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Gauthaman DK, Luthra K, Lele V. Comparison of Ga-68 PSMA PET/CT and Multiparametric MRI for Initial Detection and Staging of Prostate Cancer. World J Nucl Med 2024; 23:79-87. [PMID: 38933063 PMCID: PMC11199037 DOI: 10.1055/s-0044-1779749] [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] [Indexed: 06/28/2024] Open
Abstract
Background Multiparametric magnetic resonance imaging (mpMRI) is widely used for the evaluation of prostate cancer and is known to have better accuracy. Gallium-68 prostate-specific membrane antigen (Ga-68 PSMA) is a radiotracer that shows high localization in prostate cancer cells. Purpose The purpose of this study was to assess the sensitivity and utility of Ga-68 PSMA positron emission tomography/computed tomography (PET/CT) in comparison with mpMRI as a noninvasive imaging technique for the initial diagnosis and locoregional staging of prostate cancer using transrectal ultrasound (TRUS)-guided biopsy as gold standard. Materials and Methods This prospective observational study conducted from August 2017 to April 2020 evaluated 60 men ( n = 60) with biopsy-proven prostate carcinoma. They underwent mpMRI and Ga-68 PSMA PET/CT scans within 14 days with TRUS biopsy being gold standard. T staging of disease, N staging of lymph nodes within the pelvis, and M staging of lesions in pelvic bones (within the imaging field of mpMRI) were compared using PSPP version 1.0.1 statistical software. Results All 60 men with a mean age of 69.9 ± 9.35 years showed Ga-68 PSMA avid disease, whereas 55 were detected by mpMRI. The sensitivity in detection of prostate lesions (with 95% confidence interval) was 99.08% for Ga-68 PSMA PET/CT and 84.40% for mpMRI. Ga-68 PSMA PET/CT detected greater number of patients with regional lymph nodal involvement (19/60) as compared with mpMRI (12/60). Ga-68 PSMA PET/CT showed PSMA avid pelvic skeletal lesions in nine patients, whereas mpMRI detected pelvic lesions in six patients. In addition, four other patients showed extrapelvic skeletal lesions on Ga-68 PSMA PET/CT. Conclusion Ga-68 PSMA PET/CT has superior sensitivity in detection of primary prostate tumor, as compared with mpMRI. Both modalities correlate well in detection of seminal vesicle involvement. Ga-68 PSMA PET/CT outperformed mpMRI in detection of lymph nodal and skeletal metastases. Hence, Ga-68 PSMA PET/CT should be considered as first-line diagnostic modality for carcinoma prostate. Summary Statement : Ga-68 PSMA PET/CT shows superior diagnostic performance than mpMRI in the evaluation of prostate cancer.
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Affiliation(s)
| | - Karuna Luthra
- Department of Nuclear Medicine and PET/CT, Jaslok Hospital, Mumbai, Maharashtra, India
| | - Vikram Lele
- Department of Nuclear Medicine and PET/CT, Jaslok Hospital, Mumbai, Maharashtra, India
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Wang Z, Zhu B, Jiang F, Chen X, Wang G, Ding N, Song S, Xu X, Zhang W. Design, synthesis and evaluation of novel prostate-specific membrane antigen-targeted aryl [ 18F]fluorosulfate PET tracers. Bioorg Med Chem 2024; 106:117753. [PMID: 38749342 DOI: 10.1016/j.bmc.2024.117753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Abstract
The expression of prostate-specific membrane antigen (PSMA) in prostate cancer is 100-1000 times higher than that in normal tissues, and it has shown great advantages in the diagnosis and treatment of prostate cancer. The combination of PSMA and PET imaging technology based on the principle of metabolic imaging can achieve high sensitivity and high specificity for diagnosis. Due to its suitable half-life (109 min) and good positron abundance (97%), as well as its cyclotron accelerated generation, 18F has the potential to be commercialize, which has attracted much attention. In this article, we synthesized a series of fluorosulfate PET tracers targeting PSMA. All four analogues have shown high affinity to PSMA (IC50 = 1.85-5.15 nM). After the radioisotope exchange labeling, [18F]L9 and [18F]L10 have PSMA specific cellular uptake (0.65 ± 0.04% AD and 1.19 ± 0.03% AD) and effectively accumulated in 22Rv1 xenograft mice model. This study demonstrates that PSMA-1007-based PSMA-targeted aryl [18F]fluorosulfate novel tracers have the potential for PET imaging in tumor tissues.
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Affiliation(s)
- Zhaolin Wang
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
| | - Bin Zhu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Fan Jiang
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
| | - Xiangping Chen
- PET Center, Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Guangfa Wang
- PET Center, Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Ning Ding
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
| | - Xiaoping Xu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
| | - Wei Zhang
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China.
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McKone EL, Sutton EA, Johnson GB, Phillips RM. Application of Advanced Imaging to Prostate Cancer Diagnosis and Management: A Narrative Review of Current Practice and Unanswered Questions. J Clin Med 2024; 13:446. [PMID: 38256579 PMCID: PMC10816977 DOI: 10.3390/jcm13020446] [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: 12/15/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Major advances in prostate cancer diagnosis, staging, and management have occurred over the past decade, largely due to our improved understanding of the technical aspects and clinical applications of advanced imaging, specifically magnetic resonance imaging (MRI) and prostate-cancer-specific positron emission tomography (PET). Herein, we review the established utility of these important and exciting technologies, as well as areas of controversy and uncertainty that remain important areas for future study. There is strong evidence supporting the utility of MRI in guiding initial biopsy and assessing local disease. There is debate, however, regarding how to best use the imaging modality in risk stratification, treatment planning, and assessment of biochemical failure. Prostate-cancer-specific PET is a relatively new technology that provides great value to the evaluation of newly diagnosed, treated, and recurrent prostate cancer. However, its ideal use in treatment decision making, staging, recurrence detection, and surveillance necessitates further research. Continued study of both imaging modalities will allow for an improved understanding of their best utilization in improving cancer care.
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Affiliation(s)
| | - Elsa A. Sutton
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Geoffrey B. Johnson
- Department of Radiology, Nuclear Medicine Division, Mayo Clinic, Rochester, MN 55905, USA
| | - Ryan M. Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
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4
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Bolzati C, Gobbi C, Ferro-Flores G, Turato S, Ocampo-Garcia B, Carpanese D, Marzano C, Spolaore B, Fracasso G, Rosato A, Meléndez-Alafort L. Development and Characterization of 99mTc-scFvD2B as a Potential Radiopharmaceutical for SPECT Imaging of Prostate Cancer. Int J Mol Sci 2023; 25:492. [PMID: 38203663 PMCID: PMC10779128 DOI: 10.3390/ijms25010492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Previously, we demonstrated that the 177Lu-labeled single-chain variable fragment of an anti-prostate-specific membrane antigen (PSMA) IgG D2B antibody (scFvD2B) showed higher prostate cancer (PCa) cell uptake and tumor radiation doses compared to 177Lu-labeled Glu-ureide-based PSMA inhibitory peptides. To obtain a 99mTc-/177Lu-scFvD2B theranostic pair, this research aimed to synthesize and biochemically characterize a novel 99mTc-scFvD2B radiotracer. The scFvD2B-Tag and scFvD2B antibody fragments were produced and purified. Then, two HYNIC derivatives, HYNIC-Gly-Gly-Cys-NH2 (HYNIC-GGC) and succinimidyl-HYNIC (S-HYNIC), were used to conjugate the scFvD2B-Tag and scFvD2B isoforms, respectively. Subsequently, chemical characterization, immunoreactivity tests (affinity and specificity), radiochemical purity tests, stability tests in human serum, cellular uptake and internalization in LNCaP(+), PC3-PIP(++) or PC3(-) PCa cells of the resulting unlabeled HYNIC-scFvD2B conjugates (HscFv) and 99mTc-HscFv agents were performed. The results showed that incorporating HYNIC as a chelator did not affect the affinity, specificity or stability of scFvD2B. After purification, the radiochemical purity of 99mTc-HscFv radiotracers was greater than 95%. A two-sample t-test of 99mTc-HscFv1 and 99mTc-HscFv1 uptake in PC3-PIP vs. PC3 showed a p-value < 0.001, indicating that the PSMA receptor interaction of 99mTc-HscFv agents was statistically significantly higher in PSMA-positive cells than in the negative controls. In conclusion, the results of this research warrant further preclinical studies to determine whether the in vivo pharmacokinetics and tumor uptake of 99mTc-HscFv still offer sufficient advantages over HYNIC-conjugated peptides to be considered for SPECT/PSMA imaging.
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Affiliation(s)
- Cristina Bolzati
- Institute of Condensed Matter Chemistry and Energy Technologies, Consiglio Nazionale delle Ricerche, Corso Stati Uniti 4, 35127 Padova, Italy; (C.B.); (C.G.)
| | - Carolina Gobbi
- Institute of Condensed Matter Chemistry and Energy Technologies, Consiglio Nazionale delle Ricerche, Corso Stati Uniti 4, 35127 Padova, Italy; (C.B.); (C.G.)
| | - Guillermina Ferro-Flores
- Laboratorio Nacional de Investigación y Desarrollo de Radiofármacos, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N. La Marquesa, Ocoyoacac 52750, Mexico; (G.F.-F.); (B.O.-G.)
| | - Sofia Turato
- Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35138 Padova, Italy; (S.T.); (A.R.)
| | - Blanca Ocampo-Garcia
- Laboratorio Nacional de Investigación y Desarrollo de Radiofármacos, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N. La Marquesa, Ocoyoacac 52750, Mexico; (G.F.-F.); (B.O.-G.)
| | - Debora Carpanese
- Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35138 Padova, Italy; (S.T.); (A.R.)
| | - Cristina Marzano
- Dipartimento di Scienze del Farmaco, Università degli Studi di Padova, Via Marzolo 5, 35131 Padova, Italy; (C.M.); (B.S.)
| | - Barbara Spolaore
- Dipartimento di Scienze del Farmaco, Università degli Studi di Padova, Via Marzolo 5, 35131 Padova, Italy; (C.M.); (B.S.)
| | - Giulio Fracasso
- Dipartimento di Scienze Biomediche, Università degli Studi di Padova, Viale G. Colombo 3, 35131 Padova, Italy
| | - Antonio Rosato
- Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35138 Padova, Italy; (S.T.); (A.R.)
- Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Via Gattamelata 64, 35138 Padova, Italy
| | - Laura Meléndez-Alafort
- Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35138 Padova, Italy; (S.T.); (A.R.)
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Gomez Rivas J, Nicoletti R, Ibáñez L, Steinbeisser C, de Meulder B, Golozar A, Axelsson SE, Snijder R, Bjartell A, Cornford P, Van Hemelrijck M, Beyer K, Willemse PP, Murtola T, Roobol MJ, Moreno-Sierra J, Campi R, Gacci M, Mottet N, Merseburger A, Ndow J. Research protocol to identify progression and death amongst patients with metastatic hormone-sensitive prostate cancer treated with available treatments: PIONEER IMI's "big data for better outcomes" program. Int J Surg Protoc 2023; 27:122-129. [PMID: 38046899 PMCID: PMC10688536 DOI: 10.1097/sp9.0000000000000009] [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: 02/14/2023] [Accepted: 06/24/2023] [Indexed: 12/05/2023] Open
Abstract
Androgen deprivation therapy-based with or without first-generation anti-androgens, was the standard of care for patients with metastatic hormone-sensitive prostate cancer (mHSPC) for decades. However, the development of docetaxel chemotherapy and new androgen receptor-targeted agents, abiraterone acetate and prednisolone, apalutamide , enzalutamide and darolutamide (in combination with docetaxel chemotherapy) has proven that combination of treatments is more effective. Recently, intensification therapy, so-called "triplets", have emerged in the armamentarium of mHSPC treatment. Metastatic disease is a clinical state that remains poorly understood. The optimal diagnostic and management of patients with mHSPC are changing thanks to the development of new imaging techniques and therapies. The primary objective of this study is to develop and validate a predictive model for the occurrence of symptomatic progression, initiation of new treatments and death amongst patients with mHSPC treated with one of the approved treatment plans, on characteristics present at admission.
