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Henríquez I, Malave B, Campos FL, Hidalgo EC, Muelas R, Ferrer C, Muñoz-Rodriguez J, Villamón AM, Pascual MC, Badia J, Fuertes J, Hinojosa-Salas P. PSMA PET/CT SUVmax as a prognostic biomarker in patients with metachronous metastatic hormone-sensitive prostate cancer (mHSPC). Clin Transl Oncol 2024:10.1007/s12094-024-03625-y. [PMID: 39073734 DOI: 10.1007/s12094-024-03625-y] [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: 04/08/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Metastatic hormone-sensitive prostate cancer (mHSPC) is treatment-resistant and generally considered incurable. The development of prostate-specific membrane antigen positron emission-computed tomography (PSMA PET/CT) has generated immense expectations due to its diagnostic accuracy in prostate cancer (PCa). PSMA expression of the primary tumor, quantified by SUVmax, is a predictor of oncological outcomes. The role of PSMA-PET/CT SUVmax in metachronous mHSPC treated with ADT plus second-generation antiandrogens (ARSI) is unknown. The main aim of this study was to evaluate 68Ga-PSMA-11expression (SUVmax) as a potential prognostic biomarker in patients with metachronous mHSPC treated with ADT and first or second-generation antiandrogens. A second aim was to determine the association between PSMA SUVmax and PSA response to hormone therapy. MATERIAL AND METHODS Patients diagnosed with metachronous mHSPC between July 2017 and February 2023 who developed biochemical recurrence following radical surgery (with or without salvage radiotherapy and/or ADT) or external radiation therapy (with or without ADT) were included. All patients underwent 68 Ga-PSMA-11 PET/CT imaging and the SUVmax value was determined for all measurable locations. The SUVmax value was used for the semiquantitative analysis. The Wilcoxon method was used to compare responders (PSA reduction ≥ 50%) to non-responders (PSA reduction < 50%). The SUVmax value and hormone therapy were evaluated as independent variables relative to the PSA response rate or PSA reduction using the linear regression method. A mixed-effects model (ANOVA) was used for the comparisons. RESULTS A total of 82 patients were included. Median follow-up was 11.7 months. On the linear regression analysis, patients with a high SUVmax treated with ADT + ARSI showed a greater PSA response (p = 0.034) than those treated with ADT + first-generation antiandrogens. In the mixed-effects model, SUVmax was significant (p = 0.041). On the univariate analysis, PSA at recurrence (HR, 3.2; 95% CI: 1.07-13.6; p = 0.078) and the number of metastases (HR, 4.77; 95% CI 1.1-26.1: p = 0.002) were associated with the type of hormone therapy administered. CONCLUSIONS PSMA-PET/CT SUVmax is a prognostic biomarker that can be used to predict a PSA response to ADT + ARSI in patients with metachronous mHSPC. However, these findings need to be confirmed in larger prospective studies.
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Affiliation(s)
- Iván Henríquez
- Department of Radiation Oncology, Hospital Universitario Sant Joan, Pere i Virgili Health Research Institute (IISPV), Reus, Spain.
| | - Bárbara Malave
- Department of Radiation Oncology, Hospital Universitario Sant Joan, Pere i Virgili Health Research Institute (IISPV), Reus, Spain
| | | | | | - Rodrigo Muelas
- Department of Radiation Oncology. Hospital Provincial Castellón, Valencia, Spain
| | - Carlos Ferrer
- Department of Radiation Oncology. Hospital Provincial Castellón, Valencia, Spain
| | | | | | | | - Joan Badia
- Statistical Support Platform. Pere I Virgili Health Research Institute (IISPV), Instituto de Oncología de La Cataluña Sud (IOCS), Reus, Spain
| | - Jordi Fuertes
- Nuclear Medicine Department. Hospital, Universitario Sant Joan, Reus, Spain
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Pérez Fentes D, Willisch P, Martínez Breijoo S, Domínguez M, Anido U, Álvarez C, Gómez Caamaño A. Controversies in prostate cancer management: Consensus recommendations from experts in northern Spain. Actas Urol Esp 2024:S2173-5786(24)00083-0. [PMID: 38960063 DOI: 10.1016/j.acuroe.2024.06.005] [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: 04/04/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024]
Abstract
In recent years, various aspects of prostate cancer (PC) management have undergone significant changes, including the implementation of therapeutic strategies such as the use of new hormonal agents like abiraterone, apalutamide, enzalutamide or darolutamide and the incorporation of next generation imaging techniques (NGI). However, the evidence regarding the role of NGI and the therapeutic decision-making based on their findings is not solid. Following the methodology of the Advanced Prostate Cancer Consensus Conference (APCCC), a multidisciplinary expert consensus was developed to address controversial questions concerning the use of NGI and clinical management in four priority scenarios: localized PC, PC after radical prostatectomy, PC after radiotherapy with curative intent, and metastatic hormone-sensitive PC. This consensus represents the opinions of medical oncology, radiation oncology and urology physicians and provides useful recommendations for clinical practice.
