Impact of  68 Ga-PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta-analysis

Han, Sangwon; Woo, Sungmin; Kim, Yeon Joo; Suh, Chong Hyun

doi:10.1016/j.eururo.2018.03.030

Cited by 274 publications

(182 citation statements)

References 39 publications

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“…In patients with BCR after RP 68 Ga-PSMA PET has been found to have a high management impact and detection rate [61]; however, the recommendation to perform 68 Ga-PSMA PET after RP to guide salvage treatment is only weak [3]. Although all patients in the different studies included in the present review underwent RP as primary therapy, not all treatments between RP and 68 Ga-PSMA PET were similar.…”

Section: Discussionmentioning

confidence: 99%

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

Luiting¹,

Leeuwen

Busstra³

et al. 2019

BJU International

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ObjectivesTo review the literature to determine the sensitivity and specificity of gallium-68 prostate-specific membrane antigen ( 68 Ga-PSMA) positron-emission tomography (PET) for detecting pelvic lymph node metastases in patients with primary prostate cancer (PCa), and the positive predictive value in patients with biochemical recurrence (BCR) after initial curative treatment, and, in addition, to determine the detection rate and management impact of 68 Ga-PSMA PET in patients with BCR after radical prostatectomy (RP). Materials and MethodsWe performed a comprehensive literature search. Search terms used in MEDLINE, EMBASE and Science Direct were '(PSMA, 68 Ga-PSMA, 68 Gallium-PSMA, Ga-68-PSMA or prostate-specific membrane antigen)' and '(histology, lymph node, staging, sensitivity, specificity, positive predictive value, recurrence, recurrent or detection)'. Relevant abstracts were reviewed and full-text articles obtained where possible. References to and from obtained articles were searched to identify further relevant articles. ResultsNine retrospective and two prospective studies described the sensitivity and specificity of 68 Ga-PSMA PET for detecting pelvic lymph node metastases before initial treatment, which ranged from 33.3% to 100% and 80% to 100%, respectively. In eight retrospective studies, the positive predictive value of 68 Ga-PSMA PET in patients with BCR before salvage lymph node dissection ranged from 70% to 100%. The detection rate of 68 Ga-PSMA PET in patients with BCR after RP in the PSA subgroups <0.2 ng/mL, 0.2-0.49 ng/mL and 0.5 to <1.0 ng/ mL ranged from 11.3% to 50.0%, 20.0% to 72.7% and 25.0% to 87.5%, respectively. ConclusionThe review results showed that 68 Ga-PSMA PET had a high specificity for the detection of pelvic lymph node metastases in primary PCa. Furthermore, 68 Ga-PSMA PET had a very high positive predictive value in detecting lymph node metastases in patients with BCR. By contrast, sensitivity was only moderate; therefore, based on the currently available literature, 68 Ga-PSMA PET cannot yet replace pelvic lymph node dissection to exclude lymph node metastases. In the salvage phase, 68 Ga-PSMA PET had both a high detection rate and impact on radiotherapy planning in early BCR after RP. Keywords 68Ga-PSMA PET/CT, pelvic lymph node dissection, detection rate, pelvic lymph node metastases, #ProstateCancer, #PCSM Use of 68Ga-PSMA PET/CT after RP: review IQR, interquartile range; LNM, lymph node metastases. *Gallium-68 prostate-specific membrane antigen positron-emission tomography ( 68 Ga-PSMA PET)/MRI was used instead of 68 Ga-PSMA PET/CT. 208

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Section: Discussionmentioning

confidence: 99%

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

Luiting¹,

Leeuwen

Busstra³

et al. 2019

BJU International

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“…This result is higher than those found by Morigi et al 63% or in Gauthé et al study 67% . A recent meta‐analysis of Han et al found a management impact of 54% of patients . How can one explain this difference?…”

