Management of Patients with Recurrent and Metachronous Oligometastatic Prostate Cancer in the Era of PSMA PET

Abstract

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scans have higher sensitivity and specificity for detecting lymph nodes or metastatic disease relative to conventional imaging in prostate cancer staging. Since its FDA approval and incorporation into treatment guidelines, the use of PSMA PET has increased in patients undergoing initial staging, those with recurrence after initial definitive treatment, and patients with metastatic disease. Although the early detection of metastatic lesions is changing disease management, it is unclear whether this impact on management translates into clinical benefit. This review will summarize evidence pertaining to the change in patient management due to PSMA PET use and will discuss the implications of PSMA PET on treatment decisions in prostate cancer, particularly in the settings of biochemical recurrence and metachronous oligometastatic disease.

Predictive value of volumetric parameters based on 18F-PSMA-1007 PET/CT for prostate cancer metastasis

“…Patients with extensive metastasis had the shortest PFS on ADT. Evidence suggests that in individuals with oligometastasis, the implementation of active treatment for both primary and metastatic lesions may result in a more favorable prognosis, our study is consistent with previous research ( 36 , 37 ). Additionally, it suggests that patients with elevated SUVmax, TL-PSMAp, and PSMA-TVp values for primary lesions may have a poorer prognosis compared to those with lower values, which needs to be further verified by large-scale prospective studies.…”

Progress in Oligometastatic Prostate Cancer: Emerging Imaging Innovations and Therapeutic Approaches

“…Oligometastasis, as introduced by Hellman and Weichselbaum in 1995, is a concept postulating that patients with metastatic cancer harboring a limited number of metastases and confined sites of metastasis might achieve curative outcomes through the comprehensive management of all metastatic lesions using RT or surgical interventions [8]. Oligometastasis is delineated by various contributing factors, including: (1) the cancer's inherent sluggish growth, (2) the cancer's modest metastatic propensity, (3) an early diagnosis during the metastatic course of a rapidly proliferating cancer, and (4) the heightened detectability of metastatic foci owing to advancements in imaging modalities [17,18]. Oligometastasis is fundamentally characterized by the presence of slowly evolving metastatic lesions that manifest on a monthly to yearly basis.…”

“…Conventional computed tomography (CT) and 99m Tc bone scintigraphy represent routine diagnostic tools for the evaluation of oligometastases in clinical practice. While CT and bone scintigraphy offer advantages in terms of cost-efficiency, practicality, and alignment with the established guidelines, their diagnostic sensitivity remains at approximately 70% to 80% for CT and 60-80% for bone scintigraphy [14,15,18]. Additionally, emerging imaging modalities, notably magnetic resonance imaging (MRI) and positron emission tomography (PET)-CT, have garnered attention for their utility in diagnosing oligometastasis [26,27].…”

“…In the realm of PET imaging, 18 F-sodium fluoride (Na 18 F) stands as the internationally recognized radiotracer of choice, and it is particularly adept at identifying osteogenic metastases due to its avidity for bone remodeling sites. Na 18 F PET-CT surpasses bone scintigraphy in the detection of bone metastases [15].…”

“…Na 18 F PET-CT surpasses bone scintigraphy in the detection of bone metastases [15]. Beyond Na 18 F, various radiotracers have exhibited efficacy, including 11C-choline and 18 F-fluoroethylcholine for phospholipid synthesis, 18 F-FACBC for protein synthesis, and 68 Ga-prostate-specific membrane antigen (PSMA)-11 and 18 F-DCFPyL for PSMA imaging [14,15,[26][27][28][29][30]. Earlier, 18 F-FACBC PET-CT and MRI were deemed proficient in the identification of metastatic lesions among CRPC patients [29,30].…”