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Affiliation(s)
- Juan Gomez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Rossella Nicoletti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Laura Ibáñez
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Bertrand de Meulder
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon
| | - Asieh Golozar
- Regeneron Pharmaceuticals, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | | | | | | | | | - Peter-Paul Willemse
- Department of Urology, Cancer Center University Medical Center Utrecht, Utrecht
| | - Teemu Murtola
- Department of Urology, Tampere University Hospital, Tampere, Finland; Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | | | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Nicolas Mottet
- Department of Urology, Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Axel Merseburger
- University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - James Ndow
- Department of Urology, University of Aberdeen, Aberdeen, Scotland
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6
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Huls SJ, Burkett B, Ehman E, Lowe VJ, Subramaniam RM, Kendi AT. Clinical practice in prostate PET imaging. Ther Adv Med Oncol 2023; 15:17588359231213618. [PMID: 38028142 PMCID: PMC10666681 DOI: 10.1177/17588359231213618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Positron emission tomography (PET) imaging in prostate cancer has advanced significantly in the past decade with prostate cancer targeted radiopharmaceuticals now playing a growing role in diagnosis, staging, and treatment. This narrative review focuses on the most commonly used PET radiopharmaceuticals in the USA: prostate-specific membrane antigen (PSMA), fluciclovine, and choline. 18F-fluorodeoxyglucose (FDG) is used in many other malignancies, but rarely in prostate cancer. Previous literature is discussed regarding each radiopharmaceutical's utility in the settings of screening/diagnosis, initial staging, biochemical recurrence, advanced disease, and evaluation prior to targeted radiopharmaceutical therapy and radiation therapy. PET imaging has demonstrated utility over traditional imaging in various scenarios; however, there are few head-to-head studies comparing PET radiopharmaceuticals. PSMA radiopharmaceuticals are the newest tracers developed and have unique properties and uses, especially at low prostate-specific antigen (PSA) levels. However, each PET radiopharmaceutical has different properties which can affect image interpretation. Choline and fluciclovine have minimal urinary activity, whereas PSMA agents can have high urinary activity which may affect locoregional disease evaluation. Of the three radiopharmaceuticals, only PSMA is approved for both diagnostic and therapeutic indications with 177Lu-PSMA. A variety of diagnostic PET radiotracers for prostate cancer allows for increased flexibility, especially in the setting of supply chain and medication shortages. For the time being, keeping a diverse group of PET radiopharmaceuticals for prostate cancer is justifiable.
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Affiliation(s)
- Sean J. Huls
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester MN 55905, USA
| | - Brian Burkett
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eric Ehman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Rathan M. Subramaniam
- Department of Medicine, University of Otago Medical School, Dunedin, New Zealand
- Department of Radiology, Duke University, Durham, NC, USA
| | - A. Tuba Kendi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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7
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Ju J, Xu D, Mo X, Miao J, Xu L, Ge G, Zhu X, Deng H. Multifunctional polysaccharide nanoprobes for biological imaging. Carbohydr Polym 2023; 317:121048. [PMID: 37364948 DOI: 10.1016/j.carbpol.2023.121048] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
Imaging and tracking biological targets or processes play an important role in revealing molecular mechanisms and disease states. Bioimaging via optical, nuclear, or magnetic resonance techniques enables high resolution, high sensitivity, and high depth imaging from the whole animal down to single cells via advanced functional nanoprobes. To overcome the limitations of single-modality imaging, multimodality nanoprobes have been engineered with a variety of imaging modalities and functionalities. Polysaccharides are sugar-containing bioactive polymers with superior biocompatibility, biodegradability, and solubility. The combination of polysaccharides with single or multiple contrast agents facilitates the development of novel nanoprobes with enhanced functions for biological imaging. Nanoprobes constructed with clinically applicable polysaccharides and contrast agents hold great potential for clinical translations. This review briefly introduces the basics of different imaging modalities and polysaccharides, then summarizes the recent progress of polysaccharide-based nanoprobes for biological imaging in various diseases, emphasizing bioimaging with optical, nuclear, and magnetic resonance techniques. The current issues and future directions regarding the development and applications of polysaccharide nanoprobes are further discussed.
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Affiliation(s)
- Jingxuan Ju
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Danni Xu
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xuan Mo
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jiaqian Miao
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Li Xu
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Guangbo Ge
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Xinyuan Zhu
- School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Hongping Deng
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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Chen Y, Zhang X, Ni M, Gao X, Wang X, Xie Q, Zhang J, Cui M. Synthesis, Preclinical Evaluation, and First-in-Human PET Study of [ 68Ga]-Labeled Biphenyl-Containing PSMA Tracers. J Med Chem 2023; 66:13332-13345. [PMID: 37708404 DOI: 10.1021/acs.jmedchem.3c01475] [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: 09/16/2023]
Abstract
Radioisotope-labeled prostate-specific membrane antigen (PSMA) PET tracers have gained popularity in diagnosing prostate cancer (PCa). This study aimed to improve the affinity and tumor-targeting capabilities of new PSMA tracers by increasing the number of pharmacophores that specifically bind to PSMA. Using biphenyl as a core scaffold, we investigated the relationship among spacer segments, affinity, and pharmacokinetic properties. In preclinical PET studies on mice with 22Rv1 tumors, compared with [68Ga]Ga-PSMA-11 (SUVmax = 3.37), [68Ga]Ga-PSMA-D5 (Ki = 0.15) showed higher tumor uptake (SUVmax = 3.51) and lower renal uptake (T/K = 1.84). In the first-in-human study, [68Ga]Ga-PSMA-D5 effectively detected small PCa-associated lesions and distant metastases. The advantages of [68Ga]Ga-PSMA-D5 include high tumor uptake, straightforward synthesis, and labeling, making it a promising PSMA PET tracer. Furthermore, [68Ga]Ga-PSMA-D5 contains a DOTA chelator, allowing convenient labeling with therapeutic radionuclides such as 177Lu and 225Ac, providing the potential for targeted radioligand therapy in PCa.
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Affiliation(s)
- Yimin Chen
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, China
| | - Xiaojun Zhang
- Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Ming Ni
- Department of Nuclear Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei 230001, China
| | - Xi Gao
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, China
| | - Xinlin Wang
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, China
| | - Qiang Xie
- Department of Nuclear Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei 230001, China
| | - Jinming Zhang
- Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Mengchao Cui
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, China
- Center for Advanced Materials Research, Beijing Normal University at Zhuhai, Zhuhai 519087, China
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Lawless A, Kneebone A, Armstrong S, Chander S, Christie D, Finnigan R, Hayden A, Higgs B, Knox M, Sasso G, Sidhom M, Shakespeare TP, Holt T. Patterns of practice regarding use of radiation therapy following radical prostatectomy: A survey of Radiation Oncologists and Urologists in Australia and New Zealand. J Med Imaging Radiat Oncol 2023; 67:556-563. [PMID: 37343171 DOI: 10.1111/1754-9485.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION This study aimed to investigate the patterns of practices of radiation oncologists (ROs) and urologists in Australia and New Zealand with respect to the utilisation of post-prostatectomy radiation therapy (RT) and help guide the development of an update to the existing Faculty of Radiation Oncology Genito-Urinary Group post-prostatectomy guidelines. METHODS ROs and urologists with subspecialty practice in prostate cancer from Australia and New Zealand were invited to participate in an online survey comprised of clinical scenarios regarding post-prostatectomy RT. RESULTS Sixty-five ROs and 28 urologists responded to the survey. In the setting of low-risk biochemical relapse, the threshold for initiating RT was lower for ROs than urologists. ROs were more likely than urologists to recommend adjuvant RT for node-positive disease. When salvage RT was advised for a pT3N0R1 recurrence, there was no consensus amongst ROs on whether to add either ADT or nodal treatment over prostate bed RT alone. For a solitary PSMA-avid pelvic lymph node recurrence, whole pelvis RT with androgen deprivation therapy was the preferred treatment option (72% ROs, 43% urologists). Most ROs (92%) recommended conventionally fractionated RT to 66-70 Gy, with a boost to any PSMA PET avid recurrent disease. CONCLUSION This survey highlights the marked discordance in practice for the management of prostate cancer relapse post-prostatectomy. This is seen not only between specialties but also within the radiation oncology community. This emphasises the need for an updated evidence-based guideline to be produced.
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Affiliation(s)
- Anna Lawless
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Kneebone
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Shreya Armstrong
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore Base Hospital, Lismore, New South Wales, Australia
| | - Sarat Chander
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Christie
- Genesis Care, Gold Coast, Queensland, Australia
- Bond University, Gold Coast, Queensland, Australia
| | - Renee Finnigan
- Icon Cancer Centre, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Amy Hayden
- Department of Radiation Oncology, Westmead & Blacktown Hospital, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Braden Higgs
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew Knox
- Department of Radiation Oncology, St George Hospital, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Giuseppe Sasso
- Department of Radiation Oncology, Auckland City Hospital, Te Whatu Ora, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Waipapa Taumata Rau, Auckland, New Zealand
| | - Mark Sidhom
- Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Tanya Holt
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Elakshar S, Tolba M, Tisseverasinghe S, Pruneau L, Di Lalla V, Bahoric B, Niazi T. Salvage Whole-Pelvic Radiation and Long-Term Androgen-Deprivation Therapy in the Management of High-Risk Prostate Cancer: Long-Term Update of the McGill 0913 Study. Curr Oncol 2023; 30:7252-7262. [PMID: 37623007 PMCID: PMC10453184 DOI: 10.3390/curroncol30080526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE To report the long-term outcomes of the McGill 0913 study and the potential benefits of combining prostate-bed radiotherapy (PBRT), pelvic-lymph-node radiotherapy (PLNRT), and long term ADT (LT-ADT). MATERIALS AND METHODS From 2010 to 2016, 46 high-risk prostate cancer patients who experienced biochemical recurrence (BCR) after radical prostatectomy (RP) were enrolled in this single-arm phase II clinical trial. The patients were eligible if they had a Gleason score > 8, locally advanced disease (≥pT3), a preoperative PSA of >20 ng/mL, or positive lymph nodes (LN). The patients were treated with a combination of 24 months of ADT, PBRT, and PLNRT. The primary outcome was biochemical progression-free survival (bPFS) and the predefined secondary endpoints included distant-metastasis-free survival (DMFS), overall survival (OS), and toxicity. In this update, we also report the median follow-up of 8.8 years and 10 years OS. RESULTS At a median follow-up of 8.8 years, 43 patients were eligible for analysis. The median pre-salvage PSA was 0.30 μg/L. Half (51%) of the patients (n = 22) had positive margins, 40% (n = 17) had Gleason scores > 8, 63% (n = 27) had extracapsular extension, 42% (n = 18) had seminal vesicle invasion, and 19% (n = 8) had LN involvement. The 10-year bPFS was 68.3 %. The 10-year DMFS was 72.9%. The 10-year OS was 97%. There were two non-cancer-related deaths. The first patient died of congestive heart failure while the other died of an unknown cause. No new toxicity was observed after the initial report. CONCLUSIONS Our study demonstrates that treatment escalation with PBRT, PLNRT, and LT-ADT improves long term outcomes. In view of the recently published SPPORT study, we conclude that this novel approach of treatment intensification in high-risk post-prostatectomy patients is safe and effective, and that it should be offered as the standard of care.
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Affiliation(s)
- Sara Elakshar
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
- Department of Clinical Oncology, Tanta University Hospitals, Tanta University, Tanta 6632110, Egypt
| | - Marwan Tolba
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
| | - Steven Tisseverasinghe
- Department of Radiation Oncology, Gatineau Hospital, McGill University, Gatineau, QC J8P 7H2, Canada;
| | - Laurie Pruneau
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
| | - Vanessa Di Lalla
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
| | - Boris Bahoric
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
| | - Tamim Niazi
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
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11
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Rong J, Haider A, Jeppesen TE, Josephson L, Liang SH. Radiochemistry for positron emission tomography. Nat Commun 2023; 14:3257. [PMID: 37277339 PMCID: PMC10241151 DOI: 10.1038/s41467-023-36377-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 01/30/2023] [Indexed: 06/07/2023] Open
Abstract
Positron emission tomography (PET) constitutes a functional imaging technique that is harnessed to probe biological processes in vivo. PET imaging has been used to diagnose and monitor the progression of diseases, as well as to facilitate drug development efforts at both preclinical and clinical stages. The wide applications and rapid development of PET have ultimately led to an increasing demand for new methods in radiochemistry, with the aim to expand the scope of synthons amenable for radiolabeling. In this work, we provide an overview of commonly used chemical transformations for the syntheses of PET tracers in all aspects of radiochemistry, thereby highlighting recent breakthrough discoveries and contemporary challenges in the field. We discuss the use of biologicals for PET imaging and highlight general examples of successful probe discoveries for molecular imaging with PET - with a particular focus on translational and scalable radiochemistry concepts that have been entered to clinical use.
