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

Güler, Ozan Cem; Engels, Benedikt; Onal, Cem; Everaert, Hendrik; Begin, Robbe Van den; Gevaert, Thierry; Ridder, Mark De

doi:10.1007/s12094-017-1736-9

Cited by 42 publications

(33 citation statements)

References 26 publications

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“…This was in line with the results of Guler and Henkenberens et al 23,24 who found similar levels of PSA response to MDT in OPCa diagnosed by PSMA-PET/CT. 23,24 However, in the study of Guler et al 23 all patients also had ADT throughout treatment and in the study of Henkenberens et al 24 patients with bone metastases continued ADT during and after radiotherapy. 23,24 Considering that 8 of 20 patients (40%) in our present study also received ADT during and after RT, we analyzed the PSA response separately in the subgroup with (n=8) and without (n=12) additional ADT (Figure 2).…”

Section: Discussionsupporting

confidence: 92%

“…22 Nevertheless, to our knowledge, only few studies have investigated the efficacy of MDT based on PSMA-PET/CT-imaging in OPCa. [23][24][25] In our present retrospective study on PSMA-PET/CT-guided RT as MDT, we found a significant decrease in PSA levels of median 1.47ng/ml prior to RT down to median 0.20ng/ml at last follow up (p<0.001). This was in line with the results of Guler and Henkenberens et al 23,24 who found similar levels of PSA response to MDT in OPCa diagnosed by PSMA-PET/CT.…”

Section: Discussionmentioning

confidence: 49%

“…[23][24][25] In our present retrospective study on PSMA-PET/CT-guided RT as MDT, we found a significant decrease in PSA levels of median 1.47ng/ml prior to RT down to median 0.20ng/ml at last follow up (p<0.001). This was in line with the results of Guler and Henkenberens et al 23,24 who found similar levels of PSA response to MDT in OPCa diagnosed by PSMA-PET/CT. 23,24 However, in the study of Guler et al 23 all patients also had ADT throughout treatment and in the study of Henkenberens et al 24 patients with bone metastases continued ADT during and after radiotherapy.…”

Section: Discussionmentioning

confidence: 49%

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PSA outcome after metastasis directed therapy (MDT) of oligometastatic prostate cancer patients diagnosed by 68Ga-PSMA-PET/CT

Dumke

Mortasawi

Thiemer

et al. 2020

IJRRT

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Background: Metastasis Directed Therapy (MDT) of oligometastatic prostate cancer (OPCa) is an emerging treatment option which may delay systemic therapy and its side effects. Identifying OPCa patients suitable for local treatment by imaging modalities with a high sensitivity and specificity is crucial. Therefore, we analyzed PSA outcome after MDT of OPCa patients diagnosed by 68Ga-PSMA PET/CT retrospectively. Methods: Overall 20 OPCa patients with ≤3 metastases in 68 Ga-PSMA PET/CT treated with radiotherapy (RT) doses >50 Gy (EQD2, α/β=2) were identified. Biochemical progression free survival (bPFS) was calculated with Kaplan Meier method. After stratifying patients by clinical and pathological parameters, differences in bPFS were compared using log rank tests. Cox regression analysis was performed to identify predictors of bPFS. Toxicity was assessed using CTCAE (V.4). Results: A total of 31 metastases were treated. Localizations were pelvic lymph nodes (n=21), and bones (n=9) of which were pelvic bones (n=4), ribs and sternal (n=3), vertebral body (n=2). One patient had a metastasis of the penis (n=1). The median follow-up was 13.5 months (3-48) with an overall survival of 100%. A treatment response was detected in 18/20 (90%) patients. The median PSA of 1.47ng/ml (0.38-8.82) prior to MDT decreased significantly to 0.20 ng/ml (0.0-1.93) after treatment (p<0.001). For the entire cohort (n=20) median bPFS was 14 months (9.3-18.7). Patients with solitary metastases had a significant longer bPFS with mean 20.2 months (10.6-29.9) compared to 9.7 months (4.9-14.6) for those with 2-3 metastases (p=0.037). Furthermore, patients without additional ADT and 2-3 metastases in 68Ga-PSMA PET/CT had a significant higher risk for PSA progression after MDT (HR 10.928, CI 1.053-113.421, p=0.045). Of 20 patients 9 (45%) had acute toxicity I° and 1 patient (5%) also experienced acute toxicity II°. Late toxicities I° occurred in 1 patient (5%). No acute or late toxicities >II° were observed. Conclusion: Using PSMA-PET/CT guided RT for MDT of OPCa led to a significant decrease in PSA-levels with minimal therapy associated toxicity. Especially patients with solitary metastases may benefit from this treatment approach. However, randomized trials with larger patient collectives are necessary.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 49%

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PSA outcome after metastasis directed therapy (MDT) of oligometastatic prostate cancer patients diagnosed by 68Ga-PSMA-PET/CT

Dumke

Mortasawi

Thiemer

et al. 2020

IJRRT

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“…The use of image-guided, metastasis-directed ablative therapy (such as stereotactic body radiation therapy) to distant lesions is an attractive strategy (35)(36)(37)(38) being investigated in prospective trials (NCT01558427, NCT02274779) (39,40). The success of this approach, however, depends on accurate staging.…”

Section: Discussionmentioning

confidence: 99%

⁶⁸Ga-PSMA-11 PET/CT Mapping of Prostate Cancer Biochemical Recurrence After Radical Prostatectomy in 270 Patients with a PSA Level of Less Than 1.0 ng/mL: Impact on Salvage Radiotherapy Planning

