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Ambrosini F, Falkenbach F, Budäus L, Steuber T, Graefen M, Koehler D, Knipper S, Maurer T. Comparative analysis of robot-assisted and open approach for PSMA-radioguided surgery in recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2024; 51:3079-3088. [PMID: 37831123 PMCID: PMC11300565 DOI: 10.1007/s00259-023-06460-5] [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: 07/25/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE To compare the oncological and surgical outcomes of patients with recurrent prostate cancer (PCa) who underwent either open or newly established robot-assisted salvage prostate-specific membrane antigen-radioguided surgery (PSMA-RGS). MATERIALS AND METHODS Patients who consecutively underwent PSMA-RGS for PCa recurrence between January 2021 and December 2022 were identified. The rate of complete biochemical response, biochemical recurrence-free survival [BFS], and the rate of salvage therapy were evaluated. Univariable and multivariable regression models tested the association between the surgical approach and surgical outcomes. RESULTS Overall, 85 patients were selected, with 61 patients (72%) undergoing open PSMA-RGS and 24 patients (28%) receiving a robot-assisted approach. The oncological outcomes of the two groups were comparable (12-month BFS: 41% (Confidence interval (CI): 29-58%) vs. 39% (CI: 19-79%), p = 0.9, respectively). According to multivariable regression models, the robotic approach did not significantly influence estimated blood loss (EBL) (β = -40, 95% CI: -103, 22; p = 0.2) and significantly increased operative time (OT) (β = 28, 95% CI: 10, 46; p = 0.002). No Clavien-Dindo III-V complications were reported in the robotic group. CONCLUSION Both, the open as well as the robot-assisted approach for PSMA-RGS had comparable oncological outcomes. No safety concerns arose for the robotic-assisted approach offering a potentially improved quality of life for patients.
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Affiliation(s)
- Francesca Ambrosini
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabian Falkenbach
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Lars Budäus
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniel Koehler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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2
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Antonarakis ES, Shui IM, Zaidi O, Bernauer M, Gratzke C. Current Treatment Paradigms and Clinical Outcomes in Oligometastatic Prostate Cancer Patients: A Targeted Literature Review. Eur Urol Oncol 2024:S2588-9311(24)00149-4. [PMID: 38964996 DOI: 10.1016/j.euo.2024.06.002] [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: 02/27/2024] [Revised: 05/10/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024]
Abstract
CONTEXT Prostate cancer is the most common noncutaneous malignancy among men in the USA and Europe. There is no consensus definition of oligometastatic prostate cancer (omPC), which is often considered in two subgroups, synchronous (de novo) and metachronous (oligorecurrent), and may include patients with a low metastatic disease burden. OBJECTIVE To summarize the epidemiology, disease definitions, mortality/survival outcomes, and treatment characteristics in both clinical trial and real-world settings among patients with synchronous, metachronous, and mixed-subtype (ie, synchronous and metachronous or undefined type) omPC, as well as low burden disease states. EVIDENCE ACQUISITION We searched MEDLINE and Embase to identify publications reporting on epidemiology, disease definitions, clinical outcomes, and treatment characteristics of omPC. Gray literature sources (eg, ClinicalTrials.gov) were searched for ongoing trials. EVIDENCE SYNTHESIS We identified 105 publications. Disease definitions varied across publications and omPC subtypes on the number and location of lesions, type of imaging used, and type of oligometastatic disease. Most studies defined omPC as five or fewer metastatic lesions. Data on the epidemiology of omPC were limited. Mortality rates and overall survival tended to be worse among synchronous versus metachronous omPC cohorts. Progression-free survival was generally longer among synchronous than among metachronous omPC cohorts but was more similar at longer time points. A summary of ongoing clinical trials investigating a variety of local, metastasis-directed, and systemic therapies in men with omPC is also provided. CONCLUSIONS Definitions of oligometastatic disease depend on the imaging technique used. Epidemiologic data for omPC are scarce. Survival rates differ between synchronous and metachronous cohorts, and heterogeneous treatment patterns result in varied outcomes. Ongoing clinical trials using modern imaging techniques are awaited and needed. PATIENT SUMMARY Definitions of oligometastatic prostate cancer (omPC) vary depending on the imaging technique used. Different treatment patterns lead to different outcomes. Robust omPC epidemiologic data are lacking.
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Falkenbach F, Knipper S, Koehler D, Ambrosini F, Steuber T, Graefen M, Budäus L, Eiber M, Lunger L, Lischewski F, Heck MM, Maurer T. Safety and efficiency of repeat salvage lymph node dissection for recurrence of prostate cancer using PSMA-radioguided surgery (RGS) after prior salvage lymph node dissection with or without initial RGS support. World J Urol 2023; 41:2343-2350. [PMID: 37515651 PMCID: PMC10465644 DOI: 10.1007/s00345-023-04534-5] [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: 04/11/2023] [Accepted: 07/06/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Metastasis-directed therapy is a feasible option for low PSA, recurrent locoregional metastatic prostate cancer. After initial salvage surgery, patients with good response might consider a repeat salvage surgery in case of recurrent, isolated, and PSMA-positive metastases. This analysis aimed to evaluate the oncological outcome and safety of repeat PSMA-targeted radioguided surgery (RGS) after either prior RGS or "standard" salvage lymph node dissection (SLND). MATERIALS AND METHODS We identified 37 patients undergoing repeat RGS after prior SLND (n = 21) (SLND-RGS) or prior RGS (n = 16) (RGS-RGS) between 2014 and 2021 after initial radical prostatectomy with or without pelvic radiation therapy at two German tertiary referral centers. Kaplan-Meier analyses and uni-/multivariable Cox regression models were used to investigate factors associated with biochemical recurrence-free survival (BRFS) and treatment-free survival (TFS) after repeat salvage surgery. RESULTS AND LIMITATIONS Complete Biochemical Response (cBR, PSA < 0.2 ng/ml) was observed in 20/32 patients (5 NA). Median overall BRFS [95% confidence interval (CI)] after repeat salvage surgery was 10.8 months (mo) (5.3-22). On multivariable regression, only age (HR 1.09, 95% CI 1.01-1.17) and preoperative PSA (HR 1.23, 95% CI 1.01-1.50) were associated with shorter BRFS, although PSA (HR 1.16, 95% CI 0.99-1.36) did not achieve significant predictor status in univariable analysis before (p value = 0.07). Overall, one year after second salvage surgery, 89% of the patients (number at risk: 19) did not receive additional treatment and median TFS was not reached. Clavien-Dindo grade > 3a complications were observed in 8% (3/37 patients). Limitations are the retrospective evaluation, heterogeneous SLND procedures, lack of long-term follow-up data, and small cohort size. CONCLUSION In this study, repeat RGS was safe and provided clinically meaningful biochemical recurrence- and treatment-free intervals for selected cases. Patients having low preoperative PSA seemed to benefit most of repeat RGS, irrespective of prior SLND or RGS or the time from initial RP/first salvage surgery.
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Affiliation(s)
- Fabian Falkenbach
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Daniel Koehler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesca Ambrosini
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Urology, IRCCS Policlinico San Martino Hospital, University of Genova, Genoa, Italy
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lars Budäus
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Lukas Lunger
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Flemming Lischewski
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Matthias M Heck
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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4
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Alberto M, Yim A, Papa N, Siva S, Ischia J, Touijer K, Eastham JA, Bolton D, Perera M. Role of PSMA PET-guided metastases-directed therapy in oligometastatic recurrent prostate cancer. Front Oncol 2022; 12:929444. [PMID: 36059632 PMCID: PMC9433573 DOI: 10.3389/fonc.2022.929444] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Oligometastatic prostate cancer (OMPC) has been proposed as an intermediary state between localised disease and widespread metastases, with varying definitions including 1, 3, or ≤5 visceral or bone metastasis. Traditional definitions of OMPC are based on staging with conventional imaging, such as computerised tomography (CT) and whole-body bone scan (WBBS). Novel imaging modalities such as prostate-specific membrane antigen positron emission tomography (PSMA PET) have improved diagnostic utility in detecting early metastatic prostate cancer (PC) metastases compared with conventional imaging. Specifically, meta-analytical data suggest that PSMA PET is sensitive in detecting oligometastatic disease in patients with biochemical recurrence (BCR) post-radical treatment of PC. Recent trials have evaluated PSMA PET-guided metastases-directed therapy (MDT) in oligometastatic recurrent disease, typically with salvage surgery or radiotherapy (RT). To date, these preliminary studies demonstrate promising results, potentially delaying the need for systemic therapy. We aim to report a comprehensive, multidisciplinary review of PSMA-guided MDT in OMPC. In this review, we highlight the utility of PMSA PET in biochemically recurrent disease and impact of PSMA PET on the definition of oligometastatic disease and outline data pertaining to PSMA-guided MDT.
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Affiliation(s)
- Matthew Alberto
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Arthur Yim
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nathan Papa
- Department of Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Joseph Ischia
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - James A. Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- *Correspondence: Marlon Perera,
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5
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Pozdnyakov A, Kulanthaivelu R, Bauman G, Ortega C, Veit-Haibach P, Metser U. The impact of PSMA PET on the treatment and outcomes of men with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00544-3. [PMID: 35440642 DOI: 10.1038/s41391-022-00544-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate-specific membrane antigen (PSMA) PET is highly sensitive in identifying disease recurrence in men with biochemical recurrence of prostate cancer (BCR) after primary therapy and is rapidly being adopted in clinical practice. The purpose of this systematic review and meta-analysis was to assess the documented impact of PSMA-PET on patient management and outcomes, including prostate-specific antigen (PSA) response, and intermediate and long-term outcome measures. MATERIALS AND METHODS MBASE, PubMed, Web of Science, Cochrane and OVID databases were searched for studies reporting on the impact of PSMA-PET on the management and outcomes of patients with BCR after definitive primary therapy. Outcome measures assessed included biochemical response to therapy after PET and BCR-free survival (BRFS). The proportions of patients in whom management changed, and the proportion of patients in whom each outcome measure was obtained were tabulated and pooled into meta-analysis using DerSimonian-Laird method. RESULTS A total of 34 studies with 3680 men reported change in management after PSMA-PET and 27 studies with 2639 men reported on at least one outcome measure and had follow-up data. PSMA-PET was positive in 2508/3680 (68.2%). The pooled proportion of change in management after PSMA-PET was 56.4% (95% CI, 48.0-63.9%). A decrease in serum PSA was documented in 72.4% of men (95% CI, 63.4-81.5%), and complete biochemical response in 23.3% (95% CI, 14.6-32.0%) at a median follow-up of 8.1 and 11 months, respectively. The pooled BRFS rate was 60.2% (95% CI, 49.1-71.4%) at a median follow-up of 20 months. CONCLUSION In conclusion, PSMA PET is positive in more than 2/3 of men with BCR and impacts patient management in more than half of the men. BRFS after PET-directed management is 60% at a median of 20 months after salvage therapy, and complete biochemical response may be achieved in up to a quarter of men.
