Prostate Cancer Biochemical Recurrence Resulted Negative on [68Ga]Ga-PSMA-11 but Positive on [18F]Fluoromethylcholine PET/CT

Laudicella, Riccardo; Torre, Flavia La; Davì, Valerio; Crocè, Ludovica; Aricò, Demetrio; Leonardi, Giuseppe; Russo, Simona; Minutoli, Fabio; Burger, Irene A.; Baldari, Sergio

doi:10.3390/tomography8050205

Cited by 8 publications

(3 citation statements)

References 20 publications

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“…However, it should be acknowledged that most of the PSMA PET data are based on retrospective series, and the high cost and limited availability of this method are still major limitations ( 15 ). Therefore, taking into account also the heterogeneity of the disease and that almost 10% of PCa is PSMA negative, we believe that choline PET/CT still represents an effective molecular imaging technique that should be considered ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Choline PET/CT in recurrent prostate cancer

et al. 2023

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PurposeBiochemical recurrence (BR) occurs in up to 40% of patients with prostate cancer (PCa) treated with primary radical prostatectomy (RP). Choline PET/CT may show, in a single-step examination, the site of tumor recurrence earlier than traditional imaging methods, particularly at low prostate-specific antigen (PSA) levels, thus influencing subsequent treatment. Methods/patientsPatients with recurrent and non-metastatic prostate cancer (nmPCa), who were assessed with choline PET/CT, were included in the analysis. Based on imaging results, the following therapeutic strategies were chosen: radiotherapy to the prostatic bed, androgen deprivation therapy (ADT), and chemotherapy or stereotactic body radiotherapy (SBRT) to either the pelvic lymph nodes or distant metastases. We assessed the impact of age, PSA levels, Gleason score (GS), and adjuvant therapy on oncological outcomes.ResultsData from 410 consecutive nmPCa patients with BR who underwent RP as primary treatment were analyzed. One hundred seventy-six (42.9%) patients had a negative choline PET/CT, and 234 (57.1%) patients resulted positive. In the multivariate analysis, only chemotherapy and PSA at recurrence were significant independent prognostic factors on overall survival (OS). In the PET-positive subgroup, the number of relapses, PSA post-prostatectomy, and chemotherapy impacted on OS. PSA (post-surgery and at recurrence) affected progression-free survival (PFS) in the univariate analysis. In the multivariate analysis, GS, the number of relapse sites, and PSA (post-surgery and at recurrence) were significant prognostic factors for disease-free survival (DFS).ConclusionCholine PET/CT provides better accuracy than conventional imaging for the assessment of nmPCa with BR after prostatectomy, thereby enabling salvage strategies and improving quality of life.

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Section: Discussionmentioning

confidence: 99%

Choline PET/CT in recurrent prostate cancer

et al. 2023

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“…Nevertheless, as highlighted by immunohistochemistry studies, it is now known that there is a heterogenous PSMA expression in both primary tumors and distant metastasis [ 14 ]. Furthermore, around 10% of cases occur with low or without PSMA expression [ 15 , 16 , 17 ]. Interestingly, in these studies, most of the patients with low/absent PSMA expression showed infiltrative growth patterns.…”

Section: Introductionmentioning

confidence: 99%

Histology and PSMA Expression on Immunohistochemistry in High-Risk Prostate Cancer Patients: Comparison with 68Ga-PSMA PET/CT Features in Primary Staging

Vetrone

Mei

Bianchi

et al. 2023

Cancers

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PSMA-PET/CT is a suitable replacement for conventional imaging in the primary staging of PCa. The aim of this retrospective study was to assess the correlation between parameters discovered by PSMA PET/CT in primary staging and either prostate histopathology (pT) findings or PSMA-IHC expression in a cohort of biopsy-proven high-risk PCa candidates for surgery. Clinical information (age, iPSA-value, and grading group) and PSMA-PET/CT parameters (SUVmax, PSMA tumor volume [PSMA-TV], and total lesion [PSMA-TL]) were compared with pT (including histologic pattern, Gleason grade, and lymphovascular invasion [LVI]) and PSMA-IHC features, including visual quantification (VS) with a four-tiered score (0 = negative, 1+ = weak, 2+ = moderate, 3+ = strong), growth pattern (infiltrative vs expansive), and visual pattern (cytoplasmic vs membranous). In total, 44 patients were enrolled, with a median age of 67 (IQR 57-77); the median iPSA was 9.4 ng/dL (IQR 12.5-6.0). One patient (3%) was grading group (GG) 3, 27/44 (61%) were GG4, and 16/44 (36%) were GG5. PSMA-PET/CT detection rate for the presence of primary prostate cancer was 100%. Fused/poorly formed Gleason grade 4 features were predominant (22/44–50%); a cribriform pattern was present in 18/44 (41%) and acinar in 4/44 (9%). We found that lower PSMA-TVs were mostly related to acinar, while higher PSMA-TVs correlated with a higher probability to have a cribriform pattern (p-value 0.04). LVI was present in 21/44(48%) patients. We found that higher PSMA-TV and PSMA-TL are predictive of LVI p-value 0.002 and p-value 0.01, respectively. There was no correlation between PET-parameters and perineural invasion (PNI), probably because this was present in almost all the patients. Moreover, patients with high PSMA-TL values displayed the highest PSMA-IHC expression (VS3+) with a membranous pattern. In conclusion, PSMA-TV and PSMA-TL are predictors of a cribriform pattern and LVI. These conditions are mostly related to higher aggressiveness and worse outcomes.

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“…However, the diagnostic accuracy of PSMA PET is challenged by findings that claim that up to 15% of clinically relevant PCa cases do not express this protein [ 8 ], leading to false negative results. Moreover, further cancer de-differentiation in the metastatic castration-resistant (mCR) late stages of the disease increases this percentage [ 9 , 10 ]. Therefore, identifying alternative imaging biomarkers that complement PSMA PET in such clinical circumstances represents an unmet clinical need.…”

Section: Introductionmentioning

confidence: 99%

Preliminary Findings of the Role of FAPi in Prostate Cancer Theranostics

et al. 2023

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Prostate cancer (PCa) is the most frequently diagnosed cancer worldwide and the second most common cause of cancer-related deaths among men. Progress in molecular imaging has magnified its clinical management; however, an unmet clinical need involves the identification of new imaging biomarkers that complement the gold standard of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) in cases of clinically significant PCa that do not express PSMA. Fibroblast activation protein (FAP) is a type II transmembrane serine overexpressed in many solid cancers that can be imaged through quinoline-based PET tracers derived from an FAP inhibitor (FAPi). Preliminary results of FAPi application in PCa (in PSMA-negative lesions, and in comparison with fluorodeoxyglucose—FDG) are now available in the literature. FAP-targeting ligands for PCa are not limited to detection, but could also include therapeutic applications. In this preliminary review, we provide an overview of the clinical applications of FAPi ligands in PCa, summarising the main results and highlighting contemporary strengths and limitations.

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Prostate Cancer Biochemical Recurrence Resulted Negative on [68Ga]Ga-PSMA-11 but Positive on [18F]Fluoromethylcholine PET/CT

Cited by 8 publications

References 20 publications

Choline PET/CT in recurrent prostate cancer

Choline PET/CT in recurrent prostate cancer

Histology and PSMA Expression on Immunohistochemistry in High-Risk Prostate Cancer Patients: Comparison with 68Ga-PSMA PET/CT Features in Primary Staging

Preliminary Findings of the Role of FAPi in Prostate Cancer Theranostics

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