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Nikitas J, Lam E, Booker KA, Fendler WP, Eiber M, Hadaschik B, Herrmann K, Hirmas N, Lanzafame H, Stuschke M, Czernin J, Steinberg ML, Nickols NG, Kishan AU, Calais J. Randomized Trial of Prostate-Specific Membrane Antigen PET/CT Before Definitive Radiotherapy for Unfavorable Intermediate- and High-Risk Prostate Cancer (PSMA-dRT Trial). J Nucl Med 2024; 65:1076-1079. [PMID: 38664019 DOI: 10.2967/jnumed.123.267004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/28/2024] [Indexed: 07/03/2024] Open
Abstract
This multicenter randomized phase III trial (NCT04457245) evaluated the effect of performing prostate-specific membrane antigen (PSMA) PET/CT before definitive radiotherapy. Methods: Men with unfavorable intermediate- or high-risk prostate cancer were randomized 1.08:1 between receiving and not receiving a PSMA PET/CT scan before definitive radiotherapy. All other imaging modalities were allowed in the control arm. The primary endpoint was 5-y progression-free survival. Results: Fifty-four men were randomized between November 2020 and December 2021 (PSMA PET/CT, n = 25; control, n = 29). The trial closed early after approval and insurance coverage of PSMA PET/CT. In the PSMA PET/CT arm, 14 patients had localized disease (miT2b-cN0M0), 6 had locally advanced disease (miT3a-bN0M0), 3 had regional metastasis (miN1M0), and 1 had distant metastasis (miM1b). Four patients were upstaged. Conclusion: PSMA PET/CT upstaged 17% of patients, which allowed for more accurate radiotherapy planning. Unfortunately, this trial closed early before completion of target enrollment (54/316, 17%) and was underpowered to assess the effect of PSMA PET/CT on progression-free survival.
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Affiliation(s)
- John Nikitas
- Department of Radiation Oncology, UCLA, Los Angeles, California
| | - Ethan Lam
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Kiara Adame Booker
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Matthias Eiber
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Nader Hirmas
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Helena Lanzafame
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | | | - Nicholas G Nickols
- Department of Radiation Oncology, UCLA, Los Angeles, California
- Radiation Oncology Service, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
| | - Amar U Kishan
- Department of Radiation Oncology, UCLA, Los Angeles, California
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;
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Pozdnyakov A, Kulanthaivelu R, Bauman G, Ortega C, Veit-Haibach P, Metser U. The impact of PSMA PET on the treatment and outcomes of men with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00544-3. [PMID: 35440642 DOI: 10.1038/s41391-022-00544-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate-specific membrane antigen (PSMA) PET is highly sensitive in identifying disease recurrence in men with biochemical recurrence of prostate cancer (BCR) after primary therapy and is rapidly being adopted in clinical practice. The purpose of this systematic review and meta-analysis was to assess the documented impact of PSMA-PET on patient management and outcomes, including prostate-specific antigen (PSA) response, and intermediate and long-term outcome measures. MATERIALS AND METHODS MBASE, PubMed, Web of Science, Cochrane and OVID databases were searched for studies reporting on the impact of PSMA-PET on the management and outcomes of patients with BCR after definitive primary therapy. Outcome measures assessed included biochemical response to therapy after PET and BCR-free survival (BRFS). The proportions of patients in whom management changed, and the proportion of patients in whom each outcome measure was obtained were tabulated and pooled into meta-analysis using DerSimonian-Laird method. RESULTS A total of 34 studies with 3680 men reported change in management after PSMA-PET and 27 studies with 2639 men reported on at least one outcome measure and had follow-up data. PSMA-PET was positive in 2508/3680 (68.2%). The pooled proportion of change in management after PSMA-PET was 56.4% (95% CI, 48.0-63.9%). A decrease in serum PSA was documented in 72.4% of men (95% CI, 63.4-81.5%), and complete biochemical response in 23.3% (95% CI, 14.6-32.0%) at a median follow-up of 8.1 and 11 months, respectively. The pooled BRFS rate was 60.2% (95% CI, 49.1-71.4%) at a median follow-up of 20 months. CONCLUSION In conclusion, PSMA PET is positive in more than 2/3 of men with BCR and impacts patient management in more than half of the men. BRFS after PET-directed management is 60% at a median of 20 months after salvage therapy, and complete biochemical response may be achieved in up to a quarter of men.
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Affiliation(s)
- Alex Pozdnyakov
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Roshini Kulanthaivelu
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada
| | - Glenn Bauman
- Department of Oncology, Western University, London, ON, Canada
| | - Claudia Ortega
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada.
