Clinical Significance of Routine Follow-Up Examinations in Patients with
Metastatic Cancer of the Prostate under Hormone Treatment

Fosså, Sophie D.; Heilo, Arne; Lindegaard, Mette W.; Skinningrud, Anders; Ous, S.

doi:10.1159/000474099

Cited by 10 publications

(4 citation statements)

References 6 publications

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“…Cook et al [15] suggested that PET/CT with NaF may reflect the true tumour response earlier and more specifically than bone scans. Importantly, such examinations may indicate that the new sites of HDP uptake reflect tumour growth and not only transient reparative reactions of the bone ("pseudoprogression" [16]") which, in the present study, is supported by increasing PSA and decreased alkaline phosphatases. Experience from pretreatment and post-treatment FACBC PET/CT examinations in two patients combined with bone scans suggests that small tumour sites without major pretreatment osteoblastic reactions expand during Ra-223 therapy, as reflected by expanded or new posttreatment HDP uptake and visualized by tumour uptake on FACBC PET/CT.…”

Section: Discussionsupporting

confidence: 50%

Changes in prostate-specific antigen, markers of bone metabolism and bone scans after treatment with radium-223

Nome¹,

Hernes

Bogsrud

et al. 2014

Scandinavian Journal of Urology

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Objective.The aim of this study was to assess treatment-related changes in prostate-specific antigen (PSA), total and bone alkaline phosphatase (total ALP, bone ALP), and changes on conventional bone scans in patients with metastatic castration-resistant prostate cancer (mCRPC) with bone metastases who received six cycles of radium-223 (Ra-223). Materials and methods. Changes in PSA, total ALP and bone ALP ( ‡30% increase or decrease), and changes on bone scans were assessed before and after six monthly cycles of Ra-223 therapy (50 kBq/kg body weight) in 14 patients with mCRPC with bone metastases and four patients on placebo. Results.Post-treatment PSA increased by at least 30% in 11 out of 14 patients and remained stable in three. Total ALP and bone ALP decreased in six and nine patients, respectively. In 10 out of 12 evaluable patients the uptake on post-treatment bone scan was reduced in lesions with high pretreatment uptake, in 11 patients accompanied by the development of new or expanded bone lesions. FACBC position emission tomography/computed tomography scans confirmed the growth of new or expanded bone metastases in two patients. Conclusions.These observations support the notion that Ra-223 kills tumour cells in metastases surrounded by highly proliferating osteoblasts, consistent with the reported survival benefit. The radiation effect in small tumour deposits not surrounded by increased osteoblast activity seems, however, insufficient, thus allowing continuous tumour growth. Long-lasting PSA reductions are the exception rather than the rule during Ra-223 treatment, whereas alkaline phosphatases decrease more frequently. To improve the overall anticancer effect, Ra-223 might be a valuable component of combination treatment.

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Section: Discussionsupporting

confidence: 50%

Changes in prostate-specific antigen, markers of bone metabolism and bone scans after treatment with radium-223

Nome¹,

Hernes

Bogsrud

et al. 2014

Scandinavian Journal of Urology

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“…The appearance of abnormal levels in patients with previously normal values was defined as progressive disease. Due to the known methodological difficulties in evaluating early response in bone metastases by X-rays (Fossi et a/., 1983), only progression of skeletal lesions after at least 8 months of treatment was recorded. Thus the appearance of skeletal meta-static deposits or an increase in their number as evidenced by X-rays or bone scan was defined as progression.…”

Section: Evaluation Of' Treatment Responsecontrasting

confidence: 59%

Carcinoma of the Prostate with Soft Tissue or Non-regional Lymphatic Metastases at the Time of Diagnosis: a Review of 47 Cases

