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Meraouna Y, Blanchard P, Losa S, Labib A, Krhili S, Pommier P, Crehange G, Flam T, Cosset JM, Kissel M. Salvage low-dose-rate brachytherapy for locally recurrent prostate cancer after definitive irradiation. Clin Transl Radiat Oncol 2024; 48:100809. [PMID: 39027689 PMCID: PMC11254530 DOI: 10.1016/j.ctro.2024.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose The optimal management of locally recurrent prostate cancer after definitive irradiation is still unclear but local salvage treatments are gaining interest. A retrospective, single-institution analysis of clinical outcomes and treatment-related toxicity after salvage I-125 low-dose-rate (LDR) brachytherapy (BT) for locally-recurrent prostate cancer was conducted in a Comprehensive Cancer Center. Patients and methods A total of 94 patients treated with salvage LDR-BT between 2006 and 2021 were included. The target volume was either the whole-gland +/- a boost on the GTV, the hemigland, or only the GTV. The prescribed dose ranged from 90 to 145 Gy. Toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results Median follow-up was 34 months. Initial radiotherapy was external beam radiotherapy in 73 patients (78 %) with a median dose of 76 Gy and I-125 BT in 21 patients (22 %) with a prescribed dose of 145 Gy. Median PSA at salvage was 3.75 ng/ml with a median interval between first and salvage irradiation of 9.4 years. Salvage brachytherapy was associated with androgen deprivation therapy for 32 % of the patients. Only 4 % of the patients were castrate-resistant. Failure free survival was 82 % at 2 years and 66 % at 3 years. The only factors associated with failure-free survival on multivariate analysis were hormonosensitivity at relapse and European Association of Urology (EAU) prognostic group. Late grade 3 urinary and rectal toxicities occurred in 12 % and 1 % of the patients respectively.No significant difference in toxicity or efficacy was observed between the three implant volume groups. Conclusion The efficacy and toxicity results are consistent with those in the LDR group of the MASTER meta-analysis. Salvage BT confirms to be an effective and safe option for locally recurrent prostate cancer. A focal approach could be interesting to reduce late severe toxicities, especially urinary.
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Affiliation(s)
- Y. Meraouna
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
- Faculté de médecine Sorbonne Université, 91-105 Boulevard de l’Hôpital, 75013 Paris, France
| | - P. Blanchard
- Radiotherapy Department, Gustave Roussy, 114 Boulevard Edouard Vaillant, 94220 Villejuif, France
| | - S. Losa
- Physics Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - A. Labib
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - S. Krhili
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - P. Pommier
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - G. Crehange
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - T. Flam
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
- Urology Department, Clinique Saint Jean de Dieu, 2 rue Rousselet, 75007 Paris, France
| | - J-M. Cosset
- Radiotherapy Department, Centre Charlebourg – La Défense – Amethyst Radiothérapie, 65 Avenue Foch, 92250 La Garenne-Colombes, France
| | - M. Kissel
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
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García-Zoghby L, Amo-Salas M, Soriano Castrejón ÁM, García Vicente AM. Whole-body tumour burden on [18F]DCFPyL PET/CT in biochemical recurrence of prostate cancer: association with tumour biology and PSA kinetics. Eur J Nucl Med Mol Imaging 2024; 51:2467-2483. [PMID: 38520513 DOI: 10.1007/s00259-024-06685-y] [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: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE The objective was to assess the association between molecular imaging (mi) variables on [18F]DCFPyL-PET/CT with clinical and disease characteristics and prostate specific antigen (PSA) related variables in patients with biochemical recurrence of prostate cancer (BRPC). MATERIAL AND METHODS We analysed patients with BRPC after radical treatment. We obtained clinical and PSA variables: International Society of Urology Pathology (ISUP) grade group, European Association of Urology (EAU) risk classification, PSA (PSA≤1ng/ml, 1 2), PSA doubling time (PSAdt) and PSA velocity (PSAvel). All PET/CT scans were reviewed with the assistance of automated Prostate Molecular Imaging Standardized Evaluation (aPROMISE) software and lesions' segmentation in positive scans was performed using this platform. Standardized uptake value (SUV) derived variables; tumour burden variables [whole-body tumour volume (wbTV), whole-body tumour lesion activity (wbTLA) and whole-body mi PSMA (wbPSMA)] and miTNM staging were obtained. Cut-off of PSA and kinetics able to predict PET/CT results were obtained. Associations between disease and mi variables were analysed using ANOVA, Kruskal-Wallis and Spearman's correlation tests. Multivariate analysis was also performed. RESULTS Two hundred and seventy-five patients were studied. [18F]DCFPyL-PET/CT were positive in 165/275 patients. In multivariate analysis, moment of biochemical recurrence, ISUP group, PSA level and PSAvel showed significant association with the detection rate. miTNM showed significant association with PSA level (p<0.001) and kinetics (p<0.001), being higher in patients with metastatic disease. Both PSA and PSAvel showed moderate correlation with wbTV, wbTLA and wbPSMA (p<0.001). A weak correlation with SUVs was found. Mean wbTV, wbTLA and wbPSMA values were significantly higher in PSA > 2ng/ml, PSAdt ≤ 6 months and PSAvel ≥ 0.2ng/ml/month groups. Also, wbTV (p=0.039) and wbPSMA (p=0.020) were significantly higher in patients with ISUP grade group 5. PSA and PSAvel cut-offs (1.15 ng/ml and 0.065 ng/ml/month) were significantly associated with a positive PET/CT. CONCLUSION Higher PSA values, unfavourable PSA kinetics and ISUP grade group 5 were robust predictive variables of larger tumour burden variables on [18F]DCFPyL PET/CT assessed by aPROMISE platform.
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Affiliation(s)
- Laura García-Zoghby
- Nuclear Medicine Department, University Hospital of Toledo, Av. del Río Guadiana, s/n, 45007, Toledo, Spain.
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, Cam. Moledores, s/n, 13071, Ciudad Real, Spain
| | | | - Ana María García Vicente
- Nuclear Medicine Department, University Hospital of Toledo, Av. del Río Guadiana, s/n, 45007, Toledo, Spain
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Muraglia L, Lopci E, Jandric J, Zanca R, Rodari M, Perrino M, Lucchini R, Baldaccini D, Ceci F, Evangelista L. Prostate cancer: nuclear medicine imaging in the biochemical recurrence and in oligometastatic disease. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:95-100. [PMID: 38860273 DOI: 10.23736/s1824-4785.24.03569-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
INTRODUCTION The aim of this article was to offer a comprehensive non-systematic review of the literature about the use of Nuclear Medicine imaging exams for the evaluation of prostate cancer (PCa) in the recurrent setting, with a particular regard to positron emission tomography/computed tomography (PET/CT) imaging. EVIDENCE ACQUISITION A comprehensive nonsystematic literature review was performed in March 2024. Literature search was updated until March 2024. The most relevant studies have been summarized, giving priority to registered clinical trials and multicenter collaborations. EVIDENCE SYNTHESIS Restaging BCR with advanced Nuclear Medicine Imaging, such as prostate-specific membrane antigen-PET/CT could lead to stage migration and pave the way for additional management strategies, such as stereotactic ablative radiotherapy in patients with low-burden or oligometastatic disease, potentially delaying the need of systemic therapies. While OS benefits of targeting PET/CT positive disease are still lacking, data on progression- and metastasis-free-survival are emerging. Improvements in quality-of-life assessments are already evident. CONCLUSIONS PCa is one of the most common malignancy in men. In the last 10 years PCa imaging has become significantly more accurate and is now essential for the definition of the extent of the disease in different phases of its natural history. This opened the road to novel management strategies, especially in the recurrent setting, in which the oligometastatic state is now being explored in several trials regarding the prognostic significance of metastasis directed therapies aimed at personalizing the treatment for every single patient.
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Affiliation(s)
- Lorenzo Muraglia
- Department of Nuclear Medicine, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy -
| | - Egesta Lopci
- Department of Nuclear Medicine, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Jelena Jandric
- Department of Nuclear Medicine, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Roberta Zanca
- Department of Nuclear Medicine, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marcello Rodari
- Department of Nuclear Medicine, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Matteo Perrino
- Department of Oncology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Raffaella Lucchini
- Department of Radiation Oncology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Davide Baldaccini
- Department of Radiation Oncology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Francesco Ceci
- Department of Nuclear Medicine, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Laura Evangelista
- Department of Nuclear Medicine, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Moul JW, Shore ND, Pienta KJ, Czernin J, King MT, Freedland SJ. Application of next-generation imaging in biochemically recurrent prostate cancer. Prostate Cancer Prostatic Dis 2024; 27:202-211. [PMID: 37679601 PMCID: PMC11096127 DOI: 10.1038/s41391-023-00711-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Biochemical recurrence (BCR) following primary interventional treatment occurs in approximately one-third of patients with prostate cancer (PCa). Next-generation imaging (NGI) can identify local and metastatic recurrence with greater sensitivity than conventional imaging, potentially allowing for more effective interventions. This narrative review examines the current clinical evidence on the utility of NGI for patients with BCR. METHODS A search of PubMed was conducted to identify relevant publications on NGI applied to BCR. Given other relevant recent reviews on the topic, this review focused on papers published between January 2018 to May 2023. RESULTS NGI technologies, including positron emission tomography (PET) radiotracers and multiparametric magnetic resonance imaging, have demonstrated increased sensitivity and selectivity for diagnosing BCR at prostate-specific antigen (PSA) concentrations <2.0 ng/ml. Detection rates range between 46% and 50%, with decreasing PSA levels for choline (1-3 ng/ml), fluciclovine (0.5-1 ng/ml), and prostate-specific membrane antigen (0.2-0.49 ng/ml) PET radiotracers. Expert working groups and European and US medical societies recommend NGI for patients with BCR. CONCLUSIONS Available data support the improved detection performance and selectivity of NGI modalities versus conventional imaging techniques; however, limited clinical evidence exists demonstrating the application of NGI to treatment decision-making and its impact on patient outcomes. The emergence of NGI and displacement of conventional imaging may require a reexamination of the current definitions of BCR, altering our understanding of early recurrence. Redefining the BCR disease state by formalizing the role of NGI in patient management decisions will facilitate greater alignment across research efforts and better reflect the published literature.