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Mena E, Lindenberg L, Choyke P. The Impact of PSMA PET/CT Imaging in Prostate Cancer Radiation Treatment. Semin Nucl Med 2022; 52:255-262. [PMID: 35016755 PMCID: PMC8960055 DOI: 10.1053/j.semnuclmed.2021.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Imaging of prostate cancer is rapidly evolving with the introduction of the novel prostate-specific membrane antigen (PSMA)-targeted PET imaging tool for managing recurrent prostate cancer. One immediate impact of PSMA PET is the identification of residual or recurrent lesions that are amenable to external beam radiotherapy. Radiotherapy is used as a definitive curative treatment option for patients with localized prostate cancer alone or in combination therapy. In the setting of biochemical failure after radical prostatectomy, salvage radiation is a potential curative option, and the application of metastasis-directed radiotherapy in the setting of oligometastatic prostate cancer is currently being studied. To maximize the chances of curative therapy, the irradiated tumor volumes should completely encompass the actual extent of disease. Thus, an accurate estimation of the location and delineation of disease targets is critical for radiotherapy planning. The integration of PSMA PET imaging into the routine evaluation of prostate cancer has markedly improved sensitivity and specificity for recurrent disease, even at very low PSA values, which may enable further tailored radiation treatment plans, and help reduce the risk of radiation to adjacent normal tissues. However, while the introduction of PSMA PET will likely change behavior regarding earlier application of radiotherapy, the long-term impact of PSMA PET on patient outcomes is yet to be determined. The aim of the review is to give an overview of the use of PSMA-PET/CT imaging in the setting of radiation therapy for prostate cancer.
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Affiliation(s)
- Esther Mena
- Molecular Imaging Branch, NCI, NIH, Bethesda, MD.
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Al-Ibraheem A, Abuhijla F, Salah S, Shahait M, Khader J, Mohamad I, Al-Rasheed U, Pomykala KL, Herrmann K, Abu-Hijlih R. The influence of 68Ga-prostate-specific membrane antigen PET/computed tomography on prostate cancer staging and planning of definitive radiation therapy. Nucl Med Commun 2021; 42:811-817. [PMID: 33660693 DOI: 10.1097/mnm.0000000000001394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) is a novel imaging tool with an evolving role in the management of prostate cancer. This study aims to retrospectively evaluate the impact of 68Ga-PSMA PET/CT on prostate cancer staging and definitive radiation therapy planning. METHODS Between April 2015 and June 2020, 366 men with prostate cancer were evaluated with 68Ga-PSMA PET/CT. Of these, 108 patients had PSMA PET/CT before radiation therapy. Radiation was given as primary treatment in 58 (54%) and as salvage radiation therapy for biochemical recurrence after primary surgery in 50 (46%) patients, respectively. Patient and disease characteristics were analyzed, and impact of PSMA PET/CT on disease staging and radiotherapy planning was evaluated in comparison to conventional imaging. RESULTS Median age at presentation was 69 years, and median prostate-specific antigen was 18 ng/mL (3.6-400) for primary and 0.4 ng/mL (0.1-4.6) for salvage radiation, respectively. The combined change of disease stage rate was 36% (39/108) with 45% (26/58) in the subgroup of primary radiation and 26% (13/50) in the patients intended for salvage radiation. Upstaging was found in 24 (22%) and downstaging in 15 (14%) patients. Radiation planning was changed based on PSMA PET/CT in 34 (31%) patients, including 7 (6.4%) patients in which stereotactic body radiotherapy (SBRT) was added to oligometastatic sites. The radiation field was extended to include pelvic lymph node involvement in 21 patients. CONCLUSIONS 68Ga-PSMA PET/CT changed the prostate cancer stage in around one-third of men. PSMA PET/CT significantly impacted radiation planning. Further prospective studies are still required.
