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Patel KR, van der Heide UA, Kerkmeijer LGW, Schoots IG, Turkbey B, Citrin DE, Hall WA. Target Volume Optimization for Localized Prostate Cancer. Pract Radiat Oncol 2024:S1879-8500(24)00148-6. [PMID: 39019208 DOI: 10.1016/j.prro.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To provide a comprehensive review of the means by which to optimize target volume definition for the purposes of treatment planning for patients with intact prostate cancer with a specific emphasis on focal boost volume definition. METHODS Here we conduct a narrative review of the available literature summarizing the current state of knowledge on optimizing target volume definition for the treatment of localized prostate cancer. RESULTS Historically, the treatment of prostate cancer included a uniform prescription dose administered to the entire prostate with or without coverage of all or part of the seminal vesicles. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase 3 data has demonstrated that incorporating focal dose escalation to high-risk subvolumes of the prostate improves biochemical control without significantly increasing toxicity. Still, several fundamental questions remain regarding the optimal target volume definition and prescription strategy to implement this technique. Given the remaining uncertainty, a knowledge of the pathological correlates of radiographic findings and the anatomic patterns of tumor spread may help inform clinical judgement for the definition of clinical target volumes. CONCLUSION Advanced imaging has the ability to improve outcomes for patients with prostate cancer in multiple ways, including by enabling focal dose escalation to high-risk subvolumes. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice, and key knowledge gaps remain. A detailed understanding of the pathological correlates of radiographic findings and the patterns of local tumor spread may help inform clinical judgement for target volume definition given the current state of uncertainty.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo G Schoots
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William A Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
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2
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Gammel MCM, Solari EL, Eiber M, Rauscher I, Nekolla SG. A Clinical Role of PET-MRI in Prostate Cancer? Semin Nucl Med 2024; 54:132-140. [PMID: 37652782 DOI: 10.1053/j.semnuclmed.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
PET/MRI is a relevant application field for prostate cancer management, offering advantages in early diagnosis, staging, and therapy planning. Despite drawbacks such as higher costs, longer acquisition time, and the need for skilled personnel, the technical integration of PET and MRI provides valuable information for detecting primary tumors, identifying metastases, and characterizing the disease, leading to more accurate staging and personalized treatment strategies. However, PET/MRI adoption has been slow, but ongoing technological advancements and AI integration might overcome challenges and improve clinical utility. As precision medicine gains importance in oncology, PET/MRI's multiparametric data can tailor treatment plans to individual patients, providing a comprehensive assessment of tumor biology and aggressiveness for more effective therapeutic strategies.
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Affiliation(s)
- Michael C M Gammel
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Esteban L Solari
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan G Nekolla
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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3
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Basso Dias A, Ghai S, Ortega C, Mirshahvalad SA, Perlis N, Berlin A, Avery L, Veit-Haibach P, van der Kwast T, Metser U. Impact of 18F-DCFPyL PET/MRI in Selecting Men With Low-/Intermediate-Risk Prostate Cancer for Focal Ablative Therapies. Clin Nucl Med 2023; 48:e462-e467. [PMID: 37682613 DOI: 10.1097/rlu.0000000000004819] [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: 09/09/2023]
Abstract
PURPOSE To compare the diagnostic performance of multiparametric (mp) MRI to 18F-DCFPyL PET/MRI for detecting clinically significant (cs) prostate cancer (PCa) in men with low-/intermediate-risk PCa being considered for focal ablative therapy (FT), using 2 interpretation schemes, and to assess the rate of exclusion from FT for each modality. METHODS This prospective study evaluated men with low- or intermediate-risk PCa, potential candidates for FT based on initial biopsy as per institutional protocol, who underwent 18F-DCFPyL PET/MRI. Each modality (mpMRI, PET/MRI using PROMISE classification [PET/MRI PROMISE], and PET/MRI considering any focal lesion on PET as positive [PETFL/MRI]) was assessed independently. All suspicious lesions underwent PET/MRI-ultrasound fusion biopsies. Diagnostic performances were calculated and compared using the exact binomial test on paired proportions. RESULTS Thirty-four men (median age, 64 years; interquartile range, 60-70 years) were included. Overall, 40 of 67 lesions (60%) identified on mpMRI and/or PET/MRI were malignant, and 34 of 40 lesions (85%) were csPCa (≥6 mm ISUP [International Society of Urological Pathology Grade Group] GG1 or ISUP-GG ≥2). On lesion-level analysis, for detecting csPCa, sensitivity appeared higher for PETFL/MRI than mpMRI and PET/MRI PROMISE (97% vs 76% and 79%, respectively [P = 0.02 and 0.03]), whereas specificity was lower (30% vs 85% and 88%, respectively [P < 0.001]). The calculated overall accuracy rates for PETFL/MRI, mpMRI, and PET/MRI PROMISE were 64%, 81%, and 84%, respectively. PETFL/MRI, mpMRI, and PET/MRI PROMISE excluded 10 of 34 (29%), 7 of 34 (21%), and 6 of 34 (18%) men from FT, respectively. CONCLUSIONS 18F-DCFPyL PET/MRI excluded nearly 30% of patients with low-/intermediate-risk PCa from FT, with a potential role in decreasing selection failure. Compared with mpMRI, PET/MRI had a higher sensitivity for detecting csPCa in men who were candidates for FT.ClinicalTrials.gov identifier NCT03149861.
