68Ga-PSMA-11 PET imaging in patients with ongoing androgen deprivation therapy for advanced prostate cancer

Abstract

Purpose Prostate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) imaging significantly improved the detection of recurrent prostate cancer (PCa). However, the value of PSMA PET imaging in patients with advanced hormone-sensitive or hormone-resistant PCa is still largely unknown. The aim of this study was to analyze the detection rate and distribution of lesions using PSMA PET imaging in patients with advanced PCa and ongoing androgen deprivation therapy (ADT). Methods A total of 84 patients diagnosed with hormone-sensitive or hormone-resistant PCa who underwent 68Ga-PSMA-11 PET/magnetic resonance imaging (MRI) or computer tomography (CT) under ongoing ADT were retrospectively analyzed. We assessed the detection of PSMA-positive lesions overall and for three PSA subgroups (0 to < 1 ng/mL, 1 to < 20 ng/mL and > 20 ng/mL). In addition, PSMA-positive findings were stratified by localization (prostatic fossa, pelvic, para-aortic, mediastinal/supraclavicular and axillary lymph nodes, bone lesions and visceral lesions) and hormone status (hormone-sensitive vs. hormone-resistant). Furthermore, we assessed how many patients would be classified as having oligometastatic disease (≤ 3 lesions) and theoretically qualify for metastasis-directed radiotherapy (MDRT) in a personalized patient management. Results We detected PSMA-positive lesions in 94.0% (79 of 84) of all patients. In the three PSA subgroups detection rates of 85.2% (0 to < 1 ng/mL, n = 27), 97.3% (1 to < 20 ng/mL, n = 37) and 100% (> 20 ng/mL, n = 20) were observed, respectively. PSMA-positive visceral metastases were observed only in patients with a PSA > 1 ng/mL. Detection of PSMA-positive lesions did not significantly differ between patients with hormone-sensitive and hormone-resistant PCa. Oligometastatic PCa was detected in 19 of 84 patients (22.6%). Almost all patients, 94.7% (n = 18) would have been eligible for MDRT. Conclusions In this study, we observed an overall very high detection rate of 94% using PSMA PET imaging in patients with advanced PCa and ongoing ADT. Even in a majority of patients with very low PSA values < 1 ng/ml PSMA-positive lesions were found.

Assessment of Prostate Carcinoma Aggressiveness: Relation to68Ga-PSMA-11-PET/MRI and Gleason Score

“…We conducted a prospective study evaluating the surgically removed prostates with proven carcinoma. The aim was to determine whether 68 Ga-PSMA-11 accumulation and/or the assessment of the vascularization can reliably and accurately assess the level of aggressiveness in prostatic carcinoma, as well as to correlate the level of the radiopharmaceutical uptake with the presence of PSMA molecule, which was confirmed using immunochemistry (10,11). The overall concordance in the PET accumulation of 68 Ga-PSMA-11 with the level of PSMA-specific staining was very high, especially when the semiquantitative matter of the assessments, both of SUV and staining, is taken in account.…”

Synthesis and Preclinical Evaluation of Two Novel 68Ga-Labeled Bispecific PSMA/FAP-Targeted Tracers with 2-Nal-Containing PSMA-Targeted Pharmacophore and Pyridine-Based FAP-Targeted Pharmacophore

“…Therefore, early and accurate detection is important to further improve the survival rates of prostate cancer patients. Recently, the application of radiopharmaceuticals for the non-invasive detection and treatment of prostate cancer has shown positive outcomes, such as improving positive lesion detection rate and prolonging imaging-based progression-free survival [ 3 , 4 ]. One of the promising radiotracers for metastatic prostate cancer diagnosis, which has been approved by the US FDA, is [ 68 Ga]Ga-PSMA-11, which targets prostate-specific membrane antigen (PSMA) [ 5 , 6 ].…”

Preliminary Findings of the Role of FAPi in Prostate Cancer Theranostics

“…Fortunately, the progress of next-generation imaging in the past few years has revolutionised PCa management. For example, using tracers that target the prostate-specific membrane antigen (PSMA) in positron emission tomography (PET) has become a well-established technique for the assessment of biochemical recurrence (BCR) [ 4 ], as well as further applications for biopsy guidance [ 5 ], staging [ 6 ] and the evaluation of disease progression [ 7 ]. However, the diagnostic accuracy of PSMA PET is challenged by findings that claim that up to 15% of clinically relevant PCa cases do not express this protein [ 8 ], leading to false negative results.…”