Prostate-specific Membrane Antigen PET in Prostate                     Cancer

Lawhn-Heath, Courtney; Salavati, Ali; Behr, Spencer C.; Rowe, Steven P.; Calais, Jérémie; Fendler, Wolfgang P.; Eiber, M.; Emmett, Louise; Hofman, Michael S; Hope, Thomas A.

doi:10.1148/radiol.2021202771

Cited by 50 publications

(75 citation statements)

References 114 publications

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“…Nonetheless future studies should also include follow-up PSMA-PET/CTs for response assessment (including early biochemical response and OS) to further define the value of changes in PET parameters, such as delta values of PSMA-TV, TL-PSMA or occurrence of new metastases for subsequent outcome. Besides the properties of the specific radiopharmaceutical, SUVs are also influenced by a variety of technical factors including image reconstruction and system resolution [36,37]. In addition, future studies may also test the predictive value of standardized reporting systems for outcome in the setting of mCRPC patients scheduled for RLT [38][39][40].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, future studies may also test the predictive value of standardized reporting systems for outcome in the setting of mCRPC patients scheduled for RLT [38][39][40]. Furthermore, results of published and ongoing prospective trials using PSMA-directed treatment in end-stage disease may set the scene for a more widespread adoption of this promising treatment earlier in the therapeutic algorithm of PC patients [37]. Therefore, the concept of identifying patients prone to early RLT response will become more relevant, in particular at a disease stage with a broader armamentarium of available treatment options, e.g., in nonmetastatic CRPC.…”

Section: Discussionmentioning

confidence: 99%

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PSMA Expression Predicts Early Biochemical Response in Patients with Metastatic Castration-Resistant Prostate Cancer under 177Lu-PSMA-617 Radioligand Therapy

Widjaja

Werner

Roß

et al. 2021

Cancers

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177Lu-Prostate-specific membrane antigen (PSMA)-radioligand therapy (RLT) is a promising treatment option in patients with metastatic castration-resistant prostate cancer (mCRPC). We aimed to determine the predictive value of pretherapeutic PSMA-ligand positron emission tomography (PET) and established clinical parameters for early biochemical response after two cycles of RLT. In total, 71 mCRPC patients who had undergone PET/computed tomography (CT) with 68Ga-PSMA-11 prior to two cycles of 177Lu-PSMA-617 RLT were included. Malignant lesions on pretherapeutic PET/CTs were manually segmented and average maximum PSMA expression (maximum standardized uptake values, SUVmax), whole-body PSMA-tumor volume (TV), and whole-body total lesion (TL)-PSMA were calculated. We then tested the predictive performance of these parameters for early biochemical response (defined as prostate-sepcific antigen (PSA) decrease of ≥50% according to PCWG2) after two cycles of RLT, relative to established clinical parameters. Early PSA response was observed in 34/71 patients. PSA change after two cycles of RLT correlated with pretherapeutic SUVmax (r = −0.49; p < 0.001), but not with PSMA-TV (r = 0.02; p = 0.89) or TL-PSMA (r = −0.15; p = 0.22). A cut-off of 19.8 for SUVmax and 75.5 years for age was defined by receiver operating characteristics and revealed a significant outcome difference for early biochemical response between patients with adversely low vs. high PSMA expression and low vs. high age (p < 0.001). Multivariate analysis identified SUVmax (HR, 7.94, p = 0.001) and age (HR, 8.05, p = 0.002) as independent predictors for PSA response early in the treatment course. Thus, high age and high PSMA expression in patients scheduled for RLT identify patients with early biochemical response. This study provides a rationale for further prospective studies exploring PET-guided treatment intensification in selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

PSMA Expression Predicts Early Biochemical Response in Patients with Metastatic Castration-Resistant Prostate Cancer under 177Lu-PSMA-617 Radioligand Therapy

Widjaja

Werner

Roß

et al. 2021

Cancers

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“…PSMA is expressed at 100–1000-fold higher levels in prostate cancer compared to healthy prostate tissue, and importantly, shows highest expression in high-grade and castration-resistant prostate cancer ( 3 , 4 ). Multiple studies have demonstrated correlation between PSMA expression and prostate cancer aggressiveness ( 5 ), Gleason score ( 6 ), metastatic potential ( 7 ) and castration resistance ( 8 , 9 ), suggesting that PSMA is a promising imaging/therapeutic target.…”