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Affiliation(s)
| | | | | | | | | | | | - Lisa Avery
- Biostatistics, Princess Margaret Cancer Centre
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4
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Mendez LC, Dhar A, Laidley D, Moussa M, Gomez JA, Chin J, Lee TY, Thiessen JD, Hoover D, Surrey K, Helou J, Velker V, Correa RJ, D'Souza D, Bayani J, Bauman G. The use of Lutetium-177 PSMA radioligand therapy with high dose rate brachytherapy for locally recurrent prostate cancer after previous definitive radiation therapy: a randomized, single-institution, phase I/II study (ROADSTER). BMC Cancer 2023; 23:362. [PMID: 37081426 PMCID: PMC10116658 DOI: 10.1186/s12885-023-10851-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/14/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Isolated local failure (ILF) can occur in patients who initially receive definitive radiation therapy for prostate cancer. Salvage therapy for ILF includes high dose rate (HDR) brachytherapy. Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET) can accurately detect ILF and can exclude extraprostatic disease. Lutetium-177 PSMA Radioligand Therapy (RLT) is a novel treatment for prostate cancer that can target prostate cancer accurately, while sparing radiation dose to normal tissues. METHODS ROADSTER is a phase I/II randomized, single-institution study. Patients with an ILF of prostate cancer after definitive initial radiation therapy are eligible. The ILF will be confirmed with biopsy, magnetic resonance imaging (MRI) and PSMA PET. Patients will be randomized between HDR brachytherapy in two fractions (a standard of care salvage treatment at our institution) (cohort 1) or one treatment of intravenous Lutetium-177 PSMA RLT, followed by one fraction of HDR brachytherapy (cohort 2). The primary endpoints for the phase I portion of the study (n = 12) will be feasibility, defined as 10 or more patients completing the study protocol within 24 months of study activation; and safety, defined as zero or one patients in cohort 2 experiencing grade 3 or higher toxicity in the first 6 months post-treatment. If feasibility and safety are achieved, the study will expand to a phase II study (n = 30 total) where preliminary efficacy data will be evaluated. Secondary endpoints include changes in prostate specific antigen levels, acute toxicity, changes in quality of life, and changes in translational biomarkers. Translational endpoints will include interrogation of blood, urine, and tissue for markers of DNA damage and immune activation with each treatment. DISCUSSION ROADSTER explores a novel salvage therapy for ILF after primary radiotherapy with combined Lutetium-177 PSMA RLT and HDR brachytherapy. The randomized phase I/II design will provide a contemporaneous patient population treated with HDR alone to facilitate assessment of feasibility, tolerability, and biologic effects of this novel therapy. TRIAL REGISTRATION NCT05230251 (ClinicalTrials.gov).
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Affiliation(s)
- Lucas C Mendez
- London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - Aneesh Dhar
- London Health Sciences Centre, London, Ontario, Canada
| | - David Laidley
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Jose A Gomez
- London Health Sciences Centre, London, Ontario, Canada
| | - Joseph Chin
- London Health Sciences Centre, London, Ontario, Canada
| | - T-Y Lee
- Lawson Health Research Institute, London, Ontario, Canada
| | | | - Douglas Hoover
- London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | | | - Joelle Helou
- London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - Vikram Velker
- London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - Rohann J Correa
- London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - David D'Souza
- London Health Sciences Centre, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
| | - Jane Bayani
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Glenn Bauman
- London Health Sciences Centre, London, Ontario, Canada.
- Lawson Health Research Institute, London, Ontario, Canada.
- Department of Oncology, Western University, London, Ontario, Canada.
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Functional Imaging of Liver Cancer (FLIC): Study protocol of a phase 2 trial of 18F-DCFPyL PET/CT imaging for patients with hepatocellular carcinoma. PLoS One 2022; 17:e0277407. [PMID: 36367894 DOI: 10.1371/journal.pone.0277407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background
While prostate specific membrane antigen (PSMA) is overexpressed in high-grade prostate cancers, it is also expressed in tumor neovasculature and other malignancies, including hepatocellular carcinoma (HCC). Importantly, no functional imaging for HCC is clinically available, making diagnosis and surveillance following local therapies particularly challenging. 18F-DCFPyL binds with high affinity to PSMA yet clears rapidly from the blood pool. PET imaging with 18F-DCFPyL may represent a new tool for staging, surveillance and assessment of treatment response in HCC. The purpose of this Functional Imaging Liver Cancer (FLIC) trial is to assess the ability of 18F-DCFPyL-PET/CT to detect sites of HCC.
Methods
This is a phase II multi-site prospective imaging trial with a plan to enroll 50 subjects with suspected HCC on standard of care CT or MRI and eligible for standard local treatment. Participants will undergo a baseline 18F-DCFPyL-PET/CT, prior to therapy. Subjects will also be scanned with 18F-FDG-PET/CT within 2 weeks of 18F-DCFPyL-PET/CT. Participants will undergo histopathologic assessment and standard of care local treatment for HCC within a multidisciplinary team context. Participants with histopathologic confirmation of HCC and a positive baseline 18F-DCFPyL-PET/CT will undergo a post-treatment 18F-DCFPyL-PET/CT during the first routine follow-up, typically within 4–8 weeks. Subjects with negative baseline 18F-DCFPyL-PET/CT will not be re-scanned after treatment but will remain in follow-up. Participants will be followed for 5-years to assess for progression-free-survival. The primary endpoint is the positive predictive value of 18F-DCFPyL-PET for HCC as confirmed by histopathology. Secondary endpoints include comparison of 18F-DCFPyL-PET/CT with CT, MRI, and 18F-FDG-PET/CT, and evaluation of the value of 18F-DCFPyL-PET/CT in assessing treatment response following local treatment. Exploratory endpoints include next generation sequencing of tumors, and analysis of extracellular vesicles to identify biomarkers associated with response to therapy.
Discussion
This is a prospective imaging trial designed to evaluate whether PSMA-PET/CT imaging with 18F-DCFPyL can detect tumor sites, assess local treatment response in HCC patients, and to eventually determine whether PSMA-PET/CT could improve outcomes of patients with HCC receiving standard of care local therapy. Importantly, this trial may help determine whether PSMA-selective radiopharmaceutical therapies may be beneficial for patients with HCC.
Clinical trial registration
NIH IND#133631. Submission date: 04-07-2021. Safe-to-proceed letter issued by FDA: 05.07.2021. NIH IRB #00080. ClinicalTrials.gov Identifier NCT05009979. Date of Registry: 08-18-2021. Protocol version date: 01-07-2022.
