PSMA-PET based radiotherapy: a review of initial experiences, survey on current practice and future perspectives

Zschaeck, Sebastian; Lohaus, Fabian; Beck, Marcus; Habl, Gregor; Kroeze, S.G.C.; Zamboglou, Constantinos; Koerber, Stefan A.; Debus, Jürgen; Hölscher, Tobias; Wust, Peter; Ganswindt, Ute; Baur, Alexander; Zöphel, Klaus; Čihorić, Nikola; Gückenberger, Matthias; Combs, Stephanie E.; Grosu, Anca L.; Ghadjar, Pirus; Belka, Claus

doi:10.1186/s13014-018-1047-5

Cited by 37 publications

(29 citation statements)

References 68 publications

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“…Although these previous publications have investigated the correlation between GS and SUV, the correlation between GS and more sophisticated PET image features has not yet been evaluated. First studies analyzed the value of PSMA PET in detection of lymph nodes metastases in patients with primary PCa 15, 16. Maurer et al reported a sensitivity of 0.66 and a specificity of 0.99 for PSMA PET in lymph node detection 17.…”

Section: Introductionmentioning

confidence: 99%

Radiomic features from PSMA PET for non-invasive intraprostatic tumor discrimination and characterization in patients with intermediate- and high-risk prostate cancer - a comparison study with histology reference

et al. 2019

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Purpose: To evaluate the performance of radiomic features (RF) derived from PSMA PET for intraprostatic tumor discrimination and non-invasive characterization of Gleason score (GS) and pelvic lymph node status. Patients and methods: Patients with prostate cancer (PCa) who underwent [ 68 Ga]-PSMA-11 PET/CT followed by radical prostatectomy and pelvic lymph node dissection were prospectively enrolled (n=20). Coregistered histopathological gross tumor volume (GTV-Histo) in the prostate served as reference. 133 RF were derived from GTV-Histo and from manually created segmentations of the intraprostatic tumor volume (GTV-Exp). Spearman´s correlation coefficients (ρ) were assessed between RF derived from the different GTVs. We additionally analyzed the differences in RF values for PCa and non-PCa tissues. Furthermore, areas under receiver-operating characteristics curves (AUC) were calculated and uni- and multivariate analyses were performed to evaluate the RF based discrimination of GS 7 and ≥8 disease and of patients with nodal spread (pN1) and non-nodal spread (pN0) in surgical specimen. The results found in the latter analyses were validated by a retrospective cohort of 40 patients. Results: Most RF from GTV-Exp showed strong correlations with RF from GTV-Histo (86% with ρ>0.7). 81% and 76% of RF from GTV-Exp and GTV-Histo significantly discriminated between PCa and non-PCa tissue. The texture feature QSZHGE discriminated between GS 7 and ≥8 considering GTV-Histo (AUC=0.93) and GTV-Exp (prospective cohort: AUC=0.91 / validation cohort: AUC=0.84). QSZHGE also discriminated between pN1 and pN0 disease considering GTV-Histo (AUC=0.85) and GTV-Exp (prospective cohort: AUC=0.87 / validation cohort: AUC=0.85). In uni- and multivariate analyses including patients of both cohorts QSZHGE was a statistically significant (p<0.01) predictor for PCa patients with GS ≥8 tumors and pN1 status. Conclusion: RF derived from PSMA PET discriminated between PCa and non-PCa tissue within the prostate. Additionally, the texture feature QSZHGE discriminated between GS 7 and GS ≥8 tumors and between patients with pN1 and pN0 disease. Our results support the role of RF in PSMA PET as a new tool for non-invasive PCa discrimination and characterization of its biological properties.

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Section: Introductionmentioning

confidence: 99%

Radiomic features from PSMA PET for non-invasive intraprostatic tumor discrimination and characterization in patients with intermediate- and high-risk prostate cancer - a comparison study with histology reference

et al. 2019

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“… 7,8 It has been suggested by some groups that PSMA PET/CT should be the gold standard for imaging in biochemical recurrent prostate cancer as well as having utility in staging and assessing treatment response. 9 …”

Section: Discussionmentioning

confidence: 99%

Local failure after definitive radiation treatment of lymph-node positive prostate cancer: supporting the use of novel imaging techniques to personalize treatment options

et al. 2020

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Patients with lymph-node positive prostate cancer are often treated with external beam radiotherapy with androgen deprivation therapy 1 , but are expected to have a high rate of biochemical failure. Recently, MRI and molecular imaging have afforded the opportunity to elucidate otherwise occult sites of recurrence after conventional imaging. We present an unusual case of local failure within the prostate after definitive radiation treatment of lymph-node positive prostate cancer, in which advanced imaging allowed for a potentially curative salvage treatment option.