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Affiliation(s)
- Judd W Moul
- Duke Cancer Institute and Division of Urology, Duke University, Durham, NC, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | | | - Johannes Czernin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Martin T King
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stephen J Freedland
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Veterans Affairs Medical Center, Durham, NC, USA.
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Ouvrard E, Kaseb A, Poterszman N, Porot C, Somme F, Imperiale A. Nuclear medicine imaging for bone metastases assessment: what else besides bone scintigraphy in the era of personalized medicine? Front Med (Lausanne) 2024; 10:1320574. [PMID: 38288299 PMCID: PMC10823373 DOI: 10.3389/fmed.2023.1320574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Accurate detection and reliable assessment of therapeutic responses in bone metastases are imperative for guiding treatment decisions, preserving quality of life, and ultimately enhancing overall survival. Nuclear imaging has historically played a pivotal role in this realm, offering a diverse range of radiotracers and imaging modalities. While the conventional bone scan using 99mTc marked bisphosphonates has remained widely utilized, its diagnostic performance is hindered by certain limitations. Positron emission tomography, particularly when coupled with computed tomography, provides improved spatial resolution and diagnostic performance with various pathology-specific radiotracers. This review aims to evaluate the performance of different nuclear imaging modalities in clinical practice for detecting and monitoring the therapeutic responses in bone metastases of diverse origins, addressing their limitations and implications for image interpretation.
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Affiliation(s)
- Eric Ouvrard
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Ashjan Kaseb
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
- Radiology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Nathan Poterszman
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Clémence Porot
- Radiopharmacy, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Francois Somme
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
- IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
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Vanden Berg RNW, Zilli T, Achard V, Dorff T, Abern M. The diagnosis and treatment of castrate-sensitive oligometastatic prostate cancer: A review. Prostate Cancer Prostatic Dis 2023; 26:702-711. [PMID: 37422523 DOI: 10.1038/s41391-023-00688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Oligometastatic prostate cancer (OMPCa) is emerging as a transitional disease state between localized and polymetastatic disease. This review will assess the current knowledge of castrate-sensitive OMPCa. METHODS A review of the current literature was performed to summarize the definition and classification of OMPCa, assess the diagnostic methods and imaging modalities utilized, and to review the treatment options and outcomes. We further identify gaps in knowledge and areas for future research. RESULTS Currently there is no unified definition of OMPCa. National guidelines mostly recommend systemic therapies without distinguishing oligometastatic and polymetastatic disease. Next generation imaging is more sensitive than conventional imaging and has led to early detection of metastases at initial diagnosis or recurrence. While mostly retrospective in nature, recent studies suggest that treatment (surgical or radiation) of the primary tumor and/or metastatic sites might delay initiation of androgen deprivation therapy while increasing survival in selected patients. CONCLUSIONS Prospective data are required to better assess the incremental improvement in survival and quality of life achieved with various treatment strategies in patients with OMPCa.
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Affiliation(s)
| | - Thomas Zilli
- Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vérane Achard
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland
| | - Tanya Dorff
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Michael Abern
- Department of Urology, Duke University, Durham, NC, USA.
- Duke Cancer Institute, Durham, NC, USA.
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Huls SJ, Burkett B, Ehman E, Lowe VJ, Subramaniam RM, Kendi AT. Clinical practice in prostate PET imaging. Ther Adv Med Oncol 2023; 15:17588359231213618. [PMID: 38028142 PMCID: PMC10666681 DOI: 10.1177/17588359231213618] [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: 06/12/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Positron emission tomography (PET) imaging in prostate cancer has advanced significantly in the past decade with prostate cancer targeted radiopharmaceuticals now playing a growing role in diagnosis, staging, and treatment. This narrative review focuses on the most commonly used PET radiopharmaceuticals in the USA: prostate-specific membrane antigen (PSMA), fluciclovine, and choline. 18F-fluorodeoxyglucose (FDG) is used in many other malignancies, but rarely in prostate cancer. Previous literature is discussed regarding each radiopharmaceutical's utility in the settings of screening/diagnosis, initial staging, biochemical recurrence, advanced disease, and evaluation prior to targeted radiopharmaceutical therapy and radiation therapy. PET imaging has demonstrated utility over traditional imaging in various scenarios; however, there are few head-to-head studies comparing PET radiopharmaceuticals. PSMA radiopharmaceuticals are the newest tracers developed and have unique properties and uses, especially at low prostate-specific antigen (PSA) levels. However, each PET radiopharmaceutical has different properties which can affect image interpretation. Choline and fluciclovine have minimal urinary activity, whereas PSMA agents can have high urinary activity which may affect locoregional disease evaluation. Of the three radiopharmaceuticals, only PSMA is approved for both diagnostic and therapeutic indications with 177Lu-PSMA. A variety of diagnostic PET radiotracers for prostate cancer allows for increased flexibility, especially in the setting of supply chain and medication shortages. For the time being, keeping a diverse group of PET radiopharmaceuticals for prostate cancer is justifiable.
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Affiliation(s)
- Sean J. Huls
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester MN 55905, USA
| | - Brian Burkett
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eric Ehman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Rathan M. Subramaniam
- Department of Medicine, University of Otago Medical School, Dunedin, New Zealand
- Department of Radiology, Duke University, Durham, NC, USA
| | - A. Tuba Kendi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Zhu M, Liang Z, Feng T, Mai Z, Jin S, Wu L, Zhou H, Chen Y, Yan W. Up-to-Date Imaging and Diagnostic Techniques for Prostate Cancer: A Literature Review. Diagnostics (Basel) 2023; 13:2283. [PMID: 37443677 DOI: 10.3390/diagnostics13132283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Prostate cancer (PCa) faces great challenges in early diagnosis, which often leads not only to unnecessary, invasive procedures, but to over-diagnosis and treatment as well, thus highlighting the need for modern PCa diagnostic techniques. The review aims to provide an up-to-date summary of chronologically existing diagnostic approaches for PCa, as well as their potential to improve clinically significant PCa (csPCa) diagnosis and to reduce the proliferation and monitoring of PCa. Our review demonstrates the primary outcomes of the most significant studies and makes comparisons across the diagnostic efficacies of different PCa tests. Since prostate biopsy, the current mainstream PCa diagnosis, is an invasive procedure with a high risk of post-biopsy complications, it is vital we dig out specific, sensitive, and accurate diagnostic approaches in PCa and conduct more studies with milestone findings and comparable sample sizes to validate and corroborate the findings.
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Affiliation(s)
- Ming Zhu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhen Liang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Tianrui Feng
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhipeng Mai
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shijie Jin
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Liyi Wu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Huashan Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuliang Chen
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Hill S, Kassam F, Verma S, Sidana A. Traditional and novel imaging modalities for advanced prostate cancer: A critical review. Urol Ann 2023; 15:249-255. [PMID: 37664103 PMCID: PMC10471808 DOI: 10.4103/ua.ua_170_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/26/2021] [Indexed: 09/05/2023] Open
Abstract
Accurate detection of metastatic prostate cancer in the setting of preoperative staging as well as posttreatment recurrence is crucial to provide patients with appropriate and timely treatment of their disease. This has traditionally been accomplished with a combination of computed tomography, magnetic resonance imaging, and bone scan. Recently, more novel imaging techniques have been developed to help improve the detection of advanced and metastatic prostate cancer. This review discusses the efficacy of the traditional imaging modalities as well as the novel imaging techniques in detecting metastatic prostate cancer. Articles discussed were gathered through a formal PubMed search.
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Affiliation(s)
- Spencer Hill
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Farzaan Kassam
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sadhna Verma
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abhinav Sidana
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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García-Zoghby L, Lucas-Lucas C, Amo-Salas M, Soriano-Castrejón ÁM, García-Vicente AM. Head-to-Head Comparison of [ 18F]F-choline and Imaging of Prostate-Specific Membrane Antigen, Using [ 18F]DCFPyL PET/CT, in Patients with Biochemical Recurrence of Prostate Cancer. Curr Oncol 2023; 30:6271-6288. [PMID: 37504324 PMCID: PMC10378109 DOI: 10.3390/curroncol30070464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE To analyse diagnostic and therapeutic impact of molecular imaging TNM (miTNM) stage obtained with [18F]DCFPyL versus [18F]F-choline in head-to-head comparison in biochemical recurrence (BCR) of prostate cancer (PCa). MATERIAL AND METHODS Patients with BCR of PCa after radical treatment with previous [18F]F-choline-PET/CT (negative or oligometastatic disease) were recruited to [18F]DCFPyL-PET/CT. Patients were classified according to: grade group, European Association of Urology classification, PSA, PSA doubling time (PSAdt) and PSA velocity (PSAvel). The overall detection rate (DR) and miTNM stage according to PROMISE criteria were assessed for both radiotracers and also correlated (Kappa). The influence of PSA and kinetics on both PET/CT (DR and miTNM) and predictive value of unfavourable kinetics on miTNM were determined. Cut-off PSA, PSAdt and PSAvel values able to predict PET/CT results were determined. Change in miTNM and treatment derived from [18F]DCFPyL information compared with [18F]F-choline were also evaluated. RESULTS We studied 138 patients. [18F]DCFPyL showed a higher DR than [18F]F-choline (64.5% versus 33.3%) with a fair agreement. [18F]DCFPyL and [18F]F-choline detected T in 33.3% versus 19.6%, N in 27.5% versus 13.8%, and M in 30.4% versus 8.7%. Both tracers' DR showed significant associations with PSA and PSAvel. Significant association was only found between miTNM and PSA on [18F]F-choline-PET/CT (p = 0.033). For [18F]F-choline and [18F]DCFPyL-PET/CT, a PSAdt cut-off of 4.09 and 5.59 months, respectively, were able to predict M stage. [18F]DCFPyL changed therapeutic management in 40/138 patients. CONCLUSIONS [18F]DCFPyL provides a higher DR and superior miTNM staging than [18F]F-choline in restaging BCR, especially with high PSA and unfavourable PSA kinetics, showing a fair agreement to [18F]F-choline.