Section: Discussionmentioning

confidence: 61%

68Ga‐PSMA‐11 PET‐CT study in prostate cancer patients with biochemical recurrence and non‐contributive 18F‐Choline PET‐CT: Impact on therapeutic decision‐making and biomarker changes

et al. 2018

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Background In this retrospective study, we investigated the impact of 68Ga‐PSMA‐11 PET‐CT (PSMA PET‐CT) upon the treatment plan and therapeutic response obtained for Prostate Cancer (PCa) patients presenting an occult biochemical recurrence. Methods Forty‐two patients with previously negative or doubtful 18F‐Choline (FCH) were enrolled. PET images were recorded 1 h after injection of tracer. Only a few months after treatment ended, a PSA assay was requested to evaluate the therapeutic efficacy of the treatment based on PSMA results. Results PSMA—positive lesions were detected in 34/42 (80.9%) patients. Detection rates were 85.7% and 89.3% for serum PSA levels lower than 2 ng/mL, and >2 ng/mL, respectively. One hundred seventy‐three lesions were detected: 132/173 in lymph nodes (76.3%), 22/173 as metastatic sites (bone or lung) (12.7%), and 19/173 in the prostate bed (10.9%). As a result of the PSMA PET‐CT, therapeutic management changed in 31/42 patients (73.8%). With a follow‐up of 4.9 ± 2.27 months, 32/42 (76.2%) PSA assays after treatment guided by PSMA PET‐CT were collected. For 37.5% (12/32) of patients, the serum PSA level was lower than 0.2 ng/mL and a PSA decrease of over 50% in 8 (25.0%) other patients were obtained. Conclusion Performing a PSMA PET‐CT when FCH PET‐CT was doubtful or negative allows the recurrence localization in more 80% of patients and this had a major clinical impact, as it resulted in treatment change in more than 70% of patients as well as a significant decrease in PSA levels in more than 60% of them.

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“…6,[13][14][15][16] Approximately, PSMA PET-CTpositive rates in a heterogenous group of patients at biochemical recurrence are in the range of 90-97% (at PSA >2.0ng/ml), 70-93% (at PSA 1.0-2.0ng/ ml), 50-60% (at PSA 0.5-1.0ng/ml) and 30-40% (at PSA 0.2-0.5ng/ml). 6,16 The cornerstone of management at biochemical recurrence after curative surgery is salvage RT of the prostate fossa with or without ADT, delivered on the presumption that recurrence is local. Early disease localisation on PSMA PET opens up the possibility to intervene with more personalised, targeted treatment options.…”

Section: Psma Pet-ct In Biochemical Relapse: What Is the Rationale?mentioning

confidence: 99%

“…More objective evidence is emerging that PSMA PET has a direct impact on patient management. Recent metaanalyses in a diverse, heterogenous group of patients, predominantly in biochemical recurrence, estimate that approximately 50% of patients had a change in intended management plan based on results of the PSMA PET-CT. 16 Changes in management included alteration of conventional salvage RT fields, doses, and preference for more focussed treatment with stereotactic RT techniques or even limited surgery.…”

Section: Does Psma Pet-ct Change Management and Outcomes?mentioning

confidence: 99%

“…It has been hypothesised that SBRT may translate into a better quality of life by delaying the need for ADT and systemic chemotherapy. 16 The eventual adoption of new technology depends not just on whether they alter management, but whether they alter final patient outcomes. Outcome studies are long and laborious, but such scientific rigor is necessary.…”

Section: Does Psma Pet-ct Change Management and Outcomes?mentioning

confidence: 99%

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PSMA PET ligands in prostate cancer: a game‐changer?

Dhawan

Barwick

Khan

et al. 2019

Trends Urol & Men's Health

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Impact of 68 Ga-PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta-analysis

Cited by 274 publications

References 39 publications

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

68Ga‐PSMA‐11 PET‐CT study in prostate cancer patients with biochemical recurrence and non‐contributive 18F‐Choline PET‐CT: Impact on therapeutic decision‐making and biomarker changes

PSMA PET ligands in prostate cancer: a game‐changer?

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