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“…Our departmental policy is that evidence of pelvic lymph nodes should lead to irradiation of the pelvic lymphatic basin according to the Radiation Therapy Oncology Group consensus recommendations on delineation of pelvic lymphatic pathways (40) with a simultaneous boost to the PET-positive lymph nodules and additional androgen deprivation therapy. Interestingly, there is strong controversy on the best therapeutic approach in cases of positive lymph nodes, with some centers opting for stereotactic body radiotherapy to the PET-positive lymph nodes only (48). Having recently presented our data on outcome in patients with biochemical recurrence treated on the basis of the results of 68 Ga-PSMA PET/CT (9), we believe that eradicating microscopic spread to surrounding lymphatic pathways, dose escalation to macroscopic tumor burden, and at least concomitant use of androgen deprivation therapy might be more favorable than stereotactic body radiotherapy of PET-positive nodes only.…”

Section: Discussionmentioning

confidence: 99%

Impact of ⁶⁸Ga-PSMA PET/CT on the Radiotherapeutic Approach to Prostate Cancer in Comparison to CT: A Retrospective Analysis

Schmidt-Hegemann

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et al. 2018

J Nucl Med

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Ga-prostate-specific membrane antigen PET/CT (68 Ga-PSMA PET/CT) offers unprecedented accuracy for staging of primary, persistent, or recurrent prostate cancer. Thus, we hypothesized that 68 Ga-PSMA PET/CT before radiotherapy significantly affects the radiotherapeutic approach in comparison to the current standard, a CT-based approach. Methods: Between February 2014 and December 2017, 172 patients underwent 68 Ga-PSMA PET/CT before radiotherapy and were included in this retrospective analysis. Twenty-two (13%) patients were referred for primary definitive radiotherapy, 51% (88/172) for prostate-specific antigen (PSA) persistence, and 36% (62/172) for PSA recurrence after radical prostatectomy. An experienced radiation oncologist, masked to the CT and PET/CT results, decided on the radiation treatment management of all patients on the basis of the clinical and pathologic variables. The potential increase in diagnostic accuracy, and the subsequent change in radiotherapeutic approach, were documented separately for PET/CT versus CT. Results: The overall detection rate was 70% (120/172) for 68 Ga-PSMA PET/CT. Patients with a pre-PET/CT PSA level of more than 0.5 ng/mL (98/ 111; 88%) had PET-positive results significantly more often. Overall, PSMA PET/CT revealed 171 lesions, PET alone 156, and CT alone 85. For all patients, a continuous diagnostic increase in positive findings was observed for primary tumor/local recurrence (CT, 18%, vs. PET/CT, 37%), pelvic lymph nodes (CT, 21%, vs. PET/CT, 44%), and distant metastases (CT, 7%, vs. PET/CT, 19%) when comparing CT with PET/CT. Compared with CT, the combination of PET/CT information resulted in a change in treatment in 107 of 172 (62%) patients, that is, 8 of 22 (36%) patients before any treatment, 31 of 62 (50%) with PSA recurrence, and 68 of 88 (77%) with PSA persistence. Comparing the different radiotherapy indications with one another, there was a higher rate of change in management for postoperative patients than for patients before any treatment. Conclusion: Compared with conventional CT, 68 Ga-PSMA PET/CT had a remarkable impact on radiotherapeutic approach, especially in postoperative patients. Thus, considering the growing amount of data on the impact of 68 Ga-PSMA PET/CT on postoperative patients, 68 Ga-PSMA PET/CT has recently been endorsed by a few cancer guidelines as an imaging modality in patients with PSA persistence or recurrence (e.g., the German S3 guideline and the European Association of Urology guideline).

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PSMA-PET based radiotherapy: a review of initial experiences, survey on current practice and future perspectives

Cited by 37 publications

References 68 publications

Radiomic features from PSMA PET for non-invasive intraprostatic tumor discrimination and characterization in patients with intermediate- and high-risk prostate cancer - a comparison study with histology reference

Radiomic features from PSMA PET for non-invasive intraprostatic tumor discrimination and characterization in patients with intermediate- and high-risk prostate cancer - a comparison study with histology reference

Local failure after definitive radiation treatment of lymph-node positive prostate cancer: supporting the use of novel imaging techniques to personalize treatment options

Impact of ⁶⁸Ga-PSMA PET/CT on the Radiotherapeutic Approach to Prostate Cancer in Comparison to CT: A Retrospective Analysis

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PSMA-PET based radiotherapy: a review of initial experiences, survey on current practice and future perspectives

Cited by 37 publications

References 68 publications

Radiomic features from PSMA PET for non-invasive intraprostatic tumor discrimination and characterization in patients with intermediate- and high-risk prostate cancer - a comparison study with histology reference

Radiomic features from PSMA PET for non-invasive intraprostatic tumor discrimination and characterization in patients with intermediate- and high-risk prostate cancer - a comparison study with histology reference

Local failure after definitive radiation treatment of lymph-node positive prostate cancer: supporting the use of novel imaging techniques to personalize treatment options

Impact of 68Ga-PSMA PET/CT on the Radiotherapeutic Approach to Prostate Cancer in Comparison to CT: A Retrospective Analysis

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Impact of ⁶⁸Ga-PSMA PET/CT on the Radiotherapeutic Approach to Prostate Cancer in Comparison to CT: A Retrospective Analysis