The Impact of68Ga-PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study

Objectives: To investigate the impact of total variation regularized expectation maximization (TVREM) reconstruction on the image quality of 68Ga-PSMA-11 PET/CT using phantom and patient data. Methods: Images of a phantom with small hot sphere inserts and 20 prostate cancer patients were acquired with a digital PET/CT using list-mode and reconstructed with ordered subset expectation maximization (OSEM) and TVREM with seven penalisation factors between 0.01 and 0.42 for 2 and 3 minutes-per-bed (m/b) acquisition. The contrast recovery (CR) and background variability (BV) of the phantom, image noise of the liver, and SUVmax of the lesions were measured. Qualitative image quality was scored by two radiologists using a 5-point scale (1-poor, 5-excellent). Results: The performance of CR, BV, and image noise, and the gain of SUVmax was higher for TVREM 2 m/b groups with the penalization of 0.07 to 0.28 compared to OSEM 3 m/b group (all p < 0.05). The image noise of OSEM 3 m/b group was equivalent to TVREM 2 and 3 m/b groups with a penalization of 0.14 and 0.07, while lesions’ SUVmax increased 15 and 20%. The highest qualitative score was attained at the penalization of 0.21 (3.30 ± 0.66) for TVREM 2 m/b groups and the penalization 0.14 (3.80 ± 0.41) for 3 m/b group that equal to or greater than OSEM 3 m/b group (2.90 ± 0.45, p = 0.2 and p < 0.001). Conclusions: TVREM improves lesion contrast and reduces image noise, which allows shorter acquisition with preserved image quality for PSMA PET/CT. Advances in knowledge: TVREM reconstruction with optimized penalization factors can generate higher quality PSMA-PET images for prostate cancer diagnosis.

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The Impact of 68Ga-PSMA PET/CT and PET/MRI on the Management of Prostate Cancer

Urology ◽

10.1016/j.urology.2019.04.004 ◽

2019 ◽

Vol 130 ◽

pp. 1-12 ◽

Cited By ~ 14

Author(s):

Manuela A. Hoffmann ◽

Helmut J. Wieler ◽

Christian Baues ◽

Nicholas J. Kuntz ◽

Ines Richardsen ◽

...

Keyword(s):

Prostate Cancer ◽

Psma Pet ◽

Pet Ct ◽

The Impact

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A Phase 2/3 Prospective Multicenter Study of the Diagnostic Accuracy of Prostate-Specific Membrane Antigen PET/CT with 18 F-DCFPyL in Prostate Cancer Patients (OSPREY)

The Journal of Urology ◽

10.1097/ju.0000000000001698 ◽

2021 ◽

Author(s):

Kenneth J. Pienta ◽

Michael A. Gorin ◽

Steven P. Rowe ◽

Peter R. Carroll ◽

Frédéric Pouliot ◽

...

Keyword(s):

Prostate Cancer ◽

Diagnostic Accuracy ◽

Cancer Patients ◽

Multicenter Study ◽

Prostate Specific Membrane Antigen ◽

Phase 2 ◽

Prospective Multicenter Study ◽

Pet Ct ◽

Specific Membrane

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Reply: “The Impact of 68Ga-PSMA PET/CT and PET/MRI on the Management of Prostate Cancer”

Urology ◽

10.1016/j.urology.2019.06.001 ◽

2019 ◽

Vol 131 ◽

pp. 262-263

Author(s):

Manuela A. Hoffmann ◽

Helmut J. Wieler ◽

Christian Baues ◽

Nicholas J. Kuntz ◽

Ines Richardsen ◽

...

Keyword(s):

Prostate Cancer ◽

Psma Pet ◽

Pet Ct ◽

The Impact

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The Establishment of New Thresholds for PLND-Validated Clinical Nomograms to Predict Non-Regional Lymph Node Metastases: Using 68Ga-PSMA PET/CT as References

Frontiers in Oncology ◽

10.3389/fonc.2021.658669 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jianhua Jiao ◽