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Affiliation(s)
| | | | | | | | | | | | | | - Kelsey L Pomykala
- Department of Radiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University Clinic Essen, Essen, Germany
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Bottke D, Miksch J, Thamm R, Krohn T, Bartkowiak D, Beer M, Bolenz C, Beer AJ, Prasad V, Wiegel T. Changes of Radiation Treatment Concept Based on 68Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy. Front Oncol 2021; 11:665304. [PMID: 34141618 PMCID: PMC8204009 DOI: 10.3389/fonc.2021.665304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Salvage radiotherapy (SRT) is the main potentially curative treatment option for prostate cancer patients with post-prostatectomy PSA progression. Improved diagnostics by positron emission tomography/computed tomography (PET/CT) can lead to adjustments in treatment procedures (e.g. target volume of radiotherapy, androgen deprivation therapy). We analyzed the impact of 68Ga-PSMA-11-PET/CT on the target volume in early biochemical recurrence (PSA up to 0.5 ng/ml). Patients and Methods We retrospectively analyzed 76 patients with biochemical recurrence after radical prostatectomy in whom SRT was planned after 68Ga-PSMA-11-PET/CT. All patients had a PSA ≤0.5 ng/ml. An experienced radiation oncologist determined the radiotherapy concept, first with consideration of the PET/CT, second hypothetically based on the clinical and pathological features excluding PET/CT results. Results Without considering the PET/CT, all 76 patients would have been assigned to RT, 60 (79%) to the bed of the prostate and seminal vesicles alone, and 16 (21%) also to the pelvic lymph nodes because of histopathologic risk factors. Uptake indicative for tumor recurrence in 68Ga-PSMA-11-PET/CT was found in 54% of the patients. The median pre-PET/CT PSA level was 0.245 ng/ml (range 0.07-0.5 ng/ml). The results of the PET/CT led to a change in the radiotherapeutic target volume in 21 patients (28%). There were major changes in the target volume including the additional irradiation of lymph nodes or the additional or exclusive irradiation of bone metastases in 13 patients (17%). Minor changes including the additional irradiation of original seminal vesicle (base) position resulted in eight patients (11%). Conclusion Using 68Ga-PSMA-11-PET/CT for radiation planning, a change in the treatment concept was indicated in 28% of patients. With PET/CT, the actual extent of the tumor can be precisely determined even with PSA values of ≤0.5 ng/ml. Thus, the treatment concept can be improved and individualized. This may have a positive impact on progression free survival. Our results warrant further prospective studies.
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Affiliation(s)
- Dirk Bottke
- Xcare Praxis für Strahlentherapie, Trier, Germany
| | - Jonathan Miksch
- Department of Nuclear Medicine, University Hospital of Ulm, Ulm, Germany
| | - Reinhard Thamm
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | | | - Detlef Bartkowiak
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - Meinrad Beer
- Department of Radiology, University Hospital of Ulm, Ulm, Germany
| | | | - Ambros J Beer
- Department of Nuclear Medicine, University Hospital of Ulm, Ulm, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, University Hospital of Ulm, Ulm, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
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Calais J, Zhu S, Hirmas N, Eiber M, Hadaschik B, Stuschke M, Herrmann K, Czernin J, Kishan AU, Nickols NG, Elashoff D, Fendler WP. Phase 3 multicenter randomized trial of PSMA PET/CT prior to definitive radiation therapy for unfavorable intermediate-risk or high-risk prostate cancer [PSMA dRT]: study protocol. BMC Cancer 2021; 21:512. [PMID: 33962579 PMCID: PMC8103642 DOI: 10.1186/s12885-021-08026-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Definitive radiation therapy (dRT) is an effective initial treatment of intermediate-risk (IR) and high-risk (HR) prostate cancer (PCa). PSMA PET/CT is superior to standard of care imaging (CT, MRI, bone scan) for detecting regional and distant metastatic PCa. PSMA PET/CT thus has the potential to guide patient selection and the planning for dRT and improve patient outcomes. METHODS This is a multicenter randomized phase 3 trial (NCT04457245). We will randomize 312 patients to proceed with standard dRT (control Arm, n = 150), or undergo a PSMA PET/CT scan at the study site (both 18F-DCFPyL and 68Ga-PSMA-11 can be used) prior to dRT planning (intervention arm, n = 162). dRT will be performed at the treating radiation oncologist facility. In the control arm, dRT will be performed as routinely planned. In the intervention arm, the treating radiation oncologist can incorporate PSMA PET/CT findings into the RT planning. Androgen deprivation therapy (ADT) is administered per discretion of the treating radiation oncologist and may be modified as a result of the PSMA PET/CT results. We assume that approximately 8% of subjects randomized to the PSMA PET arm will be found to have M1 disease and thus will be more appropriate candidates for long-term systemic or multimodal therapy, rather than curative intent dRT. PET M1 patients will thus not be included in the primary endpoint analysis. The primary endpoint is the success rate of patients with unfavorable IR and HR PCa after standard dRT versus PSMA PET-based dRT. Secondary Endpoints (whole cohort) include progression free survival (PFS), metastasis-free survival after initiation of RT, overall survival (OS), % of change in initial treatment intent and Safety. DISCUSSION This is the first randomized phase 3 prospective trial designed to determine whether PSMA PET/CT molecular imaging can improve outcomes in patients with PCa who receive dRT. In this trial the incorporation of PSMA PET/CT may improve the success rate of curative intent radiotherapy in two ways: to optimize patient selection as a biomarker and to personalizes the radiotherapy plan. CLINICAL TRIAL REGISTRATION UCLA IND#147591 ○ Submission: 02.27.2020 ○ Safe-to-proceed letter issued by FDA: 04.01.2020 UCLA IRB #20-000378 ClinicalTrials.gov Identifier NCT04457245 . Date of Registry: 07.07.2020. Essen EudraCT 2020-003526-23.