Section: Psma: a Promising Imaging/therapeutic Targetmentioning

confidence: 99%

“…Several SPECT-imaging agents targeting PSMA were developed after ProstaScint, including agents labeled with 99m Tc ( 14 – 16 ) and 123 I ( 17 ). However, more recent attention has been focused on positron emission tomography (PET) agents, which offer higher sensitivity and spatial resolution compared to SPECT ( 4 , 18 ).…”

Section: Psma-targeted Imaging Agentsmentioning

confidence: 99%

“…PSMA radioligand therapy is an area of active investigation, with most notable areas focused on testing various choices of radionuclides and ligands to improve outcomes and reduce toxicity ( 78 ). For instance, several radiopharmaceuticals have been engineered to enable radiolabeling of the same ligand using both imaging and therapeutic radionuclides, allowing an accurate pharmacokinetic readout using imaging prior to radioligand therapy ( 75 ) ( 4 ). Other areas of investigation focus on the development of therapeutic agents with more favorable pharmacokinetics for therapeutic payload delivery such as antibody constructs with longer biological half-lives and different organ toxicity profiles ( 79 , 80 ).…”

Section: Therapeutic Role Of Psma In Metastatic Diseasementioning

confidence: 99%

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Incorporating PSMA-Targeting Theranostics Into Personalized Prostate Cancer Treatment: a Multidisciplinary Perspective

Gào

Salari

et al. 2021

Front. Oncol.

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Recent developments in prostate-specific membrane antigen (PSMA) targeted diagnostic imaging and therapeutics (theranostics) promise to advance the management of primary, biochemically recurrent, and metastatic prostate cancer. In order to maximize the clinical impact of PSMA-targeted theranostics, a coordinated approach between the clinical stakeholders involved in prostate cancer management is required. Here, we present a vision for multidisciplinary use of PSMA theranostics from the viewpoints of nuclear radiology, medical oncology, urology, and radiation oncology. We review the currently available and forthcoming PSMA-based imaging and therapeutics and examine current and potential impacts on prostate cancer management from early localized disease to advanced treatment-refractory disease. Finally, we highlight the clinical and research opportunities related to PSMA-targeted theranostics and describe the importance of multidisciplinary collaboration in this space.

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Positron emission tomography: Evolving modalities, radiopharmaceuticals and professional collaboration

Ayesa

Murphy

2022

J of Medical Radiation Sci

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Positron emission tomography (PET) as an imaging modality has undergone considerable innovation over the past few decades. Hybrid anatomical and functional imaging has become commonplace (initially PET/CT but now also PET/MRI) with improvements in imaging technology continually delivering studies with increasing diagnostic accuracy and decreasing radiation dose to the patient. More and more radiopharmaceuticals have emerged from the research sphere into clinical practice, with the traditional PET workhorse tracer 18F‐FDG accompanied by a range of novel radiopharmaceuticals with specific molecular targets. Imaging facilities offering PET/CT and PET/MRI provide a unique collaborative environment for the medical imaging multidisciplinary team. Diagnostic radiographers and nuclear medicine technologists especially have the opportunity to not only work together but also share knowledge and technical skills, ultimately benefitting the quality of patient care.

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Prostate-specific Membrane Antigen PET in Prostate Cancer

Cited by 50 publications

References 114 publications

PSMA Expression Predicts Early Biochemical Response in Patients with Metastatic Castration-Resistant Prostate Cancer under 177Lu-PSMA-617 Radioligand Therapy

PSMA Expression Predicts Early Biochemical Response in Patients with Metastatic Castration-Resistant Prostate Cancer under 177Lu-PSMA-617 Radioligand Therapy

Incorporating PSMA-Targeting Theranostics Into Personalized Prostate Cancer Treatment: a Multidisciplinary Perspective

Positron emission tomography: Evolving modalities, radiopharmaceuticals and professional collaboration

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