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Affiliation(s)
- Jian Rong
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital & Department of Radiology, Harvard Medical School, Boston, MA, 02114, USA
| | - Ahmed Haider
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital & Department of Radiology, Harvard Medical School, Boston, MA, 02114, USA
| | - Troels E Jeppesen
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital & Department of Radiology, Harvard Medical School, Boston, MA, 02114, USA
| | - Lee Josephson
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital & Department of Radiology, Harvard Medical School, Boston, MA, 02114, USA
| | - Steven H Liang
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA.
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital & Department of Radiology, Harvard Medical School, Boston, MA, 02114, USA.
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12
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Nishimura K. Management of bone metastasis in prostate cancer. J Bone Miner Metab 2023; 41:317-326. [PMID: 37162606 DOI: 10.1007/s00774-023-01435-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Abstract
Progression of bone metastases is the primary cause of death in prostate cancer, and skeletal-related events (SREs), including pathologic fractures, spinal cord compression, radiation, or surgery to bone can impair patients' quality of life. Over the past decade, the development of cytotoxic agents, androgen-receptor-axis-targeted therapies (ARATs), and radioligand therapies has prolonged overall survival of prostate cancer patients with bone metastases and reduced the risk of SREs. The use of bone-modifying agents has also contributed to the reduced risk of SREs. Initial use of a cytotoxic agent, docetaxel, or an ARAT agent with androgen deprivation therapy (ADT) is the current approach to metastatic castration-sensitive prostate cancer. However, there is no consensus on the optimal medication for upfront use in combination with ADT, or on specific patient selection. Recently, next-generation imaging modalities, such as whole-body magnetic resonance imaging and prostate-specific membrane antigen-positron emission tomography have been utilized to detect bone metastases at an early stage. In addition, metastasis-directed therapy, such as stereotactic body radiation therapy, has been attempted. In the future, patients with bone metastatic prostate cancer will be divided into subgroups and their treatment options will be tailored to their specific characteristics.
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Affiliation(s)
- Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
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13
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Rednam N, Kundra V. Hybrid magnetic resonance and PET imaging for prostate cancer recurrence. Curr Opin Oncol 2023; 35:231-238. [PMID: 36966496 DOI: 10.1097/cco.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
PURPOSE OF REVIEW Recurrence post definitive local therapy by prostatectomy or radiation therapy is often detected via rise in serum prostate-specific antigen (PSA) levels; however, PSA rise does not localize the disease. Distinguishing local versus distant recurrence guides whether to choose subsequent local versus systemic therapy. The purpose of this article is to review imaging for prostate cancer recurrence post local therapy. RECENT FINDINGS Among imaging modalities, multiparametric MRI (mpMRI) is commonly used to assess for local recurrence. New radiopharmaceuticals target prostate cancer cells and enable whole-body imaging. These tend to be more sensitive for lymph node metastases than MRI or computed tomography (CT) and for bone lesions than bone scan at lower PSA levels but can be limited for local prostate cancer recurrence. Given greater soft tissue contrast, similar criteria for lymph nodes, and greater sensitivity for prostate bone metastases, MRI is advantageous to CT. MRI of the whole body and mpMRI are now feasible within a reasonable time frame and complementary to PET imaging, enabling whole-body and pelvis-focused PET-MRI, which should be advantageous in the setting of recurrent prostate cancer. SUMMARY Hybrid PET-MRI with prostate cancer targeted radiopharmaceuticals and whole body with local multiparametric MRI can be complementary for detecting local and distant recurrence to guide treatment planning.
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Affiliation(s)
- Nikita Rednam
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
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14
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Padayachee J, Chaudhary S, Shim B, So J, Lim R, Raman S. Utilizing clinical, pathological and radiological information to guide postoperative radiotherapy in prostate cancer. Expert Rev Anticancer Ther 2023; 23:293-305. [PMID: 36795862 DOI: 10.1080/14737140.2023.2181795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION A detectable and rising PSA following radical prostatectomy is indicative of recurrent prostate cancer. Salvage radiotherapy (SRT) with/without androgen deprivation therapy represents the main treatment option for these patients and has been historically associated with a biochemical control rate of ~70%. To determine the optimal timing, diagnostic workup, radiotherapy dosefractionation, treatment volume, and use of systemic therapy, several informative studies have been conducted in the last decade. AREAS COVERED This review examines the recent evidence to guide radiotherapy decision making in the SRT setting. Key topics include adjuvant vs salvage RT, utilization of molecular imaging and genomic classifiers, length of androgen deprivation therapy, inclusion of elective pelvic volume, and emerging role for hypofractionation. EXPERT OPINION Recently reported trials, conducted in an era prior to the routine use of molecular imaging and genomic classifiers, have been pivotal in establishing the current standard of care for SRT in prostate cancer. However, decisions about radiation treatment and systemic therapy may be tailored based on available prognostic and predictive biomarkers. Data from contemporary clinical trials are awaited to define and establish individualized, biomarker-driven approaches for SRT.
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Affiliation(s)
- Jerusha Padayachee
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | - Simone Chaudhary
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, ON, Canada
| | - Brian Shim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jonathan So
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Remy Lim
- Mercy PET/CT Epsom, Auckland, New Zealand.,Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Srinivas Raman
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, ON, Canada
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15
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Kemble J, Kwon ED, Karnes RJ. Addressing the need for more therapeutic options in neuroendocrine prostate cancer. Expert Rev Anticancer Ther 2023; 23:177-185. [PMID: 36698089 DOI: 10.1080/14737140.2023.2173174] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Neuroendocrine prostate cancer (NEPC) is an aggressive form of prostate cancer frequently seen after prolonged treatment of castration resistant prostate cancer (CRPC). NEPC has become increasingly prevalent over the last 20 years, with a poor prognosis caused by a late diagnosis and limited treatment options. Recent advances in PET/CT imaging and targeted radioimmunotherapy are promising, but more research into additional treatment options is needed. AREAS COVERED The aim of this review is to analyze the current imaging and treatment options for NEPC, and to highlight future potential treatment strategies. A Pubmed search for 'Neuroendocrine Prostate Cancer' was performed and relevant articles were reviewed. EXPERT OPINION The recent FDA approval and success of 177 PSMA Lutetium in CRPC is promising, as 177 Lutetium could potentially be paired with a NEPC specific biomarker for targeted therapy. Recent laboratory studies pairing DLL3, which is overexpressed in NEPC, with 177 Lutetium and new PET agents have showed good efficacy in identifying and treating NEPC. The success of future development of NEPC therapies may depend on the availability of 177 Lutetium, as current supplies are limited. Further research into additional imaging and treatment options for NEPC is warranted.
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Affiliation(s)
- Jayson Kemble
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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16
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Alamiri J, Britton CJ, Ahmed ME, Andrews JR, Higa JL, Dundar A, Karnes RJ, Kwon E, Lowe VJ, Kendi AT, Bold MS, Pagliaro LC. Radiographic paradoxical response in metastatic castrate-resistant prostate cancer (mCRPC) managed with new generation anti-androgens: a retrospective analysis. Prostate 2022; 82:1483-1490. [PMID: 36089822 DOI: 10.1002/pros.24413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/11/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prostatic specific antigen (PSA) has well-recognized limitations as a marker for treatment response and disease progression. Post hoc analysis of the PREVAIL trial reported 24.5% of chemotherapy naïve metastatic castration-resistant prostate cancer (mCRPC) patients on enzalutamide had radiographic progression on conventional imaging with nonrising PSA. In this study, we sought to study the discordance of imaging with PSA kinetics in mCRPC patients on second generation anti-androgens (SGA) post-chemotherapy using combined conventional imaging, and new generation imaging in the form of C-11 choline positron emission tomography/computed tomography (C[11] choline PET/CT) scan. METHODS We retrospectively reviewed the medical records of 123 patients with mCRPC treated with SGA (Abiraterone or Enzalutamide) after docetaxel between 2016 and 2019. Patients underwent PSA testing, and C[11] choline PET/CT scan at baseline level before starting treatment with SGA, then every 3-6 months as part of their follow up evaluation. Loss of response to SGA was defined by increase in corrected maximum standardized uptake value (SUVmax) of pretreatment lesions on C-11 Choline PET/CT, and/or development of new lesions. Suspicious new lesions were confirmed by biopsy and/or conventional imaging. RESULTS We identified 123 mCRPC patients who received SGA (Abiraterone, n = 106; Enzalutamide, n = 17) after docetaxel. Median duration of therapy was 13.9 months (interquartile range: 8.75-21.14). Approximately 43% (n = 53) of subjects in this study exhibited an increase in choline avidity while on SGA. Of this group, 60.4% of patients experienced a parallel rise in PSA (Group-A), whereas 39.6% displayed a paradoxical response (PR) (Group-B), defined as increased choline avidity combined with stable or down-trending PSA. Median PSA at time of increase in choline avidity was 3.1 ng/ml for Group-A, and 1.3 ng/ml for Group-B (p = 0.0176). Median SUVmax was similar in both groups (4.9 for Group-A, 4.6 for Group-B; p = 0.6072). The median time for increase in choline avidity was 9.5 versus 3.9 months for Group-A versus Group-B, respectively (Log-Rank = 0.0063). CONCLUSION Nearly 40% of mCRPC patients placed on SGA post docetaxel chemotherapy will exhibit paradoxical responses to therapy, therefore, warranting close follow up with imaging. C-11 choline PET/CT imaging is a useful tool that can help in early predication of disease progression or treatment failure.
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Affiliation(s)
- Jamal Alamiri
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamed E Ahmed
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jack R Andrews
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julianna L Higa
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayca Dundar
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Eugene Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Val J Lowe
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayse T Kendi
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael S Bold
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lance C Pagliaro
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
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17
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Ulaner GA, Thomsen B, Bassett J, Torrey R, Cox C, Lin K, Patel T, Techasith T, Mauguen A, Rowe SP, Lindenberg L, Mena E, Choyke P, Yoshida J. 18F-DCFPyL PET/CT for Initially Diagnosed and Biochemically Recurrent Prostate Cancer: Prospective Trial with Pathologic Confirmation. Radiology 2022; 305:419-428. [PMID: 35852431 PMCID: PMC9619197 DOI: 10.1148/radiol.220218] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 08/26/2023]
Abstract
Background Prostate-specific membrane antigen (PSMA) PET is standard for newly diagnosed high-risk and biochemically recurrent (BCR) prostate cancer. Although studies suggest high specificity of 2-(3-{1-carboxy-5-[(6-[(18)F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (DCFPyL) for targeting PSMA, false-positive findings have been identified and most studies lack histologic confirmation of malignancy. Purpose To estimate the positive predictive value (PPV) of DCFPyL PET/CT by providing histopathologic proof for DCFPyL-avid lesions suspected of being distant metastases at initial diagnosis and recurrence in BCR prostate cancer. Materials and Methods In this prospective trial, men with newly diagnosed high-risk prostate cancer (sample 1) or BCR prostate cancer and negative findings at conventional CT and/or bone scanning (sample 2) were enrolled between January and December 2021. All men underwent DCFPyL PET/CT. Suspected distant metastases and/or recurrences were biopsied. PPV was calculated. Results A total of 92 men with newly diagnosed prostate cancer (median age, 70 years; IQR, 64-75 years) (sample 1) and 92 men with BCR prostate cancer (median age, 71 years; IQR, 66-75 years) (sample 2) were enrolled. In sample 1, 25 of the 92 men (27%) demonstrated DCFPyL-avid lesions suspicious for distant metastases. Biopsy was performed in 23 of the 25 men (92%), with 17 of the 23 (74%) biopsies positive for malignancy and six (26%) benign. Of the six benign biopsies, three were solitary rib foci and three were solitary pelvic bone foci. In sample 2, 57 of the 92 men (62%) demonstrated DCFPyL-avid lesions suspicious for recurrence. Biopsy was performed in 37 of the 57 men (65%), with 33 of the 37 (89%) biopsies positive for malignancy and four (11%) benign. Of the four benign biopsies, two were subcentimeter pelvic nodes and/or nodules, one was a rib, and one was a pelvic bone focus. Conclusion PET/CT with 2-(3-{1-carboxy-5-[(6-[(18)F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (DCFPyL) had a high biopsy-proven positive predictive value for distant metastases in newly diagnosed prostate cancer (74%) and for recurrence sites in men with biochemical recurrence (89%). However, there were DCFPyL-avid false-positive findings (particularly in ribs and pelvic bones). Solitary DCFPyL avidity in these locations should not be presumed as malignant. Biopsy may still be needed prior to therapy decisions. ClinicalTrials.gov registration no. NCT04700332 © RSNA, 2022 See also the editorial by Zukotynski and Kuo in this issue.
