Performance of a Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography–Derived Risk-Stratification Tool for High-risk and Very High-risk Prostate Cancer

Xiang, Michael; Martin, Ting; Savjani, Ricky R.; Pollom, Erqi L.; Karnes, R. Jeffrey; Grogan, Tristan; Wong, J.K.; Motterle, Giovanni; Tosoian, Jeffrey J.; Trock, Bruce J.; Klein, Eric A.; Stish, Bradley J.; Dess, Robert T.; Spratt, Daniel E.; Pilar, Avinash; Reddy, C.A.; Levin-Epstein, Rebecca; Wedde, Trude B.; Lilleby, Wolfgang; Fiano, Ryan; Merrick, Gregory S.; Stock, Richard G.; Demanes, D. Jeffrey; Moran, Brian; Huland, Hartwig; Tran, Phuoc T.; Martin, Santiago; Martı́nez-Monge, Rafael; Krauss, Daniel; Abu-Isa, Eyad; Alam, Ridwan; Schwen, Zeyad; Pisansky, Thomas M.; Choo, C. Richard; Song, Daniel Y.; Greco, Stephen; Deville, Curtiland; McNutt, Todd; DeWeese, Theodore L.; Ross, Ashley E.; Ciezki, Jay P.; Boutros, Paul C.; Nickols, Nicholas G.; Bhat, Prashant; Shabsovich, David; Juarez, Jesus E.; Chong, Natalie; Kupelian, Patrick A.; Rettig, Matthew B.; Zaorsky, Nicholas G.; Berlín, Alejandro; Tward, Jonathan D.; Davis, Brian J.; Reiter, Robert E.; Steinberg, Michael L.; Elashoff, David; Horwitz, Eric M.; Tendulkar, Rahul D.; Tilki, Derya; Czernin, Johannes; Gafita, Andrei; Romero, Tahmineh; Calais, Jérémie; Kishan, Amar U.

doi:10.1001/jamanetworkopen.2021.38550

Cited by 21 publications

(7 citation statements)

References 22 publications

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“…To our knowledge, this is the first study evaluating the performance of piflufolastat F-18 PSMA PET imaging across all three prostate cancer disease stages, compared to the previous literature assessing the impact of 68gallium estimating the risk of upstaging to the regional or metastatic disease on PSMA PET/CT in high-risk and very high-risk patients with the localized disease by conventional imaging was used as a proxy for the long-term prognostic significance of PSMA PET/CT and was associated with significantly inferior long-term outcomes, including distant metastasis and prostate cancer-specific mortality. 10 It was previously demonstrated that the impact of the 68 Ga-PSMA-11 PET/CT scan was found to be the highest in patients with biochemical relapse after definitive surgery or radiation, demonstrating a 62% change in management. 24 Similarly, piflufolastat F-18 PET/CT imaging in the CONDOR trial detected metastatic lesions with high PPV regardless of the anatomic location in patients who had negative or equivocal conventional imaging and led to a change in management in 131/205 (63.9%) patients.…”

Section: Discussionmentioning

confidence: 98%

“…PSMA PET imaging has been used to improve diagnosis, stratification, and treatment planning for prostate cancer patients. 10,11 The gallium-68 PSMA-11 and piflufolastat F-18 PSMA (18F-DCFPyL) PSMA PET scans have been specifically approved for initial staging in patients with high risk of metastasis, evaluation of patients with biochemical relapse after definitive treatment biochemical recurrence (BCR), and restaging of patients with hormonesensitive/castration-resistant metastatic disease (mCSPC/mCRPC).…”

Section: Introductionmentioning

confidence: 99%

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Impact of piflufolastat F‐18 PSMA PET imaging on clinical decision‐making in prostate cancer across disease states: A retrospective review

et al. 2023

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Introduction Piflufolastat F‐18 (18F‐DCFPyL) prostate‐specific membrane antigen (PSMA) positron emission tomography (PET) imaging is approved by the US food and drug administration for initial staging of high‐risk prostate cancer, biochemical recurrence (BCR), and restaging of metastatic prostate cancer. Here, we sought to assess how its integration into clinical care may have impacted the management of patients. Methods We identified 235 consecutive patients who underwent an 18F‐DCFPyL PET scan from August 2021 to June 2022. The median prostate‐specific antigen at the time of imaging was 1.8 ng/mL (Range: 0−3740 ng/mL). Descriptive statistics were used to analyze its impact on clinical care for a subset of 157 patients with available treatment information: 22 for initial staging, 109 with BCR, and 26 patients with known metastatic disease. Results PSMA‐avid lesions were detected in 154/235 (65.5% of) patients. In patients undergoing initial staging, 18/39 (46.2% of) patients had extra‐prostatic metastatic lesions; 15/39 (38.5% of) scans were negative and 6/39 (15.4%) had equivocal results. 12/22 (54.5% of) patients had a change in their treatment plan post‐PSMA PET scan while 10/22 (45.5%) had no change in their treatment plan. In the BCR cohort, 93/150 (62.0%) had a local recurrence or metastatic lesions. Equivocal and negative scans accounted for 11/150 (7.3%) and 46/150 (30.7%) of scans, respectively. 37/109 (33.9% of) patients had a change in their treatment plan, while treatment was not altered in 72/109 (66.1% of) cases. In patients with metastatic disease, 43/46 (93.5%) had PSMA‐avid lesions identified; equivocal and negative scans accounted for 2/46 (4.3%) and 1/46 (2.2%) of scan results, respectively. 6/26 (23.1%) had their tentative treatment plan adjusted after the PSMA PET scan. No change in the treatment plan was observed in 20/26 (76.9% of) cases. Conclusion Integration of F‐18 PSMA PET imaging impacted clinical decision‐making and subsequent management across all stages of prostate cancer. It remains to be seen whether this translates into superior survival outcomes.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Impact of piflufolastat F‐18 PSMA PET imaging on clinical decision‐making in prostate cancer across disease states: A retrospective review