Calais¹,

Czernin²,

Cao³

et al. 2017

J Nucl Med

234

198

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Target volume delineations for prostate cancer (PCa) salvage radiotherapy (SRT) after radical prostatectomy are usually drawn in the absence of visibly recurrent disease. Ga-labeled prostate-specific membrane antigen (PSMA-11) PET/CT detects recurrent PCa with sensitivity superior to standard-of-care imaging at serum prostate-specific antigen (PSA) values low enough to affect target volume delineations for routine SRT. Our objective was to map the recurrence pattern of PCa early biochemical recurrence (BCR) after radical prostatectomy withGa-PSMA-11 PET/CT in patients with serum PSA levels of less than 1 ng/mL, determine how often consensus clinical target volumes (CTVs) based on the Radiation Therapy Oncology Group (RTOG) guidelines cover Ga-PSMA-11 PET/CT-defined disease, and assess the potential impact ofGa-PSMA-11 PET/CT on SRT. This was a post hoc analysis of an intention-to-treat population of 270 patients who underwentGa-PSMA-11 PET/CT at 4 institutions for BCR after prostatectomy without prior radiotherapy at a PSA level of less than 1 ng/mL. RTOG consensus CTVs that included both the prostate bed and the pelvic lymph nodes were contoured on the CT dataset of the PET/CT image by a radiation oncologist masked to the PET component. Ga-PSMA-11 PET/CT images were analyzed by a nuclear medicine physician.Ga-PSMA-11-positive lesions not covered by planning volumes based on the consensus CTVs were considered to have a potential major impact on treatment planning. The median PSA level at the time ofGa-PSMA-11 PET/CT was 0.48 ng/mL (range, 0.03-1 ng/mL). One hundred thirty-two of 270 patients (49%) had a positive Ga-PSMA-11 PET/CT result. Fifty-two of 270 (19%) had at least one PSMA-11-positive lesion not covered by the consensus CTVs. Thirty-three of 270 (12%) had extrapelvic PSMA-11-positive lesions, and 19 of 270 (7%) had PSMA-11-positive lesions within the pelvis but not covered by the consensus CTVs. The 2 most commonGa-PSMA-11-positive lesion locations outside the consensus CTVs were bone (23/52, 44%) and perirectal lymph nodes (16/52, 31%). Post hoc analysis ofGa-PSMA-11 PET/CT implied a major impact on SRT planning in 52 of 270 patients (19%) with PCa early BCR (PSA < 1.0 ng/mL). This finding justifies a randomized imaging trial of SRT with or without Ga-PSMA-11 PET/CT investigating its potential benefit on clinical outcome.

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“…Although it remains unclear if oligoprogressive CRPC patients represent a distinct biological entity or whether the PSMA-positive lesions are just a snapshot of a systemic disease, the improved sensitivity resulting in an earlier detection and the 3D localization of oligoprogressive disease may offer a window of opportunity. In the study of Guler et al, 10 CRPC patients treated with intensitymodulated and image-guided radiotherapy showed a progression free survival (PFS) of 0% at 12 months[40]. Similarly Muldermanns et al reported a biochemical PFS of 54% and a distant PFS of 45 % at 16 months[39].…”

mentioning

confidence: 96%

Current and potential future role of PSMA-PET in patients with castration-resistant prostate cancer

et al. 2018

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

Abstract: By providing optimal LC, low toxicity and a promising PFS in CS patients, the current retrospective study illustrated that Ga PSMA PET-CT-guided RT may be an attractive treatment strategy in patients with oligometastatic prostate cancer. Validation by randomized trials is eagerly awaited.

Cited by 42 publications

References 26 publications

PSA outcome after metastasis directed therapy (MDT) of oligometastatic prostate cancer patients diagnosed by 68Ga-PSMA-PET/CT

PSA outcome after metastasis directed therapy (MDT) of oligometastatic prostate cancer patients diagnosed by 68Ga-PSMA-PET/CT

⁶⁸Ga-PSMA-11 PET/CT Mapping of Prostate Cancer Biochemical Recurrence After Radical Prostatectomy in 270 Patients with a PSA Level of Less Than 1.0 ng/mL: Impact on Salvage Radiotherapy Planning

Current and potential future role of PSMA-PET in patients with castration-resistant prostate cancer

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

Abstract: By providing optimal LC, low toxicity and a promising PFS in CS patients, the current retrospective study illustrated that Ga PSMA PET-CT-guided RT may be an attractive treatment strategy in patients with oligometastatic prostate cancer. Validation by randomized trials is eagerly awaited.

Cited by 42 publications

References 26 publications

PSA outcome after metastasis directed therapy (MDT) of oligometastatic prostate cancer patients diagnosed by 68Ga-PSMA-PET/CT

PSA outcome after metastasis directed therapy (MDT) of oligometastatic prostate cancer patients diagnosed by 68Ga-PSMA-PET/CT

68Ga-PSMA-11 PET/CT Mapping of Prostate Cancer Biochemical Recurrence After Radical Prostatectomy in 270 Patients with a PSA Level of Less Than 1.0 ng/mL: Impact on Salvage Radiotherapy Planning

Current and potential future role of PSMA-PET in patients with castration-resistant prostate cancer

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⁶⁸Ga-PSMA-11 PET/CT Mapping of Prostate Cancer Biochemical Recurrence After Radical Prostatectomy in 270 Patients with a PSA Level of Less Than 1.0 ng/mL: Impact on Salvage Radiotherapy Planning