The management impact of 68gallium-tris(hydroxypyridinone) prostate-specific membrane antigen (68Ga-THP-PSMA) PET-CT imaging for high-risk and biochemically recurrent prostate cancer

Abstract

Purpose To determine the impact on clinical management of patients with high-risk (HR) prostate cancer at diagnosis and patients with biochemical recurrence (BCR) using a new kit form of 68 Ga-prostate-specific membrane antigen (PSMA), namely tris(hydroxypyridinone) (THP)-PSMA, with positron emission tomography-computed tomography (PET-CT). Methods One hundred eighteen consecutive patients (50 HR, 68 BCR) had management plans documented at a multidisciplinary meeting before 68 Ga-THP-PSMA PET-CT. Patients underwent PET-CT scans 60-min post-injection of 68 Ga-THP-PSMA (mean 159 ± 21.2 MBq). Post-scan management plans, Gleason score, prostate-specific antigen (PSA) and PSA doubling time (PSAdt) were recorded. Results HR group: 12/50 (24%) patients had management changed (9 inter-modality, 3 intra-modality). Patients with PSA < 20 μg/L had more frequent management changes (9/26, 34.6%) compared with PSA > 20 μg/L (3/24, 12.5%). Gleason scores > 8 were associated with detection of more nodal (4/16, 25% vs 5/31, 16.1%) and bone (2/16, 12.5% vs 2/31, 6.5%) metastases. BCR group: Clinical management changed in 23/68 (34%) patients (17 inter-modality, 6 intra-modality). Forty out of 68 (59%) scans were positive. Positivity rate increased with PSA level (PSA < 0.5 μg/L, 0%; PSA 0.5-1.0 μg/L, 35%; PSA 1.0-5.0 μg/L, 69%; PSA 5.0-10.0 μg/L, 91%), PSAdt of < 6 months (56% vs 45.7%) and Gleason score > 8 (78.9% vs 51.2%). Conclusions 68 Ga-THP-PSMA PET-CT influences clinical management in significant numbers of patient with HR prostate cancer pre-radical treatment and is associated with PSA. Management change also occurs in patients with BCR and is associated with PSA and Gleason score, despite lower scan positivity rates at low PSA levels < 0.5 μg/L.

Clinical Utility of 18F-PSMA-1007 Positron Emission Tomography/Magnetic Resonance Imaging in Prostate Cancer: A Single-Center Experience

“…prospectively investigated 50 patients with high-risk PCa. Of the 50 patients, 12 (24%) had management changed after PSMA PET/CT imaging ( 16 ). Hofman et al.…”

68Ga-PSMA PET/CT for Patients with PSA Relapse after Radical Prostatectomy or External Beam Radiotherapy

“…Francolini et al also found that a short time to PSA relapse (2.5 years) increased the rate of positive sites in 68 Ga-PSMA PET/CT findings [ 51 ]. Kulkarni et al showed that patients with a high ISUP grade and a short PSADT had a high rate of 68 Ga-PSMA PET/CT positive findings [ 52 ]. Additionally, a previous meta-analysis reported that a short PSADT at PSA relapse predicted many positive sites on 68 Ga-PSMA PET/CT [ 53 ].…”

Clinical impact of PSMA PET in biochemically recurrent prostate cancer; a review of the literature

“…Ultimately 16 studies were included in the review (Tab. 2; [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]). Twelve studies reported outcomes using [ 68 Ga]-PSMA-11 PET, while four studies reported data on other PSMA-tracers.…”

“…The pooled data of all patients included in this review show an overall change of management in 861 of 1899 patients (45%). Nine studies, including 729 patients, reported sufficient data to extract the kind of change in management [20,24,26,27,29,33,36,38,40]. In 332 (46%) of these 729 patients a change in management was seen.…”