Defining radio-recurrent intra-prostatic target volumes using PSMA-targeted PET/CT and multi-parametric MRI

Liu, Wei; Fakir, Hatim; Randhawa, Gurpreet Kaur; Alfano, Ryan; Corkum, Mark T.; Kassam, Zahra; Rachinsky, Irina; Chung, Hans T.; Chung, Peter; Loblaw, Andrew; Morton, Gerard; Sexton, Tracy; Kapoor, Anil; Ward, Aaron D.; Zukotynski, Katherine; Emmett, Louise

doi:10.1016/j.ctro.2021.11.006

Cited by 11 publications

(14 citation statements)

References 33 publications

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“…Notably, we found that with a pT3 disease prevalence of 38% the NPV was strong (92%), which allow considering PSMA‐PET/CT as a rule‐out test for the nonorgan confined disease in patients with radiorecurrent PCa. Considering detection rates of local recurrence—96% for MRI and 100% for PSMA‐PET/CT, both imaging modalities are reliable tools in this setting, which has been also shown previously by Liu et al 30 …”

Section: Discussionsupporting

confidence: 71%

“…29 Notably, we found that with a pT3 disease prevalence of 38% the NPV was strong (92%), which allow considering PSMA-PET/CT as a rule-out test for the nonorgan confined disease in patients with radiorecurrent PCa. Considering detection rates of local recurrence-96% for MRI and 100% for PSMA-PET/CT, both imaging modalities are reliable tools in this setting, which has been also shown previously by Liu et al 30 Our study shows that due to 100% specificity and 100% PPV patients with positive lymph nodes on PSMA-PET/CT should either undergo extended PLND, which may improve survival outcomes, 16 or can forgo SRP due to significant morbidity and lower chance of cure and may be considered for other treatment modalities such as systemic therapy. 7,20 A recent multicenter prospective phase 3 trial 31 reported PSMA-PET sensitivity of 40% and specificity of 95% for lymph node metastases at primary RP.…”

Section: Patient Characteristicssupporting

confidence: 72%

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Importance of magnetic resonance imaging and prostate‐specific membrane antigen PET‐CT in patients treated with salvage radical prostatectomy for radiorecurrent prostate cancer

et al. 2022

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Background: Accurate staging and identification of optimal candidates for local salvage therapy, such as salvage radical prostatectomy (SRP), is necessary to ensure optimal care in patients with radiorecurrent prostate cancer (PCa). We aimed to analyze performance of magnetic resonance imaging (MRI) and prostate-specific membrane antigen (PSMA)-positron emission tomography (PET)/computed tomography (CT) for predicting pathologic nonorgan confined disease (pT3) and lymph node involvement (pN+) in patients treated with SRP for radiorecurrent PCa. Methods:We retrospectively reviewed the institutional database to identify patients who underwent MRI or 68 Ga-PSMA-PET/CT before SRP for radiorecurrent PCa. The diagnostic estimates of MRI and PSMA-PET/CT for pT3 and pN+, were calculated. Results:We identified 113 patients with radiorecurrent PCa who underwent preoperative MRI followed by SRP; 53 had preoperative 68 Ga-PSMA-PET/CT. For the detection of pT3 disease, the overall accuracy of MRI was 70% (95% confidence interval[CI] 61−78), sensitivity 40% (95% CI 26−55) and specificity 94% (95% CI 85−98); PSMA-PET/CT had slightly higher accuracy of 77% (95% CI 64−88), and higher sensitivity of 90% (95% CI 68−99), but lower specificity of 70% (95% CI 51−84). For pN+ disease, MRI had poor sensitivity of 14% (95% CI 3−36), specificity of 50 (95% CI 39−61) and total accuracy of 43% (95% CI 34−53); PSMA-PET/CT had an accuracy of 85% (95% CI 72−93), sensitivity of 27% (95% CI 6−61), and specificity of 100% (95% CI 92−100). Conclusion:In patients with radiorecurrent PCa, both, MRI, and 68 Ga-PSMA PET/CT are valuable tools for the pre-SRP staging and should be integrated into the standard workup.For lymph node metastases, 68 Ga-PSMA PET/CT is a strong rule-in test with nearly perfect specificity; in contrast MRI had a low accuracy for lymph node metastases.

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Section: Discussionsupporting

confidence: 71%

Section: Patient Characteristicssupporting

confidence: 72%

Importance of magnetic resonance imaging and prostate‐specific membrane antigen PET‐CT in patients treated with salvage radical prostatectomy for radiorecurrent prostate cancer

et al. 2022

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“…In addition, advanced imaging has improved the ability to characterize patterns of disease recurrence and identify men with isolated local recurrence who may be suitable for local salvage or oligometastatic recurrence who may be eligible for metastasis-directed therapy ( 14 , 45 , 52 , 60 ). To date, response to prostate SBRT is mostly commonly evaluated using biochemical response with the Phoenix Criteria for BF.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…PSMA-targeted PET/CT in addition to mpMRI improves detection of local recurrence after EBRT ( 45 ). However, while criteria for the response have been broadly defined ( 46 ), the significance of PSMA response and correlation with clinical endpoints are not known ( 47 ).…”

Section: Introductionmentioning

confidence: 99%

Imaging Biomarkers in Prostate Stereotactic Body Radiotherapy: A Review and Clinical Trial Protocol

et al. 2022

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Advances in imaging have changed prostate radiotherapy through improved biochemical control from focal boost and improved detection of recurrence. These advances are reviewed in the context of prostate stereotactic body radiation therapy (SBRT) and the ARGOS/CLIMBER trial protocol. ARGOS/CLIMBER will evaluate 1) the safety and feasibility of SBRT with focal boost guided by multiparametric MRI (mpMRI) and 18F-PSMA-1007 PET and 2) imaging and laboratory biomarkers for response to SBRT. To date, response to prostate SBRT is most commonly evaluated using the Phoenix Criteria for biochemical failure. The drawbacks of this approach include lack of lesion identification, a high false-positive rate, and delay in identifying treatment failure. Patients in ARGOS/CLIMBER will receive dynamic 18F-PSMA-1007 PET and mpMRI prior to SBRT for treatment planning and at 6 and 24 months after SBRT to assess response. Imaging findings will be correlated with prostate-specific antigen (PSA) and biopsy results, with the goal of early, non-invasive, and accurate identification of treatment failure.

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“…Furthermore, MRI has been shown to miss small lesions and underestimate lesion size in the radiorecurrent setting ( 26 ). Although MRI and PSMA PET may provide complementary information regarding lesion location ( 27 ), further multi-modality target delineation studies, preferably against a pathologic gold-standard, are needed.…”

Section: Focal Salvage Therapymentioning

confidence: 99%

Risk-adaptive paradigm for focal versus whole-gland salvage treatment for radio-recurrent prostate cancer

King

Yang²,

D’Amico³

et al. 2022

Front. Oncol.

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Defining radio-recurrent intra-prostatic target volumes using PSMA-targeted PET/CT and multi-parametric MRI

Cited by 11 publications

References 33 publications

Importance of magnetic resonance imaging and prostate‐specific membrane antigen PET‐CT in patients treated with salvage radical prostatectomy for radiorecurrent prostate cancer

Importance of magnetic resonance imaging and prostate‐specific membrane antigen PET‐CT in patients treated with salvage radical prostatectomy for radiorecurrent prostate cancer

Imaging Biomarkers in Prostate Stereotactic Body Radiotherapy: A Review and Clinical Trial Protocol

Risk-adaptive paradigm for focal versus whole-gland salvage treatment for radio-recurrent prostate cancer

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