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Murad V, Glicksman RM, Berlin A, Santiago A, Ramotar M, Metser U. Association of PSMA PET-derived Parameters and Outcomes of Patients Treated for Oligorecurrent Prostate Cancer. Radiology 2023; 309:e231407. [PMID: 38051188 DOI: 10.1148/radiol.231407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Background Prostate-specific membrane antigen (PSMA) PET is useful in the early detection of oligorecurrent prostate cancer (PCa), but whether PSMA PET parameters can be used to identify patients who would benefit from metastasis-directed therapy (MDT) with radiation or surgery remains uncertain. Purpose To assess the association of PSMA PET parameters with outcomes of patients with oligorecurrent PCa after MDT. Materials and Methods In this retrospective analysis of a single-center phase II trial that enrolled patients with biochemical recurrence of PCa after maximal local therapy and with no evidence of disease at conventional imaging, patients underwent PSMA PET (between May 2017 and November 2021), and unveiled recurrences were treated with MDT. Maximum standardized uptake value (SUVmax) and mean standardized uptake value (SUVmean) and PSMA tumor volume derived using thresholds of 2.5 (SUVmean2.5) and 41% (SUVmean41%), respectively, were recorded for sites of recurrence on PSMA PET scans, and a molecular imaging PSMA score was assigned. These parameters were also corrected for smooth filter and partial volume effects, and the PSMA score was reassigned. Cox proportional hazards models were used to evaluate the relationship between PSMA PET parameters and outcomes. Results A total of 74 men (mean age, 68.3 years ± 6.6 [SD]) with biochemical recurrence of PCa were included. PSMA PET revealed 145 lesions in the entire cohort, of which 125 (86%) were metastatic lymph nodes. Application of the correction factor changed the PSMA score in 88 of 145 lesions (61%). Mean SUVmax, SUVmean2.5, and SUVmean41% were associated with lower risk of biochemical progression (hazard ratio [HR] range, 0.77-0.95; 95% CI: 0.61, 1.00; P = .03 to P = .04). For corrected parameters, mean SUVmax, mean SUVmean2.5, mean SUVmean41%, mean PSMA score, maximum SUVmean2.5, maximum SUVmean41%, and maximum PSMA score were associated with a lower risk of biochemical progression (HR, 0.61-0.98; 95% CI: 0.39, 1.00; P = .01 to P = .04). Conclusion Measured and corrected PSMA PET parameters were associated with biochemical progression in men with oligorecurrent PCa treated with MDT. Clinical trial registration no. NCT03160794 © RSNA, 2023 See also the editorial by Civelek in this issue.
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Affiliation(s)
- Vanessa Murad
- From University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Princess Margaret Cancer Centre, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (V.M., U.M.); Department of Medical Imaging (V.M., U.M.), Department of Radiation Oncology (R.M.G., A.B., M.R.), and TECHNA Institute, University Health Network (A.B., U.M.), University of Toronto, Toronto, Canada; and Radiation Medicine Program (R.M.G., A.B.) and Department of Biostatistics (A.S.), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Rachel M Glicksman
- From University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Princess Margaret Cancer Centre, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (V.M., U.M.); Department of Medical Imaging (V.M., U.M.), Department of Radiation Oncology (R.M.G., A.B., M.R.), and TECHNA Institute, University Health Network (A.B., U.M.), University of Toronto, Toronto, Canada; and Radiation Medicine Program (R.M.G., A.B.) and Department of Biostatistics (A.S.), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Alejandro Berlin
- From University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Princess Margaret Cancer Centre, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (V.M., U.M.); Department of Medical Imaging (V.M., U.M.), Department of Radiation Oncology (R.M.G., A.B., M.R.), and TECHNA Institute, University Health Network (A.B., U.M.), University of Toronto, Toronto, Canada; and Radiation Medicine Program (R.M.G., A.B.) and Department of Biostatistics (A.S.), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Anna Santiago
- From University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Princess Margaret Cancer Centre, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (V.M., U.M.); Department of Medical Imaging (V.M., U.M.), Department of Radiation Oncology (R.M.G., A.B., M.R.), and TECHNA Institute, University Health Network (A.B., U.M.), University of Toronto, Toronto, Canada; and Radiation Medicine Program (R.M.G., A.B.) and Department of Biostatistics (A.S.), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Matthew Ramotar
- From University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Princess Margaret Cancer Centre, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (V.M., U.M.); Department of Medical Imaging (V.M., U.M.), Department of Radiation Oncology (R.M.G., A.B., M.R.), and TECHNA Institute, University Health Network (A.B., U.M.), University of Toronto, Toronto, Canada; and Radiation Medicine Program (R.M.G., A.B.) and Department of Biostatistics (A.S.), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Ur Metser
- From University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Princess Margaret Cancer Centre, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (V.M., U.M.); Department of Medical Imaging (V.M., U.M.), Department of Radiation Oncology (R.M.G., A.B., M.R.), and TECHNA Institute, University Health Network (A.B., U.M.), University of Toronto, Toronto, Canada; and Radiation Medicine Program (R.M.G., A.B.) and Department of Biostatistics (A.S.), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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Rossetti S, Di Napoli M, Pisano C, C Cecere S, Tambaro R, Ventriglia J, Passarelli A, Iovane G, Feroce F, Lastoria S, Di Gennaro F, Muto P, Borzillo V, Di Franco R, Perdonà S, Quarto G, Pignata S. Oligometastatic prostate cancer treatment. Future Oncol 2021; 17:3893-3899. [PMID: 34296622 DOI: 10.2217/fon-2021-0126] [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: 11/21/2022] Open
Abstract
Oligometastatic prostate cancer is an intermediate state between localized disease and widespread metastasis. Its biological and clinical peculiarities are still to be elucidated. New imaging techniques contribute to the detection of patients with oligometastatic disease. PET/CT scanning with prostate-specific membrane antigen can improve the selection of men with true early, low-volume oligometastatic disease, who are candidates for metastasis-directed therapy. Clinical studies demonstrated that androgen deprivation therapy can be delayed in oligometastatic patients with a low tumor burden, although no survival benefit has been demonstrated at present. This article presents available evidence on the treatment strategies for oligometastatic prostate cancer.
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Affiliation(s)
- Sabrina Rossetti
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Marilena Di Napoli
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Carmela Pisano
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Sabrina C Cecere
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Rosa Tambaro
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Jole Ventriglia
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Anna Passarelli
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Gelsomina Iovane
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
| | - Florinda Feroce
- Pathology Unit, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Secondo Lastoria
- Nuclear Medicine, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Francesca Di Gennaro
- Nuclear Medicine, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Paolo Muto
- Radiotherapy, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Valentina Borzillo
- Radiotherapy, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Rossella Di Franco
- Radiotherapy, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Sisto Perdonà
- Urology Unit, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Giuseppe Quarto
- Urology Unit, Istituto Nazionale Tumori Fondazione G Pascale IRCCS, Naples, 80131, Italy
| | - Sandro Pignata
- Department of Urology & Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli, 80131, Italy
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