Bridging the Imaging Gap: PSMA PET/CT Has a High Impact on Treatment Planning in Prostate Cancer Patients with Biochemical Recurrence—A Narrative Review of the Literature

Abstract

68 Ga-and 18 F-labeled prostate-specific membrane antigen (PSMA) molecules have created new opportunities for the unmet diagnostic needs in prostate cancer. The purpose of this article is to give an overview of studies that have examined the role of PSMA PET in treatment planning for prostate cancer patients with biochemical recurrence (BCR). Methods: Medline, Embase, Web of Science, Google Scholar, and Cochrane Central were searched for relevant articles. After excluding the articles that did not fulfill the required criteria, we included in this review 12 publications that reported the impact of PSMA PET on the treatment plan for prostate cancer patients with BCR. Results: All studies in our review emphasized the impact of PSMA PET images on therapy management in prostate cancer patients with BCR. Overall, the impact of PSMA PET/CT on therapy management varied between 30% and 76% among the 1,346 patients included in the review. Upstaging was reported in 32%-67% of the patients. Patients with low prostate-specific antigen values (,0.5 ng/mL) also demonstrated positive lesions, which could not have been detected by means of conventional imaging techniques. Important modifications to the original treatment plan included avoidance of systemic therapy (17%-40%) and PET-directed local therapy (in #60% of the patients). Conclusion: PSMA imaging demonstrated a high clinical impact in patients with BCR, with modifications to the original treatment plan occurring among half the patients. Detecting recurrence in BCR can prevent unnecessary toxicity and lead to individualized therapy.

(Radio)Theranostic Patient Management in Oncology Exemplified by Neuroendocrine Neoplasms, Prostate Cancer, and Breast Cancer

“…PSMA PET has demonstrated strong impact on therapy planning and clinical decision making with treatment regimen adjustment in 27%-77% of patients [136][137][138][139][140][141][142][143][144] [120]. Since then numerous original research and review articles have pointed out that the PSMA imaging using PET/CT is a sensitive, specific, safe, efficient and reproducible diagnostic method allowing visualization of local disease, lymph node, bone, and visceral organ lesions with high detection rate, and it has positive predictive value [121][122][123][124][125][126][127][128].…”

“…PSMA PET has demonstrated strong impact on therapy planning and clinical decision making with treatment regimen adjustment in 27%-77% of patients [136][137][138][139][140][141][142][143][144] Tc-PSMA scintigraphy has minimally less noise than posttherapy scanning and can be used for imaging follow-up in out-patient setting. GM 5 geometric mean; MIP 5 maximum-intensity projections; p.i.…”

High uptake of 68Ga-PSMA and 18F-DCFPyL in the peritumoral area of rat gliomas due to activated astrocytes

“…DO, CS, AH, KJL and AW designed the research project and drafted the manuscript, DO and CS performed the experiments and analyzed and interpreted data under supervision of AW, JE and BN provided radiotracers including quality control and substantially revised the manuscript, NJS and FMM substantially revised the manuscript. All authors read and approved the final manuscript Authors' information 1 Institute of Neuroscience and Medicine (INM 4, 5) Forschungszentrum Jülich, Jülich, Germany.…”

“…PET ligands for the prostate specific membrane antigen (PSMA) are very successful in the diagnostic 4 assessment of prostate cancer [1,2]. The most widely studied agent is the 68 Ga-labelled PSMA inhibitor Glu-NH-CO-NH-Lys(Ahx)-HBED-CC ( 68 Ga-PSMA) but in recent years 18 F-labelled ligands such as 2-(3-(1-carboxy-5-[(6-[ 18 F]fluoro-pyridine-3-carbonyl)-amino]-pentyl)-ureido)-pentanedioic acid ( 18 F-DCFPyL) have been developed which show advantages with respect to production amount, availability, clinical utility, and image resolution [3,4].…”

High uptake of 68Ga-PSMA-HBED-CC and 18F-DCFPyL in the peritumoral area of rat gliomas due to activated astrocytes

“…PET ligands for the prostate specific membrane antigen (PSMA) are very successful in the diagnostic assessment of prostate cancer [1,2]. The most widely studied agent is the 68 Ga-labelled PSMA inhibitor Glu-NH-CO-NH-Lys(Ahx)-HBED-CC ( 68 Ga-PSMA) but in recent years 18 F-labelled ligands such as 2-(3-(1-carboxy-5-[(6-[ 18 F]fluoro-pyridine-3-carbonyl)-amino]-pentyl)-ureido)-pentanedioic acid ( 18 F-DCFPyL) have been developed which show advantages with respect to production amount, availability, clinical utility, and image resolution [3,4].…”