Prostate‐specific membrane antigen positron emission tomography/computed tomography funding grants free access to superior staging for Australian men with prostate cancer

O’Brien, J; McVey, Aoife; Kelly, Brian D.; Jenjitranant, Pocharapong; Buteau, James Patrick; Hofman, Michael S; Kasivisvanithan, Veeru; Eapen, Renu; Moon, Daniel; Murphy, Declan; Lawrentschuk, Nathan

doi:10.1111/bju.15773

Cited by 7 publications

(7 citation statements)

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“…At the APCCC 2019, most experts chose PSMA-PET imaging for detecting metastasis, but the Japanese chose conventional imaging modalities. While PSMA-PET is now funded for men with prostate cancer in Australia ( 46 ), PSMA-PET imaging is not available in clinical practice, and PSMA-targeted therapy is not approved in Japan; however, a questionnaire survey conducted at the JUA2021 revealed that many doctors are aware of the need for PSMA-PET in treating prostate cancer. PSMA-PET have also a predictive role in the management of patients with BCR.…”

Section: Discussionmentioning

confidence: 99%

Management of patients with advanced prostate cancer in Japan: ‘real-world’ consideration of the results from the Advanced Prostate Cancer Consensus Conference

et al. 2022

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A multidisciplinary approach is necessary to manage advanced prostate cancer. The Advanced Prostate Cancer Consensus Conference (APCCC) in 2019 provided a practical guide to help clinicians consider therapeutic options in controversial areas, but healthcare systems vary across the world. At the 109th annual meeting of the Japanese Urological Association in December 2021, Japanese urologists voted on the questions in the APCCC2019 guidelines regarding prostate-specific membrane antigen-positron emission tomography (PSMA-PET), management of oligometastatic prostate cancer, management of nonmetastatic castration-resistant prostate cancer (CRPC), management of a primary tumor in metastatic settings, systemic treatment of newly diagnosed metastatic castration-sensitive prostate cancer (CSPC), management of metastatic CRPC (mCRPC), and tumor genomic testing. We summarize the "real-world" status of the management of advanced prostate cancer in Japan. Several differences were noted in the management of advanced prostate cancer between Japanese urologists and the APCCC2019 guidelines. Many Japanese urologists chose conventional imaging modalities for detecting metastasis instead of PSMA-PET. More Japanese urologists prefer androgen-deprivation therapy (ADT) alone in the management of low-volume metastatic CSPC than the APCCC panelists do, In the management of M0 CRPC, darolutamide and enzalutamide were chosen more by Japanese urologists than by the voters at the APCCC2019. Bicalutamide remains one of the options for the management of mCRPC in Japan. More Japanese urologists do not recommend microsatellite instability (MSI) and BRCA1/2 tests than the voters at the APCCC2019.

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Section: Discussionmentioning

confidence: 99%

Management of patients with advanced prostate cancer in Japan: ‘real-world’ consideration of the results from the Advanced Prostate Cancer Consensus Conference

et al. 2022

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“…Studies (including proPSMA) have shown 68 Ga-PSMA PET/CT to offer improved treatment selection in both pre-and post-prostatectomy settings [12][13][14][15]. Given the evidence favouring modern imaging options and these tests now being publicly funded in Australia, paired mpMRI and 68 Ga-PSMA PET/CT-guided therapy may reduce radiation-related morbidity from standard of care and permit better patient selection for adjuvant/salvage therapies [16].…”

Section: Introductionmentioning

confidence: 99%

Can ⁶⁸Ga‐PSMA positron emission tomography and multiparametric MRI guide treatment for biochemical recurrence after radical prostatectomy?