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Affiliation(s)
- Gary A. Ulaner
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Beth Thomsen
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Jeffrey Bassett
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Robert Torrey
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Craig Cox
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Kevin Lin
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Trushar Patel
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Tust Techasith
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Audrey Mauguen
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Steven P. Rowe
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Liza Lindenberg
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Esther Mena
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Peter Choyke
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
| | - Jeffrey Yoshida
- From the Departments of Molecular Imaging and Therapy (G.A.U., B.T.),
Urology (J.B., R.T., J.Y.), Radiation Oncology (C.C., K.L.), and Radiology
(T.P., T.T.), Hoag Family Cancer Institute, 16105 Sand Canyon Ave, Irvine, CA
92618; Departments of Radiology and Translational Genomics, University of
Southern California, Los Angeles, Calif (G.A.U.); Department of Epidemiology and
Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (A.M.); The
Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, Md (S.P.R.); and Molecular
Imaging Branch, National Cancer Institute, National Institutes of Health,
Bethesda, Md (L.L., E.M., P.C.)
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Simultaneous treatment of a pubovesical fistula and lymph node metastasis secondary to multimodal treatment for prostate cancer: Case report and review of the literature. Open Med (Wars) 2022; 17:1715-1723. [DOI: 10.1515/med-2022-0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/22/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
Abstract
Pubovesical fistula (PVF) is a rare complication of radical treatments for prostate cancer (PCa), especially when a multimodal approach is performed. We present a case of PVF with extensive communication between the bladder and the pubic bones, and lymph node metastases of PCa treated by cystectomy and salvage lymphadenectomy. We describe a case of a 65-year old male patient who, after radical prostatectomy and adjuvant radiation therapy, suffered from suprapubic and perineal pain, ambulation difficulties and recurrent urinary tract infections. Cystoscopy, cystography and contrast-enhanced magnetic resonance imaging diagnosed a PVF. Choline positron emission tomography/computed tomography scan demonstrated PCa lymph node metastases. After the failure of conservative treatment, open radical cystectomy with ureterocutaneostomy diversion and salvage lymphadenectomy were performed with resolution of symptoms. At 3-month follow-up, the pelvic and perineal pain was completely regressed and 1-year later the patient was still asymptomatic. This clinical case shows efficacy and safety of combined salvage lymphadenectomy and cystectomy with urinary diversion for the treatment of late PCa node metastasis and PVF.
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Rosar F, Hügle MJ, Ries M, Bartholomä M, Maus S, Fries P, Khreish F, Ezziddin S. Benefit of including CT urography in [68Ga]PSMA-11 PET/CT with low-dose CT: first results from a larger prostate cancer cohort analysis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:280-289. [PMID: 31992688 DOI: 10.23736/s1824-4785.20.03224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Accuracy of [68Ga]PSMA-11 PET/CT may be hampered by ureter accumulation, mimicking lymph node metastases depending on localization and configuration. The benefit of CT urography for differentiation of lymph node metastasis from urinary tract activity was evaluated in a "PET/CT with low-dose CT" setting. METHODS Retrospective analysis of PET/CT for primary staging, biochemical recurrence or local treatment planning in patients with prostate cancer. For CT urography (CTU), iodinated contrast agent was administered 10 minutes prior to image acquisition. All potential pathologic (peri)ureteral tracer uptake was assigned to excretory ureteral accumulation or pathological lesion. To assess additional provided benefit of CTU all foci were rated with an introduced scoring system (ranging from 0 pts: CTU not needed; up to 3 pts: no differentiation possible without CTU). Success of ureter contrasting was assessed by measurement of Hounsfield units. Besides benefit for reading urography-enhanced PET/CT, the possible impact on subsequent patient treatment was evaluated. RESULTS A number of N.=247 patients were included in this study. By CT urography, it was possible to identify each ureter on low-dose CT, with its major part contrasted. In 120/247 (48.6%) patients, urography increased the diagnostic confidence while providing substantial support for interpretation in 60 (24.3%) cases. In 42 (17.0%) patients, urography was clinically relevant (up-/downstaging) with potential impact on subsequent patient care. In 30 of these 42 cases (12.1% of all), discrepant treatment would have resulted from a misdiagnosed tracer accumulation without urography. CONCLUSIONS CT urography benefits the interpretation of [68Ga]-PSMA-11 PET/CT with low-dose CT and leads to discrepant patient treatment in a small but significant subset of patients (12% in our cohort). The implementation of CT urography into standard protocols of [68Ga]PSMA-11 PET/CT with low-dose CT is recommended.
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Affiliation(s)
- Florian Rosar
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany -
| | - Martin J Hügle
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Martin Ries
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Mark Bartholomä
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Stephan Maus
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Peter Fries
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - Fadi Khreish
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
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20
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Advanced Neuroimaging Approaches to Pediatric Brain Tumors. Cancers (Basel) 2022; 14:cancers14143401. [PMID: 35884462 PMCID: PMC9318188 DOI: 10.3390/cancers14143401] [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] [Received: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary After leukemias, brain tumors are the most common cancers in children, and early, accurate diagnosis is critical to improve patient outcomes. Beyond the conventional imaging methods of computed tomography (CT) and magnetic resonance imaging (MRI), advanced neuroimaging techniques capable of both structural and functional imaging are moving to the forefront to improve the early detection and differential diagnosis of tumors of the central nervous system. Here, we review recent developments in neuroimaging techniques for pediatric brain tumors. Abstract Central nervous system tumors are the most common pediatric solid tumors; they are also the most lethal. Unlike adults, childhood brain tumors are mostly primary in origin and differ in type, location and molecular signature. Tumor characteristics (incidence, location, and type) vary with age. Children present with a variety of symptoms, making early accurate diagnosis challenging. Neuroimaging is key in the initial diagnosis and monitoring of pediatric brain tumors. Conventional anatomic imaging approaches (computed tomography (CT) and magnetic resonance imaging (MRI)) are useful for tumor detection but have limited utility differentiating tumor types and grades. Advanced MRI techniques (diffusion-weighed imaging, diffusion tensor imaging, functional MRI, arterial spin labeling perfusion imaging, MR spectroscopy, and MR elastography) provide additional and improved structural and functional information. Combined with positron emission tomography (PET) and single-photon emission CT (SPECT), advanced techniques provide functional information on tumor metabolism and physiology through the use of radiotracer probes. Radiomics and radiogenomics offer promising insight into the prediction of tumor subtype, post-treatment response to treatment, and prognostication. In this paper, a brief review of pediatric brain cancers, by type, is provided with a comprehensive description of advanced imaging techniques including clinical applications that are currently utilized for the assessment and evaluation of pediatric brain tumors.
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21
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Synthesis and in vitro proof-of-concept studies on bispecific iron oxide magnetic nanoparticles targeting PSMA and GRP receptors for PET/MR imaging of prostate cancer. Int J Pharm 2022; 624:122008. [PMID: 35820513 DOI: 10.1016/j.ijpharm.2022.122008] [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: 11/27/2021] [Revised: 06/08/2022] [Accepted: 07/05/2022] [Indexed: 11/20/2022]
Abstract
Prostate cancer (PCa) is the most common malignancy worldwide in men. This is a proof-of-concept study describing the development of 68Ga-magnetic iron oxide nanoparticles (mNP) targeting prostate specific membrane antigen (PSMA) and gastrin releasing peptide (GRPR) receptors as potential tools for diagnosis of PCa with PET/MRI. Two pharmacophores targeting PSMA, 1, and GRPR, 2, were coupled to mNPs carrying -SH (mNP-S1/2) or -NH2 (mNP-N1/2) groups. The mNP-S1/2 and mNP-N1/2 were characterized for their size, zeta potential, structure, and efficiency of functionalization using dynamic light scattering (DLS), FT-IR and RP-HPLC. A direct 68Ga-labelling procedure was followed, where 68Ga-mNP-N1/2 proved superior to 68Ga-mNP-S1/2 regarding radiolabelling efficiency, and thus were further evaluated in vitro. Toxicity studies in PCa cells (LNCaP, PC-3) showed low toxicity, and minimal hemolysis of red blood cells. In vitro assays in cells expressing PSMA (LNCaP), and GRPR (PC-3), showed specific time-dependent binding (40 min to plateau), high avidity (PC-3: Kd = 28.27 nM, LNCaP: Kd = 11.49 nM) and high internalization rates for 68Ga-mNP-N1/2 in both cell lines.
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22
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Fernandes EFA, Wilbs J, Raavé R, Jacobsen CB, Toftelund H, Helleberg H, Boswinkel M, Heskamp S, Gustafsson MBF, Bjørnsdottir I. Comparison of the Tissue Distribution of a Long-Circulating Glucagon-like Peptide-1 Agonist Determined by Positron Emission Tomography and Quantitative Whole-Body Autoradiography. ACS Pharmacol Transl Sci 2022; 5:616-624. [DOI: 10.1021/acsptsci.2c00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Jonas Wilbs
- Global Research Technologies, Novo Nordisk A/S, Novo Nordisk Park 1, DK-2760 Måløv, Denmark
| | - Rene Raavé
- Radboudumc, Department of Medical Imaging − Nuclear Medicine, Radboud Institute for Molecular Life Sciences, 6500 HB Nijmegen, The Netherlands
| | - Christian Borch Jacobsen
- Isotope Chemistry, CMC Development, Novo Nordisk A/S, Novo Nordisk Park 1, DK-2760 Måløv, Denmark
| | - Hanne Toftelund
- Global Drug Discovery, Novo Nordisk A/S, Novo Nordisk Park 1, DK-2760 Måløv, Denmark
| | - Hans Helleberg
- Global Drug Discovery, Novo Nordisk A/S, Novo Nordisk Park 1, DK-2760 Måløv, Denmark
| | - Milou Boswinkel
- Radboudumc, Department of Medical Imaging − Nuclear Medicine, Radboud Institute for Molecular Life Sciences, 6500 HB Nijmegen, The Netherlands
| | - Sandra Heskamp
- Radboudumc, Department of Medical Imaging − Nuclear Medicine, Radboud Institute for Molecular Life Sciences, 6500 HB Nijmegen, The Netherlands
| | | | - Inga Bjørnsdottir
- Global Drug Discovery, Novo Nordisk A/S, Novo Nordisk Park 1, DK-2760 Måløv, Denmark
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23
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Where Do We Stand in the Management of Oligometastatic Prostate Cancer? A Comprehensive Review. Cancers (Basel) 2022; 14:cancers14082017. [PMID: 35454924 PMCID: PMC9029666 DOI: 10.3390/cancers14082017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/10/2022] [Accepted: 04/14/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Oligometastatic prostate cancer is an intermediate stage between localised and metastatic disease. Today, there are many advances in the diagnosis of this stage of the disease, with the appearance of new imaging techniques and treatments, thanks to the development of new modalities, both local and systemic therapies, the emergence of personalised medicine, and theragnostics. Abstract Oligometastatic prostate cancer (OMPC) is an intermediate state between localised disease and widespread metastases that includes a spectrum of disease biology and clinical behaviours. This narrative review will cover the current OMPC scenario. We conducted comprehensive English language literature research for original and review articles using the Medline database and grey literature through December 2021. OMPC is a unique clinical state with inherently more indolent tumour biology susceptible to multidisciplinary treatment (MDT). With the development of new imaging techniques, patients with OMPC are likely to be identified at an earlier stage, and the paradigm for treatment is shifting towards a more aggressive approach to treating potentially curable patients. Multimodal management is necessary to improve patient outcomes due to the combination of available therapies, such as local therapy of primary tumour, metastasis directed therapy or systemic therapy, to reduce tumour load and prevent further disease progression. Additional prospective data are needed to select patients most likely to benefit from a given therapeutic approach.