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Liu W, Loblaw A, Laidley D, Fakir H, Mendez L, Davidson M, Kassam Z, Lee TY, Ward A, Thiessen J, Bayani J, Conyngham J, Bailey L, Andrews JD, Bauman G. Imaging Biomarkers in Prostate Stereotactic Body Radiotherapy: A Review and Clinical Trial Protocol. Front Oncol 2022; 12:863848. [PMID: 35494042 PMCID: PMC9043802 DOI: 10.3389/fonc.2022.863848] [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: 01/27/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Advances in imaging have changed prostate radiotherapy through improved biochemical control from focal boost and improved detection of recurrence. These advances are reviewed in the context of prostate stereotactic body radiation therapy (SBRT) and the ARGOS/CLIMBER trial protocol. ARGOS/CLIMBER will evaluate 1) the safety and feasibility of SBRT with focal boost guided by multiparametric MRI (mpMRI) and 18F-PSMA-1007 PET and 2) imaging and laboratory biomarkers for response to SBRT. To date, response to prostate SBRT is most commonly evaluated using the Phoenix Criteria for biochemical failure. The drawbacks of this approach include lack of lesion identification, a high false-positive rate, and delay in identifying treatment failure. Patients in ARGOS/CLIMBER will receive dynamic 18F-PSMA-1007 PET and mpMRI prior to SBRT for treatment planning and at 6 and 24 months after SBRT to assess response. Imaging findings will be correlated with prostate-specific antigen (PSA) and biopsy results, with the goal of early, non-invasive, and accurate identification of treatment failure.
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Affiliation(s)
- Wei Liu
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, ON, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre and Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - David Laidley
- Division of Nuclear Medicine, St. Joseph's Health Centre and Western University, London, ON, Canada
| | - Hatim Fakir
- Department of Oncology and Department of Medical Biophysics, London Health Sciences Centre and Western University, London, ON, Canada
| | - Lucas Mendez
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, ON, Canada
| | - Melanie Davidson
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre and Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care and Western University, London, ON, Canada
| | - Ting-Yim Lee
- Department of Medical Biophysics, Western University and Lawson Health Research Institute, London, ON, Canada
| | - Aaron Ward
- Department of Medical Biophysics, Western University and Lawson Health Research Institute, London, ON, Canada
| | - Jonathan Thiessen
- Department of Medical Biophysics, Western University and Lawson Health Research Institute, London, ON, Canada
| | - Jane Bayani
- Ontario Institute for Cancer Research and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Laura Bailey
- Clinical Research Unit, London Regional Cancer Program, London, ON, Canada
| | - Joseph D Andrews
- Clinical Research Unit, London Regional Cancer Program, London, ON, Canada
| | - Glenn Bauman
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, ON, Canada
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7
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Bodar YJL, Zwezerijnen BGJC, van der Voorn PJ, Jansen BHE, Smit RS, Kol SQ, Meijer D, de Bie K, Yaqub M, Windhorst BAD, Hendrikse HNH, Vis AN, Oprea-Lager DE. Prospective analysis of clinically significant prostate cancer detection with [ 18F]DCFPyL PET/MRI compared to multiparametric MRI: a comparison with the histopathology in the radical prostatectomy specimen, the ProStaPET study. Eur J Nucl Med Mol Imaging 2021; 49:1731-1742. [PMID: 34725727 PMCID: PMC8940822 DOI: 10.1007/s00259-021-05604-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/22/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Multiparametric magnetic resonance imaging (mpMRI) is a well-established imaging method for localizing primary prostate cancer (PCa) and for guiding targeted prostate biopsies. [18F]DCFPyL positron emission tomography combined with MRI (PSMA-PET/MRI) might be of additional value to localize primary PCa. The aim of this study was to assess the diagnostic performance of [18F]DCFPyL-PET/MRI vs. mpMRI in tumour localization based on histopathology after robot-assisted radical-prostatectomy (RARP), also assessing biopsy advice for potential image-guided prostate biopsies. METHODS Thirty prospectively included patients with intermediate to high-risk PCa underwent [18F]DCFPyL-PET/MRI and mpMRI prior to RARP. Two nuclear medicine physicians and two radiologists assessed tumour localization on [18F]DCFPyL-PET/MRI and on mpMRI respectively, and gave a prostate biopsy advice (2 segments) using a 14-segment model of the prostate. The uro-pathologist evaluated the RARP specimen for clinically significant PCa (csPCa) using the same model. csPCa was defined as any PCa with Grade Group (GG) ≥ 2. The biopsy advice based on imaging was correlated with the final histology in the RARP specimen for a total-agreement analysis. An additional near-agreement correlation was performed to approximate clinical reality. RESULTS Overall, 142 of 420 (33.8%) segments contained csPCa after pathologic examination. The segments recommended for targeted biopsy contained the highest GG PCa segment in 27/30 patients (90.0%) both for [18F]DCFPyL-PET/MRI and mpMRI. Areas under the receiver operating characteristics curves (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the total-agreement detection of csPCa per segment using [18F]DCFPyL-PET/MRI were 0.70, 50.0%, 89.9%, 71.7%, and 77.9%, respectively. These results were 0.75, 54.2%, 94.2%, 82.8%, and 80.1%, respectively, for mpMRI only. CONCLUSION Both [18F]DCFPyL-PET/MRI and mpMRI were only partly able to detect csPCa on a per-segment basis. An accurate detection (90.0%) of the highest GG lesion at patient-level was observed when comparing both [18F]DCFPyL-PET/MRI and mpMRI biopsy advice with the histopathology in the RARP specimen. So, despite the finding that [18F]DCFPyL-PET/MRI adequately detects csPCa, it does not outperform mpMRI.
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Affiliation(s)
- Yves J L Bodar
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands. .,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands. .,Prostate Cancer Network, Amsterdam, the Netherlands.
| | - Ben G J C Zwezerijnen
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Patrick J van der Voorn
- Department of Pathology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Bernard H E Jansen
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Prostate Cancer Network, Amsterdam, the Netherlands
| | - Ruth S Smit
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Sabrine Q Kol
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Dennie Meijer
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Prostate Cancer Network, Amsterdam, the Netherlands
| | - Katelijne de Bie
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Bert A D Windhorst
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Harry N H Hendrikse
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - André N Vis
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Prostate Cancer Network, Amsterdam, the Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
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8
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Smith CW, Alfano R, Hoover D, Surry K, D'Souza D, Thiessen J, Rachinsky I, Butler J, Gomez JA, Gaed M, Moussa M, Chin J, Pautler S, Bauman GS, Ward AD. Prostate specific membrane antigen positron emission tomography for lesion-directed high-dose-rate brachytherapy dose escalation. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 19:102-107. [PMID: 34589619 PMCID: PMC8459608 DOI: 10.1016/j.phro.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
This paper evaluated lesion-directed prostatic high dose rate brachytherapy. Lesions defined by prostate specific membrane antigen positron emission tomography. Dose escalation was confirmed using whole-mount digital histology. Targeting lesions led to significantly higher dose to high-grade histologic cancer.
