Impact of ⁶⁸Ga-PSMA-11 PET on the Management of Recurrent Prostate Cancer in a Prospective Single-Arm Clinical Trial

Abstract

Prostate-specific membrane antigen (PSMA) ligand PET induces management changes in patients with prostate cancer. We aim to better characterize the impact of 68 Ga-PSMA-11 PET ( 68 Ga-PSMA PET) on management of recurrent prostate cancer in a large prospective cohort. Methods: We report management changes after 68 Ga-PSMA PET, a secondary endpoint of a prospective multicenter trial in men with biochemical recurrence of prostate cancer. Pre-PET (Q1), post-PET (Q2), and posttreatment (Q3) questionnaires were sent to referring physicians recording site of recurrence and intended (Q1 to Q2 change) and implemented (Q3) therapeutic and diagnostic management. Results: Q1 and Q2 response was collected for 382 of 635 patients (60%, intended cohort), and Q1, Q2, and Q3 response was collected for 206 patients (32%, implemented cohort). An intended management change occurred in 260 of 382 (68%) patients. The intended change was considered major in 176 of 382 (46%) patients. Major changes occurred most often for patients with prostate-specific antigen of 0.5 to less than 2.0 ng/mL (81/147, 55%). By analysis of stage groups, management change was consistent with PET disease location, that is, a majority of major changes toward active surveillance (47%) for unknown disease site (103/382, 27%), toward local or focal therapy (56%) for locoregional disease (126/382, 33%), and toward systemic therapy (69% M1a; 43% M1b/c) for metastatic disease (153/382, 40%). According to Q3 responses, the intended management was implemented in 160 of 206 (78%) patients. In total, 150 intended diagnostic tests, mostly CT (n 5 43, 29%) and bone scans or 18 F-NaF PET (n 5 52, 35%), were prevented by 68 Ga-PSMA PET; 73 tests, mostly biopsies (n 5 44, 60%) as requested by the study protocol, were triggered. Conclusion: According to referring physicians, sites of recurrence were clarified by 68 Ga-PSMA PET, and disease localization translated into management changes in more than half of patients with biochemical recurrence of prostate cancer.

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

“…Although the direction of management change is diverse, there is a detectable pattern [35]. Patients with undetectable disease using 68 Ga‐PSMA tracers were more often switched to no treatment, whereas patients with local recurrence were switched to local therapy.…”

Use of 68Ga-PSMA-11 and 18F-FDG PET-CT Dual-Tracer to Differentiate Between Lymph Node Metastases and Ganglia

“…However, conventional imaging techniques, including magnetic resonance imaging (MRI) and computed tomography (CT) (3), have limited sensitivity. Since 2012, the application of 68 Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)-CT has significantly improved detection rates in BCR patients (4)(5)(6)(7). Various studies showed that 68Ga-PSMA PET-CT detection efficiency is higher than conventional imaging approaches and choline PET (4,8).…”

Rationale for Involved Field Stereotactic Body Radiation Therapy-Enhanced Intermittent Androgen Deprivation Therapy in Hormone-Sensitive Nodal Oligo-Recurrent Prostate Cancer Following Prostate Stereotactic Body Radiation Therapy

“…If a patient's PSA starts to rise following a cycle of ADT and SBRT, we recommend repeat PET imaging when the patient's PSA rises to ≥1 ng/ml. At this PSA level, PSMA-PET has been shown to perform well in the detection (> 80%) of recurrent prostate cancer ( 67 ). While the performance of PET imaging improves with increasing PSA, this PSA cut off balances a relatively high rate of disease detection without allowing undue progression of disease that may sacrifice clinical outcomes ( 68 ).…”