PSMA Ligand PET/MRI for Primary Prostate Cancer: Staging Performance and Clinical Impact

Abstract

Primary staging of prostate cancer relies on modalities, which are limited. We evaluate simultaneous [Ga]Ga-PSMA-11 PET (PSMA-PET)/MRI as a new diagnostic method for primary tumor-node-metastasis staging compared with histology and its impact on therapeutic decisions. We investigated 122 patients with PSMA-PET/MRI prior to planned radical prostatectomy (RP). Primary endpoint was the accuracy of PSMA-PET/MRI in tumor staging as compared with staging-relevant histology. In addition, a multidisciplinary team reassessed the initial therapeutic approach to evaluate its impact on the therapeutic management. PSMA-PET/MRI correctly identified prostate cancer in 119 of 122 patients (97.5%). Eighty-one patients were treated with RP and pelvic lymphadenectomy. The accuracy for T staging was 82.5% [95% confidence interval (CI), 73-90; < 0.001], for T2 stage was 85% (95% CI, 71-94; < 0.001), for T3a stage was 79% (95% CI, 43-85; < 0.001), for T3b stage was 94% (95% CI, 73-100; < 0.001), and for N1 stage was 93% (95% CI, 84-98; < 0.001). PSMA-PET/MRI changed the therapeutic strategy in 28.7% of the patients with either the onset of systemic therapy/radiotherapy ( = 16) or active surveillance ( = 19). PSMA-PET/MRI can provide an accurate staging of newly diagnosed prostate cancer. In addition, treatment strategies were changed in almost a third of the patients due to the information of this hybrid imaging technique.

Response assessment using [68Ga]Ga‐PSMA ligand PET in patients undergoing systemic therapy for metastatic castration‐resistant prostate cancer

“…[6][7][8] Nowadays, [ 68 Ga]Ga-prostate specific membrane antigen (PSMA)-11 ([ 68 Ga]Ga-PSMA-HBED-CC; PSMA 11)-PET has emerged as a promising molecular imaging tool and is used more and more for the staging of PC. It has shown superior performance compared to standard imaging for primary staging 9,10 and in patients with biochemical recurrence after local therapy with curative intent. 11 Concerning response to therapy in mCRPC patients, to date, two studies have been published.…”

Modular Synthesis of DOTA‐Metal‐Based PSMA‐Targeted Imaging Agents for MRI and PET of Prostate Cancer

“…[9][10][11][12][13] Recently,astudy using simultaneousP ET/MRI has reported remarkablyh igh accuracy( 80-97.5%)i nt he detection of multiple stages of PCa, underscoring the need for reliable synthetic methods for targeted probesfor both PET andM RI of PCa. [14] The success of targeted molecular imaging agents( TMIAs) for PCa has largely been made possible by the discovery of prostate-specific membrane antigen (PSMA) overexpression in PCa cells. [15][16][17] PSMA, also known as glutamate carboxypeptidase II (GCPII), NAALADase,a nd folate hydrolase FOLH1, is a well-characterized trans-membrane glycoprotein.…”

“…[20,21] Currently,t he PCa TMIAs most widely investigated are 68 Galabeled DCL probesf or PET imaging, with the agent 68 Ga-PSMA-11 (also known as 68 Ga-DKFZ-PSMA-11) being most prevalent in clinical studies. [3][4][5][6][7]14] While 68 Ga-DKFZ-PSMA-11e mploys an acyclic metal-chelating group,H BED-CC, the alternative and well-known cyclic chelator,1 ,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA), is at the core of many other reported TMIAs for both PET and MRI of PCa. [17,[22][23][24] DOTAi sa lso the chelating moiety in 177Lu-PSMA-617, ana nalogousr adiotherapeutic agent in currentc linical use for PCa therapy.…”

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis

“…In the reference standard domain, all studies were at low risk of bias and concern for applicability. In the ow and timing domain, 6 studies had unknown risk of bias as the interval between PSMA-PET and prostatectomy was not provided [26,28,31,32,35,36].…”