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Affiliation(s)
- Alex Pozdnyakov
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Roshini Kulanthaivelu
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada
| | - Glenn Bauman
- Department of Oncology, Western University, London, ON, Canada
| | - Claudia Ortega
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada.
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Liu FY, Sheng TW, Tseng JR, Yu KJ, Tsui KH, Pang ST, Wang LJ, Lin G. Prostate-specific membrane antigen (PSMA) fusion imaging in prostate cancer: PET-CT vs PET-MRI. Br J Radiol 2022; 95:20210728. [PMID: 34767482 PMCID: PMC8978229 DOI: 10.1259/bjr.20210728] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate whether PET-CT or PET-MRI is more appropriate for imaging prostate cancer, in terms of primary tumor detection, local staging and recurrence, as well as lymph nodes and distant metastases. METHODS A systematic literature search was conducted on Embase, PubMed/MEDLINE, and the Cochrane Library database. Studies evaluating the diagnostic performance of PET-CT vs PET-MRI in prostate cancer patients were emphasized. RESULTS We reviewed 57 original research articles during the period 2016-2021: 14 articles regarding the radiotracer PSMA; 18 articles regarding the primary tumor detection, local tumor staging, managing local recurrence; 17 articles for managing lymph node metastases; and eight articles for managing bone and other distant metastases. PSMA PET could be complementary to mpMRI for primary prostate cancer localization and is particularly valuable for PI-RADS three lesions. PET-MRI is better than PET-CT in local tumor staging due to its specific benefit in predicting extracapsular extension in MRI-occult prostate cancer patients. PET-MRI is likely superior as compared with PET-CT in detecting local recurrence, and has slightly higher detection rates than PET-CT in lymph node recurrence. PET-CT and PET-MRI seem to have equivalent performance in detecting distant bony or visceral metastases. CONCLUSION In conclusion, PET-MRI is suitable for local and regional disease, either primary staging or restaging, whereas PET-CT is valuable for managing distant bony or visceral metastasis. ADVANCES IN KNOWLEDGE We reviewed the emerging applications of PET-MRI and PET-CT in clinical aspects. Readers will gain an objective overview on the strength and shortfalls of PET-MRI or PET-CT in the management of prostate cancer.
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Affiliation(s)
- Feng-Yuan Liu
- Department of Nuclear Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Ting-Wen Sheng
- Department of Medical Imaging and Intervention, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Jing-Ren Tseng
- Department of Nuclear Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Kai-Jie Yu
- Department of Urology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Ke-Hong Tsui
- Department of Urology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Se-Tong Pang
- Department of Urology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Wang
- Department of Medical Imaging and Intervention, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
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7
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Bobrowski A, Metser U, Finelli A, Fleshner N, Berlin A, Perlis N, Kulkarni GS, Chung P, Kuhathaas K, Atenafu EG, Hamilton RJ. Salvage lymph node dissection for prostate-specific membrane antigen (PSMA) positron emission tomography (PET)-identified oligometastatic disease. Can Urol Assoc J 2021; 15:E545-E552. [PMID: 34665714 DOI: 10.5489/cuaj.6988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The availability of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) imaging, particularly in the setting of rising prostate-specific antigen (PSA) after definitive treatment, has led to oligometastatic prostate cancer being increasingly identified. Despite the enthusiasm surrounding treating oligometastatic disease, it has been relatively understudied. We sought to review our salvage lymphadenectomy experience in the PSMA PET/CT era. METHODS We retrospectively reviewed patients undergoing lymphadenectomy following curative-intent primary therapy with rising PSA who had undergone a PSMA PET/CT identifying oligometastatic disease (defined as ≤5 PSMA-avid lesions) between January 2016 and April 2020. The primary endpoint was complete response, defined as achieving a PSA <0.2 ng/ml without concomitant androgen deprivation therapy (ADT). RESULTS Twenty-two patients were included. Primary curative therapy included radical prostatectomy (86.4%) and brachytherapy (13.6%). Median PSA at salvage surgery was 1.72 ng/ml. Pelvic lymph node dissection was the most performed procedure (72.7%). Median node yield was 10.5, with a median of 1.5 positive nodes on pathology. Eight patients (36.4%) achieved PSA <0.2, with six (27.3%) remaining with PSA <0.2 after a median followup of 23.1 months. Nine (40.9%) had an initial PSA decline, but nadired ≥0.2, and in five (22.7%) the PSA rose immediately after surgery. Overall, ADT was started in seven patients (31.8%) at a median of 10.1 months post-salvage surgery. CONCLUSIONS In our series of salvage dissection for PSMA-PET-detected nodal oligometastases, approximately a third achieved PSA <0.2; yet, it was only durable in 27%. Prospective trials of salvage nodal radiation are ongoing, however, more prospective trials of salvage node dissection are needed.
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Affiliation(s)
- Adam Bobrowski
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ur Metser
- Department of Diagnostic Radiology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Neil Fleshner
- Division of Urology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kopika Kuhathaas
- Division of Urology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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le Guevelou J, Achard V, Mainta I, Zaidi H, Garibotto V, Latorzeff I, Sargos P, Ménard C, Zilli T. PET/CT-Based Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy: Impact on Treatment Management and Future Directions. Front Oncol 2021; 11:742093. [PMID: 34532294 PMCID: PMC8438304 DOI: 10.3389/fonc.2021.742093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/09/2021] [Indexed: 12/25/2022] Open
Abstract
Biochemical recurrence is a clinical situation experienced by 20 to 40% of prostate cancer patients treated with radical prostatectomy (RP). Prostate bed (PB) radiation therapy (RT) remains the mainstay salvage treatment, although it remains non-curative for up to 30% of patients developing further recurrence. Positron emission tomography with computed tomography (PET/CT) using prostate cancer-targeting radiotracers has emerged in the last decade as a new-generation imaging technique characterized by a better restaging accuracy compared to conventional imaging. By adapting targeting of recurrence sites and modulating treatment management, implementation in clinical practice of restaging PET/CT is challenging the established therapeutic standards born from randomized controlled trials. This article reviews the potential impact of restaging PET/CT on changes in the management of recurrent prostate cancer after RP. Based on PET/CT findings, it addresses potential adaptation of RT target volumes and doses, as well as use of androgen-deprivation therapy (ADT). However, the impact of such management changes on the oncological outcomes of PET/CT-based salvage RT strategies is as yet unknown.
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Affiliation(s)
- Jennifer le Guevelou
- Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Division of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Vérane Achard
- Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Ismini Mainta
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland
| | - Habib Zaidi
- Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland.,Geneva Neuroscience Center, Geneva University, Geneva, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Valentina Garibotto
- Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland.,Geneva Neuroscience Center, Geneva University, Geneva, Switzerland
| | - Igor Latorzeff
- Department of Radiation Oncology, Groupe Oncorad-Garonne, Clinique Pasteur, Toulouse, France
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Cynthia Ménard
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Thomas Zilli
- Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
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9
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Hopland OA, Fosså SD, Ottosson F, Brennhovd B, Svindland A, Hole KH, Hernes E, Eri LM, Diep LM, Berge V. Robotic salvage pelvic lymph node dissection for locoregional recurrence after radical prostatectomy: a single institution experience. Scand J Urol 2021; 55:287-292. [PMID: 34196594 DOI: 10.1080/21681805.2021.1946135] [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: 10/21/2022]
Abstract
OBJECTIVES To assess treatment response (PSA < 0.2 ng/ml), need for additional therapy and complication rate after robot assisted salvage pelvic lymph node dissection (sPLND). MATERIAL AND METHODS Analysis of outcomes data from radical prostatectomy (RP) patients consecutively operated with robot assisted sPLND due to biochemical recurrence and positron-emission tomography (PET)/computed tomography (CT)-detected nodal recurrence of pelvic lymph nodes. RESULTS Sixty-nine patients underwent robotic sPLND after a median time of 47 months post- RP. Sixty-four patients (93%) had malignant lymph nodes upon histological assessment of sPLND specimen. Twenty patients (29%) achieved PSA < 0.2 ng/ml 6 weeks postoperatively. After median (IQR) follow-up of 15 months (10-27), fourteen patients (20%) still had PSA < 0.2 ng/ml without additional therapy and forty-one patients (59%) had started additional therapy. No significant predictor for treatment response was found. Postoperative complications occurred in 14 patients (20%). Eleven of these complications were classified as Clavien-Dindo grade 1. CONCLUSION Oncological benefit of sPLND as the only salvage procedure seems to be limited, though almost one third of patients achieved treatment response. Clinical trials are needed to determine if sPLND as part of a multimodal treatment may improve outcome.
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Affiliation(s)
| | - Sophie D Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Radiumhospitalet, Oslo University, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fredrik Ottosson
- Department of Urology, Radiumhospital, Oslo University Hospital, Oslo, Norway
| | - Bjørn Brennhovd
- Department of Urology, Radiumhospital, Oslo University Hospital, Oslo, Norway
| | - Aud Svindland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pathology, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Knut Håkon Hole
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Eivor Hernes
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Lars Magne Eri
- Department of Urology, Radiumhospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lien My Diep
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo University Hospital, Oslo, Norway
| | - Viktor Berge
- Department of Urology, Radiumhospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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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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11
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Farolfi A, Hadaschik B, Hamdy FC, Herrmann K, Hofman MS, Murphy DG, Ost P, Padhani AR, Fanti S. Positron Emission Tomography and Whole-body Magnetic Resonance Imaging for Metastasis-directed Therapy in Hormone-sensitive Oligometastatic Prostate Cancer After Primary Radical Treatment: A Systematic Review. Eur Urol Oncol 2021; 4:714-730. [PMID: 33750684 DOI: 10.1016/j.euo.2021.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/18/2021] [Accepted: 02/12/2021] [Indexed: 01/15/2023]
Abstract
CONTEXT Next-generation imaging includes positron emission tomography (PET) imaging and whole-body magnetic resonance imaging (wbMRI) including diffusion-weighted imaging. Accurate quantification of oligometastatic disease using next-generation imaging is important to define the role and value of metastasis-directed therapy (MDT). OBJECTIVE To perform a review of next-generation imaging modalities in the detection of recurrent oligometastatic hormone-sensitive prostate cancer in men who received prior radical treatment for localized disease. EVIDENCE ACQUISITION MEDLINE, Scopus, Cochrane Libraries, and Web of Science databases were systematically searched for studies reporting next-generation imaging and oncological outcomes. An expert panel of urologists, radiation oncologists, radiologists, and nuclear medicine physicians performed a nonsystematic review of strengths and limitations of currently available imaging options for detecting the presence and extent of recurrent oligometastatic disease. EVIDENCE SYNTHESIS From 370 articles identified, three clinical trials and 21 observational studies met the following inclusion criteria: metachronous oligometastatic recurrence after radical treatment for prostate cancer, MDT, and hormone-sensitive patients. Androgen deprivation therapy (ADT) was allowed before MDT. Next-generation imaging modalities included PET/computed tomography and/or PET/MRI with the following tracers: choline (n = 1), NaF (n = 1), and prostate-specific membrane antigen (PSMA; n = 1) for clinical trials; choline (n = 7) or PSMA (n = 11) or both (n = 3) for observational studies. The number of metastases ranged from two to five lesions in most studies. In PSMA-based studies, progression-free survival ranged from 19% to 100%, whereas in studies employing choline, progression-free survival ranged from 16% to 93%. Overall, ADT-free survival ranged from 48% to 79%, while local control was reported as 75-100% and prostate-specific antigen response as 23-94%. Among the different PET tracers and wbMRI, PSMA PET is emerging as the most accurate imaging technique in defining the oligometastatic status. CONCLUSIONS PSMA and choline PET contribute to guiding MDT in men with hormone-sensitive oligometastatic prostate cancer. Further studies are warranted to ascertain their role and optimize the timing of imaging for such patients. PATIENT SUMMARY We looked at the evidence regarding the use of modern imaging techniques to direct additional treatments in men with early spread of prostate cancer after they receive their initial radical treatment. We found that next-generation imaging, in particular prostate-specific membrane antigen and choline positron emission tomography, can successfully guide metastasis-directed therapies, and further trials should evaluate which modalities are best suited to improve outcomes for our patients.