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Affiliation(s)
- Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine, University of California, Peter Norton Medical Building, 200 Medical Plaza, Suite B-114-51, Los Angeles, CA 90095-7370 USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA USA
- Institute of Urologic Oncology, University of California Los Angeles, Los Angeles, CA USA
| | - Shaojun Zhu
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine, University of California, Peter Norton Medical Building, 200 Medical Plaza, Suite B-114-51, Los Angeles, CA 90095-7370 USA
| | - Nader Hirmas
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, 45131 Essen, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, 45131 Essen, Germany
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, David Geffen School of Medicine, University of California, Peter Norton Medical Building, 200 Medical Plaza, Suite B-114-51, Los Angeles, CA 90095-7370 USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA USA
- Institute of Urologic Oncology, University of California Los Angeles, Los Angeles, CA USA
| | - Amar U. Kishan
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA USA
- Institute of Urologic Oncology, University of California Los Angeles, Los Angeles, CA USA
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Nicholas G. Nickols
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA USA
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA
- Department of Radiation Oncology, VA Greater Los Angeles Healthcare System, Los Angeles, California USA
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - David Elashoff
- Institute of Urologic Oncology, University of California Los Angeles, Los Angeles, CA USA
- Department of Medicine Statistics Core (DOMStat), UCLA CTSI Biostatistics and Computational Biology, University of California, Los Angeles, USA
| | - Wolfgang P. Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstraße 55, 45131 Essen, Germany
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Vogel MME, Dewes S, Sage EK, Devecka M, Gschwend JE, Eiber M, Combs SE, Schiller K. A survey among German-speaking radiation oncologists on PET-based radiotherapy of prostate cancer. Radiat Oncol 2021; 16:82. [PMID: 33933111 PMCID: PMC8088662 DOI: 10.1186/s13014-021-01811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background Positron emission tomography-(PET) has evolved as a powerful tool to guide treatment for prostate cancer (PC). The aim of this survey was to evaluate the acceptance and use of PET—especially with prostate-specific membrane antigen (PSMA) targeting tracers—in clinical routine for radiotherapy (RT) and the impact on target volume definition and dose prescription. Methods We developed an online survey, which we distributed via e-mail to members of the German Society of Radiation Oncology (DEGRO). The survey included questions on patterns of care of RT for PC with/without PET. For evaluation of doses we used the equivalent dose at fractionation of 2 Gy with α/β = 1.5 Gy [EQD2(1.5 Gy)].
Results From 109 participants, 78.9% have the possibility to use PET for RT planning. Most centers use PSMA-targeting tracers (98.8%). In 39.5%, PSMA-PET for biochemical relapse after prior surgery is initiated at PSA ≥ 0.5 ng/mL, while 30.2% will perform PET at ≥ 0.2 ng/mL (≥ 1.0 ng/mL: 16.3%, ≥ 2.0 ng/mL: 2.3%, regardless of PSA: 11.7%). In case of PET-positive local recurrence (LR) and pelvic lymph nodes (LNs), 97.7% and 96.5% of the participants will apply an escalated dose. The median total dose in EQD2(1.5 Gy) was 70.00 Gy (range: 56.89–85.71) for LR and 62.00 Gy (range: 52.61–80.00) for LNs. A total number of ≤ 3 (22.0%) or ≤ 5 (20.2%) distant lesions was most often described as applicable for the definition as oligometastatic PC. Conclusion PSMA-PET is widely used among German radiation oncologists. However, specific implications on treatment planning differ among physicians. Therefore, further trials and guidelines for PET-based RT are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01811-8.
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Affiliation(s)
- Marco M E Vogel
- Department of Radiation Oncology, Klinikum rechts der isar, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany. .,Department of Radiation Sciences (DRS), Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.
