Prostate Specific Membrane Antigen Positron Emission Tomography/Computerized Tomography in the Evaluation of Initial Response in Candidates Who Underwent Salvage Radiation Therapy after Radical Prostatectomy for Prostate Cancer

Meijer, Dennie; Luiting, Henk B.; Leeuwen, Pim J. van; Remmers, Sebastiaan; Jansen, B.H.E.; Bodar, Yves J. L.; Witteveen, Thelma; Schaake, Eva E.; Poel, Henk G. van der; Wondergem, Maurits; Busstra, Martijn B.; Nieuwenhuijzen, Jakko A.; Meijnen, Philip; Brabander, Tessa; Moorselaar, R. Jeroen A. van; Hendrikse, N. Harry; Oprea-Lager, Daniela E.; Roobol, Monique J.; Vis, André N.

doi:10.1097/ju.0000000000001437

Cited by 5 publications

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“…Emmett et al [20] showed that in 100 patients with either negative PSMA-PET or local recurrent disease on PSMA-PET, approximately 10% of patients experienced biochemical progression of disease at 1 yr after SRT. Besides, Meijer et al [21] and Schmidt-Hegemann et al [22] showed an overall treatment response, defined as a PSA value of 0.1 ng/ml after PSMA-PET/CT-guided SRT, rate of 75-78%.…”

Section: Discussionmentioning

confidence: 99%

“…First, in the studies performed by Emmett et al [20] and Schmidt-Hegemann et al [22], patients underwent more extensive SRT to both the prostatic fossa and the pelvis, whereas patients with known (lymph-node) metastases at lymph-node dissection were not excluded. Besides, Meijer et al [21] performed their analyses on patients who underwent SRT at a median PSA value of 0.4 ng/ml, compared with 0.7 ng/ml in the study performed by Stephenson et al [19]. Furthermore, the use of ADT was no reason for exclusion in most of these studies, making biochemical endpoints difficult to interpret.…”

Section: Discussionmentioning

confidence: 99%

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Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Is Associated with Improved Oncological Outcome in Men Treated with Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer

Meijer¹,

Eppinga

Mohede³

et al. 2022

European Urology Oncology

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Background: Radiolabeled prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has shown superior diagnostic accuracy to conventional imaging for the detection of prostate cancer deposits . Consequently, clinical management changes have been reported in patients with biochemical recurrence (BCR) of disease after robot-assisted radical prostatectomy (RARP). We hypothesized that, due to the exclusion of patients with metastatic disease on PSMA-PET/CT, those who underwent local salvage radiation therapy (SRT) after restaging PSMA-PET/CT for BCR may have better oncological outcomes than patients who underwent ''blind'' SRT. Objective: To compare the oncological outcome of a patient cohort that underwent PSMA-PET imaging prior to SRT with that of a patient cohort that did not have PSMA-PET imaging before SRT. Design, setting, and participants: We included 610 patients who underwent SRT, of whom 298 underwent PSMA-PET/CT prior to SRT and 312 did not. No additional hormonal therapy was prescribed. Outcome measurements and statistical analysis: To compare both cohorts, case-control matching was performed, using the prostate-specific antigen (PSA) value at the initiation of SRT, pathological grade group, pathological T stage, surgical margin status, and biochemical persistence after RARP as matching variables. The outcome variable was

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Is Associated with Improved Oncological Outcome in Men Treated with Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer

Meijer¹,

Eppinga

Mohede³

et al. 2022

European Urology Oncology

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“…We did not single out ADT as a factor to help predict PSMA positivity. The data in the literature are conflicting and confounding factors such as ADT administration in the higher‐risk cohort and ADT flair effect reduce the reliability of this marker [28].…”

Section: Discussionmentioning

confidence: 99%

Pathological predictors of ¹⁸F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy

et al. 2022

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To assess the correlation of pathological radical prostatectomy (RP) specimen features and prostate-specific antigen (PSA) characteristics to imaging findings on subsequent 18 F-DCFPyL positron emission tomography/computed tomography (PET/ CT) in patients with biochemical failure (BF). Patients and MethodsRetrospective analysis of combined 18 F-DCFPyL PET/CT database of patients from centres in Australia and New Zealand was performed. A total of 205 patients presenting with BF after RP were included in this study. Imaging findings on 18 F-DCFPyL PET/CT were recorded and correlated with the PSA characteristics at BF and pathological features of the original tumour. ResultsOf the 205 patients, 120 (58.5%) had evidence of abnormal prostate-specific membrane antigen (PSMA) expression compatible with recurrent prostate cancer. Increasing PSA velocity (P = 0.01), International Society of Urological Pathology (ISUP) Grade Group (P = 0.02), lymphovascular invasion (P = 0.05) and nodal positivity (P = 0.02) at the time of RP were more likely to demonstrate PSMA positivity. Multivariable logistic regression revealed a higher PSA level prior to PSMA PET/CT (P < 0.01), adjuvant radiotherapy (P = 0.09), Gleason score ≥8 (P < 0.01) and nodal positivity (P = 0.05) were all predictive of PSMA positivity. Conclusion18 F-DCFPyL PET/CT positivity, both generally and site specific, correlates with PSA and RP pathological factors. Our results echo cohorts focussing on post-RP patients, those imaged with 68 Ga-PSMA and those concerning biochemical persistence. Nomograms that include risk factors for 'PSMA-positive recurrence' in the BF population may increase the catchment of patients with disease confined to the prostate bed or pelvis who have a greater probability of prolonged disease-free survival.