Background and purpose Prostate specific membrane antigen positron emission tomography imaging (PSMA-PET) has demonstrated potential for intra-prostatic lesion localization. We leveraged our existing database of co-registered PSMA-PET imaging with cross sectional digitized pathology to model dose coverage of histologically-defined prostate cancer when tailoring brachytherapy dose escalation based on PSMA-PET imaging. Materials and methods Using a previously-developed automated approach, we created segmentation volumes delineating underlying dominant intraprostatic lesions for ten men with co-registered pathology-imaging datasets. To simulate realistic high-dose-rate brachytherapy (HDR-BT) treatments, we registered the PSMA-PET-defined segmentation volumes and underlying cancer to 3D trans-rectal ultrasound images of HDR-BT cases where 15 Gray (Gy) was delivered. We applied dose/volume optimization to focally target the dominant intraprostatic lesion identified on PSMA-PET. We then compared histopathology dose for all high-grade cancer within whole-gland treatment plans versus PSMA-PET-targeted plans. Histopathology dose was analyzed for all clinically significant cancer with a Gleason score of 7or greater. Results The standard whole-gland plans achieved a median [interquartile range] D98 of 15.2 [13.8–16.4] Gy to the histologically-defined cancer, while the targeted plans achieved a significantly higher D98 of 16.5 [15.0–19.0] Gy (p = 0.007). Conclusion This study is the first to use digital histology to confirm the effectiveness of PSMA-PET HDR-BT dose escalation using automatically generated contours. Based on the findings of this study, PSMA-PET lesion dose escalation can lead to increased dose to the ground truth histologically defined cancer.
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Affiliation(s)
- Christopher W Smith
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.,Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Ryan Alfano
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.,Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Douglas Hoover
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Kathleen Surry
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - David D'Souza
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Jonathan Thiessen
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Irina Rachinsky
- Western University Department of Medical Imaging, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - John Butler
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada
| | - Jose A Gomez
- Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Mena Gaed
- Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Madeleine Moussa
- Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Joseph Chin
- Western University Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Stephen Pautler
- Western University Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Glenn S Bauman
- Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Aaron D Ward
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.,Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
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9
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Bodar Y, Koene B, Meijer D, van Leeuwen PJ, Nadorp S, Donswijk ML, Hendrikse NH, Oprea-Lager DE, Vis AN. Determining the diagnostic value of PSMA-PET/CT imaging in patients with persistent high prostate specific antigen levels and negative prostate biopsies. Urol Oncol 2021; 40:58.e1-58.e7. [PMID: 34404590 DOI: 10.1016/j.urolonc.2021.07.010] [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] [Received: 04/07/2021] [Revised: 06/04/2021] [Accepted: 07/02/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE To assess the diagnostic performance of prostate specific membranous antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging to localize primary prostate cancer (PCa) in men with persistent elevated prostate-specific antigen (PSA) levels and previous prostate biopsies that were negative for PCa. METHODS In this study, 34 men with persistently elevated PSA-levels, previous negative for PCa biopsies and who subsequently underwent diagnostic PSMA-PET/CT imaging were retrospectively evaluated. Men were divided into 3 groups: 1. 12 men with a previous negative mpMRI scan (PI-RADS 1-2) 2. 17 men with a positive mpMRI scan (PI-RADS 3-5), but negative MRI-targeted biopsies and 3. Four men in whom mpMRI was contraindicated. If PSMA-avid lesions were seen, patients underwent 2-4 cognitive targeted biopsies in combination with systematic biopsies. The detection rate of PSMA-PET/CT for PCa, and the accuracy of (possible) targeted biopsies were calculated. RESULTS Included men had a median PSA-level of 22.8 ng/mL (Interquartile Range 15.6-30.0) at the time of PSMA-PET/CT. Elevated PSMA-ligand uptake in the prostate suspicious for PCa was observed in 22/34 patients (64.7%). In 18/22 patients (54.5%), PSMA-targeted prostate biopsies were performed. In 3/18 patients (16.6%), the targeted biopsies showed International Society of Urological Pathology (ISUP) score 1-2 PCa. The other men had inflammation or benign findings after histopathological examination of the biopsy cores. CONCLUSION In this study, the clinical value of PSMA-PET/CT for patients with an elevated PSA-level, and negative for PCa biopsies was low. Only very few men were diagnosed with PCa, and no clinically significant PCa was found.
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Affiliation(s)
- Yjl Bodar
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland; Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland.
| | - Bpf Koene
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - D Meijer
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland; Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland
| | - P J van Leeuwen
- The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - S Nadorp
- Amstelland Hospital, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - M L Donswijk
- The Netherlands Cancer Institute, Department of Radiology and Nuclear Medicine, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - N H Hendrikse
- Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland; Amsterdam University Medical Center, VU University, Department of Clinical Pharmacology and Pharmacy, Amsterdam, Netherland
| | - D E Oprea-Lager
- Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland
| | - A N Vis
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
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10
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Min LA, Castagnoli F, Vogel WV, Vellenga JP, van Griethuysen JJM, Lahaye MJ, Maas M, Beets Tan RGH, Lambregts DMJ. A decade of multi-modality PET and MR imaging in abdominal oncology. Br J Radiol 2021; 94:20201351. [PMID: 34387508 PMCID: PMC9328040 DOI: 10.1259/bjr.20201351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate trends observed in a decade of published research on multimodality PET(/CT)+MR imaging in abdominal oncology, and to explore how these trends are reflected by the use of multimodality imaging performed at our institution. METHODS First, we performed a literature search (2009-2018) including all papers published on the multimodality combination of PET(/CT) and MRI in abdominal oncology. Retrieved papers were categorized according to a structured labelling system, including study design and outcome, cancer and lesion type under investigation and PET-tracer type. Results were analysed using descriptive statistics and evolutions over time were plotted graphically. Second, we performed a descriptive analysis of the numbers of MRI, PET/CT and multimodality PET/CT+MRI combinations (performed within a ≤14 days interval) performed during a similar time span at our institution. RESULTS Published research papers involving multimodality PET(/CT)+MRI combinations showed an impressive increase in numbers, both for retrospective combinations of PET/CT and MRI, as well as hybrid PET/MRI. Main areas of research included new PET-tracers, visual PET(/CT)+MRI assessment for staging, and (semi-)quantitative analysis of PET-parameters compared to or combined with MRI-parameters as predictive biomarkers. In line with literature, we also observed a vast increase in numbers of multimodality PET/CT+MRI imaging in our institutional data. CONCLUSIONS The tremendous increase in published literature on multimodality imaging, reflected by our institutional data, shows the continuously growing interest in comprehensive multivariable imaging evaluations to guide oncological practice. ADVANCES IN KNOWLEDGE The role of multimodality imaging in oncology is rapidly evolving. This paper summarizes the main applications and recent developments in multimodality imaging, with a specific focus on the combination of PET+MRI in abdominal oncology.
