The role of PSMA PET/CT imaging in restaging of prostate cancer patients with low prostate-specific antigen levels

Kabasakal, Levent; Demirci, Emre; Nematyazar, Jamal; Akyel, Reşit; Razavi, Baresh; Ocak, Meltem; Aygün, Aslan; Öbek, Can; Kural, Ali Rıza

doi:10.1097/mnm.0000000000000617

Cited by 38 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Schmidt-Hegemann et al reported 129 men with recurrent prostate carcinoma scanned with 68 Ga-PSMA-11 PET/CT and showed changes in the radiotherapy plan in 56.6% (22). These consistent results are also supported by numerous other studies supporting the role of 68 Ga-PSMA-11 PET/CT in this setting (11,12,23,24). 68 Ga-PSMA-11 PET/CT imaging identification of isolated bone metastases has led to an increase in the use of stereotactic body radiation therapy, and the detection of small nodes often leads to increased use of simultaneous integrated boost to affected areas (Fig.…”

Section: Discussionmentioning

confidence: 56%

⁶⁸Ga-PSMA-11 PET/CT in Primary and Recurrent Prostate Carcinoma: Implications for Radiotherapeutic Management in 121 Patients

et al. 2018

View full text Add to dashboard Cite

The present study analyzed the impact of Gallium-68 (Ga)-labeled prostate-specific membrane antigen-HBED-CC (Ga-PSMA-11) positron-emission tomography (PET)/computed tomography (CT) on radiotherapeutic management in a large cohort of men with primary or recurrent disease. This study investigated 121 men with carcinoma of the prostate who underwentGa-PSMA-11 PET/CT as well as conventional imaging. 50 patients were treatment naive, 11 had persistent prostate-specific antigen (PSA) soon after surgery and 60 presented with recurrent PSA following definitive therapy. Changes in TNM classification of malignant tumors (TNM) stage and radiotherapeutic management after Ga-PSMA-11 imaging were compared to results achieved with conventional imaging. In total, a change in TNM stage and radiotherapeutic management was observed for 49 patients (40.5%) and 62 patients (51.2%), respectively. In treatment naïve patients, a change in TNM stage and radiotheraeutic plan occurred in 26.0% and 44.0% of the cohort respectively. For patients with PSA persistence or recurrence, TNM and radiotherapeutic management changed in 50.7% and 56.3% respectively. Ga-PSMA-11 PET/CT may shortly become an indispensable tool for detecting prostate cancer lesions in treatment-naïve patients as well as in men with recurrent disease or persistent PSA and seems to be very helpful in personalizing radiotherapeutic management to the individual patients' distribution of disease.

show abstract

Section: Discussionmentioning

confidence: 56%

⁶⁸Ga-PSMA-11 PET/CT in Primary and Recurrent Prostate Carcinoma: Implications for Radiotherapeutic Management in 121 Patients

et al. 2018

View full text Add to dashboard Cite

show abstract

“…In our 68 Ga-PSMA-11 PET/MRI cohort, we observed a considerably higher detection rate of 65% in patients presenting with PSA values between 0.2 and 0.5 ng/mL at the time of the scan. Published data on the detection rate in patients with even lower PSA values (,0.2 ng/mL) are scarce and include only small patient cohorts (18,19,22,23). Reported detection rates for this cohort with a very low PSA range between 33% and 47.1%.…”

Section: Discussionmentioning

confidence: 96%

Detection Rate and Localization of Prostate Cancer Recurrence Using ⁶⁸Ga-PSMA-11 PET/MRI in Patients with Low PSA Values ≤ 0.5 ng/mL

et al. 2019

View full text Add to dashboard Cite

A first analysis of simultaneous 68 Ga-prostate-specific membrane antigen (PSMA)-11 PET/MRI showed some improvement in the detection of recurrent disease at low serum prostate specific antigen (PSA) values below 0.5 ng/mL compared with the already high detection rate of 68 Ga-PSMA-11 PET/CT. We therefore focused on all patients with biochemical recurrence and PSA values no higher than 0.5 ng/mL to assess the detection rate for 68 Ga-PSMA-11 PET/MRI. Methods: We retrospectively analyzed a cohort of 66 consecutive patients who underwent 68 Ga-PSMA-11 PET/MRI for biochemical recurrence with a PSA value no higher than 0.5 ng/mL at our institution. Median PSA level was 0.23 ng/mL (range, 0.03-0.5 ng/mL). Detection of PSMA-positive lesions within the prostate fossa, local and distant lymph nodes, bones, or visceral organs was recorded. In addition, all scans with 68 Ga-PSMA-11 PET/MRI-positive lesions were retrospectively assessed to analyze if lesions were detected inside or outside a standard salvage radiotherapy volume. Results: Overall, in 36 of 66 patients (54.5%) PSMA-positive lesions were detected; in 26 of 40 (65%) patients with a PSA level between 0.2 and 0.5 ng/mL and in 10 of 26 (38.5%) patients with a PSA level less than 0.2 ng/mL. Even at those low PSA values, only 8 of 66 (12.1%) patients had exclusive local recurrence. Lymph nodes were detected in 23 patients and bone metastases in 5 on 68 Ga-PSMA-11 PET/MRI. In 26 of 66 patients (39.4%), PSMA-positive lesions were located outside a standard salvage radiotherapy volume. Conclusion: Our data confirm that 68 Ga-PSMA-11 PET/MRI has a high detection rate for recurrent prostate cancer, even at low PSA levels no higher than 0.5 ng/mL. In addition, we show that 68 Ga-PSMA-11 PET/MRI detected PSMA-positive lesions outside a standard salvage radiotherapy volume in 39.4% of all patients.