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Calatayud DG, Neophytou S, Nicodemou E, Giuffrida SG, Ge H, Pascu SI. Nano-Theranostics for the Sensing, Imaging and Therapy of Prostate Cancers. Front Chem 2022; 10:830133. [PMID: 35494646 PMCID: PMC9039169 DOI: 10.3389/fchem.2022.830133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/16/2022] [Indexed: 01/28/2023] Open
Abstract
We highlight hereby recent developments in the emerging field of theranostics, which encompasses the combination of therapeutics and diagnostics in a single entity aimed for an early-stage diagnosis, image-guided therapy as well as evaluation of therapeutic outcomes of relevance to prostate cancer (PCa). Prostate cancer is one of the most common malignancies in men and a frequent cause of male cancer death. As such, this overview is concerned with recent developments in imaging and sensing of relevance to prostate cancer diagnosis and therapeutic monitoring. A major advantage for the effective treatment of PCa is an early diagnosis that would provide information for an appropriate treatment. Several imaging techniques are being developed to diagnose and monitor different stages of cancer in general, and patient stratification is particularly relevant for PCa. Hybrid imaging techniques applicable for diagnosis combine complementary structural and morphological information to enhance resolution and sensitivity of imaging. The focus of this review is to sum up some of the most recent advances in the nanotechnological approaches to the sensing and treatment of prostate cancer (PCa). Targeted imaging using nanoparticles, radiotracers and biomarkers could result to a more specialised and personalised diagnosis and treatment of PCa. A myriad of reports has been published literature proposing methods to detect and treat PCa using nanoparticles but the number of techniques approved for clinical use is relatively small. Another facet of this report is on reviewing aspects of the role of functional nanoparticles in multimodality imaging therapy considering recent developments in simultaneous PET-MRI (Positron Emission Tomography-Magnetic Resonance Imaging) coupled with optical imaging in vitro and in vivo, whilst highlighting feasible case studies that hold promise for the next generation of dual modality medical imaging of PCa. It is envisaged that progress in the field of imaging and sensing domains, taken together, could benefit from the biomedical implementation of new synthetic platforms such as metal complexes and functional materials supported on organic molecular species, which can be conjugated to targeting biomolecules and encompass adaptable and versatile molecular architectures. Furthermore, we include hereby an overview of aspects of biosensing methods aimed to tackle PCa: prostate biomarkers such as Prostate Specific Antigen (PSA) have been incorporated into synthetic platforms and explored in the context of sensing and imaging applications in preclinical investigations for the early detection of PCa. Finally, some of the societal concerns around nanotechnology being used for the detection of PCa are considered and addressed together with the concerns about the toxicity of nanoparticles–these were aspects of recent lively debates that currently hamper the clinical advancements of nano-theranostics. The publications survey conducted for this review includes, to the best of our knowledge, some of the most recent relevant literature examples from the state-of-the-art. Highlighting these advances would be of interest to the biomedical research community aiming to advance the application of theranostics particularly in PCa diagnosis and treatment, but also to those interested in the development of new probes and methodologies for the simultaneous imaging and therapy monitoring employed for PCa targeting.
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Affiliation(s)
- David G. Calatayud
- Department of Chemistry, University of Bath, Bath, United Kingdom
- Department of Electroceramics, Instituto de Ceramica y Vidrio - CSIC, Madrid, Spain
- *Correspondence: Sofia I. Pascu, ; David G. Calatayud,
| | - Sotia Neophytou
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | - Eleni Nicodemou
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | | | - Haobo Ge
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | - Sofia I. Pascu
- Department of Chemistry, University of Bath, Bath, United Kingdom
- Centre of Therapeutic Innovations, University of Bath, Bath, United Kingdom
- *Correspondence: Sofia I. Pascu, ; David G. Calatayud,
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Terlizzi M, Limkin EJ, Moukasse Y, Blanchard P. Adjuvant or Salvage Radiation Therapy for Prostate Cancer after Prostatectomy: Current Status, Controversies and Perspectives. Cancers (Basel) 2022; 14:cancers14071688. [PMID: 35406460 PMCID: PMC8996903 DOI: 10.3390/cancers14071688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The management of patients with biochemical recurrence after prostatectomy has undergone significant changes in recent years. Currently, close monitoring of prostate-specific antigen (PSA) with early salvage radiotherapy (RT) in case of recurrence is the standard of care based on several randomized trials and a meta-analysis that has demonstrated its non-inferiority to adjuvant RT. Uncertainties remain regarding the management of patients at very high risk of recurrence, including appropriate selection criteria for adjuvant hormone therapy, and the role of imaging in refining the treatment strategy. This review explains this paradigm shift, raises points of controversy, and suggests ways to think about the future. Abstract Nearly one-third of the patients who undergo prostatectomy for prostate cancer have a biochemical recurrence (BCR) during follow-up. While several randomized trials have shown that adjuvant radiation therapy (aRT) improves biochemical control, this strategy has not been widely used because of the risk of toxicity and the fear of overtreating patients who would not have relapsed. In addition, the possibility of close PSA monitoring in the era of ultrasensitive assays enables to anticipate early salvage strategies (sRT). Three recent randomized trials and their meta-analysis have confirmed that aRT does not improve event-free survival compared to sRT, imposing the latter as the new standard of treatment. The addition of androgen deprivation therapy (ADT) to RT has been shown to improve biochemical control and metastasis-free survival, but the precise definition of to whom it should be proposed is still a matter of debate. The development of genomic tests or the use of artificial intelligence will allow more individualized treatment in the future. Therapeutic intensification with the combination of new-generation hormone therapy and RT is under study. Finally, the growing importance of metabolic imaging (PET/CT) due to its performance especially for low PSA levels will help in further personalizing management strategies.
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Targeting PSMA Revolutionizes the Role of Nuclear Medicine in Diagnosis and Treatment of Prostate Cancer. Cancers (Basel) 2022; 14:cancers14051169. [PMID: 35267481 PMCID: PMC8909566 DOI: 10.3390/cancers14051169] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Imaging plays a crucial role in the accurate staging of prostate cancer. Prostate-specific membrane antigen (PSMA) is overexpressed in prostate cancer cells, and targeting the PSMA protein for diagnostic purposes has become of great clinical value. Another valuable feature of PSMA is its opportunity to serve as a target for delivering radionuclide therapy to cancer cells. PSMA-ligands can be labeled with various radionuclides, such as alpha and beta-emitters. This review offers an overview of the literature on recent developments in nuclear medicine regarding PSMA in prostate cancer diagnostics and targeted radionuclide therapy. Abstract Targeting the prostate-specific membrane antigen (PSMA) protein has become of great clinical value in prostate cancer (PCa) care. PSMA positron emission tomography/computed tomography (PET/CT) is increasingly used in initial staging and restaging at biochemical recurrence in patients with PCa, where it has shown superior detection rates compared to previous imaging modalities. Apart from targeting PSMA for diagnostic purposes, there is a growing interest in developing ligands to target the PSMA-protein for radioligand therapy (RLT). PSMA-based RLT is a novel treatment that couples a PSMA-antibody to (alpha or beta-emitting) radionuclide, such as Lutetium-177 (177Lu), to deliver high radiation doses to tumor cells locally. Treatment with 177Lu-PSMA RLT has demonstrated a superior overall survival rate within randomized clinical trials as compared to routine clinical care in patients with metastatic castration-resistant prostate cancer (mCRPC). The current review provides an overview of the literature regarding recent developments in nuclear medicine related to PSMA-targeted PET imaging and Theranostics.
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PARP Inhibitors and Radiometabolic Approaches in Metastatic Castration-Resistant Prostate Cancer: What’s Now, What’s New, and What’s Coming? Cancers (Basel) 2022; 14:cancers14040907. [PMID: 35205654 PMCID: PMC8869833 DOI: 10.3390/cancers14040907] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Prostate cancer still represents an important health problem in men, considering its high frequency. Over the last decade, novel treatment options have emerged, leading to notable clinical benefits. These recent scientific acquisitions are creating the basis to widen the treatment scenario of this tumor, evolving from targeting the androgen receptor axis or the traditional chemotherapy approach. Abstract In recent years, the advances in the knowledge on the molecular characteristics of prostate cancer is allowing to explore novel treatment scenarios. Furthermore, technological discoveries are widening diagnostic and treatment weapons at the clinician disposal. Among these, great relevance is being gained by PARP inhibitors and radiometabolic approaches. The result is that DNA repair genes need to be altered in a high percentage of patients with metastatic prostate cancer, making these patients optimal candidates for PARP inhibitors. These compounds have already been proved to be active in pretreated patients and are currently being investigated in other settings. Radiometabolic approaches combine specific prostate cancer cell ligands to radioactive particles, thus allowing to deliver cytotoxic radiations in cancer cells. Among these, radium-223 and lutetium-177 have shown promising activity in metastatic pretreated prostate cancer patients and further studies are ongoing to expand the applications of this therapeutic approach. In addition, nuclear medicine techniques also have an important diagnostic role in prostate cancer. Herein, we report the state of the art on the knowledge on PARP inhibitors and radiometabolic approaches in advanced prostate cancer and present ongoing clinical trials that will hopefully expand these two treatment fields.
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Maitre P, Sood S, Pathare P, Krishnatry R, Agarwal A, Rangarajan V, Murthy V. Timing of Ga68-PSMA PETCT and patterns of recurrence after prostate radiotherapy: Implications for potential salvage. Radiother Oncol 2022; 169:71-76. [DOI: 10.1016/j.radonc.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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Cegla P, Wojewódzka M, Gorczewska I, Chalewska W, Łapińska G, Ochman P, Sackiewicz A, Dedecjus M. Identification of the Optimal Cut-Off Value of PSA for Assessing Severity of Disease in [68Ga]Ga-PSMA-11 PET/CT Study in Prostate Cancer Patients after Radical Prostatectomy. Diagnostics (Basel) 2022; 12:diagnostics12020349. [PMID: 35204440 PMCID: PMC8871181 DOI: 10.3390/diagnostics12020349] [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] [Received: 12/14/2021] [Revised: 01/22/2022] [Accepted: 01/27/2022] [Indexed: 12/24/2022] Open
Abstract
Objective: The objective of this study was to identify the optimal cut-off value of prostate specific antigen (PSA) to assess the extent of the disease in [68Ga]Ga-PSMA-11 PET/CT study in patients after radical prostatectomy. Materials and Methods: Retrospective analysis was performed on a group of 215 patients who underwent a [68Ga]Ga-PSMA-11 PET/CT examination because of suspected recurrence after radical prostatectomy. Patients were divided into four groups: 1, no active lesions suggesting recurrence (n = 92); 2, suspected isolated local recurrence (n = 19); 3, oligometastatic disease (n = 82); and 4, polymetastatic disease (n = 22). Results: In group 1, the mean PSA level was 0.962 ng/mL (median: 0.376; min: 0.004; max: 25 ng/mL); in group 2, it was 4.970 ng/mL (median 1.320; min: 0.003; max: 40.350 ng/mL); in group 3, it was 2.802 ng/mL (median: 1.270; min: 0.020; max: 59.670 ng/mL); and in group 4, it was 4.997 ng/mL (median: 3.795; min: 0.007; max 21.110 ng/mL). Statistically significant differences were shown in PSA levels when comparing groups 1 and 2 (p = 0.0025) and groups 3 and 4 (p = 0.0474). The PSA cut-off point for discriminating groups 1 and 2 was 0.831 (sensitivity: 0.684; specificity: 0.772; area under the curve (AUC): 0.775), and for groups 3 and 4, it was 2.51 (sensitivity: 0.682; specificity: 0.780; AUC: 0.720). Conclusions: Our preliminary data suggested that the PSA level has an essential influence on determining the extent of disease in a [68Ga]Ga-PSMA-11 PET/CT study in patients after radical prostatectomy. Identification of the optimal cut-off values for the oligo- and polymetastatic diseases might be helpful in stratifying these patients.