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Affiliation(s)
- Lisa A Min
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | | | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jisk P Vellenga
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands.,Faculty or Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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11
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Liu Y, Yu H, Liu J, Zhang X, Lin M, Schmidt H, Gao J, Xu B. A Pilot Study of 18F-DCFPyL PET/CT or PET/MRI and Ultrasound Fusion Targeted Prostate Biopsy for Intra-Prostatic PET-Positive Lesions. Front Oncol 2021; 11:612157. [PMID: 33747927 PMCID: PMC7973269 DOI: 10.3389/fonc.2021.612157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the feasibility and diagnostic performance of prostate-specific membrane antigen (PSMA) based 18F-DCFPyL PET/CT-ultrasound (PET/CT-US) or PET/MRI-ultrasound (PET/MRI-US) fusion targeted biopsy for intra-prostatic PET-positive lesions. METHODS From April 2018 to November 2019, we prospectively enrolled 55 candidates to perform PET/CT-US or PET/MRI-US fusion targeted biopsies for solitary PET-positive prostate lesions (two to four cores/lesion). The positive rates of prostate cancer based on patients and biopsy cores were calculated respectively. With reference to the pathological results of biopsy cores, the MR signal characteristics in the area of the PET-positive lesion were analyzed for the patients who underwent PET/MRI. RESULTS A total of 178 biopsy cores were taken on the 55 patients. One hundred forty-six biopsy cores (82.0%, 146/178) from 51 (92.7%, 51/55) patients were positive for prostate cancer; 47 (85.5%, 47/55) were clinically significant prostate cancer. It is noteworthy that nine patients underwent both 18F-DCFPyL PET/CT and PET/MRI examinations; the seven patients with prostate cancer showed abnormal MR signal in the area of the PET-positive lesion while the other two patients with prostatic hyperplasia and prostatitis showed normal MR signal in the area of the PET-positive lesion. CONCLUSION This study indicated that 18F-DCFPyL PET/CT-US or PET/MRI-US fusion targeted prostate biopsies may be valuable for prostate cancer diagnosis and have a high detection rate of clinically significant prostate cancer for PET-positive lesions. PET/MR can rule out some false PET-positive lesions, which may potentially reduce unnecessary prostate biopsies.
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Affiliation(s)
- Yachao Liu
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Hongkai Yu
- Department of Urology Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiaojun Zhang
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Mu Lin
- Magnetic Resonance Collaboration, Diagnostic Imaging, Siemens Healthineers Ltd., Shanghai, China
| | - Holger Schmidt
- Magnetic Resonance Education, Customer Services, Siemens Healthcare GmbH, Erlangen, Germany
| | - Jiangping Gao
- Department of Urology Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
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12
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Evangelista L, Zattoni F, Cassarino G, Artioli P, Cecchin D, Dal Moro F, Zucchetta P. PET/MRI in prostate cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2020; 48:859-873. [PMID: 32901351 PMCID: PMC8036222 DOI: 10.1007/s00259-020-05025-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
Aim In recent years, the clinical availability of scanners for integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) has enabled the practical potential of multimodal, combined metabolic-receptor, anatomical, and functional imaging to be explored. The present systematic review and meta-analysis summarize the diagnostic information provided by PET/MRI in patients with prostate cancer (PCa). Materials and methods A literature search was conducted in three different databases. The terms used were “choline” or “prostate-specific membrane antigen - PSMA” AND “prostate cancer” or “prostate” AND “PET/MRI” or “PET MRI” or “PET-MRI” or “positron emission tomography/magnetic resonance imaging.” All relevant records identified were combined, and the full texts were retrieved. Reports were excluded if (1) they did not consider hybrid PET/MRI; or (2) the sample size was < 10 patients; or (3) the raw data were not enough to enable the completion of a 2 × 2 contingency table. Results Fifty articles were eligible for systematic review, and 23 for meta-analysis. The pooled data concerned 2104 patients. Initial disease staging was the main indication for PET/MRI in 24 studies. Radiolabeled PSMA was the tracer most frequently used. In primary tumors, the pooled sensitivity for the patient-based analysis was 94.9%. At restaging, the pooled detection rate was 80.9% and was higher for radiolabeled PSMA than for choline (81.8% and 77.3%, respectively). Conclusions PET/MRI proved highly sensitive in detecting primary PCa, with a high detection rate for recurrent disease, particularly when radiolabeled PSMA was used. Electronic supplementary material The online version of this article (10.1007/s00259-020-05025-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy.