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Affiliation(s)
- Andrea Farolfi
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Declan G Murphy
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
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12
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Claps F, Ramírez-Backhaus M, Mir Maresma MC, Gómez-Ferrer Á, Mascarós JM, Marenco J, Collado Serra A, Casanova Ramón-Borja J, Calatrava Fons A, Trombetta C, Rubio-Briones J. Indocyanine green guidance improves the efficiency of extended pelvic lymph node dissection during laparoscopic radical prostatectomy. Int J Urol 2021; 28:566-572. [PMID: 33675069 DOI: 10.1111/iju.14513] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate whether indocyanine green guidance can improve the quality of extended pelvic lymph node dissection in patients undergoing radical prostatectomy. METHODS A total of 214 patients underwent laparoscopic radical prostatectomy with indocyanine green-guided lymph node dissection plus extended pelvic lymph node dissection. These patients (group A) were matched 1:1 for clinical risk groups according to the National Comprehensive Cancer Network classification with patients who underwent the same procedure without fluorescence guidance (group B). Biochemical recurrence was defined as two consecutive prostate-specific antigen rises of at least 0.2 ng/mL. The Kaplan-Meier method and Cox regression models were used to identify predictors of biochemical recurrence. RESULTS The median number of retrieved nodes was significantly higher in group A (22 vs 14, P < 0.001). The rate of lymph node metastases was higher in group A (65.9% vs 34.1%, P = 0.01). Increasing the yield of lymph node dissection was independently and negatively correlated with the biochemical recurrence risk in both overall and pN-positive patients (hazard ratio 0.97, P = 0.03; and hazard ratio 0.95, P = 0.02). The 5-year biochemical recurrence-free survival rates were (75.8% vs 65.9, P = 0.09) and (54.1% vs 24.9%, P = 0.023) for group A and group B in the overall cohort and pN-positive cohort, respectively. CONCLUSION Indocyanine green-guided lymph node dissection plus extended pelvic lymph node dissection improves identification of lymphatic drainage, resulting in a higher number of lymph nodes and retrieved lymph node metastases, and allowing a more accurate local staging and a prolonged biochemical recurrence-free survival.
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Affiliation(s)
- Francesco Claps
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain.,Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | | | - Álvaro Gómez-Ferrer
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain
| | - Juan Manuel Mascarós
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain
| | - Josè Marenco
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain
| | | | | | - Ana Calatrava Fons
- Department of Pathology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain
| | - Carlo Trombetta
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Jose Rubio-Briones
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain
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13
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Hernes E, Revheim ME, Hole KH, Tulipan AJ, Strømme H, Lilleby W, Seierstad T. Prostate-Specific Membrane Antigen PET for Assessment of Primary and Recurrent Prostate Cancer with Histopathology as Reference Standard: A Systematic Review and Meta-Analysis. PET Clin 2021; 16:147-165. [PMID: 33648661 DOI: 10.1016/j.cpet.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Prostate-specific membrane antigen PET is a promising diagnostic tool in prostate cancer. The gold standard for the detection of prostate tumor and lymph node metastases is histopathology. The aim of the present review was to investigate accuracy measures of 68Ga/18F-labeled prostate-specific membrane antigen PET tracers in primary and recurrent prostate cancer with systematic sector-based histopathology as the reference standard. A systematic literature search was performed and 34 studies were included. Overall, prostate-specific membrane antigen PET showed high specificity, but variable sensitivity to localize known prostate cancer and detect pelvic lymph node metastases.
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Affiliation(s)
- Eivor Hernes
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Knut Håkon Hole
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Andreas Julius Tulipan
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Wolfgang Lilleby
- Department of Oncology, Oslo University Hospital, P.O. Box 4953 Nydalen, 0424 Oslo, Norway
| | - Therese Seierstad
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
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14
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Role of 18F-Fluciclovine and Prostate-Specific Membrane Antigen PET/CT in Guiding Management of Oligometastatic Prostate Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 216:851-859. [PMID: 33206564 DOI: 10.2214/ajr.20.24711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Twenty-five years ago, oligometastatic disease was proposed as an intermediary clinical state of cancer with unique implications for therapies that may impact cancer evolution and patient outcome. Identification of limited metastases that are potentially amenable to targeted therapies fundamentally depends on the sensitivity of diagnostic tools, including new-generation imaging methods. For men with biochemical recurrence after definitive therapy of the primary prostate cancer, PET/CT using either the FDA-approved radiolabeled amino acid analogue 18F-fluciclovine or investigational radiolabeled agents targeting prostate-specific membrane antigen (PSMA) enables identification of early metastases at lower serum PSA levels than was previously feasible using conventional imaging. Evidence supports PSMA PET/CT as the most sensitive imaging modality available for identifying disease sites in oligometastatic prostate cancer. PSMA PET/CT will likely become the modality of choice after regulatory approval and will drive the development of trials of emerging metastasis-directed therapies such as stereotactic ablative body radiation and radioguided surgery. Indeed, numerous ongoing or planned clinical trials are studying advances in management of oligometastatic prostate cancer based on this heightened diagnostic capacity. In this rapidly evolving clinical environment, radiologists and nuclear medicine physicians will play major roles in facilitating clinical decision making and management of patients with oligometastatic prostate cancer.
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15
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Carrasquilla M, Creswell ML, Pepin AN, Wang E, Forsthoefel M, McGunigal M, Bullock E, Lei S, Collins BT, Lischalk JW, Esposito G, Aghdam N, Kumar D, Suy S, Leger P, Hankins RA, Dawson NA, Collins SP. Rationale for Involved Field Stereotactic Body Radiation Therapy-Enhanced Intermittent Androgen Deprivation Therapy in Hormone-Sensitive Nodal Oligo-Recurrent Prostate Cancer Following Prostate Stereotactic Body Radiation Therapy. Front Oncol 2021; 10:606260. [PMID: 33537236 PMCID: PMC7848164 DOI: 10.3389/fonc.2020.606260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022] Open
Abstract
Lymph node recurrent prostate cancer is a common clinical scenario that is likely to increase significantly with the widespread adoption of novel positron emission tomography (PET) agents. Despite increasing evidence that localized therapy is disease modifying, most men with lymph node recurrent prostate cancer receive only systemic therapy with androgen deprivation therapy (ADT). For men who receive localized therapy the intent is often to delay receipt of systemic therapy. Little evidence exists on the optimal combination of local and systemic therapy in this patient population. In this hypothesis generating review, we will outline the rationale and propose a framework for combining involved field SBRT with risk adapted intermittent ADT for hormone sensitive nodal recurrent prostate cancer. In patients with a limited number of nodal metastases, involved field stereotactic body radiation therapy (SBRT) may have a role in eliminating castrate-resistant clones and possibly prolonging the response to intermittent ADT. We hypothesize that in a small percentage of patients, such a treatment approach may lead to long term remission or cure.
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Affiliation(s)
- Michael Carrasquilla
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | | | - Abigail N. Pepin
- George Washington University School of Medicine, Washington, DC, United States
| | - Edina Wang
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Matthew Forsthoefel
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Mary McGunigal
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Elizabeth Bullock
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Brian T. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Jonathan W. Lischalk
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Giuseppe Esposito
- Department of Nuclear Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Deepak Kumar
- Biotechnology Research Institute, North Carolina Central University, Durham, NC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Paul Leger
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Ryan A. Hankins
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Nancy A. Dawson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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16
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Fleming CW, Broughman JR, Tendulkar RD. Treatment Options in Oligometastatic Disease in Prostate Cancer: Thinking Outside the Box. Curr Treat Options Oncol 2020; 22:2. [PMID: 33216272 DOI: 10.1007/s11864-020-00798-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT Due to its relatively indolent disease course, the sensitivity of PSA testing, and the emergence of novel PET imaging, metastatic prostate cancer is particularly likely to present with a limited volume of disease. Patients with up to five metastatic lesions should be considered for an oligometastatic treatment approach. Systemic therapy remains the cornerstone of treatment for these patients. The optimal type and duration are unknown; however, the addition of a second agent to ADT appears to be beneficial. Multiple recent studies have found significant benefits to the integration of systemic therapy and local metastasis-directed therapies (MDT), including radiation and surgery, to the prostate and metastatic sites. MDT may also be used in select patients wishing to delay the initiation of systemic therapy. For patients with isolated regional nodal recurrences, whole pelvic radiotherapy or extensive lymphadenectomy is preferred, in combination with ADT.
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Affiliation(s)
- Christopher W Fleming
- Department of Radiation Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, 9500 Euclid Avenue/CA-50, Cleveland, OH, 44195, USA.
| | - James R Broughman
- Department of Radiation Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, 9500 Euclid Avenue/CA-50, Cleveland, OH, 44195, USA
| | - Rahul D Tendulkar
- Department of Radiation Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, 9500 Euclid Avenue/CA-50, Cleveland, OH, 44195, USA
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18F-choline positron emission tomography/computed tomography guided laparoscopic salvage lymph node dissection in patients after radical prostatectomy. Wideochir Inne Tech Maloinwazyjne 2020; 16:403-408. [PMID: 34136038 PMCID: PMC8193754 DOI: 10.5114/wiitm.2020.100738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/16/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Salvage lymph node dissection (sLND) using novel imaging methods is an interesting alternative to treat lymph node (LN) metastasis after radical prostatectomy (RP); however, recommendations for using sLND as such are still being developed. Aim To assess the clinical outcomes of prostate cancer (PCa) after fluorine-18-choline (18F-choline) positron emission tomography/computed tomography (PET/CT) guided sLND. Material and methods Ten patients who had undergone sLND under 18F-choline PET/CT guidance (positive nodes: median 1, range 1-3) and had biochemical recurrence or persistence of prostate-specific antigen (PSA: median PSA 2.05 ng/ml, range: 0.8–8.4) after RP were enrolled in this retrospective study. Complete biochemical response (cBCR) after salvage surgery was defined as PSA < 0.2 ng/ml. Results The median follow-up time after salvage surgery was 33 months. The median PSA level 6 weeks after sLND and at the end of follow-up was 0.93 and 2.95 ng/ml, respectively. At 6 weeks after targeted sLND only 1 patient had cBCR, whereas a PSA decrease was noted in 7 patients. No patient had cBCR at the end of follow-up. Conclusions Laparoscopic sLND in cases of LN metastatic PCa after RP is a feasible option with low morbidity. However, an initial cBCR occurs in a negligible proportion of patients, and a long-term response is unlikely to be achieved.