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Affiliation(s)
- Laura García-Zoghby
- Nuclear Medicine Department, University Hospital of Toledo, 45007 Toledo, Spain
| | - Cristina Lucas-Lucas
- Nuclear Medicine Department, University General Hospital of Ciudad Real, 13005 Ciudad Real, Spain
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, 13071 Ciudad Real, Spain
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Rednam N, Kundra V. Hybrid magnetic resonance and PET imaging for prostate cancer recurrence. Curr Opin Oncol 2023; 35:231-238. [PMID: 36966496 DOI: 10.1097/cco.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
PURPOSE OF REVIEW Recurrence post definitive local therapy by prostatectomy or radiation therapy is often detected via rise in serum prostate-specific antigen (PSA) levels; however, PSA rise does not localize the disease. Distinguishing local versus distant recurrence guides whether to choose subsequent local versus systemic therapy. The purpose of this article is to review imaging for prostate cancer recurrence post local therapy. RECENT FINDINGS Among imaging modalities, multiparametric MRI (mpMRI) is commonly used to assess for local recurrence. New radiopharmaceuticals target prostate cancer cells and enable whole-body imaging. These tend to be more sensitive for lymph node metastases than MRI or computed tomography (CT) and for bone lesions than bone scan at lower PSA levels but can be limited for local prostate cancer recurrence. Given greater soft tissue contrast, similar criteria for lymph nodes, and greater sensitivity for prostate bone metastases, MRI is advantageous to CT. MRI of the whole body and mpMRI are now feasible within a reasonable time frame and complementary to PET imaging, enabling whole-body and pelvis-focused PET-MRI, which should be advantageous in the setting of recurrent prostate cancer. SUMMARY Hybrid PET-MRI with prostate cancer targeted radiopharmaceuticals and whole body with local multiparametric MRI can be complementary for detecting local and distant recurrence to guide treatment planning.
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Affiliation(s)
- Nikita Rednam
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
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12
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Krausewitz P, Ritter M, Essler M. [Diagnosis and staging of metastatic hormone-sensitive prostate cancer]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:347-353. [PMID: 36735034 DOI: 10.1007/s00120-023-02028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Risk stratification of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has undergone significant changes in recent years in light of new therapies and innovative imaging. OBJECTIVES Established and innovative methods for detection of metastasis, risk group stratification, and treatment of mHSPC are outlined and compared. MATERIALS AND METHODS Background knowledge and treatment-relevant guideline recommendations on mHSPC are presented and complemented by recent study results. RESULTS Integration of modern imaging techniques, especially prostate-specific membrane antigen (PSMA) PET/CT, into the diagnostic algorithm has the potential to significantly improve risk stratification and treatment of mHSPC. By using PSMA PET/CT, metastases are detected early and sensitively. This leads to the definition of new subgroups amenable to modern therapeutic strategies. The prognostic value of using PSMA PET/CT with regard to established risk categories in mHSPC is currently being evaluated. CONCLUSIONS Modern imaging, especially PSMA PET/CT, has significant added value for the diagnosis and treatment of mHSPC in almost all subgroups. In particular, it helps to select patients who will benefit from intensification or de-escalation of systemic therapy.
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Affiliation(s)
- Philipp Krausewitz
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Manuel Ritter
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Markus Essler
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Deutschland
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13
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Jetty S, Loftus JR, Patel A, Gupta A, Puri S, Dogra V. Prostate Cancer-PET Imaging Update. Cancers (Basel) 2023; 15:cancers15030796. [PMID: 36765754 PMCID: PMC9913636 DOI: 10.3390/cancers15030796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Prostate cancer is the most common non-dermatologic cancer in men, and one of the leading causes of cancer-related mortality. The incidence of prostate cancer increases precipitously after the age of 65 and demonstrates variable aggressiveness, depending on its grade and stage at diagnosis. Despite recent advancements in prostate cancer treatment, recurrence is seen in 25% of patients. Advancements in prostate cancer Positron Emission Tomography (PET) molecular imaging and recent United States Food and Drug Administration (FDA) approvals have led to several new options for evaluating prostate cancer. This manuscript will review the commonly used molecular imaging agents, with an emphasis on Fluorine-18 fluciclovine (Axumin) and PSMA-ligand agents, including their protocols, imaging interpretation, and pitfalls.
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Affiliation(s)
- Sankarsh Jetty
- Department of Imaging Sciences, University of Rochester Medical Center, New York, NY 14642, USA
| | - James Ryan Loftus
- Department of Imaging Sciences, University of Rochester Medical Center, New York, NY 14642, USA
| | - Abhinav Patel
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Akshya Gupta
- Department of Imaging Sciences, University of Rochester Medical Center, New York, NY 14642, USA
| | - Savita Puri
- Department of Imaging Sciences, University of Rochester Medical Center, New York, NY 14642, USA
| | - Vikram Dogra
- Department of Imaging Sciences, University of Rochester Medical Center, New York, NY 14642, USA
- Correspondence:
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Elzaki A, Elkhader BA, Elnour H, Elhaj M, Alzain A, Abdelrahim A, Gupta DG. Clinico-pathological correlation of incidental focal colorectal uptake on 18F-Labelled 2-fluoro-2-Deoxyglucose PET/CT: A prospective single centre experience. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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Ferrari C, Mammucci P, Lavelli V, Pisani AR, Nappi AG, Rubini D, Sardaro A, Rubini G. [ 18F]fluciclovine vs. [ 18F]fluorocholine Positron Emission Tomography/Computed Tomography: A Head-to-Head Comparison for Early Detection of Biochemical Recurrence in Prostate Cancer Patients. Tomography 2022; 8:2709-2722. [PMID: 36412685 PMCID: PMC9680271 DOI: 10.3390/tomography8060226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Nowadays, there is still no consensus on the most accurate PET radiopharmaceutical to early detect prostate cancer (PCa) relapse. A tailored radiotracer choice based on a specific patient's profile could ensure prompt disease detection and an improvement in patients management. We aimed to compare the [18F]fluciclovine and [18F]fluorocholine PET/CT detection rate (DR) in PCa patients restaged for early biochemical recurrence (BCR), according to clinical and biochemical features. A cohort of 138 PCa patients with early BCR (mean age: 71 y, range: 50-87 y) were homogeneously randomized 1:1 to a [18F]fluciclovine or a [18F]fluorocholine PET/CT group. The respective PET/CT DR, according to per-patient and per-region analysis, and the impact of the biochemical, clinical, and histological parameters, were compared. The PSA cut-off values predictive of a positive scan were also calculated. Overall, the [18F]fluciclovine PET/CT DR was 64%, significantly higher than the [18F]fluorocholine PET/CT DR of 35% (p = 0.001). Similarly, in the per-region analysis, the [18F]fluciclovine PET/CT DR was 51% in the prostate region, significantly higher compared to 15% of [18F]fluorocholine (p < 0.0001). Furthermore, a statistically significant higher DR in per-patient and per-region (prostate/prostate bed) analysis was observed in the [18F]fluciclovine group for 0.5-1 ng/mL (p = 0.018, p = 0.049) and >1 ng/mL (p = 0.040, p < 0.0001) PSA values. A PSA of 0.45 ng/mL for [18F]fluciclovine and of 0.94 ng/mL for [18F]fluorocholine was identified as the optimal cut-off value in predicting a positive PET/CT scan. Our results demonstrated a better [18F]fluciclovine PET/CT DR compared to [18F]fluorocholine for restaging PCa patients in early BCR, particularly in the detection of locoregional recurrence. The significantly higher [18F]fluciclovine DR for low PSA values (PSA < 1 ng/mL) supports its use in this setting of patients.
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Affiliation(s)
- Cristina Ferrari
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Paolo Mammucci
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Valentina Lavelli
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Antonio Rosario Pisani
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Anna Giulia Nappi
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Dino Rubini
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Angela Sardaro
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Rubini
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
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16
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Adnan A, Basu S. Dual-Tracer PET-Computed Tomography Imaging for Precision Radio-Molecular Theranostics of Prostate Cancer: A Futuristic Perspective. PET Clin 2022; 17:641-652. [PMID: 36153234 DOI: 10.1016/j.cpet.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dual/multi-tracer PET-computed tomography (CT) scan has been an interesting and intriguing concept and is promising in noninvasive and overall characterization of tumor biology and heterogeneity and has scientifically augmented the practice of precision oncology. In prostate carcinoma, particularly in metastatic castration-resistant prostate carcinoma setting, dual-tracer PET-CT can be potentially useful in selecting patients for chemotherapy, androgen deprivation therapy or prostate-specific membrane antigen (PSMA)-based peptide receptor radioligand therapy either as mono-therapy or as combination therapy, ascertaining differentiation status, staging/restaging, prognostication, and predicting progression/response. PSMA PET/CT has great potential as a "rule out" test in baseline staging, while being very useful in restaging and metastatic workup.
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Affiliation(s)
- Aadil Adnan
- Radiation Medicine Centre (B.A.R.C.), Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai 400012, India; Homi Bhabha National Institute, Mumbai, India
| | - Sandip Basu
- Radiation Medicine Centre (B.A.R.C.), Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai 400012, India; Homi Bhabha National Institute, Mumbai, India.