et al. 2023

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“…Prostate-specific membrane antigen (PSMA) PET-CT has been shown to upstage high-risk and very high-risk PCa patients, challenging conventional imaging assessments [ 20 , 21 ]. Xiang et al .…”

Section: Discussionmentioning

confidence: 99%

“…Xiang et al . also highlighted a PSMA-based nomogram’s effectiveness in predicting clinical outcomes, outperforming existing risk models [ 21 ]. Nonetheless, the risk of death from PCa remains low, even among higher risk cases [ 22 ], and most patients appear to benefit from local treatment combined with ADT [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Differential outcomes of re-stratified high-risk prostate cancer patients treated with external beam radiation therapy plus high-dose-rate brachytherapy boost

Carignan,

Morales,

Després

et al. 2024

jcb

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Purpose We report outcomes of high-risk prostate cancer (PCa) patients, initially classified according to a 3-tier NCCN classification system, treated with external beam radiation therapy (EBRT) and high-dose-rate brachytherapy boost (HDR-BT). Patients were analyzed based on a re-stratification of their risk grouping using CAPRA score and a newer 5-tier NCCN classification. Material and methods 471 high-risk PCa patients treated with EBRT, HDR-BT, and androgen deprivation therapy (ADT) between 1999 and 2018 were included. Competing risk survival analyses to compare individuals with CAPRA scores < 6 vs. ≥ 6 for biochemical relapse (BCR) and metastasis incidence were conducted. Also, overall survival (OS) for both groups using Kaplan-Meier analysis was assessed. The same analyses were repeated using a 5-tier NCCN stratification comparing those classified as high-risk vs. very high-risk patients. Results The median age was 71 years, and the median follow-up period was 72 months. The whole cohort received an EQD 2 of 74 Gy or greater, with a median EQD 2 of 106.89 Gy. Both a CAPRA score ≥ 6 and belonging to the NCCN very high-risk group were associated with BCR, with subdistribution hazard ratios (sHRs) of 3.04 ( p = 0.015) and 2.53 ( p = 0.013), respectively. For metastasis incidence, both the CAPRA and NCCN groups had similar sHRs of 2.60 ( p = 0.094) and 2.71 ( p = 0.037), respectively. For 10-year OS, patients with CAPRA score ≥ 6 and belonging to the NCCN very high-risk group presented similar HRs of 2.11 ( p = 0.005) and 2.10 ( p = 0.002). Conclusions We showed that high-risk PCa patients classified according to the 3-tier NCCN system benefit from further stratification using the CAPRA score or the 5-tier NCCN stratification method. Patients with a CAPRA score ≥ 6 or classified as very high-risk demonstrate a higher hazard of BCR, metastasis, and death. These patients might benefit from further intensification of their investigations and treatment, based on ongoing research.

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“…Recently, several nomograms, derived from the combination of clinical and imaging biomarkers, have been developed for diagnostic, prognostic, predictive, or risk stratification purposes [ 4 , 5 ]. However, their validation for clinical use requires the use of a considerable amount of data [ 1 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Radiomics and artificial intelligence in prostate cancer: new tools for molecular hybrid imaging and theragnostics

Liberini¹,

Laudicella

Balma³

et al. 2022

Eur Radiol Exp

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In prostate cancer (PCa), the use of new radiopharmaceuticals has improved the accuracy of diagnosis and staging, refined surveillance strategies, and introduced specific and personalized radioreceptor therapies. Nuclear medicine, therefore, holds great promise for improving the quality of life of PCa patients, through managing and processing a vast amount of molecular imaging data and beyond, using a multi-omics approach and improving patients’ risk-stratification for tailored medicine. Artificial intelligence (AI) and radiomics may allow clinicians to improve the overall efficiency and accuracy of using these “big data” in both the diagnostic and theragnostic field: from technical aspects (such as semi-automatization of tumor segmentation, image reconstruction, and interpretation) to clinical outcomes, improving a deeper understanding of the molecular environment of PCa, refining personalized treatment strategies, and increasing the ability to predict the outcome. This systematic review aims to describe the current literature on AI and radiomics applied to molecular imaging of prostate cancer.

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Performance of a Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography–Derived Risk-Stratification Tool for High-risk and Very High-risk Prostate Cancer

Cited by 21 publications

References 22 publications

Impact of piflufolastat F‐18 PSMA PET imaging on clinical decision‐making in prostate cancer across disease states: A retrospective review

Impact of piflufolastat F‐18 PSMA PET imaging on clinical decision‐making in prostate cancer across disease states: A retrospective review

Differential outcomes of re-stratified high-risk prostate cancer patients treated with external beam radiation therapy plus high-dose-rate brachytherapy boost

Radiomics and artificial intelligence in prostate cancer: new tools for molecular hybrid imaging and theragnostics

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