| | - Fabio Zattoni
- Urology Unit, Department of Medicine, Udine University Hospital, Udine, Italy
| | - Gianluca Cassarino
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy
| | - Paolo Artioli
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy
| | - Fabrizio Dal Moro
- Urology Unit, Department of Medicine, Udine University Hospital, Udine, Italy.,Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy
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13
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Prospective Evaluation of 18F-DCFPyL PET/CT in Detection of High-Risk Localized Prostate Cancer: Comparison With mpMRI. AJR Am J Roentgenol 2020; 215:652-659. [PMID: 32755168 DOI: 10.2214/ajr.19.22042] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the utility of PET with (2S)-2-[[(1S)-1-carboxy-5-[(6-(18F)fluoranylpyridine-3-carbonyl)amino]pentyl]carbamoylamino]pentanedioic acid (18F-DCFPyL), a prostate-specific membrane antigen (PSMA)-targeted radiotracer, in the detection of high-risk localized prostate cancer as compared with multiparametric MRI (mpMRI). SUBJECTS AND METHODS. This HIPAA-compliant prospective study included 26 consecutive patients with localized high-risk prostate cancer (median age, 69.5 years [range, 53-81 years]; median prostate-specific antigen [PSA] level, 18.88 ng/mL [range, 1.03-20.00 ng/mL]) imaged with 18F-DCFPyL PET/CT and mpMRI. Images from PET/CT and mpMRI were evaluated separately, and suspicious areas underwent targeted biopsy. Lesion-based sensitivity and tumor detection rate were compared for PSMA PET and mpMRI. Standardized uptake value (SUV) and PSMA PET parameters were correlated with histopathology score, and uptake in tumor was compared with that in nonmalignant tissue. On a patient level, SUV and PSMA tumor volume were correlated with PSA density. RESULTS. Forty-four tumors (one in Gleason grade [GG] group 1, 12 in GG group 2, seven in GG group 3, nine in GG group 4, and 15 in GG group 5) were identified at histopathology. Sensitivity and tumor detection rate of 18F-DCFPyL PET/CT and mpMRI were similar (PET/CT, 90.9% and 80%; mpMRI, 86.4% and 88.4%; p = 0.58/0.17). Total lesion PSMA and PSMA tumor volume showed a relationship with GG (τ = 0.27 and p = 0.08, τ = 0.30 and p = 0.06, respectively). Maximum SUV in tumor was significantly higher than that in nonmalignant tissue (p < 0.05). Tumor burden density moderately correlated with PSA density (r = 0.47, p = 0.01). Five true-positive tumors identified on 18F-DCFPyL PET/CT were not identified on mpMRI. CONCLUSION. In patients with high-risk prostate cancer, 18F-DCFPyL PET/CT is highly sensitive in detecting intraprostatic tumors and can detect tumors missed on mpMRI. Measured uptake is significantly higher in tumor tissue, and PSMA-derived tumor burden is associated with severity of disease.
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14
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Goodman CD, Fakir H, Pautler S, Chin J, Bauman GS. Dosimetric Evaluation of PSMA PET-Delineated Dominant Intraprostatic Lesion Simultaneous Infield Boosts. Adv Radiat Oncol 2020; 5:212-220. [PMID: 32280821 PMCID: PMC7136625 DOI: 10.1016/j.adro.2019.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/30/2019] [Accepted: 09/18/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Prostate cancer is multifocal. However, there often exists a single dominant focus in the gland responsible for driving the biology of the disease. Dose escalation to the dominant lesion is a proposed strategy to increase tumor control. We applied radiobiological modeling to evaluate the dosimetric feasibility and benefit of dominant intraprostatic lesion simultaneous in-field boosts (DIL-SIB) to the gross tumor volume (GTV), defined using a novel molecular positron emission tomography (PET) probe (18F-DCFPyL) directed against prostate specific membrane antigen (PSMA). METHODS AND MATERIALS Patients with clinically localized, biopsy-proven prostate cancer underwent preoperative [18F]-DCFPyL PET/computed tomography (CT). DIL-SIB plans were generated by importing the PET/CT into the RayStation treatment planning system. GTV-PET for the DIL-SIB was defined by the highest %SUVmax (percentage of maximum standardized uptake value) that generated a biologically plausible volume. Volumetric arc-based plans incorporating prostate plus DIL-SIB treatment were generated. Tumor control probability (TCP) and normal tissue complication probability (NTCP) with fractionation schemes and boost doses specified in the FLAME (Investigate the Benefit of a Focal Lesion Ablative Microboost in Prostate Cancer; NCT01168479), PROFIT (Prostate Fractionated Irradiation Trial; NCT00304759), PACE (Prostate Advances in Comparative Evidence; NCT01584258), and hypoFLAME (Hypofractionated Focal Lesion Ablative Microboost in prostatE Cancer 2.0; NCT02853110) protocols were compared. RESULTS Comparative DIL-SIB plans for 6 men were generated from preoperative [18F]-DCFPyL PET/CT. Median boost GTV volume was 1.015 cm3 (0.42-1.83 cm3). Median minimum (D99%) DIL-SIB dose for F35BS, F20BS, F5BS, and F5BSH were 97.3 Gy, 80.8 Gy, 46.5 Gy, and 51.5Gy. TCP within the GTV ranged from 84% to 88% for the standard plan and 95% to 96% for the DIL-SIB plans. Within the rest of the prostate, TCP ranged from 89% to 91% for the standard plans and 90% to 92% for the DIL-SIB plans. NTCP for the rectum NTCP was similar for the DIL-SIB plans (0.3%-2.7%) compared with standard plans (0.7%-2.6%). Overall, DIL-SIB plans yielded higher uncomplicated TCP (NTCP, 90%-94%) versus standard plans (NTCP, 83%-85%). CONCLUSIONS PSMA PET provides a novel approach to define GTV for SIB-DIL dose escalation. Work is ongoing to validate PSMA PET-delineated GTV through correlation to coregistered postprostatectomy digitized histopathology.