show abstract

“…Kabasakal et al [ 58 ] reported a PET positivity of 31% ( n = 4), 54% ( n = 13), and 88% ( n = 14) in patients with a PSA level of less than 0.2, 0.2–2, and 2–5 ng/ml, respectively. A positive correlation was also observed between positivity and GS.…”

Section: Recurrent Pc - “Secondary Staging”mentioning

confidence: 99%

Current status of theranostics in prostate cancer

Virgolini

Decristoforo

Haug

et al. 2017

Eur J Nucl Med Mol Imaging

132

View full text Add to dashboard Cite

The aim of this review is to report on the current status of prostate-specific membrane antigen (PSMA)-directed theranostics in prostate cancer (PC) patients. The value of 68Ga-PSMA-directed PET imaging as a diagnostic procedure for primary and recurrent PC as well as the role of evolving PSMA radioligand therapy (PRLT) in castration-resistant (CR)PC is assessed. The most eminent data from mostly retrospective studies currently available on theranostics of prostate cancer are discussed. The current knowledge on 68Ga-PSMA PET/CT implicates that primary staging with PET/CT is meaningful in patients with high-risk PC and that the combination with pelvic multi parametric (mp)MR (or PET/mpMR) reaches the highest impact on patient management. There may be a place for 68Ga-PSMA PET/CT in intermediate-risk PC patients as well, however, only a few data are available at the moment. In secondary staging for local recurrence, 68Ga-PSMA PET/mpMR is superior to PET/CT, whereas for distant recurrence, PET/CT has equivalent results and is faster and cheaper compared to PET/mpMR. 68Ga-PSMA PET/CT is superior to 18F / 11Choline PET/CT in primary staging as well as in secondary staging. In patients with biochemical relapse, PET/CT positivity is directly associated with prostate-specific antigen (PSA) increase and amounts to roughly 50% when PSA is raised to ≤0.5 ng/ml and to ≥90% above 1 ng/ml. Significant clinical results have so far been achieved with the subsequent use of radiolabeled PSMA ligands in the treatment of CRPC. Accumulated activities of 30 to 50 GBq of 177Lu-PSMA ligands seem to be clinically safe with biochemical response and PERCIST/RECIST response in around 75% of patients along with xerostomia in 5–10% of patients as the only notable side effect. On the basis of the current literature, we conclude that PSMA-directed theranostics do have a major clinical impact in diagnosis and therapy of PC patients. We recommend that 68Ga-PSMA PET/CT should be performed in primary staging together with pelvic mpMR in high-risk patients and in all patients for secondary staging, and that PSMA-directed therapy is a potent strategy in CRPC patients when other treatment options have failed. The combination of PSMA-directed therapy with existing therapy modalities (such as 223Ra-chloride or androgen deprivation therapy) has to be explored, and prospective clinical multicenter trials with theranostics are warranted.

show abstract

The role of PSMA PET/CT imaging in restaging of prostate cancer patients with low prostate-specific antigen levels

Cited by 38 publications

References 23 publications

⁶⁸Ga-PSMA-11 PET/CT in Primary and Recurrent Prostate Carcinoma: Implications for Radiotherapeutic Management in 121 Patients

⁶⁸Ga-PSMA-11 PET/CT in Primary and Recurrent Prostate Carcinoma: Implications for Radiotherapeutic Management in 121 Patients

Detection Rate and Localization of Prostate Cancer Recurrence Using ⁶⁸Ga-PSMA-11 PET/MRI in Patients with Low PSA Values ≤ 0.5 ng/mL

Current status of theranostics in prostate cancer

Contact Info

Product

Resources

About

The role of PSMA PET/CT imaging in restaging of prostate cancer patients with low prostate-specific antigen levels

Cited by 38 publications

References 23 publications

68Ga-PSMA-11 PET/CT in Primary and Recurrent Prostate Carcinoma: Implications for Radiotherapeutic Management in 121 Patients

68Ga-PSMA-11 PET/CT in Primary and Recurrent Prostate Carcinoma: Implications for Radiotherapeutic Management in 121 Patients

Detection Rate and Localization of Prostate Cancer Recurrence Using 68Ga-PSMA-11 PET/MRI in Patients with Low PSA Values ≤ 0.5 ng/mL

Current status of theranostics in prostate cancer

Contact Info

Product

Resources

About

⁶⁸Ga-PSMA-11 PET/CT in Primary and Recurrent Prostate Carcinoma: Implications for Radiotherapeutic Management in 121 Patients

⁶⁸Ga-PSMA-11 PET/CT in Primary and Recurrent Prostate Carcinoma: Implications for Radiotherapeutic Management in 121 Patients

Detection Rate and Localization of Prostate Cancer Recurrence Using ⁶⁸Ga-PSMA-11 PET/MRI in Patients with Low PSA Values ≤ 0.5 ng/mL