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18
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Salvage Pelvic Lymph Node Dissection and Current State of Imaging for Recurrent Prostate Cancer: Does a Standard Exist? Curr Urol Rep 2020; 21:62. [PMID: 33159608 DOI: 10.1007/s11934-020-01011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW We aim to evaluate the efficacy of salvage lymph node dissection (SLND) for nodal recurrent prostate cancer after primary treatment. We also provide a review of the diagnostic performance of next-generation sequencing (next-generation imaging (NGI)) radiotracers in the salvage setting. RECENT FINDINGS Most studies evaluating SLND include a heterogeneous population with a small sample size and are retrospective in design. The 5-year clinical recurrence-free and cancer-specific survival following SLND are 26-52% and 57-89%, respectively, among prospective studies. NGI improves accuracy in detecting nodal recurrence compared to conventional CT, with PMSA PET-CT showing the most promise. However, limited studies exist comparing imaging modalities and performance is variable at low PSA values. SLND is a promising treatment option, but more prospective data are needed to determine the ideal surgical candidate and long-term oncologic outcomes. More studies comparing different NGI are needed to determine the best imaging modality in patients who may be candidates for salvage treatment.
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19
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Fantin JPP, Furst MCB, Tobias-Machado M, Muller RL, Machado RD, Santos AC, Magnabosco WJ, Alcantara-Quispe C, Faria EF. Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review. Int Braz J Urol 2020; 47:484-494. [PMID: 33146973 PMCID: PMC7993961 DOI: 10.1590/s1677-5538.ibju.2020.0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/09/2020] [Indexed: 12/03/2022] Open
Abstract
Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.
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Miura N, Pradere B, Mori K, Mostafaei H, Quhal F, Misrai V, D'Andrea D, Albisinni S, Papalia R, Saika T, Scarpa RM, Shariat SF, Esperto F. Metastasis-directed therapy and prostate-targeted therapy in oligometastatic prostate cancer: a systematic review. MINERVA UROL NEFROL 2020; 72:531-542. [PMID: 32550632 DOI: 10.23736/s0393-2249.20.03779-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa). EVIDENCE ACQUISITION We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: ("prostate cancer" OR "prostate carcinoma" OR "prostate neoplasm" OR "prostate tumor") AND ("oligometastatic" OR "oligometastasis" OR "PSMA") AND ("surgery" OR "prostatectomy" OR "radical prostatectomy" OR "cytoreductive" OR "local treatment" OR "radiotherapy" OR "stereotactic" OR "stereotaxic") AND ("survival" OR "mortality"). EVIDENCE SYNTHESIS After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomized studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomized controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomized phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear. CONCLUSIONS We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.
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Affiliation(s)
- Noriyoshi Miura
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria -
- Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan -
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Hospital of Tours, Tours, France
- EAU Young Urologist Office (YOU), Arnhem, the Netherlands
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Simone Albisinni
- Department of Urology, Erasme Hospital, University Clinics of Brussels, University of Brussels, Brussels, Belgium
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Takashi Saika
- Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, University of Jordan, Amman, Jordan
- European Association of Urology Research Foundation, Arnhem, the Netherlands
| | - Francesco Esperto
- EAU Young Urologist Office (YOU), Arnhem, the Netherlands
- Department of Urology, Campus Bio-Medico University, Rome, Italy
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
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21
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Mena E, Black PC, Rais-Bahrami S, Gorin M, Allaf M, Choyke P. Novel PET imaging methods for prostate cancer. World J Urol 2020; 39:687-699. [PMID: 32671604 DOI: 10.1007/s00345-020-03344-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Prostate cancer is a common neoplasm but conventional imaging methods such as CT and bone scan are often insensitive. A new class of PET agents have emerged to diagnose and manage prostate cancer. METHODS The relevant literature on PET imaging agents for prostate cancer was reviewed. RESULTS This review shows a broad range of PET imaging agents, the most successful of which is prostate specific membrane antigen (PSMA) PET. Other agents either lack the sensitivity or specificity of PSMA PET. CONCLUSION Among the available PET agents for prostate cancer, PSMA PET has emerged as the leader. It is likely to have great impact on the diagnosis, staging and management of prostate cancer patients.
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Affiliation(s)
- Esther Mena
- Molecular Imaging Program, National Cancer Institute, 10 Center Dr, Bldg 10, Room B3B69F, Bethesda, MD, 20892-1088, USA
| | - Peter C Black
- University of British Columbia, Vancouver, BC, Canada
| | | | - Michael Gorin
- Department of Urology, Johns Hopkins University, Baltimore, MD, USA
| | - Mohamad Allaf
- Department of Urology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Choyke
- Molecular Imaging Program, National Cancer Institute, 10 Center Dr, Bldg 10, Room B3B69F, Bethesda, MD, 20892-1088, USA.
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22
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Falagario U, Veccia A, Weprin S, Albuquerque EV, Nahas WC, Carrieri G, Pansadoro V, Hampton LJ, Porpiglia F, Autorino R. Robotic-assisted surgery for the treatment of urologic cancers: recent advances. Expert Rev Med Devices 2020; 17:579-590. [PMID: 32342705 DOI: 10.1080/17434440.2020.1762487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION As the medical field is moving toward personalized and tailored approaches, we entered the era of precision surgery for the management of genitourinary cancers1. This is facilitated by the implementation of new technologies, among which robotic surgery stands out for the significant impact in the surgical field over the last two decades. AREAS COVERED This article reviews the latest evidence on robotic surgery for the treatment of urologic cancers, including prostate, kidney, bladder, testis, and penile cancer. Functional and oncologic outcomes, new surgical techniques, new imaging modalities, and new robotic platforms are discussed. EXPERT OPINION Robotic surgery had a growing role in the management of genitourinary cancers over the past 10 years. Despite a lack of high-quality evidence comparing the effectiveness of robotic to open surgery, the robotic approach allowed a larger adoption of a minimally invasive surgical approach, translating into lower surgical morbidity and shorter hospital stay. New robotic platforms might allow to explore novel surgical approaches, and new technologies might facilitate surgical navigation and intraoperative identification of anatomical structures, allowing a more tailored and precise surgery. It is an exciting time for robotic surgery, and upcoming technological advances will offer better outcomes to urologic cancer patients.
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Affiliation(s)
- Ugo Falagario
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Alessandro Veccia
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology Unit, ASST Spedali Civili Hospital , Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia , Italy
| | - Samuel Weprin
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Emanuel V Albuquerque
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - William C Nahas
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Vito Pansadoro
- Department of Urology, Vincenzo Pansadoro Foundation , Rome, Italy
| | - Lance J Hampton
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Francesco Porpiglia
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital , Orbassano, Italy
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PSMA-positive nodal recurrence in prostate cancer : Salvage radiotherapy is superior to salvage lymph node dissection in retrospective analysis. Strahlenther Onkol 2020; 196:637-646. [PMID: 32211942 PMCID: PMC7305083 DOI: 10.1007/s00066-020-01605-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/09/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE This analysis compares salvage lymph node dissection (SLND) to salvage lymph node radiotherapy (SLNRT) of 68Ga-PSMA PET-positive nodal recurrences after radical prostatectomy (RPE). METHODS A total of 67 SLNRT and 33 SLND consecutive patients with pelvic and/or para-aortic nodal recurrences after RPE were retrospectively analyzed. Biochemical recurrence-free survival rates (bRFS; PSA <0.2 ng/mL) were calculated according to Kaplan-Meier and survival curves were compared using the log rank test. For multivariable analysis, binary logistic regression analysis was performed (p < 0.05). RESULTS Median follow-up was 17 months (range, 6-53 months) in SLND patients and 31 months (range, 3-56 months) in SLNRT patients (p = 0.027). SLNRT patients had significantly more tumours of pT3 and pT4 category (82% vs. 67%; p = 0.006), pathologically involved lymph nodes (45% vs. 27%; p = 0.001) and positive surgical margins (54% vs. 12%; p = 0.001) at time of RPE than SLND patients. PSA persistence after RPE was significantly more frequently observed in the SLNRT cohort (73% vs. 27%; p = 0.001). There was no significant difference in the distribution of PET-positive lymph nodes. Median PSA before SLND was higher than before SLNRT (3.07 ng/ml vs. 1.3 ng/ml; p = 0.393). The 2‑year bRFS was significantly higher in the SLNRT vs. the SLND cohort (92% vs. 30%; p = 0.001) with lower rates of distant metastases (21% vs. 52%; p = 0.002) and secondary treatments (5% vs. 39%; p = 0.011) irrespective of ongoing androgen deprivation therapy at last contact. In multivariable analysis, SLNRT was significantly associated with prolonged bRFS (regression coefficient 1.436, hazard ratio 4.204, 95% CI 1.789-9.878; p = 0.001). CONCLUSION Based on this retrospective study SLNRT might be the preferred treatment option for patients with nodal recurrence after previous RPE.
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99mTc- 68Ga-ICG-Labelled Macroaggregates and Nanocolloids of Human Serum Albumin: Synthesis Procedures of a Trimodal Imaging Agent Using Commercial Kits. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:3629705. [PMID: 32410921 PMCID: PMC7204380 DOI: 10.1155/2020/3629705] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/28/2019] [Accepted: 12/21/2019] [Indexed: 01/06/2023]
Abstract
Recent developments in sentinel lymph node (SLN) and radio occult lesion localization (ROLL) highlight the need for a multimodal contrast agent, providing better presurgical PET imaging and improved intraoperative mapping thanks to fluorescence detection. For this reason, we have studied a trimodal SLN/ROLL targeting agent (99mTc-68Ga-ICG) with commercially available kits of macroaggregated or nanocolloidal albumin (MA/NC-HSA). 68Ga PET imaging does provide better spatial resolution and makes it possible to predict signal intensity during surgery. The presence of 99mTc assesses the efficacy of these compounds in vitro and also during the surgery procedure. The aim of this study was to optimise the labelling and tagging of these two radiopharmaceuticals and assess their yields and stability. Kits of MA/NC-HSA particles (Pulmocis® and NanoAlbumon®) were used for sequential radiolabelling with 99mTc and 68Ga. Fluorescent tagging was performed using indocyanine green, a tricarbocyanine dye. The ITLC radiochemical purity of the trilabelled MA/NC-HSA was >95%. Fluorescent purity was measured by scanning the strips with a PhotoDynamicEye probe. Finally, in vitro stability tests, performed with DTPA and human serum solutions, assessed the efficacy of fluorescent tagging and radiolabelling.