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Affiliation(s)
- D Pérez Fentes
- Servicio de Urología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - P Willisch
- Departamento de Oncología Radioterápica, Hospital Meixoeiro, Vigo, Pontevedra, Spain
| | - S Martínez Breijoo
- Servicio de Urología, Hospital Universitario de A Coruña, A Coruña, Spain
| | - M Domínguez
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - U Anido
- Departamento de Oncología Médica, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - C Álvarez
- Servicio de Oncología Médica, Hospital Universitario de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - A Gómez Caamaño
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Correa RJM, Mendez LC. Helpful tool or blunt instrument?-the European Association of Urology Biochemical Recurrence Risk Classification as a decision-making tool for salvage radiotherapy. Transl Androl Urol 2024; 13:889-892. [PMID: 38855605 PMCID: PMC11157405 DOI: 10.21037/tau-23-665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/13/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Rohann J M Correa
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Lucas C Mendez
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
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Mehring G, Steinbach C, Pose R, Knipper S, Koehler D, Werner S, Riethdorf S, von Amsberg G, Ambrosini F, Maurer T. Limited prognostic role of routine serum markers (AP, CEA, LDH and NSE) in oligorecurrent prostate cancer patients undergoing PSMA-radioguided surgery. World J Urol 2024; 42:256. [PMID: 38656636 PMCID: PMC11043188 DOI: 10.1007/s00345-024-04948-9] [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: 01/20/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION We evaluated the prognostic role of pre-salvage prostate-specific membrane antigen-radioguided surgery (PSMA-RGS) serum levels of alkaline phosphatase (AP), carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH), and neuron-specific enolase (NSE). MATERIALS AND METHODS Patients who consecutively underwent PSMA-RGS for prostate cancer (PCa) oligorecurrence between January 2019 and January 2022 were selected. Biomarkers were assessed one day before surgery. Cox regression and logistic regression models tested the relationship between biochemical recurrence-free survival (BFS), 6- and 12-month biochemical recurrence (BCR), and several independent variables, including biomarkers. RESULTS 153 consecutive patients were analyzed. In the univariable Cox regression analysis, none of the biomarkers achieved predictor status (AP: hazard ratio [HR] = 1.03, 95% CI 0.99, 1.01; p = 0.19; CEA: HR = 1.73, 95% CI 0.94, 1.21; p = 0.34; LDH: HR = 1.01, 95% CI 1.00, 1.01; p = 0.05; NSE: HR = 1.02, 95% CI 0.98, 1.06; p = 0.39). The only independent predictor of BFS was the number of positive lesions on PSMA PET (HR = 1.17, 95% CI 1.02, 1.30; p = 0.03). The number of positive lesions was confirmed as independent predictor for BCR within 6 and 12 months (BCR < 6 months: odds ratio [OR] = 1.1, 95% CI 1.0, 1.3; p = 0.04; BCR < 12 months: OR = 1.1, 95% CI 1.0, 1.3; p = 0.04). CONCLUSION The assessment of AP, CEA, LDH, and NSE before salvage PSMA-RGS showed no prognostic impact. Further studies are needed to identify possible predictors that will optimize patient selection for salvage PSMA-RGS.