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17
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Tremeau L, Mottet N. Management of Biochemical Recurrence of Prostate Cancer After Curative Treatment: A Focus on Older Patients. Drugs Aging 2022; 39:685-694. [PMID: 36008748 DOI: 10.1007/s40266-022-00973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
Following a treatment with curative intent, a biochemical recurrence may be diagnosed, often many years after the primary treatment. The consequences of this relapse on survival are very heterogeneous. The expected specific survival at relapse is above 50% at 10 years. Therefore, its management needs to be balanced with the individual life expectancy. The relapse needs to be categorized as either a low- or high-risk category. The latter has to be considered for salvage therapy, provided the individual life expectancy is long enough. It is evaluated through an initial geriatric assessment, starting with the G8 score as well as the mini-Cog. A comprehensive geriatric assessment might be needed based on the G8 score. Patients will then be categorized as either fit, vulnerable, or frail. If a local salvage therapy is considered, the relapse localization might be of interest in some situations. Available salvage therapies in senior adults have nothing special compared to salvage of younger men, except for aggressive local therapy, which might be less well tolerated. The key objective in managing a biochemical recurrence in senior adults is to find the right balance between under- and over-treatment in a shared decision process. In many frail and vulnerable men, a clinically oriented watchful waiting should be preferred, while fit men with an aggressive relapse and a significant life expectancy need an active therapy.
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Affiliation(s)
- Lancelot Tremeau
- Centre Hospitalo-Universitaire de Saint Etienne, Saint Etienne, France.
| | - Nicolas Mottet
- Centre Hospitalo-Universitaire de Saint Etienne, Saint Etienne, France
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18
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Abstract
The authors define molecular imaging, according to the Society of Nuclear Medicine and Molecular Imaging, as the visualization, characterization, and measurement of biological processes at the molecular and cellular levels in humans and other living systems. Although practiced for many years clinically in nuclear medicine, expansion to other imaging modalities began roughly 25 years ago and has accelerated since. That acceleration derives from the continual appearance of new and highly relevant animal models of human disease, increasingly sensitive imaging devices, high-throughput methods to discover and optimize affinity agents to key cellular targets, new ways to manipulate genetic material, and expanded use of cloud computing. Greater interest by scientists in allied fields, such as chemistry, biomedical engineering, and immunology, as well as increased attention by the pharmaceutical industry, have likewise contributed to the boom in activity in recent years. Whereas researchers and clinicians have applied molecular imaging to a variety of physiologic processes and disease states, here, the authors focus on oncology, arguably where it has made its greatest impact. The main purpose of imaging in oncology is early detection to enable interception if not prevention of full-blown disease, such as the appearance of metastases. Because biochemical changes occur before changes in anatomy, molecular imaging-particularly when combined with liquid biopsy for screening purposes-promises especially early localization of disease for optimum management. Here, the authors introduce the ways and indications in which molecular imaging can be undertaken, the tools used and under development, and near-term challenges and opportunities in oncology.
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Affiliation(s)
- Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin G. Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Jadvar H, Colletti PM. Molecular Imaging Assessment of Androgen Deprivation Therapy in Prostate Cancer. PET Clin 2022; 17:389-397. [PMID: 35662493 DOI: 10.1016/j.cpet.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hormonal therapy has long been recognized as a mainstay treatment for prostate cancer. New generation imaging agents have provided unprecedented opportunities at all phases along the natural history of prostate cancer. We review the literature on the effect of androgens and androgen deprivation therapy on prostate tumor at its various biological phases using the new generation molecular imaging agents in conjunction with positron emission tomography.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Kenneth Norris Jr. Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Patrick M Colletti
- Division of Nuclear Medicine, Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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20
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Voter AF, Werner RA, Pienta KJ, Gorin MA, Pomper MG, Solnes LB, Rowe SP. Piflufolastat F-18 ( 18F-DCFPyL) for PSMA PET imaging in prostate cancer. Expert Rev Anticancer Ther 2022; 22:681-694. [DOI: 10.1080/14737140.2022.2081155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Andrew F. Voter
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Transitional Year Residency Program, Aurora St. Luke’s Medical Center, Advocate Aurora Health, Milwaukee, WI, USA
| | - Rudolf A. Werner
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Kenneth J. Pienta
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A. Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martin G. Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lilja B. Solnes
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Where Do We Stand in the Management of Oligometastatic Prostate Cancer? A Comprehensive Review. Cancers (Basel) 2022; 14:cancers14082017. [PMID: 35454924 PMCID: PMC9029666 DOI: 10.3390/cancers14082017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/10/2022] [Accepted: 04/14/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Oligometastatic prostate cancer is an intermediate stage between localised and metastatic disease. Today, there are many advances in the diagnosis of this stage of the disease, with the appearance of new imaging techniques and treatments, thanks to the development of new modalities, both local and systemic therapies, the emergence of personalised medicine, and theragnostics. Abstract Oligometastatic prostate cancer (OMPC) is an intermediate state between localised disease and widespread metastases that includes a spectrum of disease biology and clinical behaviours. This narrative review will cover the current OMPC scenario. We conducted comprehensive English language literature research for original and review articles using the Medline database and grey literature through December 2021. OMPC is a unique clinical state with inherently more indolent tumour biology susceptible to multidisciplinary treatment (MDT). With the development of new imaging techniques, patients with OMPC are likely to be identified at an earlier stage, and the paradigm for treatment is shifting towards a more aggressive approach to treating potentially curable patients. Multimodal management is necessary to improve patient outcomes due to the combination of available therapies, such as local therapy of primary tumour, metastasis directed therapy or systemic therapy, to reduce tumour load and prevent further disease progression. Additional prospective data are needed to select patients most likely to benefit from a given therapeutic approach.
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22
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Pasqualetti F, Trippa F, Aristei C, Borghesi S, Colosimo C, Cantarella M, Mazzola R, Ingrosso G. Stereotactic radiotherapy for oligometastases in the lymph nodes. Rep Pract Oncol Radiother 2022; 27:46-51. [PMID: 35402021 PMCID: PMC8989441 DOI: 10.5603/rpor.a2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Even though systemic therapy is standard treatment for lymph node metastases, metastasis-directed stereotactic radiotherapy (SRT ) seems to be a valid option in oligometastatic patients with a low disease burden. Positron emission tomography-computed tomography (PET-CT ) is the gold standard for assessing metastases to the lymph nodes; co-registration of PET-CT images and planning CT images are the basis for gross tumor volume (GTV ) delineation. Appropriate techniques are needed to overcome target motion. SRT schedules depend on the irradiation site, target volume and dose constraints to the organs at risk (OARs) of toxicity. Although several fractionation schemes were reported, total doses of 48–60 Gy in 4–8 fractions were proposed for mediastinal lymph node SRT, with the spinal cord, esophagus, heart and proximal bronchial tree being the dose limiting OAR s. Total doses ranged from 30 to 45 Gy, with daily fractions of 7–12 Gy for abdominal lymph nodes, with dose limiting OARs being the liver, kidneys, bowel and bladder. SRT on lymph node metastases is safe; late side effects, particularly severe, are rare.
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Affiliation(s)
- Francesco Pasqualetti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Fabio Trippa
- Radiation Oncology Centre, S. Maria Hospital, Terni, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | - Caterina Colosimo
- Operative Unit of Radiotherapy, Department of Oncology, San Luca Hospital, Lucca, Italy
| | | | - Rosario Mazzola
- Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
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Kissel M, Pounou A, Ka K, Alexis A, Irani J, Jereczek-Fossa BA, Terlizzi M, Bossi A, Blanchard P. Efficacy and toxicity following salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after radiotherapy. Brachytherapy 2022; 21:424-434. [PMID: 35331666 DOI: 10.1016/j.brachy.2022.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The management of local relapse after prostate cancer radiotherapy is frequently based on androgen deprivation therapy. The aim of the study was to report Gustave Roussy's experience with salvage prostate brachytherapy. PATIENTS AND METHODS All cases of localized prostate cancer presenting in an irradiated area who received salvage high dose rate (HDR) brachytherapy from 2013 to 2020 were retrospectively reviewed. RESULTS A total of 64 patients were included. Median follow up was 30.5 months. Median initial EBRT dose was 70 Gy [Q1-Q3: 70 - 74]. Median PSA at brachytherapy was 6.8 ng/mL [Q1-Q3: 4.4 - 8.7] with a median interval between first and salvage irradiation of 10 years [Q1-Q3: 6.9 - 12.6]. The modality of the first irradiation was an exclusive EBRT in 73% of the cases, mostly with a 3D technique (82%). Dose prescription was two fractions of 12 Gy or 13 Gy associated with androgen deprivation therapy for 63% of the patients. About 23% of the patients were castrate-resistant. Disease free survival at 2 years was 58% in the whole population and 66% in hormone sensitive patients. The only factors associated with disease free survival on multivariate analysis was a high-risk disease at initial diagnosis (HR = 3.59, IC95 [1.75; 7.39], p = 0.0005). Grade 3 urinary and rectal toxicities occurred in 1.5% and 1.5% of the patients, respectively. CONCLUSION HDR salvage brachytherapy seems to be a safe option for patients presenting with an isolated local relapse of prostate cancer.
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Affiliation(s)
- Manon Kissel
- Radiotherapy Department, Institut Curie, Paris, France
| | - Arthur Pounou
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Kanta Ka
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Anthony Alexis
- Radiophysics Department, Gustave Roussy, Villejuif, France
| | - Jacques Irani
- Urology Department, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Mario Terlizzi
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Alberto Bossi
- Radiotherapy Department, Gustave Roussy, Villejuif, France
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PARP Inhibitors and Radiometabolic Approaches in Metastatic Castration-Resistant Prostate Cancer: What’s Now, What’s New, and What’s Coming? Cancers (Basel) 2022; 14:cancers14040907. [PMID: 35205654 PMCID: PMC8869833 DOI: 10.3390/cancers14040907] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Prostate cancer still represents an important health problem in men, considering its high frequency. Over the last decade, novel treatment options have emerged, leading to notable clinical benefits. These recent scientific acquisitions are creating the basis to widen the treatment scenario of this tumor, evolving from targeting the androgen receptor axis or the traditional chemotherapy approach. Abstract In recent years, the advances in the knowledge on the molecular characteristics of prostate cancer is allowing to explore novel treatment scenarios. Furthermore, technological discoveries are widening diagnostic and treatment weapons at the clinician disposal. Among these, great relevance is being gained by PARP inhibitors and radiometabolic approaches. The result is that DNA repair genes need to be altered in a high percentage of patients with metastatic prostate cancer, making these patients optimal candidates for PARP inhibitors. These compounds have already been proved to be active in pretreated patients and are currently being investigated in other settings. Radiometabolic approaches combine specific prostate cancer cell ligands to radioactive particles, thus allowing to deliver cytotoxic radiations in cancer cells. Among these, radium-223 and lutetium-177 have shown promising activity in metastatic pretreated prostate cancer patients and further studies are ongoing to expand the applications of this therapeutic approach. In addition, nuclear medicine techniques also have an important diagnostic role in prostate cancer. Herein, we report the state of the art on the knowledge on PARP inhibitors and radiometabolic approaches in advanced prostate cancer and present ongoing clinical trials that will hopefully expand these two treatment fields.
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25
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Surcel C, Kretschmer A, Mirvald C, Sinescu I, Heidegger I, Tsaur I. Molecular Mechanisms Related with Oligometastatic Prostate Cancer-Is It Just a Matter of Numbers? Cancers (Basel) 2022; 14:cancers14030766. [PMID: 35159033 PMCID: PMC8833728 DOI: 10.3390/cancers14030766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023] Open
Abstract
During the last decade, the body of knowledge regarding the oligometastatic state has increased exponentially. Several molecular frameworks have been established, aiding our understanding of metastatic spread caused by genetically unstable cells that adapt to a tissue environment which is distant from the primary tumor. In the current narrative review, we provide an overview of the current treatment landscape of oligometastatic cancer, focusing on the current biomarkers used in the identification of true oligometastatic disease and highlighting the impact of molecular imaging on stage shift in different scenarios. Finally, we address current and future directions regarding the use of genetic and epigenetic targeting treatments in oligometastatic prostate cancer.
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Affiliation(s)
- Cristian Surcel
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, 00238 Bucharest, Romania; (C.M.); (I.S.)
- Correspondence:
| | | | - Cristian Mirvald
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, 00238 Bucharest, Romania; (C.M.); (I.S.)
| | - Ioanel Sinescu
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, 00238 Bucharest, Romania; (C.M.); (I.S.)
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany;
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26
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Jadvar H, Calais J, Fanti S, Feng F, Greene KL, Gulley JL, Hofman M, Koontz BF, Lin DW, Morris MJ, Rowe SP, Royce TJ, Salami S, Savir-Baruch B, Srinivas S, Hope TA. Appropriate Use Criteria for Prostate-Specific Membrane Antigen PET Imaging. J Nucl Med 2022; 63:59-68. [PMID: 34593595 PMCID: PMC8717184 DOI: 10.2967/jnumed.121.263262] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/21/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hossein Jadvar
- Department of Radiology, University of Southern California, Los Angeles, California
| | - Jeremie Calais
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, California
| | | | - Felix Feng
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Kirsten L. Greene
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | | | - Michael Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria Australia
| | - Bridget F. Koontz
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Daniel W. Lin
- Department of Urology, University of Washington, Seattle, Washington
| | - Michael J. Morris
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steve P. Rowe
- Department of Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Trevor J. Royce
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Simpa Salami
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | - Sandy Srinivas
- Department of Medicine (Oncology), Stanford University, California; and
| | - Thomas A. Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
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27
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Razmaria AA, Schoder H, Morris MJ. Advances in Prostate Cancer Imaging. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Koerber SA, Fink CA, Dendl K, Schmitt D, Niegisch G, Mamlins E, Giesel FL. [Imaging of oligometastatic disease in selected urologic cancers]. Urologe A 2021; 60:1561-1569. [PMID: 34850260 DOI: 10.1007/s00120-021-01708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Local treatment of the primary or metastatic sites in urologic malignancies is promising when compared to systemic therapy alone, leading to the definition of a potentially curative oligometastatic state. OBJECTIVES Comparison of imaging modalities regarding local and metastatic tumor sites in urologic cancers. METHODS Review of comparative trials addressing quality criteria of imaging modalities. RESULTS Depending on primary tumor and metastatic site, conventional imaging modalities such as computer tomography (CT) and bone scintigraphy still represent the standard of care in Germany. Due to superior quality criteria, hybrid-imaging techniques were widely adopted for oncological staging and particular due to the new PSMA-ligand (PSMA-PET/CT) in prostate cancer imaging. The development of new radioisotopes as well as their clinical application remains a focus of current research. CONCLUSIONS High-quality diagnostic imaging modalities lay the groundwork for a precise definition of an oligometastatic state. By enabling treatment of the entire tumor burden, a delay of systemic therapy, longer progression-free survival, or even curative treatment may become achievable.
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Affiliation(s)
- S A Koerber
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C A Fink
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - K Dendl
- Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.,Klinik für Nuklearmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - D Schmitt
- Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - G Niegisch
- Klinik für Urologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - E Mamlins
- Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - F L Giesel
- Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
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29
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Abstract
More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.
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30
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Galgano SJ, Calderone CE, Xie C, Smith EN, Porter KK, McConathy JE. Applications of PET/MRI in Abdominopelvic Oncology. Radiographics 2021; 41:1750-1765. [PMID: 34597228 DOI: 10.1148/rg.2021210035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With PET/MRI, the strengths of PET and MRI are combined to allow simultaneous image acquisition and near-perfect image coregistration. MRI is increasingly being used for staging and restaging of abdominopelvic oncologic lesions, including prostate, hepatobiliary, pancreatic, neuroendocrine, cervical, and rectal cancers. Fluorine 18-fluorodeoxyglucose PET/CT has long been considered a cornerstone of oncologic imaging, and the development of multiple targeted radiotracers has led to increased research on and use of these agents in clinical practice. Thus, simultaneously performed PET/MRI enables the acquisition of complementary imaging information, with distinct advantages over PET/CT and MR image acquisitions. The authors provide an overview of PET/MRI, including descriptions of the major differences between PET/MRI and PET/CT, as well as case examples and treatment protocols for patients with commonly encountered malignancies in the abdomen and pelvis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Samuel J Galgano
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Carli E Calderone
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Charlies Xie
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Elainea N Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Kristin K Porter
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Jonathan E McConathy
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
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31
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Francolini G, Bellini C, Di Cataldo V, Detti B, Bruni A, Alicino G, Triggiani L, La Mattina S, D'Angelillo RM, Demofonti C, Mazzola R, Cuccia F, Alongi F, Aquilano M, Allegra AG, Ciccone LP, Burchini L, Salvestrini V, Morelli I, Frosini G, Desideri I, Livi L. Pattern of Recurrence After Stereotactic Radiotherapy in Prostate Cancer Patients With Nodal Pelvic Relapse. A Multi-Institutional Retrospective Analysis. Clin Oncol (R Coll Radiol) 2021; 34:57-62. [PMID: 34598843 DOI: 10.1016/j.clon.2021.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 01/22/2023]
Abstract
AIMS Currently, when nodal pelvic oligorecurrent disease is detected, no standard treatment option is recommended. One possible salvage option is nodal stereotactic body radiotherapy (SBRT). Here we analysed recurrence patterns after nodal SBRT in patients affected by pelvic oligometastatic relapse after radical prostatectomy, and androgen deprivation therapy (ADT)-free survival in this population. MATERIALS AND METHODS Data on 93 patients consecutively treated in five different institutions for pelvic oligorecurrent disease were reviewed. Inclusion criteria were biochemical recurrence after radical prostatectomy and imaging showing three or fewer metachronous lymphoadenopathies under aortic bifurcation. Patients underwent SBRT on all sites of disease. Concomitant ADT was allowed. RESULTS After a median follow-up of 20 months (interquartile range 11-41), 57 patients had post-SBRT radiological evidence of relapse, for a median disease-free survival (DFS) of 15 months (95% confidence interval 9-24). Concomitant ADT was administered in 20 patients (21.5%). Overall, eight (8.6%), 21 (22.6%) and 28 (30.1%) patients had prostate bed only, pelvic nodal or distant relapse, respectively. The median ADT-free survival was not reached. Concomitant ADT, International Society for Urologic Pathology pattern at diagnosis < or ≥3, time to relapse ≤ or >12 months, prostate-specific antigen at recurrence < or ≥1.10 ng/ml and prostate-specific membrane antigen staging were not significantly associated with DFS. After relapse, 42 patients (45.2%) received a second SBRT course. CONCLUSION Nodal SBRT yielded encouraging DFS and ADT-free survival in this population. Only a minority of patients developed prostate bed recurrence, suggesting that local treatment may be safely avoided. A consistent percentage of patients could be managed with a second SBRT course.
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Affiliation(s)
- G Francolini
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - C Bellini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | | | - B Detti
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
| | - A Bruni
- Radiation Oncology Unit, Modena Hospital, Modena, Italy
| | - G Alicino
- Radiation Oncology Unit, Modena Hospital, Modena, Italy
| | - L Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - S La Mattina
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - R M D'Angelillo
- Department of Radiation Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - C Demofonti
- Department of Radiation Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - R Mazzola
- Radiation Oncology Department, IRCCS, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - F Cuccia
- Radiation Oncology Department, IRCCS, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - F Alongi
- Radiation Oncology Department, IRCCS, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - M Aquilano
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - A G Allegra
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - L P Ciccone
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - L Burchini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - V Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - I Morelli
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - G Frosini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - I Desideri
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - L Livi
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
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32
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le Guevelou J, Achard V, Mainta I, Zaidi H, Garibotto V, Latorzeff I, Sargos P, Ménard C, Zilli T. PET/CT-Based Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy: Impact on Treatment Management and Future Directions. Front Oncol 2021; 11:742093. [PMID: 34532294 PMCID: PMC8438304 DOI: 10.3389/fonc.2021.742093] [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: 07/15/2021] [Accepted: 08/09/2021] [Indexed: 12/25/2022] Open
Abstract
Biochemical recurrence is a clinical situation experienced by 20 to 40% of prostate cancer patients treated with radical prostatectomy (RP). Prostate bed (PB) radiation therapy (RT) remains the mainstay salvage treatment, although it remains non-curative for up to 30% of patients developing further recurrence. Positron emission tomography with computed tomography (PET/CT) using prostate cancer-targeting radiotracers has emerged in the last decade as a new-generation imaging technique characterized by a better restaging accuracy compared to conventional imaging. By adapting targeting of recurrence sites and modulating treatment management, implementation in clinical practice of restaging PET/CT is challenging the established therapeutic standards born from randomized controlled trials. This article reviews the potential impact of restaging PET/CT on changes in the management of recurrent prostate cancer after RP. Based on PET/CT findings, it addresses potential adaptation of RT target volumes and doses, as well as use of androgen-deprivation therapy (ADT). However, the impact of such management changes on the oncological outcomes of PET/CT-based salvage RT strategies is as yet unknown.
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Affiliation(s)
- Jennifer le Guevelou
- Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Division of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Vérane Achard
- Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Ismini Mainta
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland
| | - Habib Zaidi
- Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland.,Geneva Neuroscience Center, Geneva University, Geneva, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Valentina Garibotto
- Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland.,Geneva Neuroscience Center, Geneva University, Geneva, Switzerland
| | - Igor Latorzeff
- Department of Radiation Oncology, Groupe Oncorad-Garonne, Clinique Pasteur, Toulouse, France
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Cynthia Ménard
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Thomas Zilli
- Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
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33
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Moradi F, Farolfi A, Fanti S, Iagaru A. Prostate cancer: Molecular imaging and MRI. Eur J Radiol 2021; 143:109893. [PMID: 34391061 DOI: 10.1016/j.ejrad.2021.109893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
The role of molecular imaging in initial evaluation of men with presumed or established diagnosis of prostate cancer and work up of biochemical recurrence and metastatic disease is rapidly evolving due to superior diagnostic performance compared to anatomic imaging. However, variable tumor biology and expression of transmembrane proteins or metabolic alterations poses a challenge. We review the evidence and controversies with emphasis on emerging PET radiopharmaceuticals and experience on clinical utility of PET/CT and PET/MRI in diagnosis and management of prostate cancer.
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Affiliation(s)
- Farshad Moradi
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA.
| | - Andrea Farolfi
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA
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34
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Negative 11C-choline PET/computed tomography imaging in restaging of patients with prostate cancer with serum prostate-specific antigen values >20 ng/mL. Nucl Med Commun 2021; 41:1178-1182. [PMID: 32804916 DOI: 10.1097/mnm.0000000000001266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Several studies have reported about the performance of C-choline-PET/computed tomography (CT) (choline) in patients with biochemical recurrent (BCR) prostate cancer, but there is a lack of information regarding negative choline in the same clinical setting. Our aim was to retrospectively analyse negative choline in a cohort of BCR-patients with high prostate-specific antigen (PSA). METHODS AND RESULTS We retrospectively analysed all choline-scans performed at two high-volume imaging centres between 2005 and 2018, selecting those of interest according to the following inclusion criteria: (1) proven prostate cancer treated either with radical prostatectomy or primary external beam radiation therapy (EBRT), (2) BCR after radical prostatectomy or EBRT, (3) PSA serum values >20 ng/mL at the time of scan and (4) scan reported as negative for active disease. Overall, among 5792 scans performed for BCR-prostate cancer, 14 matched the inclusion criteria and were classified as follows: 5/14(36%) inaccurate reports, 3/14(21%) questionable underestimation of positive findings, originally described as unclear, 6/14(43%) negatives. Choline showed a high detection rate in BCR-prostate cancer patients with PSA >20 ng/mL. CONCLUSIONS Although negative reports can be found in this clinical setting, in our review various disease-relevant findings were identified in more than half of the cases originally reported as negative warranting a double reading in such cases to avoid false-negative reports.
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35
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Comparison between MRI and choline-PET trans-perineal target biopsies and saturation biopsies for detection and topography of intra-prostatic recurrence after primary radiation therapy for prostate cancer. Prog Urol 2021; 31:683-691. [PMID: 34154955 DOI: 10.1016/j.purol.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 04/07/2021] [Accepted: 04/30/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Biochemical recurrence of prostate cancer after radiation therapy occurs in 5 to 50% of cases depending on the radiation technique used. The diagnosis of recurrence of prostate adenocarcinoma must be made accurately. The aim of this study was to compare transperineal saturation and target biopsies to index lesion (IL) as defined on MRI and 18FCholine PET-CT (PETc) for detection of intra-prostatic recurrence after primary radiation therapy for prostate cancer. MATERIALS AND METHODS Thirty-eight patients with an history of prostate radiation for prostate cancer and biochemical recurrence were retrospectively included between March 2013 and June 2017. All patients had PETc and multiparametric MRI (MRI) defining IL. All patients had transperineal saturation biopsies and target biopsies the IL. RESULTS Among 38 patients with biochemical recurrence, 33 (87%) had biopsy proven recurrence in the prostate. The sensitivity and specificity of MRI were 32% (SD:19%) and 91% respectively (SD:7%). The sensitivity and specificity of PETc were 33% (SD:22%) and 78% respectively (SD:12%). Saturation trans-perineal and target biopsies allowed detection of disease recurrence in 79% and 84% of patients, respectively. CONCLUSION In case of positive imaging, both trans-perineal prostate saturation and target biopsies offer good performance to confirm intraprostatic recurrence. However, MRI and PETc low sensitivity to detect all sites of local recurrence of prostate cancer after radiation still justify the completion of systematic saturation biopsies. LEVEL OF EVIDENCE 3.
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36
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Mazzola R, Francolini G, Triggiani L, Napoli G, Cuccia F, Nicosia L, Livi L, Magrini SM, Salgarello M, Alongi F. Metastasis-directed Therapy (SBRT) Guided by PET-CT 18F-CHOLINE Versus PET-CT 68Ga-PSMA in Castration-sensitive Oligorecurrent Prostate Cancer: A Comparative Analysis of Effectiveness. Clin Genitourin Cancer 2021; 19:230-236. [DOI: 10.1016/j.clgc.2020.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 12/19/2022]
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37
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Sun J, Lin Y, Wei X, Ouyang J, Huang Y, Ling Z. Performance of 18F-DCFPyL PET/CT Imaging in Early Detection of Biochemically Recurrent Prostate Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:649171. [PMID: 33981607 PMCID: PMC8107478 DOI: 10.3389/fonc.2021.649171] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Prostate-specific membrane antigen (PSMA)-targeted 2-(3-{1-carboxy-5-[(6-[18F] fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) positron emission tomography/computed tomography (PET/CT) has shown advantages in primary staging, restaging, and metastasis detection of prostate cancer (PCa). However, little is known about the role of 18F-DCFPyL PET/CT in biochemically recurrent prostate cancer (BRPCa). Hence, we performed a systematic review and meta-analysis to evaluate 18F-DCFPyL PET/CT as first-line imaging modality in early detection of BRPCa. Methods: A comprehensive literature search of PubMed, Web of Science, Embase, and Cochrane Library was conducted until December 2020. The pooled detection rate on a per-person basis and together with 95% confidence interval (CI) was calculated. Furthermore, a prostate-specific antigen (PSA)-stratified performance of detection positivity was obtained to assess the sensitivity of 18F-DCFPyL PET/CT in BRPCa with different PSA levels. Results: A total of nine eligible studies (844 patients) were included in this meta-analysis. The pooled detection rate (DR) of 18F-DCFPyL PET/CT in BRPCa was 81% (95% CI: 76.9-85.1%). The pooled DR was 88.8% for PSA ≥ 0.5 ng/ml (95% CI: 86.2-91.3%) and 47.2% for PSA < 0.5 ng/ml (95% CI: 32.6-61.8%). We also noticed that the regional lymph node was the most common site with local recurrence compared with other sites (45.8%, 95% CI: 42.1-49.6%). Statistical heterogeneity and publication bias were found. Conclusion: The results suggest that 18F-DCFPyL PET/CT has a relatively high detection rate in BRPCa. The results also indicate that imaging with 18F-DCFPyL may exhibit improved sensitivity in BRPCa with increased PSA levels. Considering the publication bias, further large-scale multicenter studies are warranted for validation.
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Affiliation(s)
- Jiale Sun
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuxin Lin
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuedong Wei
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Ouyang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhixin Ling
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
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38
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Curative-intent Metastasis-directed Therapies for Molecularly-defined Oligorecurrent Prostate Cancer: A Prospective Phase II Trial Testing the Oligometastasis Hypothesis. Eur Urol 2021; 80:374-382. [PMID: 33685838 DOI: 10.1016/j.eururo.2021.02.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/17/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The hypothesis of a curable oligometastatic prostate cancer (PCa) state remains to be clinically-proven. Conventional imaging often fails to localize early recurrences, hampering the potential for radical approaches. OBJECTIVE We hypothesize that prostate-specific membrane antigen (PSMA)-targeted PET-MR/CT allows for earlier detection and localization of oligorecurrent-PCa, unveiling a molecularly-defined state amenable to curative-intent metastasis-directed treatment (MDT). DESIGN/SETTING/PARTICIPANTS Single-institution single-arm phase-two study. Patients with rising PSA (0.4-3.0 ng/mL) after maximal local therapy (radical prostatectomy and post-operative radiotherapy), negative conventional staging, and no prior salvage hormonal therapy (HT) were eligible. INTERVENTIONS All patients underwent [18F]DCFPyL PET-MR/CT. Patients with molecularly-defined oligorecurrent-PCa had MDT (stereotactic ablative body radiotherapy [SABR] or surgery) without HT. OUTCOME MEASUREMENTS/STATISTICAL ANALYSIS Primary endpoint was biochemical response (complete, i.e. biochemical 'no evidence of disease' [bNED], or partial response [100% or ≥50% PSA decline from baseline, respectively]) after MDT. Simon's two-stage design was employed (null and alternate hypotheses <5% and >20% response rate, respectively), with α and β of 0.1. RESULTS Seventy-two patients were enrolled (May/2017-July/2019). Thirty-eight (53%) had PSMA-detected oligorecurrent-PCa amenable for MDT. Thirty-seven (51%) agreed to MDT: 10 and 27 underwent surgery and SABR, respectively. Median follow-up was 15.9 months (IQR 9.8-19.1). Of patients receiving MDT, the overall response rate was 60%, including 22% rendered bNED. One (2.7%) grade 3 toxicity (intra-operative ureteric injury) was observed. CONCLUSIONS PSMA-defined oligorecurrent-PCa can be rendered bNED, a necessary step towards cure, in 1 of 5 patients receiving MDT alone. Randomized trials are justified to determine if MDT +/- systemic agents can expand the curative therapeutic armamentarium for PCa. PATIENT SUMMARY We studied men treated for prostate cancer with rising PSA. We found PSMA imaging detected recurrent cancer in three-quarters of patients, and targeted treatment to these areas significantly decreased PSA in half of patients.
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Dadgar H, Seyedi Vafaee M, Norouzbeigi N, Jafari E, Gholamrezanezhad A, Assadi M. Dual-phase 68Ga-PSMA-11 PET/CT may increase the rate of detected lesions in prostate cancer patients. Urologia 2021; 88:355-361. [PMID: 33627056 DOI: 10.1177/0391560321993544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study was conducted to compare the early static (3-6 min post-injection (p.i.)) and standard whole body (1 h, p.i.) 68Ga-PSMA-11 PET/CT imaging for detection of lesions in prostate cancer (PC) patients. MATERIALS AND METHODS In this study, PC patients suspected of recurrence underwent 68Ga-PSMA-11 PET/CT. Early static images were acquired from the pelvis and the lower abdomen 3-5 minutes after radiotracer injection and, a routine whole body scan was performed from the skull to the mid-thigh 1 h after injection. Quantitative analysis (SUVmax) was evaluated in suspicious lesions. RESULTS Of 19 evaluated PC patients with a median age of 72 ± 1.66 years (range: 55-85 years) and prostate-specific antigen (PSA) of 1.72 ± 6.11 ng/ml (range: 0.1-100 ng/ml) (median ± SE), 16 showed positive in the whole body PET/CT. All of the patients with positive whole body scans due to pelvic involvement had positive early scan results. Totally, 22 lesions were detected in both early and delay scans in the pelvic which 16 were related to prostate involvement, 4 were related to lymph node involvement, and 2 were related to bone involvement. Moreover, in addition to the mentioned 22 lesions, early PET imaging successfully detected local recurrence in a patient who was negative on WB PET/ CT; this lesion was masked in the delay scan due to bladder activity. The median SUVmax values of the early and delay scans were 3.69 ± 1.07 (median ± SE) (range: 1.2-14.5) and 5.85 ± 1.69 (range: 3.1-23.4), respectively. (p = 0.005). CONCLUSION Early static 68Ga-PSMA-11 PET/CT imaging might discriminate metastases from urinary bladder activity. Therefore, early static imaging in combination with whole body 60-min p.i. imaging can improve the detection of local involvement pelvic disease.
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Affiliation(s)
- Habibollah Dadgar
- RAZAVI Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran
| | - Manouchehr Seyedi Vafaee
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Translational Neuroscience, BRIDGE, University of Southern Denmark, Odense, Denmark
| | - Nasim Norouzbeigi
- RAZAVI Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran
| | - Esmail Jafari
- Department of Molecular Imaging and Radionuclide Therapy, Bushehr Medical University Hospital, The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Majid Assadi
- Department of Molecular Imaging and Radionuclide Therapy, Bushehr Medical University Hospital, The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
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Systematic review of stereotactic body radiotherapy for nodal metastases. Clin Exp Metastasis 2021; 38:11-29. [PMID: 33452954 DOI: 10.1007/s10585-020-10071-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
The aim of this analysis was to assess the efficacy of stereotactic body radiotherapy (SBRT) in terms of local control (LC) and progression-free survival (PFS) in patients with lymph node metastases (NMs) from solid tumors. A systematic literature search from the earliest date to July 25th, 2019 was performed following PRISMA guidelines. Papers reporting LC and/or PFS of NMs using SBRT (< 10 fractions) were selected. The clinical outcomes rates were pooled by means of a random or fixed-effect model. Twenty-nine studies were eligible (969 patients: 938 (LC) and 698 (PFS)). LC and PFS results were reported in 28 and 18 papers, respectively. Heterogeneity was observed in terms of patient and treatment characteristics. Pooled 2-year LC reported in 11 studies was 79.3% (95%CI, 72.8%-85.7%) with substantial heterogeneity between studies (Q2 test: p = 0.0083; I2 = 57.9%), while pooled 2-year PFS reported in 8 studies was 35.9% (95%CI, 22.1%-49.7%) with very high heterogeneity between studies (Q2 test: p < 0.0001; I2 = 86.1%). Grade ≥ 3 and Grade 5 toxicity rates were 2.0% and 0.2%, respectively. SBRT of NMs seems to be safe and effective in terms of LC. However, due to the marked heterogeneity of the included series, prospective studies are required.
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Imaging assessment of local recurrence of prostate cancer after radical prostatectomy. Abdom Radiol (NY) 2020; 45:4073-4083. [PMID: 32248258 DOI: 10.1007/s00261-020-02505-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Definitive therapy for prostate cancer includes radical prostatectomy and radiation therapy. Treatment is elected based on patient preference, biological tumor factors, and underlying health. Post prostatectomy, men are surveyed for disease recurrence with serial PSA measurements, digital rectal exam, and imaging studies depending on nomogram predicted risk of local disease recurrence and distant metastasis. In men with rising PSA levels, pathologically incomplete surgical margins or, if symptoms of metastasis develop, imaging may be obtained to localize disease. In cases of known biochemical recurrence, imaging is used to target biopsy, to contour in salvage radiation therapy and to assess disease response. For local disease recurrence, the most commonly performed exams are pelvic MRI and transrectal US. CT can evaluate for lymph node metastasis, but is suboptimal in the evaluation of the prostatectomy bed. PET/CT and PET/MRI have been used successfully to evaluate for local disease recurrence. The PI-RADSv2.1 manual provides a risk level and lexicon for use in description of prostate carcinoma prior to prostatectomy, but does not address imaging features post-surgery. A detailed description of nodal, bony, and visceral metastasis is given elsewhere. This manuscript outlines the context in which appropriate imaging exams may be obtained and focuses on imaging findings concerning for local disease recurrence after prostatectomy on various imaging modalities including CT, US, MRI, and PET.
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Slevin F, Beasley M, Cross W, Scarsbrook A, Murray L, Henry A. Patterns of Lymph Node Failure in Patients With Recurrent Prostate Cancer Postradical Prostatectomy and Implications for Salvage Therapies. Adv Radiat Oncol 2020; 5:1126-1140. [PMID: 33305073 PMCID: PMC7718540 DOI: 10.1016/j.adro.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/18/2020] [Accepted: 07/15/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There is increasing use of radical prostatectomy to treat patients with high-risk prostate cancer. This has contributed toward a pathologic stage migration, and a greater number of patients are subsequently being diagnosed with biochemical failure. There is increasing use of advanced imaging techniques in the setting of biochemical failure, including positron emission tomography-computed tomography (PET-CT). METHODS AND MATERIALS This critical literature review highlights the evidence for PET-CT in postprostatectomy biochemical failure and identifies sites of pelvic lymph node relapse in the setting of biochemical failure and the potential implications that the locations of these relapses may have for salvage therapies. Potential future directions are then considered. RESULTS The optimal PET-CT tracer remains uncertain but there is increasing use of prostate-specific membrane antigen PET-CT for investigating sites of nodal metastasis at low prostate-specific antigen levels, and this is leading to a blurring of the biochemical and radiologic recurrence phases. The optimal therapeutic approach remains undefined, with current trials investigating postoperative radiation therapy to the whole pelvis in addition to the prostatic fossa, the use of PET-CT in the setting of biochemical recurrence to guide delivery of salvage radiation therapy, and, for patients with node-only relapsed prostate cancer, the addition of whole pelvis radiation therapy to metastasis-directed therapies such as stereotactic ablative radiotherapy. CONCLUSIONS The most appropriate target volume for salvage radiation therapy remains uncertain, and the findings of studies using PET-CT to map nodal recurrences suggest that there could be a role for extending whole pelvis radiation therapy volumes to increase coverage of superior nodal regions. The emerging fields of radiomics and radiogenomics could provide important prognostic information and aid decision making for patients with relapsed prostate cancer.
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Affiliation(s)
- Finbar Slevin
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - Matthew Beasley
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - William Cross
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Andrew Scarsbrook
- University of Leeds, Leeds, United Kingdom
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Louise Murray
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - Ann Henry
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
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Mahase S, Nagar H. Hypofractionated Postoperative Radiotherapy for Prostate Cancer: Is the Field Ready Yet? EUR UROL SUPPL 2020; 22:9-16. [PMID: 34337473 PMCID: PMC8317782 DOI: 10.1016/j.euros.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 12/30/2022] Open
Abstract
Context Radiotherapy (RT) is a valid adjuvant treatment for men with high-risk pathological features after radical prostatectomy and a salvage treatment for biochemical recurrence. A major inconvenience is that RT takes course over 7–8 wk in these settings, which has been shown to limit its use. Retrospective and pilot prospective investigations suggest that hypofractionation may provide noninferior outcomes but report variable results regarding toxicities. Additionally, our evolving understanding of prostate cancer radiobiology suggests that hypofractionated regimens may not increase toxicity. Objective We examine and review the rationale and clinical evidence of hypofractionated RT in the adjuvant and salvage settings for prostate cancer. Evidence acquisition We reviewed relevant literature, with a particular focus on recent studies employing hypofractionated RT. Evidence synthesis Hypofractionated RT in the adjuvant or salvage setting is not a standard option for prostate cancer RT outside of an investigational trial. While smaller studies show conflicting data regarding toxicity, initial evidence from larger clinical trials appears to demonstrate that hypofractionated postoperative RT is as effective and safe as conventionally fractionated courses. Conclusions With the growing acceptance of hypofractionation across other cancer sites and the rise of extreme hypofractionation for definitive prostate cancer treatment, hypofractionated postoperative therapy for prostate cancer is poised to become an option, as it may reduce the burden on men and treatment centers while maintaining clinical efficacy and safety. Prospective trials are currently ongoing to address efficacy and safety concerns. Patient summary Postoperative radiotherapy is a potentially curative treatment for patients with high-risk disease or recurrence after surgery. Shortening of the treatment regimen with the availability of modern treatment delivery techniques in conjunction with the integration of molecular imaging information to refine treatment volumes may improve therapeutic benefit without increasing toxicity.