| | - Sabrina Dewes
- Department of Radiation Oncology, Klinikum rechts der isar, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany
| | - Eva K Sage
- Department of Radiation Oncology, Klinikum rechts der isar, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany
| | - Michal Devecka
- Department of Radiation Oncology, Klinikum rechts der isar, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der isar, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany.,Department of Radiation Sciences (DRS), Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Kilian Schiller
- Department of Radiation Oncology, Klinikum rechts der isar, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany
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Impact of PSMA PET on management of biochemical recurrent prostate cancer: a systematic review and meta-analysis of prospective studies. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-020-00406-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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9
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Treatment outcomes of metastasis-directed treatment using 68Ga-PSMA-PET/CT for oligometastatic or oligorecurrent prostate cancer: Turkish Society for Radiation Oncology group study (TROD 09-002). Strahlenther Onkol 2020; 196:1034-1043. [DOI: 10.1007/s00066-020-01660-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/15/2020] [Indexed: 01/05/2023]
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Henkenberens C, Oehus AK, Derlin T, Bengel F, Ross TL, Kuczyk MA, Janssen S, Christiansen H, von Klot CAJ. Efficacy of repeated PSMA PET-directed radiotherapy for oligorecurrent prostate cancer after initial curative therapy. Strahlenther Onkol 2020; 196:1006-1017. [PMID: 32399639 PMCID: PMC7581615 DOI: 10.1007/s00066-020-01629-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/25/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the outcome of prostate cancer (PCa) patients diagnosed with oligorecurrent disease and treated with a first and a second PSMA (prostate-specific membrane antigen ligand) PET(positron-emission tomography)-directed radiotherapy (RT). PATIENTS AND METHODS Thirty-two patients with oligorecurrent relapse after curative therapy received a first PSMA PET-directed RT of all metastases. After biochemical progression, all patients received a second PSMA PET-directed RT of all metastases. The main outcome parameters were biochemical progression-free survival (bPFS) and androgen deprivation therapy-free survival (ADT-FS). The intervals of BPFS were analyzed separately as follows: the interval from the last day of PSMA PET-directed RT to the first biochemical progression was defined as bPFS_1 and the interval from second PSMA PET-directed RT to further biochemical progression was defined as bPFS_2. RESULTS The median follow-up duration was 39.5 months (18-60). One out of 32 (3.1%) patients died after 47 months of progressive metastatic prostate cancer (mPCa). All patients showed biochemical responses after the first PSMA PET-directed RT and the median prostate-specific antigen (PSA) level before RT was 1.70 ng/mL (0.2-3.8), which decreased significantly to a median PSA nadir level of 0.39 ng/mL (range <0.07-3.8; p = 0.004). The median PSA level at biochemical progression after the first PSMA PET-directed RT was 2.9 ng/mL (range 0.12-12.80; p = 0.24). Furthermore, the PSA level after the second PSMA PET-directed RT at the last follow-up (0.52 ng/mL, range <0.07-154.0) was not significantly different (p = 0.36) from the median PSA level (1.70 ng/mL, range 0.2-3.8) before the first PSMA PET-directed RT. The median bPFS_1 was 16.0 months after the first PSMA PET-directed RT (95% CI 11.9-19.2) and the median bPFS_2 was significantly shorter at 8.0 months (95% CI 6.3-17.7) after the second PSMA PET-directed RT (p = 0.03; 95% CI 1.9-8.3). Multivariate analysis revealed no significant parameter for bPFS_1, whereas extrapelvic disease was the only significant parameter (p = 0.02, OR 2.3; 95% CI 0.81-4.19) in multivariate analysis for bPFS_2. The median ADT-FS was 31.0 months (95% CI 20.1-41.8) and multivariate analysis showed that patients with bone metastases, compared to patients with only lymph node metastases at first PSMA PET-directed RT, had a significantly higher chance (p = 0.007, OR 4.51; 95% CI 1.8-13.47) of needing ADT at the last follow-up visit. CONCLUSION If patients are followed up closely, including PSMA PET scans, a second PSMA PET-directed RT represents a viable treatment option for well-informed and well-selected patients.