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Affiliation(s)
- Paulina Cegla
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
- Correspondence:
| | - Marta Wojewódzka
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Izabela Gorczewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland;
| | - Wioletta Chalewska
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Grażyna Łapińska
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Paweł Ochman
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Agata Sackiewicz
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (W.C.); (G.Ł.); (P.O.); (A.S.); (M.D.)
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Damuka N, Dodda M, Bansode AH, Sai KKS. PET Use in Cancer Diagnosis, Treatment, and Prognosis. Methods Mol Biol 2022; 2413:23-35. [PMID: 35044651 PMCID: PMC9136679 DOI: 10.1007/978-1-0716-1896-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tumorigenesis is a multistep process marked by variations in numerous metabolic pathways that affect cellular architectures and functions. Cancer cells reprogram their energy metabolism to enable several basic molecular functions, including membrane biosynthesis, receptor regulations, bioenergetics, and redox stress. In recent years, cancer diagnosis and treatment strategies have targeted these specific metabolic changes and the tumor's interactions with its microenvironment. Positron emission tomography (PET) captures all molecular alterations leading to abnormal function and cancer progression. As a result, the development of PET radiotracers increasingly focuses on irregular biological pathways or cells that overexpress receptors that have the potential to function as biomarkers for early diagnosis and treatment measurements as well as research. This chapter reviews both established and evolving PET radiotracers used to image tumor biology. We have also included a few advantages and disadvantages of the routinely used PET radiotracers in cancer imaging.
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Affiliation(s)
- Naresh Damuka
- Department of Radiology, Wake Forest School of Medicine, Winston Salem, NC 27157
| | - Meghana Dodda
- Department of Radiology, Wake Forest School of Medicine, Winston Salem, NC 27157
| | - Avinash H Bansode
- Department of Radiology, Wake Forest School of Medicine, Winston Salem, NC 27157
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Assessment and Management of Cognitive Function in Patients with Prostate Cancer Treated with Second-Generation Androgen Receptor Pathway Inhibitors. CNS Drugs 2022; 36:419-449. [PMID: 35522374 PMCID: PMC9073450 DOI: 10.1007/s40263-022-00913-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
Abstract
Preservation of cognitive function is an important outcome in oncology. Optimal patient management requires an understanding of cognitive effects of the disease and its treatment and an efficacious approach to assessment and management of cognitive dysfunction, including selection of treatments to minimize the risk of cognitive impairment. Awareness is increasing of the potentially detrimental effects of cancer-related cognitive dysfunction on functional independence and quality of life. Prostate cancer occurs most often in older men, who are more likely to develop cognitive dysfunction than younger individuals; this population may be particularly vulnerable to treatment-related cognitive disorders. Prompt identification of treatment-induced cognitive dysfunction is a crucial aspect of effective cancer management. We review the potential etiologies of cognitive decline in patients with prostate cancer, including the potential role of androgen receptor pathway inhibitors; commonly used tools for assessing cognitive function validated in metastatic castration-resistant prostate cancer and adopted in non-metastatic castration-resistant prostate cancer trials; and strategies for management of cognitive symptoms. Many methods are currently used to assess cognitive function. The prevalence and severity of cognitive dysfunction vary according to the instruments and criteria applied. Consensus on the definition of cognitive dysfunction and on the most appropriate approaches to quantify its extent and progression in patients treated for prostate cancer is lacking. Evidence-based guidance on the appropriate tools and time to assess cognitive function in patients with prostate cancer is required.
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Comparing the diagnostic performance of radiotracers in prostate cancer biochemical recurrence: a systematic review and meta-analysis. Eur Radiol 2022; 32:7374-7385. [PMID: 35486169 PMCID: PMC9668945 DOI: 10.1007/s00330-022-08802-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/27/2022] [Accepted: 04/04/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To systematically assess the early detection rate of biochemical prostate cancer recurrence using choline, fluciclovine, and PSMA. METHODS Under the guidance of the Preferred Reporting Items for Systematic reviews and Meta-Analysis Diagnostic Test Accuracy guidelines, literature that assessed the detection rates (DRs) of choline, fluciclovine, and PSMA in prostate cancer biochemical recurrence was searched in PubMed and EMBASE databases for our systematic review from 2012 to July 15, 2021. In addition, the PSA-stratified performance of detection positivity was obtained to assess the DRs for various methods, including fluciclovine, PSMA, or choline PET/CT, with respect to biochemical recurrence based on different PSA levels. RESULTS In total, 64 studies involving 11,173 patients met the inclusion criteria. Of the studies, 12, 7, and 48 focused on choline, fluciclovine, and PSMA, respectively. The pooled DRs were 24%, 37%, and 44%, respectively, for a PSA level less than 0.5 ng/mL (p < 0.001); 36%, 44%, and 60% for a PSA level of 0.5-0.99 ng/mL (p < 0.001); and 50%, 61%, and 80% for a PSA level of 1.0-1.99 ng/mL (p < 0.001). The DR with 18F-labeled PSMA was higher than that with 68Ga-labeled PSMA, and the DR was 58%, 72%, and 88% for PSA levels < 0.5 ng/mL, 0.5-0.9 ng/mL, and 1.0-1.99 ng/mL, respectively. CONCLUSION The DRs of PSMA-radiotracers were greater than those of choline-radiotracers and fluciclovine-radiotracers at the patient level. 18F-labeled PSMA achieved a higher DR than 68Ga-labeled PSMA. KEY POINTS • The DRs of PSMA-radiotracers were greater than those of choline-radiotracers and fluciclovine-radiotracers at the patient level. • 18F-labeled PSMA achieved a higher DR than 68Ga-labeled PSMA.
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Zhang H, Orme JJ, Abraha F, Stish BJ, Lowe VJ, Lucien F, Tryggestad EJ, Bold MS, Pagliaro LC, Choo CR, Brinkmann DH, Iott MJ, Davis BJ, Fernando Quevedo J, Harmsen WS, Costello BA, Johnson GB, Nathan MA, Olivier KR, Pisansky TM, Kwon ED, Dong H, Park SS. Phase II Evaluation of Stereotactic Ablative Radiotherapy (SABR) and Immunity in 11C-Choline-PET/CT-Identified Oligometastatic Castration-Resistant Prostate Cancer. Clin Cancer Res 2021; 27:6376-6383. [PMID: 34593526 PMCID: PMC8639778 DOI: 10.1158/1078-0432.ccr-21-2510] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/23/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Outcomes for resistant metastatic castration-resistant prostate cancer (CRPC) are poor. Stereotactic ablative radiotherapy (SABR) induces antitumor immunity in clinical and preclinical studies, but immunologic biomarkers are lacking. PATIENTS AND METHODS Eighty-nine patients with oligometastatic CRPC were identified by 11C-Choline-PET (Choline-PET) from August 2016 to December 2019 and treated with SABR. Prespecified coprimary endpoints were 2-year overall survival (OS) and PSA progression. Secondary endpoints included 2-year SABR-treated local failure and 6-month adverse events. Correlative studies included peripheral blood T-cell subpopulations before and after SABR. RESULTS 128 lesions in 89 patients were included in this analysis. Median OS was 29.3 months, and 1- and 2-year OS were 96% and 80%, respectively. PSA PFS was 40% at 1 year and 21% at 2 years. Local PFS was 84.4% and 75.3% at 1 and 2 years, respectively, and no grade ≥3 AEs were observed. Baseline high levels of tumor-reactive T cells (TTR; CD8+CD11ahigh) predicted superior local, PSA, and distant PFS. Baseline high levels of effector memory T cells (TEM; CCR7-CD45RA-) were associated with improved PSA PFS. An increase in TTR at day 14 from baseline was associated with superior OS. CONCLUSIONS This is the first comprehensive effector T-cell immunophenotype analysis in a phase II trial before and after SABR in CRPC. Results are favorable and support the incorporation of immune-based markers in the design of future randomized trials in patients with oligometastatic CRPC treated with SABR.
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Affiliation(s)
- Henan Zhang
- Departments of Urology and Immunology, Mayo Clinic, Rochester, MN
| | - Jacob J. Orme
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Feven Abraha
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - B. J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Val J. Lowe
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN
| | - Fabrice Lucien
- Departments of Urology and Immunology, Mayo Clinic, Rochester, MN
| | | | - Michael S. Bold
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN
| | | | - C. Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - Matthew J. Iott
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Brian J. Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - William S. Harmsen
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Geoffrey B. Johnson
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN
| | - Mark A. Nathan
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Eugene D. Kwon
- Departments of Urology and Immunology, Mayo Clinic, Rochester, MN
| | - Haidong Dong
- Departments of Urology and Immunology, Mayo Clinic, Rochester, MN
| | - Sean S. Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Chen C, Margolis DJ. Prostate-Specific Membrane Antigen (PSMA) PET: A Counterpart to Prostate MRI. Semin Roentgenol 2021; 56:376-383. [PMID: 34688340 DOI: 10.1053/j.ro.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Christine Chen
- Department of Radiology, Weill Cornell Medical College: Weill Cornell Medicine, 1300 York Ave, New York, NY 10065.
| | - Daniel J Margolis
- Department of Radiology, Weill Cornell Medical College: Weill Cornell Medicine, 1300 York Ave, New York, NY 10065
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Long-Lasting Palliation of Bone Oligometastatic Prostate Cancer After Repeated Stereotactic Body Radiotherapy. Ochsner J 2021; 21:301-305. [PMID: 34566514 PMCID: PMC8442208 DOI: 10.31486/toj.20.0132] [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] [Indexed: 11/08/2022] Open
Abstract
Background: Oligometastatic disease has emerged as a distinct clinical state, with a tumor burden intermediate between localized and extensive systemic disease. Oligometastatic prostate cancer has generally been classified as ≤3 metastases in bone or lymph nodes only. Improvements in diagnostic modalities such as functional imaging allow a greater frequency of oligometastases diagnosis. Selected bone oligometastatic prostate cancer patients can be treated with metastasis-directed stereotactic body radiotherapy (SBRT) rather than androgen deprivation therapy (ADT). We describe a case representative of this scenario. Case Report: A 72-year-old male underwent surgery and salvage radiotherapy for a Gleason score 7 (3+4) adenocarcinoma confined in the prostate but with microscopic-positive surgical margins. Eight months after the end of radiotherapy, bone metastasis was diagnosed and treated with SBRT only because the patient refused ADT. In the subsequent 10 years, 6 more courses of SBRT were administered for new bone oligometastases encountered during follow-up. Neither local recurrence nor toxicity was observed after SBRT treatments. The patient, who is now 83 years old, has a Karnofsky Performance Status score of 90% and has preserved a satisfactory potentia coeundi. Conclusion: SBRT is a promising treatment for patients with bone oligometastatic prostate cancer, providing a high control rate within the irradiated volume and low toxicity. The ability to administer consecutive SBRT courses when new bone oligometastases are encountered in other sites can delay initiation of ADT. This case report reflects emerging trends for bone oligometastases treatment with metastasis-directed radiotherapy.
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36
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Moradi F, Farolfi A, Fanti S, Iagaru A. Prostate cancer: Molecular imaging and MRI. Eur J Radiol 2021; 143:109893. [PMID: 34391061 DOI: 10.1016/j.ejrad.2021.109893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
The role of molecular imaging in initial evaluation of men with presumed or established diagnosis of prostate cancer and work up of biochemical recurrence and metastatic disease is rapidly evolving due to superior diagnostic performance compared to anatomic imaging. However, variable tumor biology and expression of transmembrane proteins or metabolic alterations poses a challenge. We review the evidence and controversies with emphasis on emerging PET radiopharmaceuticals and experience on clinical utility of PET/CT and PET/MRI in diagnosis and management of prostate cancer.
