68Ga‐PSMA‐11 PET‐CT study in prostate cancer patients with biochemical recurrence and non‐contributive 18F‐Choline PET‐CT: Impact on therapeutic decision‐making and biomarker changes

Abstract

Background In this retrospective study, we investigated the impact of 68Ga‐PSMA‐11 PET‐CT (PSMA PET‐CT) upon the treatment plan and therapeutic response obtained for Prostate Cancer (PCa) patients presenting an occult biochemical recurrence. Methods Forty‐two patients with previously negative or doubtful 18F‐Choline (FCH) were enrolled. PET images were recorded 1 h after injection of tracer. Only a few months after treatment ended, a PSA assay was requested to evaluate the therapeutic efficacy of the treatment based on PSMA results. Results PSMA—positive lesions were detected in 34/42 (80.9%) patients. Detection rates were 85.7% and 89.3% for serum PSA levels lower than 2 ng/mL, and >2 ng/mL, respectively. One hundred seventy‐three lesions were detected: 132/173 in lymph nodes (76.3%), 22/173 as metastatic sites (bone or lung) (12.7%), and 19/173 in the prostate bed (10.9%). As a result of the PSMA PET‐CT, therapeutic management changed in 31/42 patients (73.8%). With a follow‐up of 4.9 ± 2.27 months, 32/42 (76.2%) PSA assays after treatment guided by PSMA PET‐CT were collected. For 37.5% (12/32) of patients, the serum PSA level was lower than 0.2 ng/mL and a PSA decrease of over 50% in 8 (25.0%) other patients were obtained. Conclusion Performing a PSMA PET‐CT when FCH PET‐CT was doubtful or negative allows the recurrence localization in more 80% of patients and this had a major clinical impact, as it resulted in treatment change in more than 70% of patients as well as a significant decrease in PSA levels in more than 60% of them.

177Lu-PSMA radioligand therapy of predominant lymph node metastatic prostate cancer

“…Now, restaging with radiolabelled choline PET/CT detects sites of recurrence in lymph nodes for many patients who have PSA recurrence and PSA levels > 2 µg/l. Further restaging PSMA PET/CT detect recurrent sites for more patients than choline PET/CT [6–8]. In addition, progressive use of lymph node dissection in connection with RP may also increase the proportion of patients diagnosed with presence of only LNM.…”

Survey by the French Medicine Agency (ANSM) of the imaging protocol, detection rate, and safety of 68Ga-PSMA-11 PET/CT in the biochemical recurrence of prostate cancer in case of negative or equivocal 18F-fluorocholine PET/CT: 1084 examinations

“…Therefore, information is still pertinent and a large series is pending about the actual added value of referring a BCR patient, whose FCH PET/CT has been non-conclusive, to one centre performing PSMA-11 PET/CT. To the best of our knowledge, some information on this topic can currently be derived only from a few short series [12][13][14][15] in a total of 168 BRC patients with a previous negative FCH PET/CT.…”

Impact of 68Gallium prostate‐specific membrane antigen tracers on the management of patients with prostate cancer who experience biochemical recurrence

“…However, the studies included in the meta‐analysis were conducted in heterogeneous patient populations, including patients undergoing BCR mixed primary staging and biochemical persistence. Moreover, since this meta‐analysis was published, there have been a number of additional studies investigating the impact of 68 Ga‐PSMA PET/CT in patients with BCR [11–22]. Considering the unique value of 68 Ga‐PSMA tracers in patients with disease recurrence, and in the context of the heterogeneous patient populations included the previous meta‐analysis and the growing amount of published literature on this topic, we conducted the present meta‐analysis to provide updated data and focus on the impact of 68 Ga‐PSMA tracers on the management of PCa patients with BCR, as well as to investigate the direction of treatment strategy changes before and after the use of 68 Ga‐PSMA tracers.…”