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Affiliation(s)
- Christoph Henkenberens
- Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Ann-Kathrin Oehus
- Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Bengel
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Tobias L Ross
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Janssen
- Medical practice for Radiotherapy and Radiation Oncology, Treibesstraße 11, 31134, Hildesheim, Germany.,Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Hans Christiansen
- Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christoph A J von Klot
- Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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11
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PSMA-positive nodal recurrence in prostate cancer : Salvage radiotherapy is superior to salvage lymph node dissection in retrospective analysis. Strahlenther Onkol 2020; 196:637-646. [PMID: 32211942 PMCID: PMC7305083 DOI: 10.1007/s00066-020-01605-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/09/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE This analysis compares salvage lymph node dissection (SLND) to salvage lymph node radiotherapy (SLNRT) of 68Ga-PSMA PET-positive nodal recurrences after radical prostatectomy (RPE). METHODS A total of 67 SLNRT and 33 SLND consecutive patients with pelvic and/or para-aortic nodal recurrences after RPE were retrospectively analyzed. Biochemical recurrence-free survival rates (bRFS; PSA <0.2 ng/mL) were calculated according to Kaplan-Meier and survival curves were compared using the log rank test. For multivariable analysis, binary logistic regression analysis was performed (p < 0.05). RESULTS Median follow-up was 17 months (range, 6-53 months) in SLND patients and 31 months (range, 3-56 months) in SLNRT patients (p = 0.027). SLNRT patients had significantly more tumours of pT3 and pT4 category (82% vs. 67%; p = 0.006), pathologically involved lymph nodes (45% vs. 27%; p = 0.001) and positive surgical margins (54% vs. 12%; p = 0.001) at time of RPE than SLND patients. PSA persistence after RPE was significantly more frequently observed in the SLNRT cohort (73% vs. 27%; p = 0.001). There was no significant difference in the distribution of PET-positive lymph nodes. Median PSA before SLND was higher than before SLNRT (3.07 ng/ml vs. 1.3 ng/ml; p = 0.393). The 2‑year bRFS was significantly higher in the SLNRT vs. the SLND cohort (92% vs. 30%; p = 0.001) with lower rates of distant metastases (21% vs. 52%; p = 0.002) and secondary treatments (5% vs. 39%; p = 0.011) irrespective of ongoing androgen deprivation therapy at last contact. In multivariable analysis, SLNRT was significantly associated with prolonged bRFS (regression coefficient 1.436, hazard ratio 4.204, 95% CI 1.789-9.878; p = 0.001). CONCLUSION Based on this retrospective study SLNRT might be the preferred treatment option for patients with nodal recurrence after previous RPE.
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12
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Siva S, Udovicich C, Tran B, Zargar H, Murphy DG, Hofman MS. Expanding the role of small-molecule PSMA ligands beyond PET staging of prostate cancer. Nat Rev Urol 2020; 17:107-118. [PMID: 31937920 DOI: 10.1038/s41585-019-0272-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/25/2022]
Abstract
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is rapidly being established as arguably the leading contemporary imaging modality in the management of prostate cancer. Outside of its conventional use in the de novo staging of localized disease and detection of biochemical recurrence, additional applications for the use of PSMA PET are emerging. Uptake of PSMA tracers in other genitourinary malignancies, particularly renal cell carcinoma, has led to new fields of investigation. Therapeutic delivery of radiolabelled PSMA small molecules has shown considerable promise in advanced prostate cancer. The ability to use the same molecule for imaging and therapy - theranostics - enables a highly personalized approach. PSMA PET can also have a considerable influence in the selection and guidance of radiotherapy fields for high-risk and recurrent disease. Intriguingly, changes in intensity of PSMA uptake during systemic therapy might provide early response assessment or novel insight into the biological responses of genitourinary malignancies to treatment. An evolving range of radiolabelled PSMA radiopharmaceuticals is emerging in the multiple facets of modern clinical practice.
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Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - Cristian Udovicich
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ben Tran
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Homi Zargar
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael S Hofman
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
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13
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Gallium-68 prostate-specific membrane antigen PET-CT and the clinical management of prostate cancer. Nucl Med Commun 2019; 40:913-919. [DOI: 10.1097/mnm.0000000000001047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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14
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Integration of 68Ga-PSMA-PET/CT in Radiotherapy Planning for Prostate Cancer Patients. Clin Nucl Med 2019; 44:e510-e516. [DOI: 10.1097/rlu.0000000000002691] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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15
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Lindström E, Velikyan I, Regula N, Alhuseinalkhudhur A, Sundin A, Sörensen J, Lubberink M. Regularized reconstruction of digital time-of-flight 68Ga-PSMA-11 PET/CT for the detection of recurrent disease in prostate cancer patients. Theranostics 2019; 9:3476-3484. [PMID: 31281491 PMCID: PMC6587171 DOI: 10.7150/thno.31970] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/09/2019] [Indexed: 02/07/2023] Open
Abstract
Accurate localization of recurrent prostate cancer (PCa) is critical, especially if curative therapy is intended. With the aim to optimize target-to-background uptake ratio in 68Ga-PSMA-11 PET, we investigated the image quality and quantitative measures of regularized reconstruction by block-sequential regularized expectation maximization (BSREM). Methods: The study encompassed retrospective reconstruction and analysis of 20 digital time-of-flight (TOF) PET/CT examinations acquired 60 min post injection of 2 MBq/kg of 68Ga-PSMA-11 in PCa patients with biochemical relapse after primary treatment. Reconstruction by ordered-subsets expectation maximization (OSEM; 3 iterations, 16 subsets, 5 mm gaussian postprocessing filter) and BSREM (β-values of 100-1600) were used, both including TOF and point spread function (PSF) recovery. Background variability (BV) was measured by placing a spherical volume of interest in the right liver lobe and defined as the standard deviation divided by the mean standardized uptake value (SUV). The image quality was evaluated in terms of signal-to-noise ratio (SNR) and signal-to-background ratio (SBR), using SUVmax of the lesions. A visual assessment was performed by four observers. Results: OSEM reconstruction produced images with a BV of 15%, whereas BSREM with a β-value above 300 resulted in lower BVs than OSEM (36% with β 100, 8% with β 1300). Decreasing the acquisition duration from 2 to 1 and 0.5 min per bed position increased BV for both reconstruction methods, although BSREM with β-values equal to or higher than 800 and 1200, respectively, kept the BV below 15%. In comparison of BSREM with OSEM, the mean SNR improved by 25 to 66% with an increasing β-value in the range of 200-1300, whereas the mean SBR decreased with an increasing β-value, ranging from 0 to 125% with a β-value of 100 and 900, respectively. Decreased acquisition duration resulted in β-values of 800 to 1000 and 1200 to 1400 for 1 and 0.5 min per bed position, respectively, producing improved image quality measures compared with OSEM at a full acquisition duration of 2 min per bed position. The observer study showed a slight overall preference for BSREM β 900 although the interobserver variability was high. Conclusion: BSREM image reconstruction with β-values in the range of 400-900 resulted in lower BV and similar or improved SNR and SBR in comparison with OSEM.