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Affiliation(s)
- Farshad Moradi
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA.
| | - Andrea Farolfi
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA
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37
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Alvarez-Maestro M, Gomez Rivas J, Moschini M. Surgery for oligometastatic prostate cancer: Where are we going? Actas Urol Esp 2021; 45:479-480. [PMID: 34330693 DOI: 10.1016/j.acuroe.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
- M Alvarez-Maestro
- Departamento de Urología, Hospital Universitario La Paz, Madrid, Spain.
| | - J Gomez Rivas
- Servicio de Urología, Hospital Clínico de San Carlos, Madrid, Spain
| | - M Moschini
- Departamento de Urología, Luzerner Kantonsspital, Luzern, Switzerland
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38
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Cistaro A, Albano D, Alongi P, Laudicella R, Pizzuto DA, Formica G, Romagnolo C, Stracuzzi F, Frantellizzi V, Piccardo A, Quartuccio N. The Role of PET in Supratentorial and Infratentorial Pediatric Brain Tumors. Curr Oncol 2021; 28:2481-2495. [PMID: 34287265 PMCID: PMC8293135 DOI: 10.3390/curroncol28040226] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This review aims to provide a summary of the clinical indications and limitations of PET imaging with different radiotracers, including 18F-fluorodeoxyglucose (18F-FDG) and other radiopharmaceuticals, in pediatric neuro-oncology, discussing both supratentorial and infratentorial tumors, based on recent literature (from 2010 to present). METHODS A literature search of the PubMed/MEDLINE database was carried out searching for articles on the use of PET in pediatric brain tumors. The search was updated until December 2020 and limited to original studies published in English after 1 January 2010. RESULTS 18F-FDG PET continues to be successfully employed in different settings in pediatric neuro-oncology, including diagnosis, grading and delineation of the target for stereotactic biopsy, estimation of prognosis, evaluation of recurrence, treatment planning and assessment of treatment response. Nevertheless, non-18F-FDG tracers, especially amino acid analogues seem to show a better performance in each clinical setting. CONCLUSIONS PET imaging adds important information in the diagnostic work-up of pediatric brain tumors. International or national multicentric studies are encouraged in order to collect larger amount of data.
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Affiliation(s)
- Angelina Cistaro
- Nuclear Medicine Department, Ospedali Galliera, 16128 Genova, Italy; (A.C.); (A.P.)
- AIMN Pediatric Study Group, 20159 Milan, Italy;
| | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, 25123 Brescia, Italy;
| | - Pierpaolo Alongi
- Unit of Nuclear Medicine, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy
- Correspondence:
| | - Riccardo Laudicella
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, A.O.U. Policlinico G. Martino, University of Messina, 98125 Messina, Italy; (R.L.); (G.F.); (F.S.)
| | | | - Giuseppe Formica
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, A.O.U. Policlinico G. Martino, University of Messina, 98125 Messina, Italy; (R.L.); (G.F.); (F.S.)
| | - Cinzia Romagnolo
- Nuclear Medicine Unit, Ospedali Riuniti, Torrette di Ancona, 60126 Ancona, Italy;
| | - Federica Stracuzzi
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, A.O.U. Policlinico G. Martino, University of Messina, 98125 Messina, Italy; (R.L.); (G.F.); (F.S.)
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, 00161 Rome, Italy;
| | - Arnoldo Piccardo
- Nuclear Medicine Department, Ospedali Galliera, 16128 Genova, Italy; (A.C.); (A.P.)
- AIMN Pediatric Study Group, 20159 Milan, Italy;
| | - Natale Quartuccio
- AIMN Pediatric Study Group, 20159 Milan, Italy;
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy
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Pirasteh A, Lovrec P, Pedrosa I. Imaging and its Impact on Defining the Oligometastatic State. Semin Radiat Oncol 2021; 31:186-199. [PMID: 34090645 DOI: 10.1016/j.semradonc.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Successful treatment of oligometastatic disease (OMD) is facilitated through timely detection and localization of disease, both at the time of initial diagnosis (synchronous OMD) and following the initial therapy (metachronous OMD). Hence, imaging plays an indispensable role in management of patients with OMD. However, the challenges and complexities of OMD management are also reflected in the imaging of this entity. While innovations and advances in imaging technology have made a tremendous impact in disease detection and management, there remain substantial and unaddressed challenges for earlier and more accurate establishment of OMD state. This review will provide an overview of the available imaging modalities and their inherent strengths and weaknesses, with a focus on their role and potential in detection and evaluation of OMD in different organ systems. Furthermore, we will review the role of imaging in evaluation of OMD for malignancies of various primary organs, such as the lung, prostate, colon/rectum, breast, kidney, as well as neuroendocrine tumors and gynecologic malignancies. We aim to provide a practical overview about the utilization of imaging for clinicians who play a role in the care of those with, or at risk for OMD.
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Affiliation(s)
- Ali Pirasteh
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, WI
| | - Petra Lovrec
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - Ivan Pedrosa
- Departments of Radiology, Urology, and Advanced Imaging Research Center. University of Texas Southwestern, Dallas, TX.
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Wang YF, Tadimalla S, Hayden AJ, Holloway L, Haworth A. Artificial intelligence and imaging biomarkers for prostate radiation therapy during and after treatment. J Med Imaging Radiat Oncol 2021; 65:612-626. [PMID: 34060219 DOI: 10.1111/1754-9485.13242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/18/2021] [Accepted: 05/02/2021] [Indexed: 12/15/2022]
Abstract
Magnetic resonance imaging (MRI) is increasingly used in the management of prostate cancer (PCa). Quantitative MRI (qMRI) parameters, derived from multi-parametric MRI, provide indirect measures of tumour characteristics such as cellularity, angiogenesis and hypoxia. Using Artificial Intelligence (AI), relevant information and patterns can be efficiently identified in these complex data to develop quantitative imaging biomarkers (QIBs) of tumour function and biology. Such QIBs have already demonstrated potential in the diagnosis and staging of PCa. In this review, we explore the role of these QIBs in monitoring treatment response during and after PCa radiotherapy (RT). Recurrence of PCa after RT is not uncommon, and early detection prior to development of metastases provides an opportunity for salvage treatments with curative intent. However, the current method of monitoring treatment response using prostate-specific antigen levels lacks specificity. QIBs, derived from qMRI and developed using AI techniques, can be used to monitor biological changes post-RT providing the potential for accurate and early diagnosis of recurrent disease.
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Affiliation(s)
- Yu-Feng Wang
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sirisha Tadimalla
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Wentworthville, New South Wales, Australia
- Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Lois Holloway
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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Ahmed ME, Phillips RM, Sharma V, Davis BJ, Karnes RJ. Oligometastatic prostatic cancer recurrence: role of salvage lymph node dissection (sLND) and radiation therapy-stereotactic body radiation therapy (RT-SBRT). Curr Opin Urol 2021; 31:199-205. [PMID: 33742974 DOI: 10.1097/mou.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Metastases directed therapy (MDT) is an increasingly utilized modality in patients with oligometastatic prostate cancer (OMPC) recurrence. The purpose of our review is to discuss the recent literature on the safety and oncologic outcomes of this treatment approach. RECENT FINDINGS Metastases directed therapy, in particular, stereotactic body radiation therapy (SBRT) and salvage lymph node dissection (sLND), has shown promising efficacy in patients with OMPC. Many case series report favorable outcomes with MDT as compared to hormonal deprivation therapy alone or surveillance. Of the few case series investigating the use of MDT as part of a multimodality approach in castrate-resistant OMPC, more favorable outcomes in comparison to the use of systemic treatment alone are reported. SUMMARY With the recent advances in imaging techniques, particularly molecular imaging, management of OMPC has progressed rapidly in the last few years. The feasibility and benefits of MDT in OMPC have been demonstrated in prospective and retrospective series. Further prospective studies investigating the role of MDT to define optimal patient subgroups and management strategies are warranted.
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Affiliation(s)
| | - Ryan M Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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42
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Breen WG, Stish BJ, Harmsen WS, Froemming AT, Mynderse LA, Choo CR, Davis BJ, Pisansky TM. The prognostic value, sensitivity, and specificity of multiparametric magnetic resonance imaging before salvage radiotherapy for prostate cancer. Radiother Oncol 2021; 161:9-15. [PMID: 34023327 DOI: 10.1016/j.radonc.2021.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/27/2021] [Accepted: 05/16/2021] [Indexed: 12/12/2022]
Abstract
AIM To determine the operational characteristics of pelvic magnetic resonance imaging (MRI) prior to salvage radiation therapy (SRT) for biochemically recurrent prostate cancer following radical prostatectomy. METHODS AND MATERIALS We reviewed the medical records of 386 patients who underwent MRI prior to SRT. We assessed associations of pre-SRT MRI findings with biochemical recurrence (BCR), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and salvage androgen deprivation therapy (ADT) use following SRT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI for detecting local recurrence were also calculated. RESULTS Pre-SRT MRI was positive for local recurrence in 216 patients (56%), indeterminate in 46 (12%), and negative in 124 (32%). On univariate analysis, BCR following SRT was significantly less likely for patients with positive (HR: 0.58, 95% CI: 0.42-0.8) or indeterminate (HR: 0.6: 0.36-1) MRI findings, compared to patients with negative imaging (p = 0.003). These associations remained significant on multivariate analysis (p < 0.05) and across pre-SRT PSA groups. For the entire cohort, the sensitivity of MRI for local recurrence was 61.0% (53.5-68.1%), specificity 60.0% (44.3-73.0%), PPV 86.1% (78.9-91.5%) and NPV 27.6% (19.0-37.5%). Sensitivity of MRI was better in men with higher pre-SRT PSA (80.0% for PSA > 1.0), and specificity was improved with lower pre-SRT PSA (73.9% for PSA 0.1-0.5). CONCLUSIONS Positive or indeterminate MRI findings prior to SRT were associated with improved biochemical control following SRT, across PSA levels. The sensitivity and specificity of MRI for local recurrence were 61% and 58.7%, respectively.
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Affiliation(s)
- William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA.
| | - William S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | | | | | - C Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
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43
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Alvarez-Maestro M, Gomez Rivas J, Moschini M. Surgery for oligometastatic prostate cancer: Where are we going? Actas Urol Esp 2021. [PMID: 34023152 DOI: 10.1016/j.acuro.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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44
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Chaudhari AJ, Badawi RD. Application-specific nuclear medical in vivoimaging devices. Phys Med Biol 2021; 66. [PMID: 33770765 DOI: 10.1088/1361-6560/abf275] [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: 11/05/2019] [Accepted: 03/26/2021] [Indexed: 11/11/2022]
Abstract
Nuclear medical imaging devices, such as those enabling photon emission imaging (gamma camera, single photon emission computed tomography, or positron emission imaging), that are typically used in today's clinics are optimized for assessing large portions of the human body, and are classified as whole-body imaging systems. These systems have known limitations for organ imaging, therefore application-specific devices have been designed, constructed and evaluated. These devices, given their compact nature and superior technical characteristics, such as their higher detection sensitivity and spatial resolution for organ imaging compared to whole-body imaging systems, have shown promise for niche applications. Several of these devices have further been integrated with complementary anatomical imaging devices. The objectives of this review article are to (1) provide an overview of such application-specific nuclear imaging devices that were developed over the past two decades (in the twenty-first century), with emphasis on brain, cardiac, breast, and prostate imaging; and (2) discuss the rationale, advantages and challenges associated with the translation of these devices for routine clinical imaging. Finally, a perspective on the future prospects for application-specific devices is provided, which is that sustained effort is required both to overcome design limitations which impact their utility (where these exist) and to collect the data required to define their clinical value.