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Affiliation(s)
- Gisa Mehring
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christina Steinbach
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Randi Pose
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Daniel Koehler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Werner
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Riethdorf
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunhild von Amsberg
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation With Section Pneumology, Hubertus Wald Tumorzentrum - University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesca Ambrosini
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Roberts MJ, Conduit C, Davis ID, Effeney RM, Williams S, Martin JM, Hofman MS, Hruby G, Eapen R, Gianacas C, Papa N, Lourenço RDA, Dhillon HM, Allen R, Fontela A, Kaur B, Emmett L. The Dedicated Imaging Post-Prostatectomy for Enhanced Radiotherapy outcomes (DIPPER) trial protocol: a multicentre, randomised trial of salvage radiotherapy versus surveillance for low-risk biochemical recurrence after radical prostatectomy. BJU Int 2024; 133 Suppl 3:39-47. [PMID: 37604702 DOI: 10.1111/bju.16158] [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] [Indexed: 08/23/2023]
Abstract
BACKGROUND Salvage radiation therapy (SRT) and surveillance for low-risk prostate-specific antigen (PSA) recurrence have competing risks and benefits. The efficacy of early SRT to the prostate bed with or without pelvic lymph nodes compared to surveillance in patients with PSA recurrence after radical prostatectomy and no identifiable recurrent disease evident on prostate specific membrane antigen-positron emission tomography/computer tomography (PSMA-PET/CT) is unknown. STUDY DESIGN The Dedicated Imaging Post-Prostatectomy for Enhanced Radiotherapy outcomes (DIPPER) is an open-label, multicentre, randomised Phase II trial. ENDPOINTS The primary endpoint is 3-year event-free survival, with events comprising one of PSA recurrence (PSA ≥0.2 ng/mL higher than baseline), radiological evidence of metastatic disease, or initiation of systemic or other salvage treatments. Secondary endpoints include patient-reported outcomes, treatment patterns, participant perceptions, and cost-effectiveness. ELIGIBILITY CRITERIA Eligible participants have PSA recurrence of prostate cancer after radical prostatectomy, defined by serum PSA level of 0.2-0.5 ng/mL, deemed low risk according to modified European Association of Urology biochemical recurrence risk criteria (International Society for Urological Pathology Grade Group ≤2, PSA doubling time >12 months), with no definite/probable recurrent prostate cancer on PSMA-PET/CT. PATIENTS AND METHODS A total of 100 participants will be recruited from five Australian centres and randomised 1:1 to SRT or surveillance. Participants will undergo 6-monthly clinical evaluation for up to 36 months. Androgen-deprivation therapy is not permissible. Enrolment commenced May 2023. TRIAL REGISTRATION This trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN: ACTRN12622001478707).
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Affiliation(s)
- Matthew J Roberts
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Royal Brisbane and Women's Hospital, Herston, Qld, Australia
- Redcliffe Hospital, Redcliffe, Qld, Australia
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
| | - Ciara Conduit
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Vic., Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia
| | - Ian D Davis
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Department of Medical Oncology, Eastern Health, Box Hill, Vic., Australia
- Monash University Eastern Health Clinical School, Box Hill, Clayton, Vic., Australia
| | - Rachel M Effeney
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Royal Brisbane and Women's Hospital, Herston, Qld, Australia
- Redcliffe Hospital, Redcliffe, Qld, Australia
| | - Scott Williams
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Jarad M Martin
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Michael S Hofman
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia
- Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Centre, Melbourne, Vic., Australia
| | - George Hruby
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
- St Vincent's Clinic, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Renu Eapen
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Vic., Australia
- Austin Hospital, Heidelberg, Vic., Australia
| | - Chris Gianacas
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Nathan Papa
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Richard De Abreu Lourenço
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Ray Allen
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
| | - Antoinette Fontela
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
| | - Baldeep Kaur
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Louise Emmett
- The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- University of NSW, Sydney, NSW, Australia
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6
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Tissot S, Wynn J, Tran V, Farag M, Wong LM, Ng M. Re-defining 18 F-DCFPyl prostate-specific membrane antigen positron emission tomography detected local recurrence from radical prostatectomy histopathology. BJU Int 2023; 132:411-419. [PMID: 37216190 DOI: 10.1111/bju.16085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess topographic concordance between the histopathological features of patients' radical prostatectomy (RP) specimens and the location of the prostate-specific membrane antigen positron emission tomography (PSMA PET) local recurrences, qualitatively and quantitatively. PATIENTS AND METHODS Our cohort was selected from the 100 men who received a 18 F-DCFPyL PET scan in the IMPPORT trial (Australian New Zealand Clinical Trials Registry Number: ACTRN12618001530213), a prospective non-randomised study completed by GenesisCare Victoria. Eligibility included patients with a rising prostate-specific antigen (PSA) level (>0.2 ng/mL) after RP and PSMA PET detected local recurrence. Histopathological parameters collated included the location of tumour, extraprostatic extension (EPE), and positive margins. Criteria for the location and 'concordance' between histopathological features and local recurrences were pre-defined. RESULTS A total of 24 patients were eligible; the median age was 71 years, the median PSA level was 0.37 ng/mL, and the time between RP and PSMA PET was 2.6 years. In all, 15 patients had recurrences within the vesicourethral anastomotic region and nine within the lateral surgical margins. There was 100% concordance in the left-right plane between tumour location and local recurrence, with 79% of these lesions concordant three-dimensionally; across craniocaudal, left-right, and anterior-posterior planes. In all, 10 of the 16 (63%) patients with EPE and five of the nine patients with positive margins had three-dimensional concordance between their pathology and their local recurrence. In quantitative assessment, 17 of the 24 patients, had local recurrences that correlated with the location of their original tumour in the craniocaudal plane. CONCLUSION Local recurrence is highly concordant with the position of the tumour within the prostate. Predicting the location of local recurrence using the location of the EPE and positive margins is less helpful. Further investigation into this field, could impact surgical technique and salvage radiotherapy clinical target volume.
