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Subiela JD, Gomis Sellés E, Maldonado A, Lopez Campos F, Aumatell Ovide J, Ajuria Illarramendi O, González-Padilla DA, Gajate P, Ortega Polledo LE, Alonso Y Gregorio S, Guerrero-Ramos F, Gómez Dos Santos V, Rodríguez-Patrón R, Calais J, Kishan AU, Burgos Revilla FJ, Couñago F. Clinical Usefulness of Prostate-specific Membrane Antigen-ligand Positron Emission Tomography/Computed Tomography for the Detection of Prostate Cancer Biochemical Recurrence after Primary Radiation Therapy in Patients with Prostate-specific Antigen Below the Phoenix Threshold: Systematic Review and Meta-analysis. Clin Oncol (R Coll Radiol) 2023; 35:e676-e688. [PMID: 37802722 DOI: 10.1016/j.clon.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/01/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
AIMS After primary radiotherapy, biochemical recurrence is defined according to the Phoenix criteria as a prostate-specific antigen (PSA) value >2 ng/ml relative to the nadir. Several studies have shown that prostate-specific membrane antigen (PSMA)-ligand positron emission tomography/computed tomography (PET/CT) can help in detecting recurrence in patients with low PSA values. This study aimed to assess the detection rate and patterns of PSMA-ligand PET/CT uptake in patients with suspected biochemical recurrence after primary radiotherapy and with PSA levels below the Phoenix threshold. MATERIALS AND METHODS The meta-analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Articles providing data on patients with suspected prostate cancer recurrence after primary radiotherapy with a PSA value below the Phoenix threshold and who underwent PSMA-ligand PET/CT were included. Quality assessment was carried out using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). RESULTS In total, five studies were included, recruiting 909 patients (202 with PSA ≤2 ng/ml). The PSMA-ligand detection rate in the patients with ≤2 ng/ml ranged from 66 to 83%. The most frequent source of PSMA-ligand PET/CT uptake was local recurrence, followed by lymph node metastasis and bone metastasis. PSMA-ligand PET/CT uptake due to local-only recurrence was more likely in patients with PSA ≤2 ng/ml compared with PSA > 2 ng/ml: risk ratio 0.72 (95% confidence interval 0.58-0.89), P = 0.003. No significant differences were observed in the detection of PSMA-ligand uptake in other areas. Limitations include a lack of biopsy confirmation, cohort reports with small sample sizes and a potentially high risk of bias. CONCLUSION A significant detection of PSMA-ligand-avid disease was observed in patients with PSA levels below the Phoenix threshold. There was a higher likelihood of detecting local-only uptake when the PSA value was ≤2 ng/ml. The findings suggest that a critical review of the Phoenix criteria may be warranted in the era of PSMA-ligand PET/CT and highlight the need for further prospective trials.
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Affiliation(s)
- J D Subiela
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain.
| | - E Gomis Sellés
- Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain
| | - A Maldonado
- Nuclear Medicine and Molecular Imaging Department, University Hospital Quiron-salud Madrid/La Luz Hospital, Madrid, Spain
| | - F Lopez Campos
- Radiation Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain
| | - J Aumatell Ovide
- Department of Urology, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | | | | | - P Gajate
- Medical Oncology Department, Ramon y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - L E Ortega Polledo
- Department of Urology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Spain
| | | | - F Guerrero-Ramos
- Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V Gómez Dos Santos
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - R Rodríguez-Patrón
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - J Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - A U Kishan
- Department of Radiation Oncology and Department of Urology, University of California, Los Angeles, CA, USA
| | - F J Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - F Couñago
- Department of Radiation Oncology, San Francisco de Asís Hospital, Madrid, Spain; Department of Radiation Oncology, La Milagrosa Hospital, Madrid, Spain; National Chair of Research, GenesisCare, Madrid, Spain
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Sevillano D, Hervás A, Rodríguez-Patrón R, García-Fuentes J, Colmenares R, Vallejo C, López-Campos F, Domínguez-Rullán J, Muñoz T, Cámara M, Capuz B, Morís R, Galiano P, Retorta P, Williamson S, Béjar M, Prieto D, García-Vicente F. PD-0405 Analysis of the internal motion of the urethra caused by urethral catheters. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02840-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hevia Palacios M, Fraile A, Rodríguez-Patrón R, Santiago M, Hevia V, Burgos Revilla J. Does aetiology of urethral stricture influence the survival of the buccal mucosa graft? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32798-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hervas Moron A, Béjar M, Alvarez S, Yanowski K, Ordóñez J, Rodríguez-Patrón R, García-Galloway E, Casanueva R, Marcos S, Ramos A. EP-1311: Fertility in prostate cancer patients treated with radiation therapy. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mayayo Dehesa T, Rodríguez-Patrón R, Zuccarino AL, Arias Funez F, Carrera Puerta C, García González R. [Echo-guided transrectal biopsy. An analysis of the results in a series of 1900 patients]. ARCH ESP UROL 1999; 52:453-63. [PMID: 10427883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To compare the results of US-guided transrectal biopsy in 1,900 patients with the diagnostic yield of DRE, transrectal US, PSA, PSA density and free PSA/total PSA ratio and to describe our approach based on the results of the comparative study. METHODS Over the last two years 1,900 patients have undergone biopsy; 4 to 6 specimens were obtained randomly from both prostatic lobes and areas identified by transrectal US and/or DRE as being suspicious. All patients underwent transrectal US, DRE and determination of serum total PSA and PSA density. Free PSA and free PSA/total PSA ratio were determined in 128 patients with PSA 4-10 ng/ml. Seventy had a second biopsy, 8 a third and 3 had a fourth biopsy. RESULTS The overall diagnostic yield was 40%. Biopsy was positive in 27% of patients with PSA 4-10 ng/ml; of these, 64% showed a positive DRE, 21% showed a negative DRE and 13% were negative for both DRE and transrectal US. DRE was positive in 32% of patients with PSA greater than 10 ng/ml, 39% of those with PSA 10-20 ng/ml and 62% of those with PSA greater than 20 ng/ml; transrectal US was positive in 58% of patients with PSA 10-20 ng/ml and in 77% of those with PSA greater than 20 ng/ml. A high specificity was found for both DRE and transrectal US. In patients with PSA 4-10 ng/ml, PSA density at a cutoff of 0.15 ng/ml/cc showed a sensitivity of 81% and a specificity of 20%, respectively. A second biopsy was positive in 20% of patients with a persistently elevated PSA and the incidence of tumors theoretically of little importance was 13%. CONCLUSIONS Patients aged less than 70 years whose general condition permit aggressive treatment of prostate cancer should undergo US-guided transrectal biopsy if PSA is greater than 4 ng/ml, regardless of DRE and ultrasound findings. PSA less than 20 ng/ml, PSA density and free PSA/total PSA ratio must be considered for a second biopsy. Sextant biopsy appears to have a good diagnostic accuracy and does not require taking additional specimens or including the transitional zone in the first biopsy. Before classifying a tumor as being of little importance on the basis of the biopsy findings, another biopsy must be performed.
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Affiliation(s)
- T Mayayo Dehesa
- Unidad de Ecografía Urológica Dr. T. Mayayo Dehesa, Madrid, España
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