Correlation between PSA kinetics and PSMA‐PET in prostate cancer restaging: A meta‐analysis

Abstract

Background Serum prostate‐specific antigen (PSA) may predict the risk of positive positron emission tomography/computed tomography with radiolabelled prostate‐specific membrane antigen (PSMA‐PET/CT) in patients with biochemical recurrent prostate cancer (BRPCa). However, to date, there are no clear data regarding the correlation between PSA kinetics and PSMA‐PET findings. We performed a systematic review and meta‐analysis to provide evidence‐based data in this setting. Methods A comprehensive literature search of studies published through October 2018 in PubMed/MEDLINE, EMBASE and Cochrane library databases was performed. A meta‐analysis to establish the detection rate (DR) of PSMA‐PET using different cut‐off values of PSA doubling time (PSAdt) and a pooled analysis to establish whether shorter PSAdt may predict positive PSMA‐PET results was performed in patients with BRPCa. Results Twelve articles were included in the systematic review, and eight articles (including about 1400 patients) were selected for the meta‐analysis. The pooled DR including 95% confidence intervals (95%CI) of PSMA‐PET in restaging prostate cancer (PCa) patients was 72% (95%CI:60%‐82%), increasing to 83% (95%CI:75%‐90%) when PSAdt was ≤6 months and decreasing to 60% (95%CI:37%‐80%) when PSAdt was >6 months, without a statistical significant difference. PSAdt ≤6 months may predict the positive result of PSMA‐PET (pooled odds ratio: 3.22; 95%CI:1.17‐8.88). Statistical heterogeneity among the included studies was found. Conclusions PSA kinetics, and in particular shorter PSAdt, may be predictor of PSMA‐PET positivity in patients with BRPCa. Further larger studies in this setting are warranted.

A pilot study of prostate‐specific membrane antigen (PSMA) dynamics in men undergoing treatment for advanced prostate cancer

“…Thus, these CTC‐negative samples corresponded to samples taken during clinical responses to therapy and were associated with declines in serum PSA. Our results are consistent with a recent report that shorter PSA doubling time, indicating faster tumor growth, may predict PSMA‐targeted PET positivity in patients with biochemically recurrent PCa …”

Prospects and Clinical Perspectives of Total-Body PET Imaging Using Plastic Scintillators

“…101 PSMA is overexpressed in prostate cancer cells, correlates to prostatespecific antigen blood levels and reflects tumor aggressiveness diagnosed both in tissue biopsies and in prostate cancer imaging. 102,103 In patients having castration-resistant prostate cancer metastasis, there is an unmet need to apply imaging-guided prostate cancer therapy based on total-body scanning and real-time theranostics. 104 For this purpose [44Sc]Sc-PSMA-617 for PET imaging is the most suitable radiotracer 68 (see Fig.…”

Diagnostic Performance of PET Imaging Using Different Radiopharmaceuticals in Prostate Cancer According to Published Meta-Analyses

“…Different radiotracers for PET imaging have been proposed in recent years, such as radiolabeled choline (Cho) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], prostate-specific membrane antigen (PSMA)-targeted agents [21][22][23][24][25][26][27][28][29][30][31][32], 18 F-fluciclovine (FACBC) [8,[32][33][34][35][36], 18 F-fluoride (NaF) [4,37], 11 C-acetate [11,14,38], and 18 F-fluorodeoxyglucose ( 18 F-FDG) [11,14]. Moreover, different radioisotopes have been proposed to label some of these radiopharmaceuticals, such as to label Cho (e.g., 18<...>…”