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25
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Luiting HB, van Leeuwen PJ, Busstra MB, Brabander T, van der Poel HG, Donswijk ML, Vis AN, Emmett L, Stricker PD, Roobol MJ. Use of gallium-68 prostate-specific membrane antigen positron-emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature. BJU Int 2019; 125:206-214. [PMID: 31680398 PMCID: PMC7383738 DOI: 10.1111/bju.14944] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives To review the literature to determine the sensitivity and specificity of gallium‐68 prostate‐specific membrane antigen (68Ga‐PSMA) positron‐emission tomography (PET) for detecting pelvic lymph node metastases in patients with primary prostate cancer (PCa), and the positive predictive value in patients with biochemical recurrence (BCR) after initial curative treatment, and, in addition, to determine the detection rate and management impact of 68Ga‐PSMA PET in patients with BCR after radical prostatectomy (RP). Materials and Methods We performed a comprehensive literature search. Search terms used in MEDLINE, EMBASE and Science Direct were ‘(PSMA, 68Ga‐PSMA, 68Gallium‐PSMA, Ga‐68‐PSMA or prostate‐specific membrane antigen)’ and ‘(histology, lymph node, staging, sensitivity, specificity, positive predictive value, recurrence, recurrent or detection)’. Relevant abstracts were reviewed and full‐text articles obtained where possible. References to and from obtained articles were searched to identify further relevant articles. Results Nine retrospective and two prospective studies described the sensitivity and specificity of 68Ga‐PSMA PET for detecting pelvic lymph node metastases before initial treatment, which ranged from 33.3% to 100% and 80% to 100%, respectively. In eight retrospective studies, the positive predictive value of 68Ga‐PSMA PET in patients with BCR before salvage lymph node dissection ranged from 70% to 100%. The detection rate of 68Ga‐PSMA PET in patients with BCR after RP in the PSA subgroups <0.2 ng/mL, 0.2–0.49 ng/mL and 0.5 to <1.0 ng/mL ranged from 11.3% to 50.0%, 20.0% to 72.7% and 25.0% to 87.5%, respectively. Conclusion The review results showed that 68Ga‐PSMA PET had a high specificity for the detection of pelvic lymph node metastases in primary PCa. Furthermore, 68Ga‐PSMA PET had a very high positive predictive value in detecting lymph node metastases in patients with BCR. By contrast, sensitivity was only moderate; therefore, based on the currently available literature, 68Ga‐PSMA PET cannot yet replace pelvic lymph node dissection to exclude lymph node metastases. In the salvage phase, 68Ga‐PSMA PET had both a high detection rate and impact on radiotherapy planning in early BCR after RP.
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Affiliation(s)
- Henk B Luiting
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Martijn B Busstra
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Tessa Brabander
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Louise Emmett
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Phillip D Stricker
- St. Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research, Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, UNSW, Sydney, NSW, Australia
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Maurer T, Graefen M, van der Poel H, Hamdy F, Briganti A, Eiber M, Wester HJ, van Leeuwen FW. Prostate-Specific Membrane Antigen–Guided Surgery. J Nucl Med 2019; 61:6-12. [DOI: 10.2967/jnumed.119.232330] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 12/31/2022] Open
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28
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Ploussard G, Gandaglia G, Borgmann H, de Visschere P, Heidegger I, Kretschmer A, Mathieu R, Surcel C, Tilki D, Tsaur I, Valerio M, van den Bergh R, Ost P, Briganti A. Salvage Lymph Node Dissection for Nodal Recurrent Prostate Cancer: A Systematic Review. Eur Urol 2019; 76:493-504. [DOI: 10.1016/j.eururo.2018.10.041] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/16/2018] [Indexed: 01/07/2023]
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29
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Devos G, Muilwijk T, Raskin Y, Calderon V, Moris L, Van den Broeck T, Berghen C, De Meerleer G, Albersen M, Van Poppel H, Everaerts W, Joniau S. Comparison of Peri-operative and Early Oncological Outcomes of Robot-Assisted vs. Open Salvage Lymph Node Dissection in Recurrent Prostate Cancer. Front Oncol 2019; 9:781. [PMID: 31555579 PMCID: PMC6737006 DOI: 10.3389/fonc.2019.00781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/01/2019] [Indexed: 01/06/2023] Open
Abstract
Introduction: Salvage lymph node dissection (sLND) has been proposed as a treatment option for prostate cancer patients with lymph node (LN) recurrence following radical prostatectomy to delay or avoid palliative androgen deprivation therapy (ADT). Historically sLND has been performed using an open approach, with its associated morbidity. A limited number of studies have reported peri-operative outcomes following robot-assisted sLND. However, a direct comparison with the open approach has hitherto not yet been reported. This study investigates whether robot-assisted sLND is associated with better peri-operative outcomes compared to the open approach. Early oncological outcomes are also compared. Patients and methods: In this retrospective study, clinical data were collected from 60 patients undergoing open sLND between 2010-2016 and 30 patients undergoing robot-assisted sLND between 2016 and 2018 at our tertiary referral center. The primary objective of the study was to compare peri-operative outcomes (length of stay, estimated blood loss, operative time, intra-operative, and postoperative complications) and LN yield between both procedures. As secondary objective early oncological outcome [biochemical recurrence-free survival (BRFS) and clinical recurrence-free survival (CRFS)] was compared. Variables of interest were compared using the chi-squared test (categorical variables), two sample t-test, and Mann-Whitney U-test (continuous variables). To compare BRFS and CRFS, Kaplan-Meier analysis, and log-rank tests were performed. Results: Robotic sLND was associated with reduced blood loss (median 100 vs. 275cc; p < 0.0001) and shorter length of stay (median 2 vs. 7 days; p < 0.0001) compared to open sLND. Moreover, postoperative complications within 30 days after surgery were more prevalent in the open sLND group compared to the robotic group (41.6% vs. 20%, p = 0.04). No significant differences in LN yield (for each sLND template), BRFS, and CRFS were detected between both groups. Conclusion: Robot-assisted sLND is associated with significantly reduced peri-operative morbidity compared to open sLND. No difference in LN yield, BRFS and CRFS was seen between both groups. Modern imaging techniques underestimate the tumor burden and therefore, the surgical sLND template should not be limited to the positive spots on pre-operative imaging.
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Affiliation(s)
- Gaëtan Devos
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Yannic Raskin
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Victor Calderon
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | | | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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The use of 68Ga-PET/CT PSMA to determine patterns of disease for biochemically recurrent prostate cancer following primary radiotherapy. Prostate Cancer Prostatic Dis 2019; 22:385-390. [DOI: 10.1038/s41391-019-0163-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/15/2019] [Accepted: 06/06/2019] [Indexed: 02/04/2023]
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31
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Kleinclauss F, Thiery-Vuillemin A. [Oligometastatic prostate cancer management]. Prog Urol 2019; 29 Suppl 1:S20-S34. [PMID: 31307628 DOI: 10.1016/s1166-7087(19)30167-8] [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: 10/26/2022]
Abstract
OBJECTIVE To review biology and management of oligometastatic prostate cancer. MATERIAL AND METHODS Relevant publications were identified through Medline (www. ncbi.nlm.nih.gov), Embase (www.embase.com) and the US National Library of Medicine (www.clinicaltrials.org) databases using the following keywords, alone or in association, «prostate cancer; metastasis; oligo-metastasis». Articles were selected according to methods, language of publication and relevance. After careful selection 99 publications were eligible for our review. RESULTS Oligometastatic prostate cancer is a new entity including prostate cancer with a limited number of metastasis. This particular state becomes more frequent with the imaging progresses especially with the common use of new PET imaging with Choline or PSMA. There is no consensus about a strict definition of oligometastatic prostate cancer, number and sites of metastasis vary widely in the literature. Moreover, oligometastatic state can be observed de novo at the time of prostate cancer diagnosis as well as in case of recurrence after a primary treatment. There is actually an important lack of evidence-based medicine and no guidelines regarding treatment can be found. In de novo oligo-metatastatic prostate cancer, treatment of the primary tumor in association with androgen deprivation therapy seems to increase survival in selected patients but this needs to be confirmed by ongoing prospective clinical trials. In recurrent prostate cancer, metastasis directed therapy with or without androgen deprivation therapy is now routinely performed but its impact needs also to be analyzed. CONCLUSION In absence of consensus or guidelines, management of prostate cancer should be an individualized, patient-based management taking into account primary tumor stage and grade, number and types of metastasis and patient characteristics.
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Affiliation(s)
- F Kleinclauss
- Service d'urologie, andrologie et transplantation rénale, CHRU Besançon, Besançon, France; Université de Franche-Comté, Besançon, France; INSERM 1098, Besançon, France.
| | - A Thiery-Vuillemin
- Université de Franche-Comté, Besançon, France; INSERM 1098, Besançon, France; Service d'oncologie médicale, CHRU Besançon, Besançon, France
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Yaxley JW, Raveenthiran S, Nouhaud FX, Samaratunga H, Yaxley WJ, Coughlin G, Yaxley AJ, Gianduzzo T, Kua B, McEwan L, Wong D. Risk of metastatic disease on 68
gallium-prostate-specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer. BJU Int 2019; 124:401-407. [DOI: 10.1111/bju.14828] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- John W. Yaxley
- Wesley Urology Clinic; Brisbane Queensland Australia
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
- Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Sheliyan Raveenthiran
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
- Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - François-Xavier Nouhaud
- Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- Department of Urology; Rouen University Hospital; Rouen France
| | - Hemamali Samaratunga
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
- Aquesta Uro-pathology; Brisbane Queensland Australia
| | - William J. Yaxley
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
- Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Geoff Coughlin
- Wesley Urology Clinic; Brisbane Queensland Australia
- Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Anna J. Yaxley
- School of Medicine; Griffith University; Brisbane Queensland Australia
| | | | - Boon Kua
- Wesley Medical Imaging; Brisbane Queensland Australia
| | - Louise McEwan
- Wesley Medical Imaging; Brisbane Queensland Australia
| | - David Wong
- Wesley Medical Imaging; Brisbane Queensland Australia
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A Multicenter Prospective Clinical Trial of 68Gallium PSMA HBED-CC PET-CT Restaging in Biochemically Relapsed Prostate Carcinoma: Oligometastatic Rate and Distribution Compared With Standard Imaging. Int J Radiat Oncol Biol Phys 2019; 104:801-808. [DOI: 10.1016/j.ijrobp.2019.03.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 02/19/2019] [Accepted: 03/11/2019] [Indexed: 12/14/2022]
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Salvage lymphadenectomy in recurrent prostate cancer: is there evidence of real benefit? World J Urol 2019; 37:1551-1556. [PMID: 31214766 DOI: 10.1007/s00345-019-02844-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 06/05/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Nodal recurrent prostate cancer (PCa) after primary radical treatment represents a heterogeneous entity with many treatment options. In some cases, surgical removal of metastatic nodes seems to improve cancer control and delay systemic treatments. The objectives of this study were to analyze the available literature on salvage lymphadenectomy for the treatment of nodal recurrent PCa and to elucidate the real oncological benefit deriving from this procedure. METHODS A PubMed search was performed using the following terms: prostate cancer, metastatic, oligometastatic, salvage lymphadenectomy, salvage lymph node dissection, salvage lymph node excision, and cytoreductive surgery. We included in the study all papers on salvage lymphadenectomy in nodal recurrent PCa, with no temporal limits. In addition, several papers addressing cytoreductive surgery and the biology of oligometastatic disease, published in different medical and basic research journals, were included. RESULTS Salvage lymphadenectomy is still characterized by a lack of standardization in patient selection and surgical template. Its primary objectives are to prolong progression-free survival and to delay the need for systemic therapy. The improvements in preoperative imaging techniques in conjunction with the wide use of minimally invasive surgery have generated growing interest in this procedure. CONCLUSION Salvage lymphadenectomy is a promising treatment approach; however, its real oncological benefit is still far from proven. Prospective randomized trials need to be designed to improve understanding of this issue.