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“…The validation cohort consisted of 157 men with rising PSA after RP from the Prostate Cancer Network Netherlands who underwent 18 F-DCFPyL PET/CT without concurrent ADT. The imaging procedure was as previously described [8] . We evaluated the performance of the two nomograms in terms of their discrimination, calibration, and clinical utility.…”

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confidence: 99%

“…Besides preventing misdirected SRT by detecting metastatic PCa recurrences, PSMA PET/CT can detect local recurrence. Detection of a local recurrence is a positive predictor for SRT efficacy [8] . Up to now, PSMA PET/CT has mainly been used to exclude metastatic disease because of radioactivity considerations for the bladder, whereas local recurrences often remain undetected.…”

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confidence: 99%

External Validation of Two Nomograms Developed for 68Ga-PSMA-11 Applied to the Prostate-specific Membrane Antigen Tracer 18F-DCFPyl: Is Prediction of the Optimal Timing of Salvage Therapy Feasible?

Luiting

Remmers

Meijer³

et al. 2021

European Urology Open Science

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Two nomograms have been developed to predict the outcome of positron emission tomography (PET)/computed tomography (CT) imaging with 68 Ga-labeled ligands for prostate-specific membrane antigen ( 68 Ga-PSMA) for patients with rising prostate-specific antigen after radical prostatectomy (RP). These nomograms quantify the ability of PSMA PET/CT to detect prostate cancer recurrences, and therefore provide critical information in determining the optimal timing for PSMA PET/CT in guiding salvage therapies. We validated the ability of these nomograms to accurately predict PET/CT outcome using another ligand tracer, 18 F-DCFPyL. The external validation cohort consisted of 157 men from the Prostate Cancer Network Netherlands who underwent 18 F-DCFPyL PET/CT to guide salvage therapies after RP. The nomogram of Rauscher et al (predicting a positive scan) showed accurate prediction of 50–80% (discrimination 0.68, 95% confidence interval [CI] 0.59–0.76). The nomogram of Luiting et al (predicting recurrence outside the prostatic fossa) showed accurate prediction for predicted probability values between 15% and 65%, with a small degree of overestimation for predicted probability values between 30% and 50% (discrimination 0.74, 95% CI 0.28–1.24). According to calibration curves, discrimination results, and decision curve analysis, we conclude that clinicians can use these 68 Ga-PSMA–based nomograms to predict 18 F-DCFPyL PET/CT outcome. These nomograms improve shared decision-making in determining the optimal time to initiate PSMA PET/CT–guided salvage therapies. Patient summary Prediction tools developed for prostate scans (positron emission tomography, PET) using one type of radioactive tracer (chemicals labeled with gallium-68) are also accurate in predicting scan findings with another tracer (a chemical labeled with fluorine-18). Our study confirms that these tools can be used to guide decisions on the timing of treatments for prostate cancer recurrence.

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Prostate Specific Membrane Antigen Positron Emission Tomography/Computerized Tomography in the Evaluation of Initial Response in Candidates Who Underwent Salvage Radiation Therapy after Radical Prostatectomy for Prostate Cancer

Cited by 5 publications

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Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Is Associated with Improved Oncological Outcome in Men Treated with Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer

Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Is Associated with Improved Oncological Outcome in Men Treated with Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer

Pathological predictors of ¹⁸F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy

External Validation of Two Nomograms Developed for 68Ga-PSMA-11 Applied to the Prostate-specific Membrane Antigen Tracer 18F-DCFPyl: Is Prediction of the Optimal Timing of Salvage Therapy Feasible?

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Prostate Specific Membrane Antigen Positron Emission Tomography/Computerized Tomography in the Evaluation of Initial Response in Candidates Who Underwent Salvage Radiation Therapy after Radical Prostatectomy for Prostate Cancer

Cited by 5 publications

References 0 publications

Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Is Associated with Improved Oncological Outcome in Men Treated with Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer

Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Is Associated with Improved Oncological Outcome in Men Treated with Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer

Pathological predictors of 18F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy

External Validation of Two Nomograms Developed for 68Ga-PSMA-11 Applied to the Prostate-specific Membrane Antigen Tracer 18F-DCFPyl: Is Prediction of the Optimal Timing of Salvage Therapy Feasible?

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Pathological predictors of ¹⁸F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy