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Hein C, Burgard C, Blickle A, Bastian MB, Maus S, Schaefer-Schuler A, Hoffmann MA, Schreckenberger M, Ezziddin S, Rosar F. Analysis of Molecular Imaging and Laboratory Baseline Biomarkers in PSMA-RLT: Whole-Body Total Lesion PSMA (TLP) Predicts Overall Survival. Cancers (Basel) 2024; 16:2670. [PMID: 39123398 PMCID: PMC11311702 DOI: 10.3390/cancers16152670] [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: 06/19/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
The aim of this retrospective study was to identify pre-therapeutic predictive laboratory and molecular imaging biomarkers for response and overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT). Pre-therapeutic laboratory and [68Ga]Ga-PSMA-11 PET/CT data of n = 102 mCRPC patients receiving [177Lu]Lu-PSMA-617 RLT within a prospective registry (REALITY Study, NCT04833517) were analyzed including laboratory parameters such as alkaline phosphatase (ALP), prostate-specific antigen (PSA), gamma glutamyl transferase (GGT), glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), neuron specific enolase (NSE), hemoglobin (Hb), and imaging parameters such as maximum standardized uptake value of the tumor lesions (SUVmax), the mean standardized uptake value of all tumor lesions (SUVmean), the whole-body molecular tumor volume (MTV), and the whole-body total lesion PSMA (TLP). Mann-Whitney U test, univariate and multivariable Cox-regression were performed to test for association of the parameters with response and OS. The SUVmean of all lesions was significantly different between responders and non-responders (SUVmean responders 8.95 ± 2.83 vs. non-responders 7.88 ± 4.46, p = 0.003), whereas all other tested biochemical and imaging parameters did not reveal significant differences. Hb and the molecular imaging parameters MTV and TLP showed a significant association with OS (p = 0.013, p = 0.005; p = 0.009) in univariant Cox regression; however, only TLP remained significant in multivariable analysis (Hazard ratio 1.033, p = 0.009). This study demonstrates a statistically significant association between the quantitative PET/CT imaging parameter SUVmean and PSA response, as well as between the baseline TLP and OS of mCRPC patients undergoing RLT.
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Affiliation(s)
- Connor Hein
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany; (C.H.); (C.B.); (A.B.); (M.B.B.); (S.M.); (A.S.-S.); (S.E.)
| | - Caroline Burgard
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany; (C.H.); (C.B.); (A.B.); (M.B.B.); (S.M.); (A.S.-S.); (S.E.)
| | - Arne Blickle
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany; (C.H.); (C.B.); (A.B.); (M.B.B.); (S.M.); (A.S.-S.); (S.E.)
| | - Moritz B. Bastian
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany; (C.H.); (C.B.); (A.B.); (M.B.B.); (S.M.); (A.S.-S.); (S.E.)
| | - Stephan Maus
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany; (C.H.); (C.B.); (A.B.); (M.B.B.); (S.M.); (A.S.-S.); (S.E.)
| | - Andrea Schaefer-Schuler
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany; (C.H.); (C.B.); (A.B.); (M.B.B.); (S.M.); (A.S.-S.); (S.E.)
| | - Manuela A. Hoffmann
- Department of Nuclear Medicine, Johannes Gutenberg University, 55101 Mainz, Germany; (M.A.H.); (M.S.)
| | - Mathias Schreckenberger
- Department of Nuclear Medicine, Johannes Gutenberg University, 55101 Mainz, Germany; (M.A.H.); (M.S.)
| | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany; (C.H.); (C.B.); (A.B.); (M.B.B.); (S.M.); (A.S.-S.); (S.E.)
| | - Florian Rosar
- Department of Nuclear Medicine, Saarland University—Medical Center, 66421 Homburg, Germany; (C.H.); (C.B.); (A.B.); (M.B.B.); (S.M.); (A.S.-S.); (S.E.)
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Lawal IO, Ndlovu H, Kgatle M, Mokoala KMG, Sathekge MM. Prognostic Value of PSMA PET/CT in Prostate Cancer. Semin Nucl Med 2024; 54:46-59. [PMID: 37482489 DOI: 10.1053/j.semnuclmed.2023.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
Prostate-specific membrane antigen (PSMA) is a transmembrane glycoprotein expressed in the majority of prostate cancer (PCa). PSMA has an enzymatic function that makes metabolic substrates such as folate available for utilization by PCa cells. Intracellular folate availability drives aggressive tumor phenotype. PSMA expression is, therefore, a marker of aggressive tumor biology. The large extracellular domain of PSMA is available for targeting by diagnostic and therapeutic radionuclides, making it a suitable cellular epitope for theranostics. PET imaging of radiolabeled PSMA ligands has several prognostic utilities. In the prebiopsy setting, intense PSMA avidity in a prostate lesion correlate well with clinically significant PCa (csPCa) on histology. When used for staging, PSMA PET imaging outperforms conventional imaging for the accurate staging of primary PCa, and findings on imaging predict post-treatment outcomes. The biggest contribution of PSMA PET imaging to PCa management is in the biochemical recurrence setting, where it has emerged as the most sensitive imaging modality for the localization of PCa recurrence by helping to guide salvage therapy. PSMA PET obtained for localizing the site of recurrence is prognostic, such that a higher lesion number predicts a less favorable outcome to salvage radiotherapy or surgical intervention. Systemic therapy is given to patients with advanced PCa with distant metastasis. PSMA PET is useful for predicting response to treatments with chemotherapy, first- and second-line androgen deprivation therapies, and PSMA-targeted radioligand therapy. Artificial intelligence using machine learning algorithms allows for the mining of information from clinical images not visible to the human eyes. Artificial intelligence applied to PSMA PET images, therefore, holds great promise for prognostication in PCa management.
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Affiliation(s)
- Ismaheel O Lawal
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA; Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
| | - Honest Ndlovu
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa; Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mankgopo Kgatle
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa; Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa
| | - Kgomotso M G Mokoala
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa; Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa; Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa.
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Güven O, Karyağar S, Arici S, Özülker T, Can O. How reliable is the high-volume definition in prostate cancer patients: the potential game-changing role of PSMA. Nucl Med Commun 2023; 44:816-824. [PMID: 37334538 DOI: 10.1097/mnm.0000000000001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
PURPOSE To evaluate whether metabolic and volumetric data from 68 Ga-PSMA PET/CT performed during staging of de-novo high-volume mCSPC patients who received docetaxel could be used to predict survival. METHODS Forty-two de-novo high-volume mCSPC patients, who received ADT + Docetaxel and underwent 68 Ga-PSMA PET/CT for staging, were included in the study. The association between patients' pathological data, all PSA measurements, treatments they received, the data obtained from 68 Ga-PSMA PET/CT and progression-free and overall survival were examined. RESULTS In the multivariate analysis, PSMA-TV (primary) and PSMA-TV (WB) variables were shown to be independent negative predictors of overall survival. For the threshold value of 19.91 cm 3 obtained for PSMA-TV (primary), HR was calculated as 6.31, the 95% confidence interval (CI): 1.01-39.18, P = 0.048. For the threshold value of 1226.5 cm 3 obtained for PSMA-TV (WB) variable, HR was calculated as 58.62, the 95% CI: 2.55-1344.43, P = 0.011. In our study, SUVmax (WB) variable was found to be an independent and negative predictor of progression-free survival. For the determined threshold value of 17.74, HR was calculated as 16.24, 95% CI: 1.18-22.76, P = 0.037. CONCLUSION Metabolic and volumetric data obtained from 68 Ga-PSMA PET/CT can be used to predict survival in de-novo high-volume mCSPC. Our results show that in ADT + Docetaxel receiving patients, a subgroup with higher PSMA-TV (WB) values have a significantly worse prognosis. This situation suggests that the high-volume disease definition in the literature may be insufficient for this group, and that 68 Ga-PSMA PET/CT can play an essential role in demonstrating the heterogeneity within the group.
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Affiliation(s)
- Osman Güven
- Department of Nuclear Medicine, Giresun Training and Research Hospital, Giresun
| | - Savaş Karyağar
- Department of Nuclear Medicine, Health Science University Medical Faculty, Cemil Taşçioğlu Training and Research Hospital
| | - Serdar Arici
- Department of Medical Oncology, Health Science University Medical Faculty, Sultan 2. Abdülhamid Han Training and Research Hospital
| | - Tamer Özülker
- Department of Nuclear Medicine, Health Science University Medical Faculty, Cemil Taşçioğlu Training and Research Hospital
| | - Orçun Can
- Department of Medical Oncology, Faculty of Medicine, Istinye University, Istanbul, Turkey
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Zheng A, Wang Z, Luo L, Chang R, Gao J, Wang B, Duan X. The prognostic value of 18F-PSMA-1007 PET/CT in predicting pathological upgrading of newly diagnosed prostate cancer from systematic biopsy to radical prostatectomy. Front Oncol 2023; 13:1169189. [PMID: 37234988 PMCID: PMC10206242 DOI: 10.3389/fonc.2023.1169189] [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: 02/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Objective This study aimed to evaluate predictors for upgrading of newly diagnosed prostate cancer from systematic biopsy (SB) to radical prostatectomy (RP) using fluorine-18 prostate-specific membrane antigen 1007 (18F-PSMA-1007) positron emission tomography/computed tomography (PET/CT) and association with clinical parameters. Materials and methods We retrospectively collected data from biopsy-confirmed prostate cancer (PCa) patients who underwent 18F-PSMA-1007 PET/CT prior to RP from July 2019 and October 2022. Imaging characteristics derived from 18F-PSMA-1007 PET/CT and clinical parameters were compared in patients of pathological upgrading and concordance subgroups. Univariable and multivariable logistic regressions were performed to analyze factors predicting histopathological upgrading from SB to RP specimens. Discrimination ability of independent predictors was further evaluated by receiver operating characteristic (ROC) analysis with corresponding area under the curve (AUC). Results Pathological upgrading occurred in 26.97% (41/152) PCa patients, and 23.03% (35/152) of all patients experienced pathological downgrading. Concordance rate reached 50% (76/152). International Society of Urological Pathology grade group (ISUP GG) 1(77.78%) and ISUP GG 2 (65.22%) biopsies were related with the highest rate of upgrading. Multivariable logistic regression analyses showed that prostate volume (OR= 0.933; 95% CI, 0.887-0.982; p = 0.008), ISUP GG 1 vs. 4 (OR= 13.856; 95% CI: 2.467-77.831; p = 0.003), and total uptake of PSMA-avid lesions (PSMA-TL) (OR = 1.003; 95% CI, 1.000-1.006; p = 0.029) were found to be independent risk factors of pathological upgrading after RP. The AUCs and corresponding sensitivity and specificity of the independent predictors of synthesis for upgrading were 0.839, 78.00%, and 83.30% respectively, which showed good discrimination capacity. Conclusion 18F-PSMA-1007 PET/CT may help to predict pathological upgrading between biopsy and RP specimens, particularly for ISUP GG 1 and ISUP GG 2 patients with higher PSMA-TL and smaller prostate volume.
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Kohada Y, Satani N, Kaiho Y, Iwamura H, Sakamoto T, Kusumoto H, Kukimoto T, Oikawa M, Mikami J, Ito J, Matsuura T, Hinata N, Koyama K, Sato M. Novel quantitative software for automatically excluding red bone marrow on whole‐body magnetic resonance imaging in patients with metastatic prostate cancer: A pilot study. Int J Urol 2022; 30:356-364. [PMID: 36539348 DOI: 10.1111/iju.15124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To establish a novel quantitative method that automatically excludes the red bone marrow and accurately quantifies the tumor volume on whole-body magnetic resonance imaging using updated imaging software. To also evaluate the association between the quantified tumor volume and the prognosis of patients with metastatic prostate cancer. METHODS This prospective analysis included patients diagnosed with metastatic hormone-sensitive or metastatic castration-resistant prostate cancer between 2017 and 2022. We developed an imaging software (Attractive BD_Score) that analyzed whole-body diffusion-weighted and in-phase and opposed-phase T1-weighted images to automatically exclude the red bone marrow. The quantified tumor volume was compared with that quantified by traditional whole-body diffusion-weighted imaging without red bone marrow exclusion. Prostate-specific antigen progression-free survival, time-to-pain progression, and overall survival were evaluated to assess the prognostic value of the quantified tumor volume. RESULTS The quantified tumor volume was significantly smaller than that quantified by the traditional method in metastatic hormone-sensitive (median: 81.0 ml vs. 149.4 ml) and metastatic castration-resistant (median: 29.4 ml vs. 63.5 ml) prostate cancer. A highly quantified tumor volume was associated with prostate-specific antigen progression-free survival (p = 0.030), time-to-pain progression (p = 0.003), and overall survival (p = 0.005) in patients with metastatic hormone-sensitive prostate cancer and with poor prostate-specific antigen progression-free survival (p = 0.001) and time-to-pain progression (p = 0.005) in patients with metastatic castration-resistant prostate cancer. CONCLUSIONS Our imaging method could accurately quantify the tumor volume in patients with metastatic prostate cancer. The quantified tumor volume can be clinically applied as a new prognostic biomarker for metastatic prostate cancer.
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Affiliation(s)
- Yuki Kohada
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
- Department of Urology Hiroshima University Graduate School of Biomedical Sciences Hiroshima Japan
| | - Nozomi Satani
- Division of Radiology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Yasuhiro Kaiho
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Hiromichi Iwamura
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | | | - Hiroki Kusumoto
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Takashi Kukimoto
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Masaaki Oikawa
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Jotaro Mikami
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Jun Ito
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Tomonori Matsuura
- Division of Radiology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Nobuyuki Hinata
- Department of Urology Hiroshima University Graduate School of Biomedical Sciences Hiroshima Japan
| | - Kaneki Koyama
- Division of Radiology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Makoto Sato
- Division of Urology, Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
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Wang Y, Galante JR, Haroon A, Wan S, Afaq A, Payne H, Bomanji J, Adeleke S, Kasivisvanathan V. The future of PSMA PET and WB MRI as next-generation imaging tools in prostate cancer. Nat Rev Urol 2022; 19:475-493. [PMID: 35789204 DOI: 10.1038/s41585-022-00618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/09/2022]
Abstract
Radiolabelled prostate-specific membrane antigen (PSMA)-based PET-CT has been shown in numerous studies to be superior to conventional imaging in the detection of nodal or distant metastatic lesions. 68Ga-PSMA PET-CT is now recommended by many guidelines for the detection of biochemically relapsed disease after radical local therapy. PSMA radioligands can also function as radiotheranostics, and Lu-PSMA has been shown to be a potential new line of treatment for metastatic castration-resistant prostate cancer. Whole-body (WB) MRI has been shown to have a high diagnostic performance in the detection and monitoring of metastatic bone disease. Prospective, randomized, multicentre studies comparing 68Ga-PSMA PET-CT and WB MRI for pelvic nodal and metastatic disease detection are yet to be performed. Challenges for interpretation of PSMA include tracer trapping in non-target tissues and also urinary excretion of tracers, which confounds image interpretation at the vesicoureteral junction. Additionally, studies have shown how long-term androgen deprivation therapy (ADT) affects PSMA expression and could, therefore, reduce tracer uptake and visibility of PSMA+ lesions. Furthermore, ADT of short duration might increase PSMA expression, leading to the PSMA flare phenomenon, which makes the accurate monitoring of treatment response to ADT with PSMA PET challenging. Scan duration, detection of incidentalomas and presence of metallic implants are some of the major challenges with WB MRI. Emerging data support the wider adoption of PSMA PET and WB MRI for diagnosis, staging, disease burden evaluation and response monitoring, although their relative roles in the standard-of-care management of patients are yet to be fully defined.
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Affiliation(s)
- Yishen Wang
- School of Clinical Medicine, University of Cambridge, Cambridge, UK. .,Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
| | - Joao R Galante
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Athar Haroon
- Department of Nuclear Medicine, Barts Health NHS Trust, London, UK
| | - Simon Wan
- Institute of Nuclear Medicine, University College London, London, UK
| | - Asim Afaq
- Institute of Nuclear Medicine, University College London, London, UK.,Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London, London, UK
| | - Sola Adeleke
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Cardoza-Ochoa DR, Cristancho-Rojas C, Pérez DJ, Moreno-Izaguirre P, Guzman M, Gutiérrez-Rivera MC, Gaxiola-Mascareño AP, Avila-Rodríguez MA, Rivera-Bravo B. Semiautomatic assessment of whole-body tumor burden with 18F-PSMA-1007 in biochemical recurrent prostate cancer. Nucl Med Commun 2022; 43:332-339. [PMID: 34954764 DOI: 10.1097/mnm.0000000000001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the 18F-PSMA-1007 PET/computed tomography (CT) semiautomatic volumetric parameters to assess the whole-body tumor burden and its correlation with prostate-specific antigen (PSA) and Gleason score in patients with biochemically recurrent prostate cancer (PCa). MATERIALS AND METHODS A total of 110 patients referred for 18F-PSMA-1007 PET/CT due to biochemical recurrence were retrospectively analyzed. Whole-body total lesion prostate-specific membrane antigen (wbTl-PSMA) and whole-body PSMA-derived tumor volume (wbPSMA-TV) metrics on 18F-PSMA-1007 were obtained semiautomatically in dedicated software. A Spearman test was performed to explore the correlation of volumetric imaging parameters with PSA levels and Gleason score. To analyze the association between volumetric measures and PSA subgroups, we used a Kruskal-Wallis test and a Dunn's test to identify each group causing an observed difference. RESULTS A total of 492 metastatic lesions were analyzed, and a significant correlation was found between wbTL-PSMA (R = 0.63, P < 0.0001) and wbPSMA-TV (R = 0.49, P < 0.0001) with serum PSA. A statistically significant difference with wbTL-PSMA was found in patients with a PSA less than or equal 0.5 ng/ml and PSA in the range of 0.51-1.0 ng/ml. CONCLUSION 18F-PSMA-1007 PSMA volumetric parameters can provide a quantitative imaging biomarker for whole-body tumor burden.
