68Ga-PSMA-11 PET/CT in a patient with non-PSA-secreting undifferentiated prostate cancer before and after treatment with cabozantinib

Artigas, Carlos; Plouznikoff, Nicolas; Gil, Thierry; Derijckere, Ivan Duran; Herchuelz, Maxime; Libert, Isabelle; Flamen, Patrick

doi:10.1007/s00259-019-04367-8

Cited by 5 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Almost all patients (97%) with a positive PET at low PSA levels (PSA < 1 ng/mL) presented less than three lesions (OMD) with only one patient presenting multimetastatic disease in the group of patients with very low PSA < 0.5 ng/mL. It is important to remember that non-PSA-secreting metastatic prostate cancer is a rare entity with a poor prognosis, which can present with high PSMA expression levels, as previously described [ 34 ].…”

Section: Discussionmentioning

confidence: 62%

“…In some cases, PSMA-PET/CT may be negative even in the presence of BCR. Possible reasons for a negative PSMA-PET/CT are the presence of slowly progressing nonaggressive disease, local relapse located adjacent to the bladder with physiologic urinary activity (which could mask small local recurrences), small disease volume below PET resolution, or the presence of undifferentiated/neuroendocrine PCa with no PSMA expression [ 34 ]. On the other hand, despite the high sensitivity (85%) and specificity (98%) of PSMA-PET/CT [ 14 ], other processes may also overexpress PSMA, probably related to the presence of PSMA expression in the endothelial cell membrane of neovessels: for example benign lesions such as Paget bone disease, vertebral hemangioma, or fibrous dysplasia [ 46 ]; and malignant lesions such as kidney cancer, breast cancer, or sarcomas [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Oligometastatic Disease Detection with 68Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact

Artigas

Diamand

Shagera

et al. 2021

Cancers

Self Cite

View full text Add to dashboard Cite

Metastasis-directed therapy (MDT) in oligometastatic prostate cancer has the potential of delaying the start of androgen deprivation therapy (ADT) and disease progression. We aimed to analyze the efficacy of PSMA-PET/CT in detecting oligometastatic disease (OMD), to look for predictive factors of OMD, and to evaluate the impact of PSMA-PET/CT findings on clinical management. We retrospectively analyzed a homogeneous population of 196 hormone-sensitive prostate cancer patients (HSPC), considered potential candidates for MDT, with a PSMA-PET/CT performed at biochemical recurrence (BCR) after radical prostatectomy (RP). Multivariable logistic regression analysis was performed based on several clinico-pathological factors. Changes in clinical management before and after PSMA-PET/CT were analyzed. The OMD detection rate was 44% for a total positivity rate of 60%. PSMA-PET/CT positivity was independently related to PSA (OR (95%CI), p) (1.7 (1.3–2.3), p < 0.0001) and PSAdt (0.4 (0.2–0.8), p = 0.013), and OMD detection was independently related to PSA (1.6 (1.2–2.2), p = 0.001) and no previous salvage therapy (0.3 (0.1–0.9), p = 0.038). A treatment change was observed in 58% of patients, mostly to perform MDT after OMD detection (60% of changes). This study showed that PSMA-PET/CT is an excellent imaging technique to detect OMD early in HSPC patients with BCR after RP, changing therapeutic management mostly into MDT.

show abstract

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Oligometastatic Disease Detection with 68Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact

Artigas

Diamand

Shagera

et al. 2021

Cancers

Self Cite

View full text Add to dashboard Cite

show abstract

“…In fact, PSA and PSMA follow different mechanisms of action explaining why patients with non-PSA-secreting metastatic disease can present with high PSMA expression at -PET/CT. 30,31 In addition, TL-PSMA, another PET quantitative parameter (the result of the product of SUV mean and PSMA-TV), was found to be a significant predictor of OS. In our study, TL-PSMA was mainly determined by PSMA-TV, as SUV mean did not significantly correlate with OS, indicating that PSMA-TV drives the predictive impact of TL-PSMA.…”

Section: Discussionmentioning

confidence: 95%

“…This finding may partially explain the moderate correlation between PSMA and PSA levels that we observed. In fact, PSA and PSMA follow different mechanisms of action explaining why patients with non–PSA-secreting metastatic disease can present with high PSMA expression at PET/CT 30,31 …”

Section: Discussionmentioning

confidence: 99%

Tumor Volume on PSMA PET as a Prognostic Biomarker in Prostate Cancer Patients Treated With Cabazitaxel