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16
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Ekmekcioglu Ö, Busstra M, Klass ND, Verzijlbergen F. Bridging the Imaging Gap: PSMA PET/CT Has a High Impact on Treatment Planning in Prostate Cancer Patients with Biochemical Recurrence—A Narrative Review of the Literature. J Nucl Med 2019; 60:1394-1398. [DOI: 10.2967/jnumed.118.222885] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/04/2019] [Indexed: 11/16/2022] Open
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17
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Calais J, Czernin J, Fendler WP, Elashoff D, Nickols NNG. Randomized prospective phase III trial of 68Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]. BMC Cancer 2019; 19:18. [PMID: 30616601 PMCID: PMC6322287 DOI: 10.1186/s12885-018-5200-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/09/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence after prostatectomy offers long-term biochemical control in about 50-60% of patients. SRT is commonly initiated in patients with serum PSA levels < 1 ng/mL, a threshold at which standard-of-care imaging is insensitive for detecting recurrence. As such, SRT target volumes are usually drawn in the absence of radiographically visible disease. 68Ga-PSMA-11 (PSMA) PET/CT molecular imaging is highly sensitive and may offer anatomic localization of PCa biochemical recurrence. However, it is unclear if incorporation of PSMA PET/CT imaging into the planning of SRT could improve its likelihood of success. The purpose of this trial is to evaluate the success rate of SRT for recurrence of PCa after prostatectomy with and without planning based on PSMA PET/CT. METHODS We will randomize 193 patients to proceed with standard SRT (control arm 1, n = 90) or undergo a PSMA PET/CT scan (free of charge for patients) prior to SRT planning (investigational arm 2, n = 103). The primary endpoint is the success rate of SRT measured as biochemical progression-free survival (BPFS) after initiation of SRT. Biochemical progression is defined by PSA ≥ 0.2 ng/mL and rising. The randomization ratio of 1:1.13 is based on the assumption that approximately 13% of subjects randomized to Arm 2 will not be treated with SRT because of PSMA-positive extra-pelvic metastases. These patients will not be included in the primary endpoint analysis but will still be followed. The choice of treating the prostate bed alone vs prostate bed and pelvic lymph nodes, with or without androgen deprivation therapy (ADT), is selected by the treating radiation oncologist. The radiation oncologist may change the radiation plan depending on the findings of the PSMA PET/CT scan. Any other imaging is allowed for SRT planning in both arms if done per routine care. Patients will be followed until either one of the following conditions occur: 5 years after the date of initiation of randomization, biochemical progression, diagnosis of metastatic disease, initiation of any additional salvage therapy, death. DISCUSSION This is the first randomized phase 3 prospective trial designed to determine whether PSMA PET/CT molecular imaging can improve outcomes in patients with PCa early BCR following radical prostatectomy. ACRONYM PSMA-SRT Phase 3 trial. CLINICAL TRIAL REGISTRATION ■ IND#130649 ◦ Submission: 04.26.2016 ◦ Safe-to-proceed letter issued by FDA: 05.25.2016 ■ UCLA IRB #18-000484, ■ First submission: 3.27.2018 ■ Date of approval: 5.31.2018 ■ UCLA JCCC Short Title NUC MED 18-000484 ■ NCI Trial Identifier NCI-2018-01518 ■ ClinicalTrials.gov Identifier NCT03582774 ■ First Submitted: 06.19.2018 ■ First Submitted that Met QC Criteria: 06.27.2018 ■ First Posted: 07.11.2018 ■ Last Update Submitted that Met QC Criteria: 07.17.2018 ■ Last Update Posted: 07.19.2018 TRIAL STATUS: Current Trial Status Active as of 08/13/2018 Trial Start Date 09/01/2018-Actual Primary Completion Date 09/01/2023-Anticipated Trial Completion Date 09/01/2024-Anticipated.