Zhiyong Quan ◽

Jingliang Zhang ◽

Weihong Wen ◽

Jun Qin ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

High Risk ◽

Lymph Nodes ◽

Clinical Decision Making ◽

Care Hospital ◽

Pelvic Region ◽

Psma Pet ◽

Pet Ct ◽

The Impact

PurposePLND (pelvic lymph node dissection)-validated nomograms are widely accepted clinical tools to determine the necessity of PLND by predicting the metastasis of lymph nodes (LNMs) in pelvic region. However, these nomograms are in lacking of a threshold to predict the metastasis of extrareolar lymph nodes beyond pelvic region, which is not suitable for PLND. The aim of this study is to evaluate a threshold can be set for current clinical PLND-validated nomograms to predict extrareolar LN metastases beyond pelvic region in high-risk prostate cancer patients, by using 68Ga-PSMA PET/CT as a reference to determine LN metastases (LNMs).Experimental DesignWe performed a retrospective analysis of 57 high-risk treatment-naïve PC patients in a large tertiary care hospital in China who underwent 68Ga-PSMA-617 PET/CT imaging. LNMs was detected by 68Ga-PSMA-617 PET/CT and further determined by imaging follow-up after anti-androgen therapy. The pattern of LN metastatic spread of PC patients were evaluated and analyzed. The impact of 68Ga-PSMA PET/CT on clinical decisions based on three clinical PLND-validated nomograms (Briganti, Memorial Sloan Kettering Cancer Center, Winter) were evaluated by a multidisciplinary prostate cancer therapy team. The diagnostic performance and the threshold of these nomograms in predicting extrareolar LNMs metastasis were evaluated via receiver operating characteristic (ROC) curve analysis.ResultsLNMs were observed in 49.1% of the patients by 68Ga-PSMA PET/CT, among which 65.5% of LNMs were pelvic-regional and 34.5% of LNMs were observed in extrareolar sites (52.1% of these were located above the diaphragm). The Briganti, MSKCC and Winter nomograms showed that 70.2%-71.9% of the patients in this study need to receive ePLND according to the EAU and NCCN guidelines. The LN staging information obtained from 68Ga-PSMA PET/CT would have led to changes of planned management in 70.2% of these patients, including therapy modality changes in 21.1% of the patients, which were mainly due to newly detected non-regional LNMs. The thresholds of nomograms to predict non-regional LNMs were between 64% and 75%. The PC patients with a score >64% in Briganti nomogram, a score >75% in MSKCC nomogram and a score >67% in Winter nomogram were more likely to have non-regional LNMs. The AUCs (Area under curves) of the clinical nomograms (Briganti, MSKCC and Winter) in predicting non-regional LNMs were 0.816, 0.830 and 0.793, respectively.ConclusionsBy using 68Ga-PSMA PET/CT as reference of LNM, the PLND-validated clinical nomograms can not only predict regional LNMs, but also predict non-regional LNMs. The additional information from 68Ga-PSMA PET/CT may provide added benefit to nomograms-based clinical decision-making in more than two-thirds of patients for reducing unnecessary PLND. We focused on that a threshold can be set for current clinical PLND-validated nomograms to predict extrareolar LN metastases with an AUC accuracy of about 80% after optimizing the simple nomograms which may help to improve the efficiency for PC therapy significantly in clinical practice.

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The Impact of PSMA PET-CT on Treatment Decisions in Prostate Cancer – Early Experience in a Single Centre

Clinical Oncology ◽

10.1016/j.clon.2020.01.021 ◽

2020 ◽

Vol 32 (5) ◽

pp. e133-e134

Author(s):

C. Rooney ◽

A. Henry ◽

A. Cole ◽

J. O’Sullivan ◽

D. Mitchell ◽

...

Keyword(s):

Prostate Cancer ◽

Early Experience ◽

Treatment Decisions ◽

Single Centre ◽

Psma Pet ◽

Pet Ct ◽

The Impact

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Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

Frontiers in Oncology ◽

10.3389/fonc.2021.640467 ◽

2021 ◽

Vol 11 ◽

Author(s):

Simon Kirste ◽

Stephanie G. C. Kroeze ◽

Christoph Henkenberens ◽

Nina-Sophie Schmidt-Hegemann ◽

Marco M. E. Vogel ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Multicenter Study ◽