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Affiliation(s)
- Sophie Tissot
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jessica Wynn
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Vy Tran
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Matthew Farag
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Lih-Ming Wong
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michael Ng
- GenesisCare, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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7
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von Eyben R, Hoffmann MA, Soydal C, Virgolini I, Tuncel M, Gauthé M, Kapp DS, von Eyben FE. Pretest PSA and Restaging PSMA PET/CT Predict Survival in Biochemically Recurrent Prostate Cancer. Biomedicines 2023; 11:2333. [PMID: 37760775 PMCID: PMC10525266 DOI: 10.3390/biomedicines11092333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND A biochemical recurrence (BCR) risk model was created based on pretest prostate specific antigen (PSA) and groupings by restaging prostate specific membrane antigen (PSMA) PET/CT. METHODS A cohort of 1216 BCR patients were analyzed for overall survival (OS) according to the PSA threshold and restaging PSMA PET/CT. A Cox regression analysis of OS was carried out to detect significant clinical characteristics. RESULTS In the cohort, 271 patients had a pretest PSA of <0.5 ng/mL and 945 patients had higher PSA values. The restaging PSMA PET/CT was positive for 834 patients and negative for 369. Of 1203 patients, 133 (11%) died, including 19 of the 369 (5%) patients without positive sites on the restaging PSMA PET/CT, 82 of the 711 (12%) with 1-5 positive sites, and 32 of the 123 (26%) with >5 positive sites. In the Cox regression analysis, four variables significantly predicted OS: treatment center, International Society of Urologic Pathology (ISUP) grade, pretest PSA threshold, and the grouping of positive sites on the restaging PSMA PET/CT. CONCLUSIONS The pretest PSA and PSMA PET/CT were important for the OS of the BCR patients. The findings argue for the new BCR risk model and serve as framework for ongoing trials.
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Affiliation(s)
| | - Manuela Andrea Hoffmann
- Institute for Preventive Medicine of German Armed Forces, 56626 Andernach, Germany
- Department of Nuclear Medicine, University Medical Center, Johannes Gutenberg University in Mainz, 55131 Mainz, Germany
| | - Cigdem Soydal
- Department of Nuclear Medicine, University of Ankara, 0600 Ankara, Turkey;
| | - Irene Virgolini
- Department of Nuclear Medicine, University Hospital in Innsbruck, 6020 Innsbruck, Austria;
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, Ankara 06230, Turkey
| | - Mathieu Gauthé
- Department of Nuclear Medicine, Incept, Institute Holland, 38100 Grenoble, France;
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
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de Bie KCC, Veerman H, Bodar YJL, Meijer D, van Leeuwen PJ, van der Poel HG, Donswijk ML, Vis AN, Oprea-Lager DE. Higher Preoperative Maximum Standardised Uptake Values (SUV max) Are Associated with Higher Biochemical Recurrence Rates after Robot-Assisted Radical Prostatectomy for [ 68Ga]Ga-PSMA-11 and [ 18F]DCFPyL Positron Emission Tomography/Computed Tomography. Diagnostics (Basel) 2023; 13:2343. [PMID: 37510087 PMCID: PMC10378114 DOI: 10.3390/diagnostics13142343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