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Affiliation(s)
- Jeremie Calais
- Department of Molecular & Medical Pharmacology, Ahmanson Translational Theranostics/ Imaging Division, University of California, Los Angeles, USA
| | - Johannes Czernin
- Department of Molecular & Medical Pharmacology, Ahmanson Translational Theranostics/ Imaging Division, University of California, Los Angeles, USA
| | - Wolfgang P. Fendler
- Department of Molecular & Medical Pharmacology, Ahmanson Translational Theranostics/ Imaging Division, University of California, Los Angeles, USA
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - David Elashoff
- Department of Medicine Statistics Core (DOMStat), UCLA CTSI Biostatistics and Computational Biology, University of California, Los Angeles, USA
| | - Nicholas Nicholas G. Nickols
- Department of Radiation Oncology, University of California, Los Angeles, USA
- Department of Radiation Oncology, VA Greater Los Angeles Healthcare System, Los Angeles, California USA
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18
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Schmidt-Hegemann NS, Eze C, Li M, Rogowski P, Schaefer C, Stief C, Buchner A, Zamboglou C, Fendler WP, Ganswindt U, Cyran C, Bartenstein P, Belka C, Ilhan H. Impact of 68Ga-PSMA PET/CT on the Radiotherapeutic Approach to Prostate Cancer in Comparison to CT: A Retrospective Analysis. J Nucl Med 2018; 60:963-970. [PMID: 30552203 DOI: 10.2967/jnumed.118.220855] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/28/2018] [Indexed: 01/27/2023] Open
Abstract
68Ga-prostate-specific membrane antigen PET/CT (68Ga-PSMA PET/CT) offers unprecedented accuracy for staging of primary, persistent, or recurrent prostate cancer. Thus, we hypothesized that 68Ga-PSMA PET/CT before radiotherapy significantly affects the radiotherapeutic approach in comparison to the current standard, a CT-based approach. Methods: Between February 2014 and December 2017, 172 patients underwent 68Ga-PSMA PET/CT before radiotherapy and were included in this retrospective analysis. Twenty-two (13%) patients were referred for primary definitive radiotherapy, 51% (88/172) for prostate-specific antigen (PSA) persistence, and 36% (62/172) for PSA recurrence after radical prostatectomy. An experienced radiation oncologist, masked to the CT and PET/CT results, decided on the radiation treatment management of all patients on the basis of the clinical and pathologic variables. The potential increase in diagnostic accuracy, and the subsequent change in radiotherapeutic approach, were documented separately for PET/CT versus CT. Results: The overall detection rate was 70% (120/172) for 68Ga-PSMA PET/CT. Patients with a pre-PET/CT PSA level of more than 0.5 ng/mL (98/111; 88%) had PET-positive results significantly more often. Overall, PSMA PET/CT revealed 171 lesions, PET alone 156, and CT alone 85. For all patients, a continuous diagnostic increase in positive findings was observed for primary tumor/local recurrence (CT, 18%, vs. PET/CT, 37%), pelvic lymph nodes (CT, 21%, vs. PET/CT, 44%), and distant metastases (CT, 7%, vs. PET/CT, 19%) when comparing CT with PET/CT. Compared with CT, the combination of PET/CT information resulted in a change in treatment in 107 of 172 (62%) patients, that is, 8 of 22 (36%) patients before any treatment, 31 of 62 (50%) with PSA recurrence, and 68 of 88 (77%) with PSA persistence. Comparing the different radiotherapy indications with one another, there was a higher rate of change in management for postoperative patients than for patients before any treatment. Conclusion: Compared with conventional CT, 68Ga-PSMA PET/CT had a remarkable impact on radiotherapeutic approach, especially in postoperative patients. Thus, considering the growing amount of data on the impact of 68Ga-PSMA PET/CT on postoperative patients, 68Ga-PSMA PET/CT has recently been endorsed by a few cancer guidelines as an imaging modality in patients with PSA persistence or recurrence (e.g., the German S3 guideline and the European Association of Urology guideline).
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Affiliation(s)
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schaefer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Clemens Cyran
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany; and
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Munich, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany; and
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