Radiotherapy treatment modification for prostate cancer patients based on PSMA-PET/CT

Abstract

Background Prostate cancer is the most common cancer among men, and its diagnosis and treatment are improving. Our study evaluated how PSMA-PET/CT prior to treatment planning might improve the optimal management of prostate cancer radiotherapy. Methods This retrospective pilot study included 43 prostate cancer (PCa) patients referred to our radiation oncologist department, from the urology department, for radiation therapy. 18F-PSMA-PET/CT was ordered by the radiation oncologists mainly due to the lack of resent image staging. The patients were divided into three different groups according to their initially planned treatments: radical radiation therapy (RT) (newly diagnosed PCa patients), salvage RT (patients with biochemical recurrence after radical prostatectomy), or oligometastatic RT (oligometastatic PCa patients with good response after systemic treatment). Results Following PSMA-PET/CT, the initially planned RT was changed for 60.5% of the patients due to new findings (metastases and/or recurrent disease). The final treatment choice was effected by PSMA-PET/CT outcome in 60.5% (26/43) of the patients, and in 50% (16/32) of patients, the radiation treatment plan changed following PSMA-PET/CT. Only 39.5% (17/43) of the patients who underwent PSMA-PET/CT were treated according to their initial treatment plans. Conclusions Our results indicate that PSMA-PET/CT impacts treatment decisions and the selection of RT as well as adjuvant treatment protocols in the management of prostate cancer.

Prostate-specific membrane antigen-based imaging for stereotactic irradiation of low-volume progressive prostate cancer: a single-center experience

“…A retrospective study ( 29 ) demonstrated that radiotherapy plans had to be modified by an average of 60.5% due to PSMA-PET/CT findings. However, these data are to be treated with caution since the total number of patients enrolled in the trial was low (43), and the indications for irradiations were heterogeneous (curative, salvage, and metastasis treatment).…”

Radiation induced therapeutic effects in cancerous and tumor cells: A review

“…Before that, early detection of treatment is critical to controlling prostate cancer. 82 External beam radiation therapy (EBRT) is an effective curative treatment option for localized prostate cancer. A total of 10-20% of patients develop long-term toxicity after radiotherapy for prostate cancer.…”

PSMA PET-CT in the Diagnosis and Staging of Prostate Cancer

“…These changes entailed a change of surgical technique (7.4%), usually the addition of an ePLND, and change in radiotherapy dose (7.4%), mostly an increase in the amount and field of radiotherapy [ 42 ]. Karagiannis et al, (2022), also found that PSMA PET-CT modified radiotherapy treatment plans in approximately 60% of their patients, usually finding further locoregional or metastatic disease and thus implementing additional systemic therapy [ 50 ].…”