Recurrent Prostate Cancer ◽

Ct Guided ◽

Prostate Bed ◽

Psma Pet ◽

Pet Ct ◽

Grade 3 ◽

Retrospective Multicenter Study

BackgroundIn case of oligo-recurrent prostate cancer (PC) following prostatectomy, 68Ga-PSMA-PET/CT can be used to detect a specific site of recurrence and to initiate metastasis-directed radiation therapy (MDT). However, large heterogeneities exist concerning doses, treatment fields and radiation techniques, with some studies reporting focal radiotherapy (RT) to PSMA-PET/CT positive lesions only and other studies using elective RT strategies. We aimed to compare oncological outcomes and toxicity between PET/CT-directed RT (PDRT) and PDRT plus elective RT (eRT; i.e. prostate bed, pelvic or paraaortal nodes) in a large retrospective multicenter study.MethodsData of 394 patients with oligo-recurrent 68Ga-PSMA-PET/CT-positive PC treated between 04/2013 and 01/2018 in six different academic institutions were evaluated. Primary endpoint was biochemical-recurrence-free survival (bRFS). bRFS was analyzed using Kaplan–Meier survival curves and log rank testing. Uni- and multivariate analyses were performed to determine influence of treatment parameters.ResultsIn 204 patients (51.8%) RT was directed only to lesions seen on 68Ga-PSMA-PET/CT (PDRT), 190 patients (48.2%) received PDRT plus eRT. PDRT plus eRT was associated with a significantly improved 3-year bRFS compared to PDRT alone (53 vs. 37%; p = 0.001) and remained an independent factor in multivariate analysis (p = 0.006, HR 0.29, 95% CI 0.12–0.68). This effect was more pronounced in the subgroup of patients who were treated with PDRT and elective prostate bed radiotherapy (ePBRT) with a 3-year bRFS of 61% versus 22% (p <0.001). Acute and late toxicity grade ≥3 was 0.8% and 3% after PDRT plus eRT versus no toxicity grade ≥3 after PDRT alone.ConclusionsIn this large cohort of patients with oligo-recurrent prostate cancer, elective irradiation of the pelvic lymphatics and the prostatic bed significantly improved bRFS when added to 68Ga-PSMA-PET/CT-guided focal radiotherapy. These findings need to be evaluated in a randomized controlled trial.

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Abi Race: A prospective, multicenter study of black (B) and white (W) patients (pts) with metastatic castrate resistant prostate cancer (mCRPC) treated with abiraterone acetate and prednisone (AAP).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.18_suppl.lba5009 ◽

2018 ◽

Vol 36 (18_suppl) ◽

pp. LBA5009-LBA5009 ◽

Cited By ~ 9

Author(s):

Daniel J. George ◽

Elisabeth I. Heath ◽

A. Oliver Sartor ◽

Guru Sonpavde ◽

William R. Berry ◽

...

Keyword(s):

Prostate Cancer ◽

Multicenter Study ◽

Prognostic Significance ◽

Progression Free Survival ◽

Abiraterone Acetate ◽

Primary Objective ◽

Prospective Multicenter Study ◽

Psa Response ◽

Castrate Resistant ◽

The Impact

LBA5009 Background: Pivotal trials of AAP for patients with mCRPC enrolled few B pts, a population with a higher mortality from prostate cancer. Retrospective data suggests B pts may have higher PSA response rates than W pts treated with AAP for mCRPC. Therefore, we prospectively investigated AAP in B vs. W pts with mCRPC. Methods: Abi Race (NCT01940276) is a prospective, multicenter, parallel group study of AP in 100 men (50 B, 50 W) with mCRPC, self-identified by race. All pts received AA 1000 mg/D and P 10 mg/D (AAP) until disease progression or unacceptable adverse events (AE). The primary objective was radiographic progression-free survival (rPFS); key secondary endpoints include PSA kinetics and safety. Exploratory analyses include SNP, metabolomics and hormonal differences by race. Results: Baseline characteristics among pts were similar. The median rPFS for B and W pts was 16.8 months (mo) in each. However, PSA PFS varied by race; median PSA PFS for B and W pts were 16.6 and 11.5 mo [Table]. B pts also had numerically higher rates of ≥30%, ≥50% and ≥90% PSA decline [Table]. AEs were similar in frequency and severity by race including hypertension (42 vs 40%); however, fatigue was higher in W pts (40 vs 26%), and hypokalemia was higher in B pts (36 vs 18%). SNP profiling revealed differences in key genes involved in androgen metabolism and transport. Conclusions: This is the first prospective multicenter study by race of secondary hormonal therapy in mCRPC. B pts may have greater and more durable PSA response to AAP than W pts. SNP patterns vary by race and will be evaluated for prognostic significance. Further prospective studies in B pts are possible and needed to understand the impact of racial determinants on outcome of new hormonal regimens. Clinical trial information: NCT01940276. [Table: see text]

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