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Jadvar H, Ballas LK, Choyke PL, Fanti S, Gulley JL, Herrmann K, Hope TA, Klitzke AK, Oldan JD, Pomper MG, Rowe SP, Subramaniam RM, Taneja SS, Vargas HA, Ahuja S. Appropriate Use Criteria for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer After Definitive Primary Treatment. J Nucl Med 2020; 61:552-562. [PMID: 32238495 DOI: 10.2967/jnumed.119.240929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Hossein Jadvar
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Leslie K Ballas
- American Society for Radiation Oncology, Arlington, Virginia
| | - Peter L Choyke
- American Society of Clinical Oncology, Alexandria, Virginia
| | - Stefano Fanti
- European Association of Nuclear Medicine, Vienna, Austria
| | - James L Gulley
- American College of Physicians, Philadelphia, Pennsylvania
| | - Ken Herrmann
- European Association of Nuclear Medicine, Vienna, Austria
| | - Thomas A Hope
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Jorge D Oldan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Clinical Oncology, Alexandria, Virginia
| | | | - Steven P Rowe
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Rathan M Subramaniam
- American College of Nuclear Medicine, Reston, Virginia.,American College of Radiology, Reston, Virginia; and
| | - Samir S Taneja
- American Urological Association, Linthicum Heights, Maryland
| | | | - Sukhjeet Ahuja
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
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Boissier R, Sanguedolce F, Territo A, Gaya JM, Huguet J, Rodriguez-Faba O, Regis F, Gallioli A, Vedovo F, Martinez C, Palou J, Breda A. Partial salvage cryoablation of the prostate for local recurrent prostate cancer after primary radiotherapy: Step-by-step technique and outcomes. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Diagnostic Performance of PET Imaging Using Different Radiopharmaceuticals in Prostate Cancer According to Published Meta-Analyses. Cancers (Basel) 2020; 12:cancers12082153. [PMID: 32759672 PMCID: PMC7463824 DOI: 10.3390/cancers12082153] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023] Open
Abstract
A significant number of meta-analyses reporting data on the diagnostic performance of positron emission tomography (PET) in prostate cancer (PCa) is currently available in the literature. In particular, different PET radiopharmaceuticals were used for this purpose. The aim of this review is to summarize information retrieved by published meta-analyses on this topic. The first step included a systematic search of the literature (last search date: June 2020), screening two databases (PubMed/MEDLINE and Cochrane Library). This combination of key words was used: (A) “PET” OR “positron emission tomography” AND (B) “prostate” OR “prostatic” AND (C) meta-analysis. Only meta-analyses on Positron Emission Tomography/Computed Tomography (PET/CT) or Positron Emission Tomography/Magnetic Resonance (PET/MR) in PCa were selected. We have summarized the diagnostic performance of PET imaging in PCa, taking into account 39 meta-analyses published in the literature. Evidence-based data showed the good diagnostic performance of PET/CT with several radiopharmaceuticals, including prostate-specific membrane antigen (PSMA)-targeted agents, radiolabeled choline, fluciclovine, and fluoride in restaging and staging settings. Less evidence-based data were available for PET/MR with different radiotracers. More prospective multicentric studies and cost-effectiveness analyses are warranted.
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Abstract
Prostate cancer is the commonest malignancy to affect men in the United Kingdom. Extraprostatic disease detection at staging and in the setting of biochemical recurrence is essential in determining treatment strategy. Conventional imaging including computed tomography and bone scintigraphy are limited in their ability to detect sites of loco-regional nodal and metastatic bone disease, particularly at clinically relevant low prostate-specific antigen levels. The use of positron emission tomography-computed tomography has helped overcome these deficiencies and is leading a paradigm shift in the management of prostate cancer using a wide range of radiopharmaceuticals. Their mechanisms of action, utility in both staging and biochemical recurrence, and comparative strengths and weaknesses will be covered in this article.
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Affiliation(s)
- Manil Subesinghe
- King's College London & Guy's & St. Thomas' PET Centre, St. Thomas' Hospital, London, UK; Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Meghana Kulkarni
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gary J Cook
- King's College London & Guy's & St. Thomas' PET Centre, St. Thomas' Hospital, London, UK; Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Clinical application of Fluciclovine PET, choline PET and gastrin-releasing polypeptide receptor (bombesin) targeting PET in prostate cancer. Curr Opin Urol 2020; 30:641-648. [PMID: 32701717 DOI: 10.1097/mou.0000000000000794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to explore the clinical application of different PET radiopharmaceuticals in prostate cancer (PCa), beyond inhibitors of the prostate-specific membrane antigen (PSMA). RECENT FINDINGS Choline PET represented in the last decades the standard of reference for PET imaging in PCa and has been recently included in clinical trials evaluating the efficacy of metastasis-directed therapy in oligo-metastatic disease. Fluciclovine, as synthetic amino acid, has been proposed for investigating PCa. The results obtained by the first prospective studies led to FDA approval in 2016 in patients with biochemical recurrence. Recently, phase II/III trials explored its accuracy compared with PSMA PET and its impact on patient management. Imaging the gastrin-releasing polypeptide receptor (GRPR) recently drawn attention. Radio-labelled GRPR antagonists have the potential to be used as theranostic agents. Further evaluation is needed to understand the relation between GRPR expression and hormonal-resistant PCa, and for tumors characterized by heterogeneity of receptors expressed (e.g. PSMA-negative) on their cell surface. SUMMARY Other new generation PET tracers may play an important role in PCa, namely in case of PSMA-negative phenotypes.
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Diagnostic Performance of [ 18F]Fluorocholine and [ 68Ga]Ga-PSMA PET/CT in Prostate Cancer: A Comparative Study. J Clin Med 2020; 9:jcm9072308. [PMID: 32708097 PMCID: PMC7408886 DOI: 10.3390/jcm9072308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 12/27/2022] Open
Abstract
The current study endeavored to closely compare the detection rate of 68-Gallium labelled prostate-specific membrane antigen ([68Ga]Ga-PSMA) versus [18F]Fluorocholine in men with prostate cancer (PC), to investigate the benefits and pitfalls of each modality in the setting of various patient characteristics. We retrospectively analyzed 29 biopsy-proven PC patients in two categories, staging and restaging, who underwent both scans within a maximum of 30 days of each other. Variables including patient demographics, prostate specific antigen (PSA) level, Gleason score, clinical course, and following treatments were recorded. The number and location of suspicious lesions as well as uptake values were noted. A total of 148 suspicious lesions were detected, of which 70.9% (105/148) were concordantly visualized in both imaging modalities. [68Ga]Ga-PSMA positron emission tomography/computed tomography (PET/CT) revealed a higher number of metastatic lesions per patients (91% vs 78%). The mean of maximum standardized uptake value (SUV max) in concordant lesions was significantly higher in [68Ga]Ga-PSMA compared to [18F]Fluorocholine PET/CT (14.6 ± 8.44 vs. 6.9 ± 3.4, p = 0.001). Discordant lesions were detected by both modalities, but more frequently by [68Ga]Ga-PSMA PET/CT (20.3% in [68Ga]Ga-PSMA versus 8.8% by [18F]Fluorocholine PET/CT). In patients with PSA levels below 1.0 ng/mL and <2.0 ng/mL, [18F]Fluorocholine PET/CT detection rate was half (57% and 55%, respectively) that of [68Ga]Ga-PSMA PET/CT. Tumor, nodes and metastases (TNM) staging, and subsequently patient management, was only influenced in 4/29 patients (14%), particularly by [68Ga]Ga-PSMA PET/CT with PSA values under 0.5 ng/mL. [68Ga]Ga-PSMA PET/CT revealed superior diagnostic performance to [18F]Fluorocholine PET/CT in staging and restaging of PC patients, especially in cases with low PSA levels. However, in a few hormone resistant high-risk PC patients, [18F]Fluorocholine PET/CT may improve overall diagnostic accuracy.
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Mena E, Black PC, Rais-Bahrami S, Gorin M, Allaf M, Choyke P. Novel PET imaging methods for prostate cancer. World J Urol 2020; 39:687-699. [PMID: 32671604 DOI: 10.1007/s00345-020-03344-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Prostate cancer is a common neoplasm but conventional imaging methods such as CT and bone scan are often insensitive. A new class of PET agents have emerged to diagnose and manage prostate cancer. METHODS The relevant literature on PET imaging agents for prostate cancer was reviewed. RESULTS This review shows a broad range of PET imaging agents, the most successful of which is prostate specific membrane antigen (PSMA) PET. Other agents either lack the sensitivity or specificity of PSMA PET. CONCLUSION Among the available PET agents for prostate cancer, PSMA PET has emerged as the leader. It is likely to have great impact on the diagnosis, staging and management of prostate cancer patients.
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Affiliation(s)
- Esther Mena
- Molecular Imaging Program, National Cancer Institute, 10 Center Dr, Bldg 10, Room B3B69F, Bethesda, MD, 20892-1088, USA
| | - Peter C Black
- University of British Columbia, Vancouver, BC, Canada
| | | | - Michael Gorin
- Department of Urology, Johns Hopkins University, Baltimore, MD, USA
| | - Mohamad Allaf
- Department of Urology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Choyke
- Molecular Imaging Program, National Cancer Institute, 10 Center Dr, Bldg 10, Room B3B69F, Bethesda, MD, 20892-1088, USA.
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