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

Fankhauser, Christian Daniel; Poyet, Cédric; Kroeze, S.G.C.; Kranzbühler, Benedikt; Schüler, Helena Garcia; Gückenberger, Matthias; Kaufmann, Philipp A.; Hermanns, Thomas; Burger, Irene A.

doi:10.1007/s00345-018-2408-2

Cited by 18 publications

(10 citation statements)

References 40 publications

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“…The specific impact of PSMA-PET on management of the overall cohort cannot be evaluated with our retrospective study design as it lacked standardized questionnaires to assess disease management and the influence of imaging. However, considerable change in clinical management based on PSMA-PET results has been reported previously in the setting of biochemical recurrence (11,17,23,24). Whether these changes in management lead to improved oncologic outcomes should be evaluated in the context of clinical trials (25).…”

Section: Discussionmentioning

confidence: 99%

Prostate-Specific Membrane Antigen Ligand Positron Emission Tomography in Men with Nonmetastatic Castration-Resistant Prostate Cancer

Fendler

Weber

Iravani

et al. 2019

Clinical Cancer Research

201

108

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Purpose: Systemic androgen-signaling inhibition added to ongoing androgen-deprivation therapy (ADT) improved clinical outcomes in patients with nonmetastatic castrationresistant prostate cancer without detectable metastases by conventional imaging (nmCRPC). Prostate-specific membrane antigen ligand positron emission tomography (PSMA-PET) detects prostate cancer with superior sensitivity to conventional imaging, but its performance in nmCRPC remains largely unknown. We characterized cancer burden in high-risk patients with nmCRPC using PSMA-PET.Experimental Design: We retrospectively included 200 patients with nmCRPC, prostate-specific antigen (PSA) >2 ng/mL, and high risk for metastatic disease [PSA doubling time (PSADT) of 10 months and/or Gleason score of 8] from six high-volume PET centers. We centrally reviewed PSMA-PET detection rate for pelvic disease and distant metas-tases (M1). We further evaluated SPARTAN patients stratified by risk factors for PSMA-PET-detected M1 disease.Results: PSMA-PET was positive in 196 of 200 patients. Overall, 44% had pelvic diseases, including 24% with local prostate bed recurrence, and 55% had M1 disease despite negative conventional imaging. Interobserver agreement was very high (k: 0.81-0.91). PSA 5.5 ng/mL, locoregional nodal involvement determined by pathology (pN1), prior primary radiation, and prior salvage radiotherapy independently predicted M1 disease (all P < 0.05).Conclusions: PSMA-PET detected any disease in nearly all patients and M1 disease in 55% of patients previously diagnosed with nmCRPC, including subgroups with PSADT of 10 months and Gleason score of 8. The value of PSMA-PET imaging for treatment guidance should be tested in future studies.

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Section: Discussionmentioning

confidence: 99%

Prostate-Specific Membrane Antigen Ligand Positron Emission Tomography in Men with Nonmetastatic Castration-Resistant Prostate Cancer

Fendler

Weber

Iravani

et al. 2019

Clinical Cancer Research

201

108

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“…As far as it concerns the role of PET/CT with 68 Ga-PSMA-11 in mCRPC, scientific data are still limited. In a recently published meta-analysis, PET/CT with 68 Ga-PSMA-11 presented higher sensitivity for detecting bone lesions than conventional bone scintigraphy and upstaged patients from the state of non-metastatic CRPC to that of mCRPC, with consequent impact on therapeutic management [79]. In this regard, Fourquet et al retrospectively investigated PET/CT's clinical impact with 68 Ga-PSMA-11 in 30 non-metastatic and asymptomatic patients with rise in PSA despite a suitable castrate serum level of testosterone.…”

Section: Molecular Theranostic Radiopharmaceuticals 321 Prostate Smentioning

confidence: 99%

Prognostic and Theranostic Applications of Positron Emission Tomography for a Personalized Approach to Metastatic Castration-Resistant Prostate Cancer

Filippi

Frantellizzi

Chiaravalloti

et al. 2021

IJMS

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Metastatic castration-resistant prostate cancer (mCRPC) represents a condition of progressive disease in spite of androgen deprivation therapy (ADT), with a broad spectrum of manifestations ranging from no symptoms to severe debilitation due to bone or visceral metastatization. The management of mCRPC has been profoundly modified by introducing novel therapeutic tools such as antiandrogen drugs (i.e., abiraterone acetate and enzalutamide), immunotherapy through sipuleucel-T, and targeted alpha therapy (TAT). This variety of approaches calls for unmet need of biomarkers suitable for patients’ pre-treatment selection and prognostic stratification. In this scenario, imaging with positron emission computed tomography (PET/CT) presents great and still unexplored potential to detect specific molecular and metabolic signatures, some of whom, such as the prostate specific membrane antigen (PSMA), can also be exploited as therapeutic targets, thus combining diagnosis and therapy in the so-called “theranostic” approach. In this review, we performed a web-based and desktop literature research to investigate the prognostic and theranostic potential of several PET imaging probes, such as 18F-FDG, 18F-choline and 68Ga-PSMA-11, also covering the emerging tracers still in a pre-clinical phase (e.g., PARP-inhibitors’ analogs and the radioligands binding to gastrin releasing peptide receptors/GRPR), highlighting their potential for defining personalized care pathways in mCRPC

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“…However, an increase in uptake of PSMA in response to ADT has been reported in patients with metastases of prostate cancer. 72,73 WB-DWI has potential to be important when estimating the prognosis of CRPC. Yoshida et al found the MET-RADS-P score to be a prognostic marker in CRPC, 74 and Perez-Lopez et al reported that WB-DWI could characterize the cancer phenotype throughout the whole body.…”

Section: Wb-dwi For Patients With Crpcmentioning

confidence: 99%

Whole‐body diffusion‐weighted magnetic resonance imaging: Diagnosis and follow up of prostate cancer and beyond

Yoshida¹,

Takahara

Arita³

et al. 2021

Int J of Urology

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Abbreviations & Acronyms ADC = apparent diffusion coefficient ADT = androgen deprivation therapy CRPC = castration-resistant prostate cancer CT = computed tomography DWI = diffusion-weighted imaging DWIBS = diffusion-weighted whole-body imaging with background body signal suppression MET-RADS-P = METastasis Reporting and Data System for Prostate Cancer MIP = maximum intensity projection MRI = magnetic resonance imaging PET = positron emission tomography PSA = prostate-specific antigen PSMA = prostate-specific membrane antigen SPECT = single-photon emission computed tomography STIR = short-tau inversion recovery T1WI = T1-weighted imaging T2WI = T2-weighted imaging USPIO = ultrasmall superparamagnetic iron oxide WB-DWI = whole-body diffusion-weighted imaging

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

Cited by 18 publications

References 40 publications

Prostate-Specific Membrane Antigen Ligand Positron Emission Tomography in Men with Nonmetastatic Castration-Resistant Prostate Cancer

Prostate-Specific Membrane Antigen Ligand Positron Emission Tomography in Men with Nonmetastatic Castration-Resistant Prostate Cancer

Prognostic and Theranostic Applications of Positron Emission Tomography for a Personalized Approach to Metastatic Castration-Resistant Prostate Cancer

Whole‐body diffusion‐weighted magnetic resonance imaging: Diagnosis and follow up of prostate cancer and beyond

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