Shagera

Karfis

Sideris³

et al. 2023

Clin Nucl Med

Self Cite

View full text Add to dashboard Cite

Purpose The aim of this study was to evaluate the prognostic value of 68Ga-labeled prostate-specific membrane antigen (PSMA) PET/CT in metastatic castration-resistant prostate cancer patients receiving second-line chemotherapy with cabazitaxel. Methods All patients with metastatic castration-resistant prostate cancer who underwent a PSMA PET/CT within 8 weeks before initiating the cabazitaxel treatment were retrospectively evaluated. The whole-body PSMA total tumor volume (PSMA-TV) was measured for each patient. Other factors such as prostate-specific antigen, hemoglobin, lactate dehydrogenase, and alkaline phosphatase were recorded. A log-rank cutoff finder was used to define the PSMA-TV optimal cutoff. Survival analyses were performed using Cox regression and Kaplan-Meier methods. Results In total, 32 patients were included, receiving a median of 6 cycles of cabazitaxel (range, 2–10). After a median follow-up of 12 months, 28 patients presented disease progression, and 18 died. Baseline PSMA-TV presented a significant association with progression-free survival (PFS) and overall survival (OS; P = 0.035 and P = 0.002, respectively). Optimal PSMA-TV cutoffs were 515 mL for PFS and 473 mL for OS. Patients with low volume presented longer PFS and OS than those with high volume: median PFS, 21 versus 12 weeks, respectively (hazard ratio, 0.33; P = 0.017); and median OS, 24 versus 8.5 months, respectively (hazard ratio, 0.21; P = 0.002). On the multivariable analyses, PSMA-TV remained an independent predictor of OS (P = 0.016). Conclusion Our results show that total tumor volume measured on PSMA PET/CT is a prognostic biomarker in patients treated with cabazitaxel. High PSMA-TV before treatment initiation is associated with shorter PFS and OS.

show abstract

“…Indeed, the mechanism of PSA secretion is different and dissociated from that of PSMA expression in prostate cancer cells. To date, there is no clear explanation for the relationship between the PSA secretion mechanisms and PSMA expression, and there are even some case reports showing high PSMA expression in patients with neuroendocrine dedifferentiation and low PSA levels (43). Further preclinical investigations are still needed to elucidate these mechanisms.…”

Section: Discussionmentioning

confidence: 99%

PSMA PET/CT for Response Assessment and Overall Survival Prediction in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors

Shagera,

Karfis,

Kristanto

et al. 2023

J Nucl Med

Self Cite

View full text Add to dashboard Cite

We aimed to evaluate the role of prostate-specific membrane antigen (PSMA) PET/CT for response assessment and outcome prediction in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with androgen receptor pathway inhibitors (ARPIs), including abiraterone acetate or enzalutamide. Methods: We retrospectively analyzed 30 ARPI-treated mCRPC patients who underwent 68 Ga-PSMA-11 PET/CT within 8 wk before (baseline) and 12 6 4 wk after treatment initiation. Total PSMA tumor volume was calculated using the fixed threshold method (SUV $ 3). Patients were categorized as PSMA responders (PSMA-Rs) or PSMA nonresponders (PSMA-NRs) on the basis of both European Association of Urology/European Association of Nuclear Medicine (EAU/EANM) criteria and Response Evaluation Criteria in PSMA PET/CT (RECIP) 1.0. PSMA-R included patients with a complete response, a partial response, or stable disease, and PSMA-NR included those with progressive disease. On the basis of prostate-specific antigen (PSA), patients were classified as biochemical responders if PSA decreased by at least 50% and as nonresponders if it did not. The F-coefficient was used to evaluate the correlation of PSMA-and PSA-based responses. Survival analysis was performed using the Cox regression hazard model and the Kaplan-Meier method. Predictive accuracy was tested for both response criteria. Results: On the basis of PSMA PET/CT, 13 (43%) patients were PSMA-NR according to the EAU/EANM criteria and 11 (37%) patients were PSMA-NR according to RECIP 1.0. Significant correlations were observed between PSMA-and PSA-based responses for both criteria (F 5 0.79 and 0.66, respectively). After a median follow-up of 25 mo (interquartile range, 21-43 mo), the median overall survival was significantly longer for PSMA-R than PSMA-NR (54 vs. 22 mo) for both the EAU/EANM criteria and RECIP 1.0, with hazard ratios of 6.9 (95% CI, 1.9-26; P 5 0.004) and 5.6 (95% CI, 1.69-18.26, P 5 0.005), respectively. No significant difference in predictive accuracy was found between the 2 criteria (C-index, 0.79 vs. 0.76, respectively, P 5 0.54). Flare phenomena at the second PSMA PET study were not observed in our cohort. Conclusion: Our results demonstrate that PSMA PET/CT is a valuable imaging biomarker for response assessment and overall survival prediction when performed at 3 mo after ARPI treatment initiation in mCRPC patients. Both proposed PSMA response criteria (EAU/EANM and RECIP 1.0) seem to perform equally well. No PSMA flare was observed. Prospective validation of these findings is strongly needed.

show abstract

68Ga-PSMA-11 PET/CT in a patient with non-PSA-secreting undifferentiated prostate cancer before and after treatment with cabozantinib

Cited by 5 publications

References 5 publications

Oligometastatic Disease Detection with 68Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact

Oligometastatic Disease Detection with 68Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact

Tumor Volume on PSMA PET as a Prognostic Biomarker in Prostate Cancer Patients Treated With Cabazitaxel

PSMA PET/CT for Response Assessment and Overall Survival Prediction in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors

Contact Info

Product

Resources

About