et al. 2023

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ObjectiveTo evaluate the role of multiparametric magnetic resonance imaging (mpMRI) and Gallium‐68 (68Ga)‐prostate‐specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) in guiding salvage therapy for patients with biochemical recurrence (BCR) post‐radical prostatectomy.Patients and MethodsPatients were evaluated with paired mpMRI and 68Ga‐PSMA PET/CT scans for BCR (prostate‐specific antigen [PSA] >0.2 ng/mL). Patient, tumour, PSA and imaging characteristics were analysed with descriptive statistics.ResultsA total of 117 patients underwent paired scans to investigate BCR, of whom 53.0% (62/117) had detectable lesions on initial scans and 47.0% (55/117) did not. Of those without detectable lesions, 8/55 patients proceeded to immediate salvage radiotherapy (sRT) and 47/55 were observed. Of patients with negative imaging who were initially observed, 46.8% (22/47) did not reach threshold for repeat imaging, while 53.2% were rescanned due to rising PSA levels. Of these rescanned patients, 31.9% (15/47) were spared sRT due to proven distant disease, or due to absence of disease on repeat imaging. Of the original 117 patients, 53 (45.3%) were spared early sRT due to absence of disease on imaging or presence of distant disease, while those undergoing delayed sRT still maintained good PSA responses. Of note, patients with high‐risk features who underwent sRT despite negative imaging demonstrated satisfactory PSA responses to sRT. Study limitations include the observational design and absence of cause‐specific or overall survival data.ConclusionOur findings support the use of mpMRI and 68Ga‐PSMA PET/CT in guiding timing and necessity of salvage therapy tailored to detected lesions, with potential to reduce unnecessary sRT‐related morbidity. Larger or randomized trials are warranted to validate this.

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“…Nevertheless, the published evidence so far on PSMA PET-CT has culminated in the increased availability and accessibility of this scan around the world. An example of this is Australia, where the inclusion of PSMA PET-CT in urological guidelines has culminated in a government rebated PSMA PET-CT scan for men who have histologically confirmed intermediate or high risk PCa or biochemical recurrent PCa [ 11 , 12 ]. Given its inevitable increase in utility, it is important to determine if treatment decisions made using PSMA PET-CT staging scans has a positive impact on the clinical outcomes of patients.…”

Section: Introductionmentioning

confidence: 99%

Distant Nodes Seen on PSMA PET-CT Staging Predicts Post-Treatment Progression in Men with Newly Diagnosed Prostate Cancer—A Prospective Cohort Study

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Kelly

et al. 2022

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PSMA PET-CT scans are now recommended in international urological guidelines for primary staging and re-staging of prostate cancer. However, there is little published literature on the clinical outcomes for patients after treatment decisions made using PSMA PET-CT results. This is a multisite, prospective cohort study investigating the clinical outcomes of men who received treatment plans based on PSMA PET-CT results for primary staging. Men with biopsy proven prostate cancer received a PSMA PET-CT scan for primary staging. Treatment plans were recommended by multidisciplinary teams (MDT). After treatment, these men were followed with 6 monthly PSA tests and imaging or biopsies if recommended by MDT. The primary outcome was treatment progression defined as the addition or change of any treatment modalities such as androgen deprivation therapy, radiation therapy or chemotherapy. In total, 80% of men did not have any treatment progression after enactment of treatment based on PSMA PET-CT primary staging results at 29 months of follow up. Men who had distant nodes seen on PSMA PET-CT had a 5 times increased risk of treatment progression. Larger studies with longer follow up are needed to validate our results and optimise the way clinicians use PSMA PET-CT results to guide management.

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Prostate‐specific membrane antigen positron emission tomography/computed tomography funding grants free access to superior staging for Australian men with prostate cancer

Cited by 7 publications

References 6 publications

Management of patients with advanced prostate cancer in Japan: ‘real-world’ consideration of the results from the Advanced Prostate Cancer Consensus Conference

Management of patients with advanced prostate cancer in Japan: ‘real-world’ consideration of the results from the Advanced Prostate Cancer Consensus Conference

Can ⁶⁸Ga‐PSMA positron emission tomography and multiparametric MRI guide treatment for biochemical recurrence after radical prostatectomy?

Distant Nodes Seen on PSMA PET-CT Staging Predicts Post-Treatment Progression in Men with Newly Diagnosed Prostate Cancer—A Prospective Cohort Study

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Prostate‐specific membrane antigen positron emission tomography/computed tomography funding grants free access to superior staging for Australian men with prostate cancer

Cited by 7 publications

References 6 publications

Management of patients with advanced prostate cancer in Japan: ‘real-world’ consideration of the results from the Advanced Prostate Cancer Consensus Conference

Management of patients with advanced prostate cancer in Japan: ‘real-world’ consideration of the results from the Advanced Prostate Cancer Consensus Conference

Can 68Ga‐PSMA positron emission tomography and multiparametric MRI guide treatment for biochemical recurrence after radical prostatectomy?

Distant Nodes Seen on PSMA PET-CT Staging Predicts Post-Treatment Progression in Men with Newly Diagnosed Prostate Cancer—A Prospective Cohort Study

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Can ⁶⁸Ga‐PSMA positron emission tomography and multiparametric MRI guide treatment for biochemical recurrence after radical prostatectomy?