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Performance of [ 68Ga] Ga-PSMA 11 PET for detecting prostate cancer in the lymph nodes before salvage lymph node dissection: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2019; 23:1-10. [PMID: 31147628 DOI: 10.1038/s41391-019-0156-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Salvage lymph node dissection (sLND) for nodal recurrence in prostate cancer (PCa) patients with biochemical recurrence (BCR) is still not recommended in current guidelines, because of the diagnostic inaccuracy of current conventional imaging. To assess the performance of [68Ga] Ga-prostate-specific membrane antigen conjugate 11 positron emission tomography (PSMA-PET) in detecting PCa lymph node metastasis using pathologic confirmation through sLND. METHODS Literature search was conducted using the MEDLINE, SCOPUS, Web of Science, and Cochrane Library on November 11th, 2018 to identify the eligible studies. Studies were eligible if they investigated the diagnostic performance of PSMA-PET before sLND in PCa patients with BCR and reported the number of true positive, false positive, false negative, and true negative on a lesion-based and/or field-based analyses to compare with histopathologic findings in sLND specimens. RESULTS Fourteen studies published between 2015 and 2018 comprising 462 patients were selected in this systematic review and meta-analysis. The positive predictive value of PSMA-PET before sLND on a patient-based analysis ranged between 0.70 and 0.93. The pooled sensitivity using lesion-based and field-based analyses were 0.84 (95%CI: 0.61-0.95) and 0.82 (95%CI: 0.72-0.89), respectively. The pooled specificity using lesion-based and field-based analyses were 0.97 (95%CI: 0.95-0.99) and 0.95 (95%CI: 0.70-0.99), respectively. The diagnostic odds ratio using lesion-based and field-based analyses were 189 (95%CI: 39-920) and 82 (95%CI: 8-832), respectively. CONCLUSIONS PSMA-PET before sLND provided highly accurate performance with clinically relevant high positive and negative predictive values for detecting lymph node disease in patients with BCR after local treatment with curative intent for PCa. PSMA-PET can identify the patients who are likely to benefit from sLND and possibly direct to lesion or region-based dissection.
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Horn T, Krönke M, Rauscher I, Haller B, Robu S, Wester HJ, Schottelius M, van Leeuwen FWB, van der Poel HG, Heck M, Gschwend JE, Weber W, Eiber M, Maurer T. Single Lesion on Prostate-specific Membrane Antigen-ligand Positron Emission Tomography and Low Prostate-specific Antigen Are Prognostic Factors for a Favorable Biochemical Response to Prostate-specific Membrane Antigen-targeted Radioguided Surgery in Recurrent Prostate Cancer. Eur Urol 2019; 76:517-523. [PMID: 30987843 DOI: 10.1016/j.eururo.2019.03.045] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prostate-specific membrane antigen (PSMA)-ligand positron emission tomography (PET) allows detection of metastatic prostate cancer (PC) lesions at low prostate-specific antigen (PSA) values. To facilitate their intraoperative detection during salvage surgery, we recently introduced PSMA-targeted radioguided surgery (RGS). OBJECTIVE To describe the outcome of a large cohort of patients treated with PSMA-targeted RGS and to establish prognostic factors. DESIGN, SETTING, AND PARTICIPANTS A total of 121 consecutive patients with recurrent PC as defined by PSMA-ligand PET (median PSA: 1.13ng/ml) underwent PSMA-targeted RGS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The frequency of a complete biochemical response (cBR; PSA <0.2ng/ml) without additional treatment and the duration of biochemical recurrence-free survival (bRFS, time from PSMA-targeted RGS with PSA <0.2ng/ml without further treatment) were evaluated and correlated with preoperatively available clinical variables. RESULTS AND LIMITATIONS In almost all patients (120/121, 99%) metastatic tissue could be removed. A cBR was achieved in 77 patients (66%). The chance of cBR was highest in patients with both low preoperative PSA and a single lesion (38/45: 84%). Median bRFS was 6.4mo in the whole patient cohort and 19.8mo for patients with cBR. Significantly longer median bRFS was observed in patients with a low preoperative PSA value (p=0.004, hazard ratio 1.48, 95% confidence interval 1.13-1.93) and with a single lesion in preoperative PSMA-ligand PET (14.0 vs 2.5mo, p=0.002). CONCLUSIONS PSMA-targeted RGS leads to a remarkable interval of bRFS in a subset of patients. The frequency of cBR and the duration of bRFS were highest in patients with a low preoperative PSA value and a single lesion on PSMA-ligand PET. PATIENT SUMMARY Prostate-specific membrane antigen radioguided surgery delays disease progression in selected patients with recurrent prostate cancer after radical prostatectomy. Patients with a single lesion of recurrence and a low prostate-specific antigen value had the best outcome.
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Affiliation(s)
- Thomas Horn
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Markus Krönke
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Stephanie Robu
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Hans-Jürgen Wester
- Institute of Pharmaceutical Radiochemistry, Technical University of Munich, Munich, Germany
| | - Margret Schottelius
- Institute of Pharmaceutical Radiochemistry, Technical University of Munich, Munich, Germany
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Antoni van Leeuwenhoek Hospital-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Matthias Heck
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Technical University of Munich, Munich, Germany; Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Abstract
Prostate cancer (PCa) is the most common cancer in men worldwide, but it exhibits a highly variable biological behavior ranging from indolent to highly aggressive disease. The standard conventional imaging for staging PCa consists of CT, MRI, and bone scans, but this imaging has suboptimal accuracy for extraprostatic tumor detection, particularly in the scenario of early biochemical relapse when the prostate-specific antigen levels are still low indicating a low volume of recurrent disease. This gap between known disease (as indicated by a rising prostate-specific antigen) and the failure to detect it on conventional imaging, has led to the development of novel imaging probes most of which have positron emitting radioactive tags. In the last decade, multiple PET probes have demonstrated promising performance in detecting sites of recurrence and extent of disease in patients with PCa. The landscape of available PET radiotracers is changing rapidly and includes radiolabeled choline, anti1-amino-3-18F-fluorocyclobutane-1-carboxylic acid (18F-fluciclovine), bombesin, dihydrotestosterone, and prostate-specific membrane antigen (PSMA) ligands, among others. Of these, radiolabeled PSMA-PET agents have shown the most encouraging results in terms of sensitivity and are likely to become universally available for imaging PCa within a few years Other PET radiotracers such as bombesin-based radiotracers and antagonist of gastrin releasing-peptide receptor (RM2) are emerging as possible alternatives for PCa imaging. This review article discusses the current and near-future of PET molecular imaging probes.
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Affiliation(s)
- Esther Mena
- Molecular Imaging Program, National Cancer Institute, NIH. Bethesda, MD
| | - Liza M Lindenberg
- Molecular Imaging Program, National Cancer Institute, NIH. Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, NIH. Bethesda, MD.
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Zhang W, van Weerden WM, de Ridder CMA, Erkens‐Schulze S, Schönfeld E, Meijer TG, Kanaar R, van Gent DC, Nonnekens J. Ex vivo treatment of prostate tumor tissue recapitulates in vivo therapy response. Prostate 2019; 79:390-402. [PMID: 30520109 PMCID: PMC6587720 DOI: 10.1002/pros.23745] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 02/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND In vitro models of prostate cancer (PCa) are not always reliable to evaluate anticancer treatment efficacy. This limitation may be overcome by using viable tumor slice material. Here we report on the establishment of an optimized ex vivo method to culture tissue slices from patient-derived xenografts (PDX) of prostate cancer (PCa), to assess responses to PCa treatments. METHODS Three PDX models were used that are characterized by different androgen receptor (AR) expression and different homology directed DNA repair capacities, due to a breast cancer associated two (BRCA2) wild-type or mutated status. Tumors were removed from mice, sliced using a vibratome and cultured for a maximum of 6 days. To test the sensitivity to androgen antagonist, tumor slices from the AR-expressing and AR-negative PDX tumors were treated with the anti-androgen enzalutamide. For sensitivity to DNA repair intervention, tumors slices from BRCA2 wild-type and mutated PDXs were treated with the poly (ADP-ribose) polymerase-1 inhibitor olaparib. Treatment response in these tumor slices was determined by measuring slice morphology, cell proliferation, apoptosis, AR expression level, and secretion of prostate specific antigen (PSA). RESULTS We compared various culture conditions (support materials, growth media, and use of a 3D smooth rocking platform) to define the optimal condition to maintain tissue viability and proliferative capacity up to least 6 days. Under optimized conditions, enzalutamide treatment significantly decreased proliferation, increased apoptosis, and reduced AR-expression and PSA secretion of AR-expressing tumor slices compared to AR-negative slices, that did not respond to the intervention. Olaparib treatment significantly increased cell death in BRCA2 mutated tumors slices as compared to slices from BRCA2 wild type tumors. CONCLUSIONS Ex vivo treatment of PCa PDX tumor slices with enzalutamide and olaparib recapitulates responses previously observed in vivo. The faithful retention of tissue structure and function in this ex vivo model offers an ideal opportunity for treatment efficacy screening, thereby reducing costs and numbers of experimental animals.