This study aimed to investigate the association between the 68Ga- or 18F-radiolabeled prostate-specific membrane antigen (PSMA) tracer expression, represented by the maximum standardised uptake value (SUVmax) of the dominant intraprostatic lesion, and biochemical recurrence (BCR) in primary prostate cancer (PCa) patients prior to robot-assisted radical prostatectomy (RARP). This was a retrospective, multi-centre cohort study of 446 patients who underwent [68Ga]Ga-PSMA-11 (n = 238) or [18F]DCFPyL (n = 206) Positron Emission Tomography/Computed Tomography (PET/CT) imaging prior to RARP. SUVmax was measured in the dominant intraprostatic PCa lesions. [18F]DCFPyL patients were scanned 60 ([18F]DCFPyL-60; n = 106) or 120 ([18F]DCFPyL-120; n = 120) minutes post-injection of a radiotracer and were analysed separately. To normalise the data, SUVmax was log transformed for further analyses. During a median follow-up of 24 months, 141 (30.4%) patients experienced BCR. Log2SUVmax was a significant predictor for BCR (p < 0.001). In the multivariable analysis accounting for these preoperative variables: initial prostate-specific antigen (PSA), radiologic tumour stage (mT), the biopsy International Society of Urological Pathology grade group (bISUP) and the prostate imaging and reporting data system (PI-RADS), Log2SUVmax was found to be an independent predictor for BCR in [68Ga]Ga-PSMA-11 (HR 1.32, p = 0.04) and [18F]DCFPyL-120 PET/CT scans (HR 1.55, p = 0.04), but not in [18F]DCFPyL-60 ones (HR 0.92, p = 0.72). The PSMA expression of the dominant intraprostatic lesion proved to be an independent predictor for BCR in patients with primary PCa who underwent [68Ga]Ga-PSMA-11 or [18F]DCFPyL-120 PET/CT scans, but not in those who underwent [18F]DCFPyL-60 PET/CT scans.
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Affiliation(s)
- Katelijne C. C. de Bie
- Department of Urology, VU University, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (H.V.); (Y.J.L.B.); (D.M.); (A.N.V.)
- Department of Radiology & Nuclear Medicine, VU University, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
- Prostate Cancer Network The Netherlands, 1066 CX Amsterdam, The Netherlands;
| | - Hans Veerman
- Department of Urology, VU University, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (H.V.); (Y.J.L.B.); (D.M.); (A.N.V.)
- Prostate Cancer Network The Netherlands, 1066 CX Amsterdam, The Netherlands;
- Department of Urology, Antoni van Leeuwenhoek Hospital—The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Yves J. L. Bodar
- Department of Urology, VU University, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (H.V.); (Y.J.L.B.); (D.M.); (A.N.V.)
- Department of Radiology & Nuclear Medicine, VU University, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
- Prostate Cancer Network The Netherlands, 1066 CX Amsterdam, The Netherlands;
| | - Dennie Meijer
- Department of Urology, VU University, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (H.V.); (Y.J.L.B.); (D.M.); (A.N.V.)
- Department of Radiology & Nuclear Medicine, VU University, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
- Prostate Cancer Network The Netherlands, 1066 CX Amsterdam, The Netherlands;
| | - Pim J. van Leeuwen
- Prostate Cancer Network The Netherlands, 1066 CX Amsterdam, The Netherlands;
- Department of Urology, Antoni van Leeuwenhoek Hospital—The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Henk G. van der Poel
- Prostate Cancer Network The Netherlands, 1066 CX Amsterdam, The Netherlands;
- Department of Urology, Antoni van Leeuwenhoek Hospital—The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Maarten L. Donswijk
- Department of Radiology and Nuclear Medicine, Antoni van Leeuwenhoek Hospital—The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
| | - André N. Vis
- Department of Urology, VU University, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (H.V.); (Y.J.L.B.); (D.M.); (A.N.V.)