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Affiliation(s)
- Christopher D. Goodman
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Hatim Fakir
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Stephen Pautler
- Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Joseph Chin
- Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Glenn S. Bauman
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
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15
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Salaün PY, Abgral R, Malard O, Querellou-Lefranc S, Quere G, Wartski M, Coriat R, Hindie E, Taieb D, Tabarin A, Girard A, Grellier JF, Brenot-Rossi I, Groheux D, Rousseau C, Deandreis D, Alberini JL, Bodet-Milin C, Itti E, Casasnovas O, Kraeber-Bodere F, Moreau P, Philip A, Balleyguier C, Luciani A, Cachin F. Good clinical practice recommendations for the use of PET/CT in oncology. Eur J Nucl Med Mol Imaging 2019; 47:28-50. [PMID: 31637482 DOI: 10.1007/s00259-019-04553-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) is a nuclear medicine functional imaging technique with proven clinical value in oncology. PET/CT indications are continually evolving with fresh advances made through research. French practice on the use of PET in oncology was framed in recommendations based on Standards-Options-Recommendations methodology and coordinated by the French federation of Comprehensive Cancer Centres (FNLCC). The recommendations were originally issued in 2002 followed by an update in 2003, but since then, a huge number of scientific papers have been published and new tracers have been licenced for market release. The aim of this work is to bring the 2003 version recommendations up to date. For this purpose, a focus group was set up in collaboration with the French Society for Nuclear Medicine (SFMN) to work on developing good clinical practice recommendations. These good clinical practice recommendations have been awarded joint French National Heath Authority (HAS) and French Cancer Institute (INCa) label status-the stamp of methodological approval. The present document is the outcome of comprehensive literature review and rigorous appraisal by a panel of experts, organ specialists, clinical oncologists, surgeons and imaging specialists. These data were also used for the EANM referral guidelines.
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Affiliation(s)
- Pierre-Yves Salaün
- Department of Nuclear Medicine, University Hospital of Brest, 5 Avenue Foch, 29609, Brest, France.
| | - Ronan Abgral
- Department of Nuclear Medicine, University Hospital of Brest, 5 Avenue Foch, 29609, Brest, France
| | - Olivier Malard
- Head and Neck, University Hospital of Nantes, Nantes, France
| | - Solène Querellou-Lefranc
- Department of Nuclear Medicine, University Hospital of Brest, 5 Avenue Foch, 29609, Brest, France
| | - Gilles Quere
- Thoracic Oncology, University Hospital of Brest, Brest, France
| | | | - Romain Coriat
- Gastroenterology, Cochin Hospital AP-HP, Paris, France
| | - Elif Hindie
- Nuclear Medicine, University Hospital of Bordeaux, Bordeaux, France
| | | | - Antoine Tabarin
- Endocrinology, University Hospital of Bordeaux, Bordeaux, France
| | | | | | | | - David Groheux
- Nuclear Medicine, Hopital Saint Louis AP-HP, Paris, France
| | | | - Désirée Deandreis
- Nuclear Medicine, Department of Medical Sciences, Citta della Salute e della Scienza, Turin, Italy
| | - Jean-Louis Alberini
- Nuclear Medicine, Georges-François Leclerc center - François Mitterrand University Hospital, Dijon, France
| | | | - Emmanuel Itti
- Nuclear Medicine, Henri Mondor Hospital AP-HP, Paris, France
| | | | - Françoise Kraeber-Bodere
- Nuclear Medicine, Ouest Cancer Institute, Nantes, France.,Nuclear Medicine, University Hospital of Nantes, Nantes, France
| | | | - Arnaud Philip
- Centre du traitement de la douleur, CHRU de Brest, Brest, France
| | | | - Alain Luciani
- Radiology, Henri Mondor Hospital AP-HP, Paris, France
| | - Florent Cachin
- Nuclear Medicine, Jean Perrin Cancer Institute, Clermont-Ferrand, France
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16
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Kwon H, Son S, Byun Y. Prostate‐Specific Membrane Antigen (PSMA)‐Targeted Radionuclide Probes for Imaging and Therapy of Prostate Cancer. ASIAN J ORG CHEM 2019. [DOI: 10.1002/ajoc.201900329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Hongmok Kwon
- College of PharmacyKorea University 2511 Sejong-ro Sejong 30019 South Korea
| | - Sang‐Hyun Son
- College of PharmacyKorea University 2511 Sejong-ro Sejong 30019 South Korea
| | - Youngjoo Byun
- College of PharmacyKorea University 2511 Sejong-ro Sejong 30019 South Korea
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17
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Salami SS, Singhal U, Spratt DE, Palapattu GS, Hollenbeck BK, Schonhoft JD, Graf R, Louw J, Jendrisak A, Dugan L, Wang Y, Tomlins SA, Dittamore R, Feng FY, Morgan TM. Circulating Tumor Cells as a Predictor of Treatment Response in Clinically Localized Prostate Cancer. JCO Precis Oncol 2019; 3. [PMID: 32832835 DOI: 10.1200/po.18.00352] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Using nonenrichment-based, potentially more sensitive Epic Sciences circulating tumor cell (CTC) platform, we sought to detect and characterize CTCs in untreated, high-risk localized prostate cancer and to evaluate their clinical implication. METHODS Between 2012 and 2015, blood samples were prospectively collected from patients with National Comprehensive Cancer Network high-risk localized prostate cancer undergoing either radiotherapy (XRT) plus androgen deprivation therapy or radical prostatectomy (RP) with curative intent. Samples were analyzed with the Epic Sciences platform with 4J,6-diamidino-2-phenylindole, CD45, cytokeratin (CK), and androgen receptor (AR) N-terminal staining. CTC counts were correlated with biochemical recurrence (BCR). RESULTS A diversity of CTC subtypes, including CK-positive, CK-negative, AR-positive, and CTC clusters, were observed in 73.3% (33 of 45) of patients with evaluable data. The median follow-up was 14.2 months (range, 0.5 to 43.7 months). BCR occurred more frequently in the RP group than XRT (15 of 26 v one of 19), with most patients in the XRT group continuing to receive androgen deprivation therapy. A higher proportion of metastatic events were observed in the RP group (five of 26 v one of 19). In the RP group, BCR and development of metastases were associated with a higher total number of CTCs, AR-positive CTCs, and CTC phenotypic heterogeneity. One patient who developed BCR and metastases quickly after RP had diverse phenotypical CTC subtypes, and single-cell genomic analyses of all detectable CTCs confirmed common prostate cancer copy number alterations and PTEN loss. CONCLUSION CTCs can be identified in most patients with high-risk localized prostate cancer before definitive therapy using the Epic Sciences platform. If confirmed in a larger cohort with longer follow-up, phenotypic and genomic characterization of CTCs pretherapy may provide an additional means of risk stratifying patients with newly diagnosed high-risk disease and potentially help identify patients who could require multimodal therapy.