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Affiliation(s)
- David R Cardoza-Ochoa
- Unidad PET-CT, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City
| | - Cesar Cristancho-Rojas
- Unidad PET-CT, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City
| | - David J Pérez
- Unidad Radiofarmacia-Ciclotrón, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Paola Moreno-Izaguirre
- Unidad PET-CT, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City
| | - Melissa Guzman
- Unidad PET-CT, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City
| | | | | | - Miguel A Avila-Rodríguez
- Unidad Radiofarmacia-Ciclotrón, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Belén Rivera-Bravo
- Unidad PET-CT, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City
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Biomarkers in Prostate-Specific Membrane Antigen Theranostics. Diagnostics (Basel) 2021; 11:diagnostics11061108. [PMID: 34207069 PMCID: PMC8235046 DOI: 10.3390/diagnostics11061108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/11/2022] Open
Abstract
Theranostics of prostate cancer (PC) represents a growing area of development of imaging agents and targeted radionuclide therapeutics against a major target, prostate specific membrane antigen (PSMA). In view of the encouraging efficacy from the use of 177Lu and other radionuclides in metastatic castration-resistant prostate cancer (mCRPC), it is becoming increasingly important to identify surrogate markers that can help predict which patients are more likely to respond and experience improved survival. This review discusses potential predictors of efficacy of PSMA-targeted radionuclide therapies (TRT) segregated in three major categories: imaging, clinical and molecular.
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Has Simsek D, Kuyumcu S, Karadogan S, Oflas M, Isik EG, Ozkan ZG, Paksoy N, Ekmekcioglu O, Ekenel M, Sanli Y. Can PSMA-based tumor burden predict response to docetaxel treatment in metastatic castration-resistant prostate cancer? Ann Nucl Med 2021; 35:680-690. [PMID: 33783752 DOI: 10.1007/s12149-021-01610-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We investigated the role of PSMA-derived tumor burden in predicting docetaxel (DTX) therapy response in metastatic castration-resistant prostate cancer (mCRPC). METHODS Fifty-two mCRPC patients who received at least six cycles of DTX as the first-line treatment following 68Ga-PSMA PET/CT were enrolled in this retrospective study. Total PSMA-derived tumor volume (TV-PSMA) and total lesion PSMA activity (TL-PSMA) were derived from metastatic lesions. A ≥ 50% decline in PSA was defined as a response; a ≥ 25% increase in PSA was defined as progression. Univariate/multivariate logistic and cox regression analyses were performed to predict PSA response, OS, and TTP. RESULTS Twelve (23%) patients had PSA progression after chemotherapy, while 40 patients (77%) achieved a PSA response. On univariate analysis, a significant association was found between TV-PSMA (p = 0.001), TL-PSMA (p = 0.001), pre-PSA (p = 0.012), LDH (p = 0.003), Hg (p = 0.035), and PSA response to DTX. High TV-PSMA (> 107 cm3) (p = 0.04) and high LDH (> 234 U/L) (p = 0.017) were 8.2 times and 12.2 times more likely for DTX failure in multivariate regression analyses. The median TTP was 16 months, and the median OS was not reached. Patients with high TV-PSMA (p = 0.017), high TL-PSMA (> 1013 cm3) (p = 0.042), high age (> 70 years) (p = 0.016), and high LDH (p ≤ 0.001) had significantly shorter OS, while only high TV-PSMA (p = 0.038) and high age (p = 0.006) were significantly related with shorter TTP. High TV-PSMA (p = 0.017) and high age (p = 0.01) were significant predictors for shorter OS, while only high age (p = 0.006) was a significant predictor for shorter TTP in multivariate analysis. CONCLUSION Patients with high TV-PSMA had a significantly higher risk for DTX failure. PSMA-based tumor burden prior to DTX therapy seems to be a reliable predictive tool for survival in mCRPC patients.
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Affiliation(s)
- Duygu Has Simsek
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, Istanbul, Turkey.
| | - Serkan Kuyumcu
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, Istanbul, Turkey
| | - Seyfullah Karadogan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, Istanbul, Turkey
| | - Melis Oflas
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, Istanbul, Turkey
| | - Emine Goknur Isik
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, Istanbul, Turkey
| | - Zeynep Gozde Ozkan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, Istanbul, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Ozgul Ekmekcioglu
- Department of Nuclear Medicine, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Meltem Ekenel
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, Istanbul, Turkey
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