- Prostate Cancer Network The Netherlands, 1066 CX Amsterdam, The Netherlands;
| | - Daniela E. Oprea-Lager
- Department of Radiology & Nuclear Medicine, VU University, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
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9
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Leplat C, Jabbour T, Diamand R, Baudewyns A, Bourgeno HA, Shagera QA, Flamen P, Roumeguere T, Peltier A, Artigas C. Peering through the PSMA PET Lens: The Role of the European Association of Urology Biochemical Recurrence Risk Groups after Radical Prostatectomy. Cancers (Basel) 2023; 15:cancers15112926. [PMID: 37296888 DOI: 10.3390/cancers15112926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: The European Association of Urology (EAU) biochemical recurrence (BCR) risk grouping relies on data from historical cohorts that used conventional imaging techniques. In the era of PSMA PET/CT, we compared the patterns of positivity in the two risk groups and provided insight into positivity predictive factors. (2) Methods: Data from 1185 patients who underwent 68Ga-PSMA-11PET/CT for BCR was analyzed, out of which 435 patients treated initially treated by radical prostatectomy were included in the final analysis. (3) Results: A significantly higher rate of positivity in the BCR high-risk group was observed (59% vs. 36%, p < 0.001). BCR low-risk group demonstrated more local (26% vs. 6%, p < 0.001) and oligometastatic (100% vs. 81%, p < 0.001) recurrences. The BCR risk group and PSA level at the time of PSMA PET/CT were independent predictive factors of positivity. (4) Conclusions: This study confirms that the EAU BCR risk groups have different rates of PSMA PET/CT positivity. Even with a lower rate in the BCR low-risk group, oligometastatic disease was 100% in those with distant metastases. Given the presence of discordant positivity and risk classification, integrating PSMA PET/CT positivity predictors into risk calculators for BCR might improve patient classification for subsequent treatment options. Future prospective studies are still needed to validate the above findings and assumptions.
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Affiliation(s)
- Charles Leplat
- Department of Urology, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Teddy Jabbour
- Department of Urology, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Arthur Baudewyns
- Department of Urology, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Henri Alexandre Bourgeno
- Department of Urology, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Qaid Ahmed Shagera
- Nuclear Medicine Department, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Thierry Roumeguere
- Department of Urology, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Carlos Artigas
- Nuclear Medicine Department, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
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10
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Roberts MJ, Hruby G, Kneebone A, Martin JM, Williams SG, Frydenberg M, Murphy DG, Namdarian B, Yaxley JW, Hofman MS, Davis ID, Emmett L. Treatment de-intensification for low-risk biochemical recurrence after radical prostatectomy: rational or risky? BJU Int 2023. [PMID: 37303121 DOI: 10.1111/bju.16086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - George Hruby
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Genesis Cancer Care, Sydney, New South Wales, Australia
| | - Andrew Kneebone
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Genesis Cancer Care, Sydney, New South Wales, Australia
| | - Jarad M Martin
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
- Genesis Care, Maitland, Metford, New South Wales, Australia
| | - Scott G Williams
- Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Surgery, Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ben Namdarian
- St Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia
| | - John W Yaxley
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Michael S Hofman
- Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Victoria, Melbourne, Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University, Victoria, Melbourne, Australia
- Department of Cancer Services, Eastern Health, Melbourne, Victoria, Australia
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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11
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Robinson H, Roberts MJ, Gardiner RA, Hill MM. Extracellular vesicles for precision medicine in prostate cancer - Is it ready for clinical translation? Semin Cancer Biol 2023; 89:18-29. [PMID: 36681206 DOI: 10.1016/j.semcancer.2023.01.003] [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: 08/31/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Biofluid-based biomarker tests hold great promise for precision medicine in prostate cancer (PCa) clinical practice. Extracellular vesicles (EV) are established as intercellular messengers in cancer development with EV cargos, including protein and nucleic acids, having the potential to serve as biofluid-based biomarkers. Recent clinical studies have begun to evaluate EV-based biomarkers for PCa diagnosis, prognosis, and disease/therapy resistance monitoring. Promising results have led to PCa EV biomarker validation studies which are currently underway with the next challenge being translation to robust clinical assays. However, EV research studies generally use low throughput EV isolation methods and costly molecular profiling technologies that are not suitable for clinical assays. Here, we consider the technical hurdles in translating EV biomarker research findings into precise and cost-effective clinical biomarker assays. Novel microfluidic devices coupling EV extraction with sensitive antibody-based biomarker detection are already being explored for point-of-care applications for rapid provision in personalised medicine approaches.
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Affiliation(s)
- Harley Robinson
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, Queensland, Australia.
| | - Matthew J Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Queensland, Australia; Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Robert A Gardiner
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Queensland, Australia; Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Michelle M Hill
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Queensland, Australia.
