35_20 ◽

2021 ◽

Vol 23 (1) ◽

pp. 1

Author(s):

JeannyB Aragon-Ching

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Prostate Specific Membrane Antigen ◽

High Risk Prostate Cancer ◽

Psma Pet ◽

Pet Ct ◽

Risk Prostate Cancer ◽

Specific Membrane

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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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