Sæter

Fosså

Ous

et al. 1984

British Journal of Urology

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The clinical course of 47 patients with carcinoma of the prostate who at the time of initial presentation had metastases to soft tissue or non-regional lymph nodes was retrospectively reviewed. The response rate to primary hormonal treatment (orchiectomy or oestrogens) and the duration of response were similar to those of 47 other patients presenting with skeletal metastases only. The survival of the patients in the study group was not statistically different from that of patients with skeletal metastases only. The results suggest that patients presenting initially with metastases to non-regional lymph nodes or soft tissue should be treated by the same therapeutic methods as for disseminated prostatic cancer in general (oestrogens or orchiectomy). Slight or no urinary symptoms at the time of initial presentation in spite of a locally advanced tumour was a common finding; 20% of the patients had normal serum prostatic acid phosphatase despite the presence of disseminated disease. Lymph node enlargement in the left supraclavicular fossa was the most common site of non-regional lymphatic spread. Elderly males with metastatic carcinoma in this region should be investigated for the possibility of prostatic cancer.

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“…In addition, although criteria for disease progression, as evident by the emergence of new lesions, are well established, controversy exists in explaining the increase in lesions after treatment based on it is likely that they originate from small bone metastases with minimal osteoblast activity, and therefore not su ciently irradiated, that may increase in size, resulting in new sites on post-treatment CT or BS due to the existence of reparative changes (" are phenomenon" also called pseudo-progression). Moreover, these de ned criteria cannot be used in patients with diffuse metastatic bone disease or malignant superscan [15,[46][47][48].…”

Section: Discussionmentioning

confidence: 99%

“…However, it seems the most probable option in case of new bone lesions at the initial post-treatment assessment (after three cycles of 223 Ra) in an otherwise stable patient who is not progressing in an extra-skeletal site (for example, soft tissue disease), and without con rmation of progression (≥2 new lesions after six cycles) [11,22]. On the other hand, the persistence of uptake at the sites of bone metastases responding to treatment, the potential interference of biphosphonate therapy and the limited resolution of planar and SPECT techniques, as compared with PET/CT and magnetic resonance imaging (MRI) are other limitations of BS [47].…”

Section: Discussionmentioning

confidence: 99%

Interim and End-treatment 18F-Fluorocholine PET/CT and Bone Scan in Prostate Cancer Patients Treated with Radium 223 Dichloride

Vicente

Amo-Salas

Espinosa

et al. 2021

Preprint

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AimTo assess the predictive and prognostic aim of interim and end-treatment 18F-fluorocholine PET/CT (FCH-PET/CT) and 99mTc-methilen diphosphonate bone scintigraphy (BS) in patients with castration-resistant prostate cancer and bone metastases (CRPC-BM) treated with Radium 223 dichloride (223Ra). Methods: Prospective and multicentre ChoPET-Rad study including 82 patients with CRPC-BM. Baseline, after 3 (interim) and 6 doses (end-treatment) BS and FCH PET/CT were performed in patients who meet the study criteria. Clinical variables, imaging and clinical progression were obtained and their association with progression free survival (PFS), and overall survival (OS) was studied. Agreement between BS and FCH PET/CT response was assessed using Kappa (K) analysis.Results:Median of PFS and OS was 3 and 16 months, respectively. Agreement between interim BS and FCH PET/CT was weak (K: 0.28; p=0.004). No agreement was observed between end-treatment diagnostic studiesInterim and end-treatment FCH PET/CT were related to PFS (p=0.011 and p<0.001, respectively). Therapeutic failure and interim BS and FCH PET/CT showed association with OS (p<0.001, p=0.037 and p=0.008, respectively).Conclusions: Interim and end-treatment FCH PET/CT were good predictors of biochemical progression in patients treated with 223Ra. Therapeutic failure and progression in interim BS or FCH PET/CT were adverse factors for OS.

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Clinical Significance of Routine Follow-Up Examinations in Patients with Metastatic Cancer of the Prostate under Hormone Treatment

Cited by 10 publications

References 6 publications

Changes in prostate-specific antigen, markers of bone metabolism and bone scans after treatment with radium-223

Changes in prostate-specific antigen, markers of bone metabolism and bone scans after treatment with radium-223

Carcinoma of the Prostate with Soft Tissue or Non-regional Lymphatic Metastases at the Time of Diagnosis: a Review of 47 Cases

Interim and End-treatment 18F-Fluorocholine PET/CT and Bone Scan in Prostate Cancer Patients Treated with Radium 223 Dichloride

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