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12
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Roberts MJ, Maurer T, Perera M, Eiber M, Hope TA, Ost P, Siva S, Hofman MS, Murphy DG, Emmett L, Fendler WP. Using PSMA imaging for prognostication in localized and advanced prostate cancer. Nat Rev Urol 2023; 20:23-47. [PMID: 36473945 DOI: 10.1038/s41585-022-00670-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 12/12/2022]
Abstract
The use of prostate-specific membrane antigen (PSMA)-directed applications in modern prostate cancer management has evolved rapidly over the past few years, helping to establish new treatment pathways and provide further insights into prostate cancer biology. However, the prognostic implications of PSMA-PET have not been studied systematically, owing to rapid clinical implementation without long follow-up periods to determine intermediate-term and long-term oncological outcomes. Currently available data suggest that traditional prognostic factors and survival outcomes are associated with high PSMA expression (both according to immunohistochemistry and PET uptake) in men with localized and biochemically recurrent disease. Treatment with curative intent (primary and/or salvage) often fails when PSMA-positive metastases are present; however, the sensitivity of PSMA-PET in detecting all metastases is poor. Low PSMA-PET uptake in recurrent disease is a favourable prognostic factor; however, it can be associated with poor prognosis in conjunction with high 18F-fluorodeoxyglucose uptake in metastatic castration-resistant prostate cancer. Clinical trials embedding PSMA-PET for guiding management with reliable oncological outcomes are needed to support ongoing clinical use.
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Affiliation(s)
- Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
- University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Queensland, Australia.
- Department of Urology, Redcliffe Hospital, Brisbane, Queensland, Australia.
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Marlon Perera
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Piet Ost
- Department of Radiation Oncology, Iridium Network, GZA Ziekenhuizen, Antwerp, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - Michael S Hofman
- Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany
- PET Committee of the German Society of Nuclear Medicine, Goettingen, Germany
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Bianchi L, Ceci F, Costa F, Balestrazzi E, Droghetti M, Piazza P, Pissavini A, Mei R, Farolfi A, Castellucci P, Puliatti S, Larcher A, Gandaglia G, Robesti D, Mottrie A, Briganti A, Morganti AG, Fanti S, Montorsi F, Schiavina R, Brunocilla E. The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence. Cancers (Basel) 2022; 15:cancers15010247. [PMID: 36612242 PMCID: PMC9818949 DOI: 10.3390/cancers15010247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is currently recommended to restage prostate cancer (PCa) and to guide the delivery of salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. Methods: 324 hormone-sensitive PCa with PSA relapse after radical prostatectomy who underwent PSMA-PET in three high-volume European Centres. Patients have been stratified as pre-salvage who never received salvage treatments (n = 134), and post-salvage, including patients who received previous salvage therapies (n = 190). Patients with oligorecurrent (≤3 lesions), PSMA-positive disease underwent PSMA-directed treatments: salvage radiotherapy (sRT) or Metastases-directed therapy (MDT). Patients with polirecurrent (>3 lesions) PSMA-positive disease were treated with systemic therapy. Patients with negative PSMA-PET were treated with sRT or systemic therapies or observation. The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were: Metastases-free survival (MFS) and Castration Resistant Pca free survival (CRPC-FS). Results: median follow up was 23 months. In the pre-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 66.2% vs. 38.9%, 95.2% vs. 73.7% and 94.9% vs. 93.1% in patients with negative vs. positive PSMA-PET, respectively (all p ≥ 0.2). In the post-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 59.5% vs. 29.1%, 92.7% vs. 65.1% and 98.8% vs. 88.8% in patients with negative vs. positive PSMA-PET, respectively (all p ≤ 0.01). At multivariable analyses, a positive PSMA-PET was an independent predictor of progression (HR = 2.15) and metastatic disease (HR 2.37; all p ≤ 0.03). Conclusion: PSMA-PET in recurrent PCa detects the site of recurrence guiding salvage treatments and has a prognostic role in patients who received previous salvage treatments.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
- University of Bologna, 40126 Bologna, Italy
- Correspondence:
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Francesco Costa
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Alessandro Pissavini
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Riccardo Mei
- Nuclear Medicine, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, 41122 Modena, Italy
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, 9300 Aalst, Belgium
- ORSI Academy, 9300 Melle, Belgium
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Daniele Robesti
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, 9300 Aalst, Belgium
- ORSI Academy, 9300 Melle, Belgium
| | - Alberto Briganti
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | | | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
- University of Bologna, 40126 Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
- University of Bologna, 40126 Bologna, Italy
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