68Ga-PSMA-11 PET/CT: a new technique with high potential for the radiotherapeutic management of prostate cancer patients

Abstract

PurposeRadiotherapy is the main therapeutic approach besides surgery of localized prostate cancer. It relies on risk stratification and exact staging. This report analyses the potential of [68Ga]Glu-urea-Lys(Ahx)-HBED-CC (68Ga-PSMA-11), a new positron emission tomography (PET) tracer targeting prostate-specific membrane antigen (PSMA) for prostate cancer staging and individualized radiotherapy planning.MethodsA cohort of 57 patients with prostate cancer scanned with 68Ga-PSMA-11 PET/CT for radiotherapy planning was retrospectively reviewed; 15 patients were at initial diagnosis and 42 patients at time of biochemical recurrence. Staging results of conventional imaging, including bone scintigraphy, CT or MRI, were compared with 68Ga-PSMA ligand PET/CT results and the influence on radiotherapeutic management was quantified.Results68Ga-PSMA ligand PET/CT had a dramatic impact on radiotherapy application in the presented cohort. In 50.8 % of the cases therapy was changed.ConclusionThe presented imaging technique of 68Ga-PSMA PET/CT could be a key technology for individualized radiotherapy management in prostate cancer.

PSMA Ligands for PET Imaging of Prostate Cancer

“…In the setting of primary treatment, a small cohort of 15 patients underwent PSMA ligand PET/CT, and the imaging was found to influence clinical TNM stage in 53.3% of patients and radiotherapy plan in 33.3% (71). Combining the settings of radiotherapy planning in both primary and recurrent disease, 2 recent publications reported PSMA ligand PET/CT to have an impact on 50.8% and 53.7% of patients (72,73).…”

“…Several studies have investigated the impact of PSMA ligand PET/CT on patient management and therapy. Most studies have focused on the value of PSMA ligand PET/CT in patients with BCR after curative treatment and have reported changes in therapeutic management depending on the specific clinical scenario and the extent of treatment modification (69)(70)(71)(72)(73)(74). Most recently, an overall change in the therapeutic management of 75% of 131 patients after primary treatment was shown (69).…”

Usefulness of Ga-68 HBED-CC PSMA PET/CT for Tumor Staging in the Initial Diagnostic Assessment of Prostate Cancer

“…PET/CT using Ga-68 HBED-CC PSMA is considered a promising new imaging tool for the diagnostic assessment of prostate cancer including metastatic spread as shown by Afshar-Oromieh et al [1] in a large study cohort and Sterzing et al [2], especially in patients with suspected recurrence. The study presented here was conducted to evaluate the use of Ga-68 HBED-CC PSMA PET/CT in the characterization of prostate cancer using the TNM stage determined by an interdisciplinary team and histopathology as the gold standard.…”

“…The study presented here was conducted to evaluate the use of Ga-68 HBED-CC PSMA PET/CT in the characterization of prostate cancer using the TNM stage determined by an interdisciplinary team and histopathology as the gold standard. In a study conducted by Sterzing et al [2], PET/CT using the new tracer Ga-68 HBED-CC PSMA resulted in a modified TNM staging with a change in treatment in 50.8% of the patients examined. To the best of our knowledge, this is the first study of Ga-68 HBED-CC PSMA PET/CT in which this modality is investigated by directly evaluating the TNM stage determined on the basis of imaging morphology and metabolic in correlation with the TNM stage determined by an interdisciplinary team using all information available including histopathology.…”

Acceleration of PSMA-Targeted Theranostics to the Clinic: Can Common Sense Prevail?

“…Sites of recurrent disease are detected at low levels of serum prostatespecific antigen, and PSMA imaging is able to stage disease more accurately than any other tool. The impact on management has been documented prospectively (24) and retrospectively (25).…”