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Affiliation(s)
- Wenhao Zhang
- Department of Molecular GeneticsErasmus MCRotterdamThe Netherlands
| | | | | | | | - Edgar Schönfeld
- Department of Molecular GeneticsErasmus MCRotterdamThe Netherlands
| | - Titia G. Meijer
- Department of Molecular GeneticsErasmus MCRotterdamThe Netherlands
- Oncode InstituteErasmus MCRotterdamThe Netherlands
| | - Roland Kanaar
- Department of Molecular GeneticsErasmus MCRotterdamThe Netherlands
- Oncode InstituteErasmus MCRotterdamThe Netherlands
| | - Dik C. van Gent
- Department of Molecular GeneticsErasmus MCRotterdamThe Netherlands
- Oncode InstituteErasmus MCRotterdamThe Netherlands
| | - Julie Nonnekens
- Department of Molecular GeneticsErasmus MCRotterdamThe Netherlands
- Department of Radiology and Nuclear MedicineErasmus MCRotterdamThe Netherlands
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Rowe SP, Gorin MA, Pomper MG. Imaging of Prostate-Specific Membrane Antigen with Small-Molecule PET Radiotracers: From the Bench to Advanced Clinical Applications. Annu Rev Med 2019; 70:461-477. [DOI: 10.1146/annurev-med-062117-073027] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In recent years, small-molecule inhibitors of prostate-specific membrane antigen (PSMA) labeled with radionuclides that allow for positron emission tomography (PET) imaging have been extensively studied in many clinical contexts in men with prostate cancer (PCa). The high sensitivity and specificity of these agents for identifying sites of PCa has quickly led to their widespread adoption as a de facto clinical standard of care throughout much of the world. PSMA-targeted PET radiotracers have been particularly well-studied in preoperatively staging men with high-risk PCa, evaluating biochemical recurrence following definitive therapy, and guiding metastasis-directed therapy in patients suspected of having oligorecurrent/oligometastatic disease. Furthermore, the expression of PSMA on the tumor neovasculature of many nonprostate malignancies has enabled a burgeoning subfield concentrated on delineating the potential utility of PSMA-targeted PET agents for imaging other cancers. In this review, we highlight the preclinical development of key small molecules that are now being clinically utilized for PCa imaging, discuss the roles of PSMA-targeted agents in guiding patient management, and consider the role these compounds may play in imaging nonprostate cancers.
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Affiliation(s)
- Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA;,
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Michael A. Gorin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA;,
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Martin G. Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA;,
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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40
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Hope TA, Goodman JZ, Allen IE, Calais J, Fendler WP, Carroll PR. Metaanalysis of 68Ga-PSMA-11 PET Accuracy for the Detection of Prostate Cancer Validated by Histopathology. J Nucl Med 2018; 60:786-793. [PMID: 30530831 DOI: 10.2967/jnumed.118.219501] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/01/2018] [Indexed: 12/17/2022] Open
Abstract
68Ga-PSMA-11 PET is used to stage patients with prostate cancer. We performed an updated metaanalysis that separates imaging at the time of diagnosis and at the time of biochemical recurrence and focuses on pathology correlation in both populations. Methods: We searched the MEDLINE and EMBASE databases using the PRISMA statement. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool 2. In total, 1,811 studies were screened, 58 were analyzed, 41 were included for qualitative synthesis, and 29 were included for quantitative analysis. A random-effect model and a hierarchical summary receiver-operating-characteristic model were used to summarize the sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy for pelvic lymph nodes in initial staging compared with pathology at prostatectomy and the PPV for lesions with pathologic correlation in those with biochemical recurrence. We also summarized the detection rate of 68Ga-PSMA-11 in those with biochemical recurrence stratified by prostate-specific antigen (PSA) at the time of imaging. Results: The metaanalysis of 68Ga-PSMA-11 at initial staging demonstrated a sensitivity and specificity of 0.74 (95% confidence interval [95% CI], 0.51-0.89) and 0.96 (95% CI, 0.85-0.99), respectively, using nodal pathology at prostatectomy as a gold standard. At biochemical recurrence, the PPV was 0.99 (95% CI, 0.96-1.00). The detection rate was 0.63 (95% CI, 0.55-0.70), with a PSA of less than 2.0 and 0.94 (95% CI, 0.91-0.96) with a PSA of more than 2.0. Conclusion: 68Ga-PSMA-11 performed well for the localization of metastatic prostate cancer at initial staging and at the time of biochemical recurrence.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California .,Department of Radiology, San Francisco VA Medical Center, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Urology, UCSF, San Francisco, California
| | | | - Isabel E Allen
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California
| | - Jeremie Calais
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California; and
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Peter R Carroll
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Urology, UCSF, San Francisco, California
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41
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Foster CC, Weichselbaum RR, Pitroda SP. Oligometastatic prostate cancer: Reality or figment of imagination? Cancer 2018; 125:340-352. [PMID: 30521067 PMCID: PMC6587458 DOI: 10.1002/cncr.31860] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/08/2018] [Accepted: 10/13/2018] [Indexed: 12/20/2022]
Abstract
The term “oligometastatic prostate cancer” refers to a heterogeneous group of disease states currently defined solely on the basis of clinical features. Oligorecurrent disease, de novo oligometastases, and oligoprogressive disease likely have unique biologic underpinnings and natural histories. Evidence suggesting the existence of a subset of patients who harbor prostate cancer with limited metastatic potential currently includes disparate and overwhelmingly retrospective reports. Nevertheless, emerging prospective data have corroborated the “better‐than‐expected,” retrospectively observed outcomes, particularly in the setting of oligorecurrent prostate cancer. Improved functional imaging with prostate‐specific membrane antigen‐targeted strategies may enhance the identification of patients with oligometastatic prostate cancer in the short term. In the long term, refinement of the oligometastatic case definition likely will require biologic risk‐stratification schemes. To determine optimal treatment strategies and identify patients most likely to benefit from metastasis‐directed therapy, future efforts should focus on conducting high‐quality, prospective trials with much‐needed molecular correlative studies. The term “oligometastatic prostate cancer” currently refers to a heterogeneous group of clinically defined disease states. To improve patient risk stratification and determine optimal treatment strategies, future efforts should focus on conducting prospective trials and determining a biologic categorization of patients with limited metastatic potential.
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Affiliation(s)
- Corey C Foster
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois
| | - Sean P Pitroda
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois
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42
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Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Detected via Prostate-specific Membrane Antigen Positron Emission Tomography. Eur Urol Oncol 2018; 1:531-537. [DOI: 10.1016/j.euo.2018.04.017] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/17/2018] [Accepted: 04/27/2018] [Indexed: 01/10/2023]
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43
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Afaq A, Bomanji J. Prostate-specific membrane antigen positron emission tomography in the management of recurrent prostate cancer. Br Med Bull 2018; 128:37-48. [PMID: 30272121 DOI: 10.1093/bmb/ldy032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/30/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION There is an unmet clinical need for early, accurate imaging of recurrent prostate cancer to improve patient outcomes. Staging, by conventional bone scintigraphy and CT have become outdated. 68Ga-PSMA PET/CT imaging in this setting has developed rapidly, with widespread International adoption in line with evidence-based guidelines in this group of patients. SOURCES OF DATA A PubMed search of English language articles was performed using following keywords: PSMA, PET/CT, biochemical recurrence, prostate cancer. The search revealed 85 articles, of which 75 were original; 70 of these involved use of the most widely available type of PSMA tracer (HBED). The review also relied on the clinical experience of reporting over 1000 PSMA PET/CT studies at a major tertiary referral centre for uro-oncology, with the majority of cases having been performed in the biochemical recurrence setting from 2015 to 2018. AREAS OF AGREEMENT 68Ga-PSMA PET is a game changer and superior to choline PET and other established tracers which have been used in prostate cancer evaluation. Detection of recurrence at the prostate bed remains challenging due to bladder and urethral tracer accumulation. The main strength of PSMA PET/CT is its ability to identify small (<8 mm) pathological lymph nodes, upstaging nodal status in up to two-thirds of cases. Additionally, PSMA PET/CT, detects bone and bone marrow metastases missed by conventional bone and CT imaging. Thus, PSMA PET/CT has major impact on patient management, with studies reporting overall changes in 39-76% of cases. AREAS OF CONTROVERSY Controversy exists regarding patient access and NHS affordability of PSMA PET/CT imaging. Currently, no reimbursement is available under the NHS tariff system. The cost outlay for tertiary hospital linked PET centres ranges from £150-170 K. Large referral volumes, and technical advances in manufacturing process will make this tracer cost neutral and similar to the current funded, but less sensitive, choline PET. Current NICE guidelines for prostate cancer management do not include a recommendation on when PSMA PET/CT should be used and this is likely to remain the case in the next revision, due in 2019. GROWING POINTS Although PSMA PET/CT imaging results in significant management change, there is a need for high quality economic evaluation and cost analysis for this modality. Lack of this data will result in poor adoption of this technique and thus limit patient access. Furthermore, it is hoped that future tracers will become even more sensitive and identify disease at earlier thresholds. AREAS TIMELY FOR DEVELOPING RESEARCH Well-designed clinical trials with consideration of the health economic benefit of using PSMA PET/CT will be essential to provide a basis for entry into guidelines such as NICE and to provide a rationale for reimbursement.
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Affiliation(s)
- Asim Afaq
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
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Yin Y, Werner RA, Higuchi T, Lapa C, Pienta KJ, Pomper MG, Gorin MA, Rowe SP. Follow-up of Lesions with Equivocal Radiotracer Uptake on PSMA-Targeted PET in Patients with Prostate Cancer: Predictive Values of the PSMA-RADS-3A and PSMA-RADS-3B Categories. J Nucl Med 2018; 60:511-516. [PMID: 30190303 DOI: 10.2967/jnumed.118.217653] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/28/2018] [Indexed: 12/21/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA)-targeted PET imaging has become commonly used in patients with prostate cancer (PCa). The PSMA reporting and data system version 1.0 (PSMA-RADS version 1.0) categorizes lesions on the basis of the likelihood of PCa involvement, with PSMA-RADS-3A (soft-tissue) and PSMA-RADS-3B (bone) lesions being indeterminate for the presence of disease. We retrospectively reviewed the imaging follow-up of such lesions to determine the rate at which they underwent changes suggestive of underlying PCa. Methods: PET/CT imaging with 18F-DCFPyL was performed in 110 patients with PCa, and lesions were categorized according to PSMA-RADS version 1.0. The study reported herein is a retrospective analysis of those patients. Fifty-six of 110 (50.9%) patients were determined to have indeterminate PSMA-RADS-3A or PSMA-RADS-3B lesions, and 22 of 56 (39.3%) patients had adequate follow-up to be included in the analysis (median follow-up time was 10 mo [range, 3-22 mo]). The SUVmax of the lesions was obtained, and the ratios of SUVmax of the lesions to SUVmean of blood pool (SUVmax-lesion/SUVmean-bloodpool) were calculated. Predetermined criteria were used to evaluate the PSMA-RADS-3A and PSMA-RADS-3B lesions on follow-up imaging to determine whether they demonstrated evidence of underlying malignancy. Results: A total of 46 lesions in 22 patients were considered indeterminate for PCa (i.e., PSMA-RADS-3A [32 lesions] or PSMA-RADS-3B [14 lesions]) and were evaluable on follow-up imaging. Twenty-seven of 46 (58.7%) lesions demonstrated changes suggesting they were true-positive for PCa. These lesions included 24 of 32 (75.0%) PSMA-RADS-3A lesions and 3 of 14 (21.4%) lesions categorized as PSMA-RADS-3B. The ranges of SUVmax and SUVmax-lesion/SUVmean-bloodpool overlapped between those lesions demonstrating changes consistent with malignancy on follow-up imaging and those lesions that remained unchanged on follow-up. The presence of additional definitive sites of PCa (PSMA-RADS-4 and PSMA-RADS-5) increases the likelihood that indeterminate lesions will manifest as true-positive on follow-up imaging. Conclusion: PSMA-RADS-3A and PSMA-RADS-3B lesions are truly indeterminate in that proportions of findings in both categories demonstrate evidence of malignancy on follow-up imaging. Overall, PSMA-RADS-3A lesions are more likely than PSMA-RADS-3B lesions to represent sites of PCa, and this information should be considered when guiding patient therapy.