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Affiliation(s)
- Simpa S Salami
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Daniel E Spratt
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Ganesh S Palapattu
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI.,Medical University of Vienna, Vienna, Austria
| | - Brent K Hollenbeck
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | | | | | | | | | - Scott A Tomlins
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Felix Y Feng
- Michigan Medicine, Ann Arbor, MI.,University of San Francisco, San Francisco, CA
| | - Todd M Morgan
- Michigan Medicine, Ann Arbor, MI.,University of Michigan Rogel Cancer Center, Ann Arbor, MI
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18
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Rousseau E, Wilson D, Lacroix-Poisson F, Krauze A, Chi K, Gleave M, McKenzie M, Tyldesley S, Goldenberg SL, Bénard F. A Prospective Study on 18F-DCFPyL PSMA PET/CT Imaging in Biochemical Recurrence of Prostate Cancer. J Nucl Med 2019; 60:1587-1593. [PMID: 30979820 PMCID: PMC6836862 DOI: 10.2967/jnumed.119.226381] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/08/2019] [Indexed: 01/05/2023] Open
Abstract
18F-DCFPyL (2-(3-{1-carboxy-5-[(6-18F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid), a prostate-specific membrane antigen–targeting radiotracer, has shown promise as a prostate cancer imaging radiotracer. We evaluated the safety, sensitivity, and impact on patient management of 18F-DCFPyL in the setting of biochemical recurrence of prostate cancer. Methods: Subjects with prostate cancer and biochemical recurrence after radical prostatectomy or curative-intent radiotherapy were included in this prospective study. The subjects underwent 18F-DCFPyL PET/CT imaging. The localization and number of lesions were recorded. The uptake characteristics of the 5 most active lesions were measured. A pre- and posttest questionnaire was sent to treating physicians to assess the impact on management. Results: One hundred thirty subjects were evaluated. 18F-DCFPyL PET/CT localized recurrent prostate cancer in 60% of cases with a prostate-specific antigen (PSA) level of ≥0.4 to <0.5, 78% with a level of ≥0.5 to <1.0, 72% with a level of ≥1.0 to <2.0, and 92% with a level of ≥2.0. Many subjects had few lesions (1 lesion in 40.8%, 2 in 8.5%, and 3 in 4.6%). The number of lesions was significantly related to PSA by ANOVA, but there was a large overlap in the PSA values for number of lesion categories. Total lesion uptake was also significantly related to PSA level. A change in treatment intent occurred in 65.5% of subjects, disease stage changed in 65.5%, and management plans changed in 87.3%. Twenty-two subjects reported mild adverse events after the scan; all resolved completely. Conclusion:18F-DCFPyL PET/CT is safe and sensitive for the localization of biochemical recurrence of prostate cancer. This test improved decision making for referring oncologists and changed management for most subjects.
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Affiliation(s)
- Etienne Rousseau
- BC Cancer, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Don Wilson
- BC Cancer, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Frédéric Lacroix-Poisson
- BC Cancer, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Kim Chi
- BC Cancer, Vancouver, British Columbia, Canada
| | - Martin Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - François Bénard
- BC Cancer, Vancouver, British Columbia, Canada .,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; and
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19
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Prato FS, Pavlosky WF, Foster SC, Thiessen JD, Beaujot RP. Screening for Dementia Caused by Modifiable Lifestyle Choices Using Hybrid PET/MRI. J Alzheimers Dis Rep 2019; 3:31-45. [PMID: 30842996 PMCID: PMC6400112 DOI: 10.3233/adr-180098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 12/19/2022] Open
Abstract
Significant advances in positron emission tomography (PET) and magnetic resonance imaging (MRI) brain imaging in the early detection of dementia indicate that hybrid PET/MRI would be an effective tool to screen for dementia in the population living with lifestyle risk factors. Here we investigate the associated costs and benefits along with the needed imaging infrastructure. A demographic analysis determined the prevalence of dementia and its incidence. The expected value of the screening program was calculated assuming a sensitivity and specificity of 0.9, a prevalence of 0.1, a QALY factor of 0.348, a willingness to pay $114,000 CAD and the cost per PET/MRI scan of $2,000 CAD. It was assumed that each head PET/MRI could screen 3,000 individuals per year. The prevalence of dementia is increasing by almost two-fold every 20 years due to the increased population at ages where dementia is more prevalent. It has been shown that a five-year delay in the incidence of dementia would decrease the prevalence by some 45%. In Canada, a five-year delay corresponds to a health care savings of $27,000 CAD per subject per year. The expected value for screening was estimated at $23,745 CAD. The number of subjects to be screened per year in Canada, USA, and China between 60 and 79 was 11,405,000. The corresponding number of head-only hybrid PET/MRI systems needed is 3,800. A brain PET/MRI screening program is financially justifiable with respect to health care costs and justifies the continuing development of MRI compatible brain PET technology.
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Affiliation(s)
- Frank S. Prato
- Department of Medical Biophysics, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
| | - William F. Pavlosky
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
| | | | - Jonathan D. Thiessen
- Department of Medical Biophysics, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
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20
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Czarniecki M, Mena E, Lindenberg L, Cacko M, Harmon S, Radtke JP, Giesel F, Turkbey B, Choyke PL. Keeping up with the prostate-specific membrane antigens (PSMAs): an introduction to a new class of positron emission tomography (PET) imaging agents. Transl Androl Urol 2018; 7:831-843. [PMID: 30456186 PMCID: PMC6212618 DOI: 10.21037/tau.2018.08.03] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/31/2018] [Indexed: 12/11/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) is an emerging prostate cancer imaging method, which has been reported to have a higher sensitivity and specificity than the currently approved PET imaging agents. Multiple PSMA ligands are being investigated around the world and applications range from primary tumor characterization, to local staging, biochemical recurrence, metastasis, and image-guided interventions. The most investigated PET tracers are labelled with 68-Gallium or 18-Fluoride and are discussed in this review. Additionally, 99mTc labeled PSMA agents for single photon emission computed tomography (SPECT) imaging are elucidated as an alternative method of PSMA image acquisition.
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Affiliation(s)
- Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Esther Mena
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Liza Lindenberg
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marek Cacko
- Department of Nuclear Medicine, Medical University Warsaw, Warsaw, Poland
| | - Stephanie Harmon
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Jan Philipp Radtke
- Department of Urology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Frederick Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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