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Affiliation(s)
- Abhijit J Chaudhari
- Department of Radiology, University of California Davis, Sacramento, CA 95817, United States of America.,Center for Molecular and Genomic Imaging, University of California Davis, Davis, CA 95616, United States of America
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis, Sacramento, CA 95817, United States of America.,Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, United States of America
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45
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Ruigrok EAM, van Vliet N, Dalm SU, de Blois E, van Gent DC, Haeck J, de Ridder C, Stuurman D, Konijnenberg MW, van Weerden WM, de Jong M, Nonnekens J. Extensive preclinical evaluation of lutetium-177-labeled PSMA-specific tracers for prostate cancer radionuclide therapy. Eur J Nucl Med Mol Imaging 2021; 48:1339-1350. [PMID: 33094433 PMCID: PMC8113296 DOI: 10.1007/s00259-020-05057-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/24/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Various radiolabeled prostate-specific membrane antigen (PSMA)-targeting tracers are clinically applied for prostate cancer (PCa) imaging and targeted radionuclide therapy. The PSMA binding affinities, biodistribution, and DNA-damaging capacities of these radiotracers have not yet been compared in detail. A major concern of PSMA-targeting radiotracers is the toxicity in other PSMA-expressing organs, such as the salivary glands, thus demanding careful evaluation of the most optimal and safest radiotracer. In this extensive preclinical study, we evaluated the clinically applied PSMA-targeting small molecule inhibitors DOTA-PSMA-617 (PSMA-617) and DOTAGA-PSMA-I&T (PSMA-I&T) and the PSMA nanobody DOTA-JVZ-007 (JVZ-007) using PSMA-expressing cell lines, a unique set of PCa patient-derived xenografts (PDX) and healthy human tissues. METHODS AND RESULTS In vitro displacement studies on PSMA-expressing cells and cryosections of a PSMA-positive PDX revealed high and specific binding affinity for all three tracers labeled with lutetium-177 with IC50 values in the nanomolar range. Interestingly, [177Lu]Lu-JVZ-007 could not be displaced by PSMA-617 or PSMA-I&T, suggesting that this tracer targets an alternative binding site. Autoradiography assays on cryosections of human salivary and renal tissues revealed [177Lu]Lu-PSMA-617 to have the lowest binding to these healthy organs compared with [177Lu]Lu-PSMA-I&T. In vivo biodistribution assays confirmed the in vitro results with comparable tumor uptake of [177Lu]Lu-PSMA-617 and [177Lu]Lu-PSMA-I&T at all timepoints, resulting in induction of similar levels of DNA double-strand breaks in the tumors. However, [177Lu]Lu-PSMA-I&T demonstrated approximately 40× higher renal uptake at 4 and 8 h post injection resulting in an unfavorable tumor-to-kidney ratio. CONCLUSION [177Lu]Lu-PSMA-617 has the most favorable biodistribution in mice as well as more favorable binding characteristics in vitro in PSMA-positive cells and human kidney and salivary gland specimens compared with [177Lu]Lu-PSMA-I&T and [177Lu]Lu-JVZ-007. Based on our preclinical evaluation, [177Lu]Lu-PSMA-617 is the best performing tracer to be taken further into clinical evaluation for PSMA-targeted radiotherapeutic development although with careful evaluation of the tracer binding to PSMA-expressing organs.
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Affiliation(s)
- Eline A M Ruigrok
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Experimental Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Nicole van Vliet
- Department of Molecular Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Simone U Dalm
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Erik de Blois
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dik C van Gent
- Department of Molecular Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Joost Haeck
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Corrina de Ridder
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Experimental Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Debra Stuurman
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Experimental Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Mark W Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Marion de Jong
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Julie Nonnekens
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
- Department of Molecular Genetics, Erasmus MC, Rotterdam, The Netherlands.
- Oncode Institute, Erasmus MC, Rotterdam, The Netherlands.
- Erasmus MC, Room Ee757R, PO box 2040, 3000, CA, Rotterdam, The Netherlands.
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Ciappuccini R, Licaj I, Lasne-Cardon A, Babin E, de Raucourt D, Blanchard D, Bastit V, Saguet-Rysanek V, Lequesne J, Peyronnet D, Grellard JM, Clarisse B, Bardet S. 18F-Fluorocholine Positron Emission Tomography/Computed Tomography is a Highly Sensitive but Poorly Specific Tool for Identifying Malignancy in Thyroid Nodules with Indeterminate Cytology: The Chocolate Study. Thyroid 2021; 31:800-809. [PMID: 33183159 PMCID: PMC8110014 DOI: 10.1089/thy.2020.0555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Refining the risk of malignancy in patients presenting with thyroid nodules with indeterminate cytology (IC) is a critical challenge. We investigated the performances of 18F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) to predict malignancy. Methods: Between May 2016 and March 2019, 107 patients presenting with a thyroid nodule ≥15 mm with IC and eligible for surgery were included in this prospective study. Head-and-neck PET/CT acquisitions were performed 20 and 60 minutes after injection of 1.5 MBq/kg of FCH. PET/CT acquisition was scored positive when maximal standardized uptake value in the IC nodule was higher than in the thyroid background. Pathology was the gold standard for diagnosis. Results: At pathology, 19 (18%) nodules were malignant, 87 were benign, and one was a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Sensitivity, specificity, accuracy, positive-predictive value (PPV), and negative-predictive value (NPV) of FCH PET/CT in detecting cancer or NIFTP were 90%, 50%, 55%, 29%, and 96% at 20 minutes and 85%, 49%, 67%, 28%, and 94% at 60 minutes, respectively. Higher specificity (58% vs. 33%, p = 0.01) was observed in nononcocytic (n = 72) than in oncocytic IC nodules (n = 35). The pre-PET/CT probability of cancer or NIFTP in Bethesda III-IV nodules was 11% and the post-PET/CT probability was 19% in PET-positives and 0% in PET-negatives. In retrospective analysis, 42% of surgeries would have been unnecessary after PET/CT and 81% before (p < 0.001), resulting in a hypothetical 48% reduction (95% confidence interval [32-64]). Conclusions: FCH PET/CT offers high NPV to reliably exclude cancer in PET-negative IC nodules, but suffers from low PPV, particularly in those with oncocytic cytology. ClinicalTrials.gov identifier: NCT02784223.
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Affiliation(s)
- Renaud Ciappuccini
- Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, Caen, France
- INSERM 1086 ANTICIPE, Caen University, Caen, France
- Address correspondence to: Renaud Ciappuccini, MD, Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, 3 Avenue Général Harris, Caen, F-14000, France
| | - Idlir Licaj
- Department of Clinical Research and François Baclesse Cancer Centre, Caen, France
| | - Audrey Lasne-Cardon
- Department of Head and Neck Surgery, François Baclesse Cancer Centre, Caen, France
| | - Emmanuel Babin
- INSERM 1086 ANTICIPE, Caen University, Caen, France
- Department of Head and Neck Surgery, University Hospital, Caen, France
| | | | - David Blanchard
- Department of Head and Neck Surgery, Hôpital Saint-Martin, Caen, France
| | - Vianney Bastit
- Department of Head and Neck Surgery, François Baclesse Cancer Centre, Caen, France
| | | | - Justine Lequesne
- Department of Clinical Research and François Baclesse Cancer Centre, Caen, France
| | - Damien Peyronnet
- Department of Nuclear Medicine, University Hospital, Caen, France
| | - Jean-Michel Grellard
- Department of Clinical Research and François Baclesse Cancer Centre, Caen, France
| | - Bénédicte Clarisse
- Department of Clinical Research and François Baclesse Cancer Centre, Caen, France
| | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, Caen, France
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Abstract
Oligometastasis represents an intermediate disease stage between localized and widely metastatic cancer. Efficient identification of patients with oligometastasis remains a barrier for accrual on clinical trials of oligometastasis-directed therapy. Here we review the prospect of circulating tumor DNA-based monitoring to promote sensitive, specific, and cost-efficient detection of cancer recurrence during posttreatment surveillance. Thus, an impetus for the development and implementation of clinical-grade circulating tumor DNA assays should be for the positive impact they will have on clinical investigations of oligometastasis-directed therapy.
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Affiliation(s)
- David Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Bhishamjit S. Chera
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Gaorav P. Gupta
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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48
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Sun J, Lin Y, Wei X, Ouyang J, Huang Y, Ling Z. Performance of 18F-DCFPyL PET/CT Imaging in Early Detection of Biochemically Recurrent Prostate Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:649171. [PMID: 33981607 PMCID: PMC8107478 DOI: 10.3389/fonc.2021.649171] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Prostate-specific membrane antigen (PSMA)-targeted 2-(3-{1-carboxy-5-[(6-[18F] fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) positron emission tomography/computed tomography (PET/CT) has shown advantages in primary staging, restaging, and metastasis detection of prostate cancer (PCa). However, little is known about the role of 18F-DCFPyL PET/CT in biochemically recurrent prostate cancer (BRPCa). Hence, we performed a systematic review and meta-analysis to evaluate 18F-DCFPyL PET/CT as first-line imaging modality in early detection of BRPCa. Methods: A comprehensive literature search of PubMed, Web of Science, Embase, and Cochrane Library was conducted until December 2020. The pooled detection rate on a per-person basis and together with 95% confidence interval (CI) was calculated. Furthermore, a prostate-specific antigen (PSA)-stratified performance of detection positivity was obtained to assess the sensitivity of 18F-DCFPyL PET/CT in BRPCa with different PSA levels. Results: A total of nine eligible studies (844 patients) were included in this meta-analysis. The pooled detection rate (DR) of 18F-DCFPyL PET/CT in BRPCa was 81% (95% CI: 76.9-85.1%). The pooled DR was 88.8% for PSA ≥ 0.5 ng/ml (95% CI: 86.2-91.3%) and 47.2% for PSA < 0.5 ng/ml (95% CI: 32.6-61.8%). We also noticed that the regional lymph node was the most common site with local recurrence compared with other sites (45.8%, 95% CI: 42.1-49.6%). Statistical heterogeneity and publication bias were found. Conclusion: The results suggest that 18F-DCFPyL PET/CT has a relatively high detection rate in BRPCa. The results also indicate that imaging with 18F-DCFPyL may exhibit improved sensitivity in BRPCa with increased PSA levels. Considering the publication bias, further large-scale multicenter studies are warranted for validation.
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Affiliation(s)
- Jiale Sun
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuxin Lin
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuedong Wei
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Ouyang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhixin Ling
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
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True LD, Chen DL. How Accurately does PSMA Inhibitor 18F-DCFPyL-PET-CT Image Prostate Cancer? Clin Cancer Res 2021; 27:3512-3514. [PMID: 33893158 DOI: 10.1158/1078-0432.ccr-21-0749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 01/31/2023]
Abstract
Current techniques for imaging prostate cancer (CT, MRI, and PET agents 18F-fluorodeoxyglucose, 11C-choline, 11C-acetate, and 18F-fluciclovine) are limited in sensitivity and specificity. PSMA PET agent 68Ga-PSMA-11 has recently been approved by the FDA. We comment on the performance of novel PSMA agent 18F-DCFPyL-PET/CT.See related article by Morris et al., p. 3674.
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Affiliation(s)
- Lawrence D True
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington.
| | - Delphine L Chen
- Department of Radiology, Molecular Imaging, Seattle Cancer Care Alliance, and Nuclear Medicine, University of Washington, Seattle, Washington.
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50
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Duclos V, Iep A, Gomez L, Goldfarb L, Besson FL. PET Molecular Imaging: A Holistic Review of Current Practice and Emerging Perspectives for Diagnosis, Therapeutic Evaluation and Prognosis in Clinical Oncology. Int J Mol Sci 2021; 22:4159. [PMID: 33923839 PMCID: PMC8073681 DOI: 10.3390/ijms22084159] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023] Open
Abstract
PET/CT molecular imaging has been imposed in clinical oncological practice over the past 20 years, driven by its two well-grounded foundations: quantification and radiolabeled molecular probe vectorization. From basic visual interpretation to more sophisticated full kinetic modeling, PET technology provides a unique opportunity to characterize various biological processes with different levels of analysis. In clinical practice, many efforts have been made during the last two decades to standardize image analyses at the international level, but advanced metrics are still under use in practice. In parallel, the integration of PET imaging with radionuclide therapy, also known as radiolabeled theranostics, has paved the way towards highly sensitive radionuclide-based precision medicine, with major breakthroughs emerging in neuroendocrine tumors and prostate cancer. PET imaging of tumor immunity and beyond is also emerging, emphasizing the unique capabilities of PET molecular imaging to constantly adapt to emerging oncological challenges. However, these new horizons face the growing complexity of multidimensional data. In the era of precision medicine, statistical and computer sciences are currently revolutionizing image-based decision making, paving the way for more holistic cancer molecular imaging analyses at the whole-body level.
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Affiliation(s)
- Valentin Duclos
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270 Le Kremlin-Bicêtre, France; (V.D.); (A.I.); (L.G.)
| | - Alex Iep
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270 Le Kremlin-Bicêtre, France; (V.D.); (A.I.); (L.G.)
| | - Léa Gomez
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270 Le Kremlin-Bicêtre, France; (V.D.); (A.I.); (L.G.)
| | - Lucas Goldfarb
- Service Hospitalier Frédéric Joliot-CEA, 91401 Orsay, France;
| | - Florent L. Besson
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270 Le Kremlin-Bicêtre, France; (V.D.); (A.I.); (L.G.)
- Université Paris Saclay, CEA, CNRS, Inserm, BioMaps, 91401 Orsay, France
- School of Medicine, Université Paris Saclay, 94720 Le Kremlin-Bicêtre, France
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