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Affiliation(s)
- Yafu Yin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, China.,Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rudolf A Werner
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany; and
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany; and
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany; and
| | - Kenneth J Pienta
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin G Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael A Gorin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland .,The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ong WM, Zargar-Shoshtari K, Siva S, Zargar H. Prostate specific membrane antigen: the role in salvage lymph node dissection and radio-ligand therapy. MINERVA UROL NEFROL 2018; 70:450-461. [PMID: 30037209 DOI: 10.23736/s0393-2249.18.03152-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Prostate-specific membrane antigen (PSMA) is a receptor highly expressed on the membranes of prostate cancer (PCa) cells and provides a new opportunity for imaging and targeted therapy in metastatic prostate cancer. The use of radio-labelled peptides with high affinity for PSMA-receptor allows for localization of oligo-metastasis to guide salvage lymph node (LN) dissection, and effective delivery of radionuclide therapy to PCa cells. This review discusses the current statistics of PSMA-guided salvage lymph-node dissection. EVIDENCE ACQUISITION A non-systematic literature search of the Medline, Embase, and Scopus databases was performed in December 2017 using medical subject headings and free-text protocol. EVIDENCE SYNTHESIS The properties of PSMA has enabled the timely detection of oligometastatic disease, potentially altering oncological outcomes of men with PCa. The utility of PSMA in directing sLND has been proven to have an impact in achieving modest biochemical response which is generally not durable. CONCLUSIONS Larger randomized controlled trials are needed to validate the current findings, determine treatment protocols, and weigh up its benefits and determine its standing amongst the current management strategies for PCa.
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Affiliation(s)
- Wei M Ong
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Shankar Siva
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Homayoun Zargar
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Australian Prostate Cancer Research Centre, Melbourne, Victoria, Australia
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Lieng H, Hayden AJ, Christie DRH, Davis BJ, Eade TN, Emmett L, Holt T, Hruby G, Pryor D, Shakespeare TP, Sidhom M, Skala M, Wiltshire K, Yaxley J, Kneebone A. Radiotherapy for recurrent prostate cancer: 2018 Recommendations of the Australian and New Zealand Radiation Oncology Genito-Urinary group. Radiother Oncol 2018; 129:377-386. [PMID: 30037499 DOI: 10.1016/j.radonc.2018.06.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022]
Abstract
The management of patients with biochemical, local, nodal, or oligometastatic relapsed prostate cancer has become more challenging and controversial. Novel imaging modalities designed to detect recurrence are increasingly used, particularly PSMA-PET scans in Australia, New Zealand and some European countries. Imaging techniques such as MRI and PET scans using other prostate cancer-specific tracers are also being utilised across the world. The optimal timing for commencing salvage treatment, and the role of local and/or systemic therapies remains controversial. Through surveys of the membership, the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group (FROGG) identified wide variation in the management of recurrent prostate cancer. Following a workshop conducted in April 2017, the FROGG management committee reviewed the literature and developed a set of recommendations based on available evidence and expert opinion, for the appropriate investigation and management of recurrent prostate cancer. These recommendations cover the role and timing of post-prostatectomy radiotherapy, the management of regional nodal metastases and oligometastases, as well as the management of local prostate recurrence after definitive radiotherapy.
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Affiliation(s)
- Hester Lieng
- Central Coast Cancer Centre, Gosford Hospital, Australia.
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Australia
| | - David R H Christie
- Genesis Cancer Care, Australia; Department of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas N Eade
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - Louise Emmett
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia
| | - Tanya Holt
- University of Queensland, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - George Hruby
- Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Thomas P Shakespeare
- North Coast Cancer Institute, Coffs Harbour, Australia; University of New South Wales Rural Clinical School, Australia
| | - Mark Sidhom
- Liverpool Hospital Cancer Therapy Centre, Sydney, Australia; University of New South Wales, Australia
| | | | | | - John Yaxley
- University of Queensland, Australia; Royal Brisbane and Women's Hospital, Australia; Wesley Urology Clinic, Brisbane, Australia
| | - Andrew Kneebone
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
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Linxweiler J, Saar M, Al-Kailani Z, Janssen M, Ezziddin S, Stöckle M, Siemer S, Ohlmann CH. Robotic salvage lymph node dissection for nodal-only recurrences after radical prostatectomy: Perioperative and early oncological outcomes. Surg Oncol 2018; 27:138-145. [DOI: 10.1016/j.suronc.2018.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 10/18/2022]
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Brassetti A, Proietti F, Pansadoro V. Oligometastatic prostate cancer and salvage lymph node dissection: systematic review. MINERVA CHIR 2018; 74:97-106. [PMID: 29806760 DOI: 10.23736/s0026-4733.18.07796-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We provide a comprehensive description of the physio-pathological theories behind oligometastatic prostate cancer (PCa) and analyze modern imaging techniques, presenting a systematic review of the available evidences regarding salvage lymph node dissection (sLND). EVIDENCE ACQUISITION A systematic review was attempted. The PubMed/Medline database was searched for "salvage" AND ("lymph node dissection" OR "lymphadenectomy") AND "prostate" AND "cancer." Only English publications were targeted. Relevant original articles addressing the role of sLND in PCa were selected. EVIDENCE SYNTHESIS Biochemical response (BR) was reported in 10-79.5% of the cases overall. These results were not durable and biochemical recurrence occurred in 54.5-93.8% of the cases, within 5 years. Furthermore, 50-80% of patients received some kind of adjuvant treatment right after sLND, regardless post-operative prostate-specific antigen levels. Surgery-related morbidity was low, with a 0-27% incidence of Clavien-Dindo III complications. No sLND-related deaths were observed. CONCLUSIONS sLND is not associated with a durable response over time but may postpone HT and its related complications, in selected patients. Although a limited morbidity was reported, sLND remains technically demanding and a careful selection of patients is advisable.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, Vincenzo Pansadoro Foundation, Center for Laparoscopic Urology and Medical Oncology, Rome, Italy -
| | - Flavia Proietti
- Department of Urology, Vincenzo Pansadoro Foundation, Center for Laparoscopic Urology and Medical Oncology, Rome, Italy
| | - Vito Pansadoro
- Department of Urology, Vincenzo Pansadoro Foundation, Center for Laparoscopic Urology and Medical Oncology, Rome, Italy
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von Eyben FE, Baumann GS, Baum RP. PSMA diagnostics and treatments of prostate cancer become mature. Clin Transl Imaging 2018; 6:145-148. [PMID: 29670866 PMCID: PMC5886992 DOI: 10.1007/s40336-018-0270-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/23/2018] [Indexed: 01/30/2023]
Affiliation(s)
| | - Glenn Stewart Baumann
- Deparment of Radiation Oncology, University of Western Ontario in London, London, ON Canada
| | - Richard Paul Baum
- Theranostic Center for Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany
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Schmidt-Hegemann NS, Fendler WP, Ilhan H, Herlemann A, Buchner A, Stief C, Eze C, Rogowski P, Li M, Bartenstein P, Ganswindt U, Belka C. Outcome after PSMA PET/CT based radiotherapy in patients with biochemical persistence or recurrence after radical prostatectomy. Radiat Oncol 2018; 13:37. [PMID: 29499730 PMCID: PMC5833127 DOI: 10.1186/s13014-018-0983-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/22/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND PSMA PET/CT visualises prostate cancer residual disease or recurrence at lower PSA levels compared to conventional imaging and results in a change of treatment in a remarkable high number of patients. Radiotherapy with dose escalation to the former prostate bed has been associated with improved biochemical recurrence-free survival. Thus, it can be hypothesised that PSMA PET/CT-based radiotherapy might improve the prognosis of these patients. METHODS One hundred twenty-nine patients underwent PSMA PET/CT due to biochemical persistence (52%) or recurrence (48%) after radical prostatectomy without evidence of distant metastases (February 2014-May 2017) and received PSMA PET/CT-based radiotherapy. Biochemical recurrence free survival (PSA ≤ 0.2 ng/ml) was defined as the study endpoint. RESULTS Patients with biochemical persistence were significantly more often high-risk patients with significantly shorter time interval before PSMA PET/CT than patients with biochemical recurrence. Patients with biochemical recurrence had significantly more often no evidence of disease or local recurrence only in PSMA PET/CT, whereas patients with biochemical persistence had significantly more often lymph node involvement. Seventy-three patients were started on antiandrogen therapy prior to radiotherapy due to macroscopic disease in PSMA PET/CT. Cumulatively, 70 (66-70.6) Gy was delivered to local macroscopic tumor, 66 (63-66) Gy to the prostate fossa, 61.6 (53.2-66) Gy to PET-positive lymph nodes and 50.4 (45-52.3) Gy to lymphatic pathways. Median PSA after radiotherapy was 0.07 ng/ml with 74% of patients having a PSA ≤ 0.1 ng/ml. After a median follow-up of 20 months, median PSA was 0.07 ng/ml with ongoing antiandrogen therapy in 30 patients. PET-positive patients without antiandrogen therapy at last follow-up (45 patients) had a median PSA of 0.05 ng/ml with 89% of all patients, 94% of patients with biochemical recurrence and 82% of patients with biochemical persistence having a PSA ≤ 0.2 ng/ml. Post-radiotherapy PSA ≤ 0.1 ng/ml and biochemical recurrence vs. persistence were significantly associated with a PSA ≤ 0.2 ng/ml at last follow-up. CONCLUSIONS PSMA PET/CT-based radiotherapy is an effective local salvage treatment option with significant PSA response in patients with biochemical recurrence or persistence after radical prostatectomy leading to deferral of long-term ADT or systemic therapy.
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Affiliation(s)
| | | | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Annika Herlemann
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Munich, Germany
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