Value of Targeted Biopsies and Combined PSMA PET/CT and mp-MRI Imaging in Locally Recurrent Prostate Cancer after Primary Radiotherapy

Rasing, M.; Son, Marieke van; Moerland, Marinus A.; Keizer, Bart de; Wessels, Frank J.; Jonges, Trudy N.; Pol, S. van de; Eppinga, Wietse S.C.; Noteboom, J.L.; Lagendijk, J J W; Zijp, Jochem van der Voort van; Peters, Max

doi:10.3390/cancers14030781

Cited by 13 publications

(10 citation statements)

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“…PET with MR imaging can provide diagnostic confidence. It has been suggested that in patients with questionable recurrent prostate cancer post radiation therapy, if both PSMA PET and MRI are positive, given nearly 100% PPV, biopsy confirmation may not be needed [51 ▪ ].…”

Section: Pet Imagingmentioning

confidence: 99%

Hybrid magnetic resonance and PET imaging for prostate cancer recurrence

Rednam

Kundra

2023

Current Opinion in Oncology

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Purpose of reviewRecurrence post definitive local therapy by prostatectomy or radiation therapy is often detected via rise in serum prostate-specific antigen (PSA) levels; however, PSA rise does not localize the disease. Distinguishing local versus distant recurrence guides whether to choose subsequent local versus systemic therapy. The purpose of this article is to review imaging for prostate cancer recurrence post local therapy. Recent findingsAmong imaging modalities, multiparametric MRI (mpMRI) is commonly used to assess for local recurrence. New radiopharmaceuticals target prostate cancer cells and enable whole-body imaging. These tend to be more sensitive for lymph node metastases than MRI or computed tomography (CT) and for bone lesions than bone scan at lower PSA levels but can be limited for local prostate cancer recurrence. Given greater soft tissue contrast, similar criteria for lymph nodes, and greater sensitivity for prostate bone metastases, MRI is advantageous to CT. MRI of the whole body and mpMRI are now feasible within a reasonable time frame and complementary to PET imaging, enabling whole-body and pelvis-focused PET-MRI, which should be advantageous in the setting of recurrent prostate cancer.

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Section: Pet Imagingmentioning

confidence: 99%

Hybrid magnetic resonance and PET imaging for prostate cancer recurrence

Rednam

Kundra

2023

Current Opinion in Oncology

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“…PSMA PET/CT may improve patient selection for salvage focal ablation through greater ability firstly to rule out distant disease, and secondly to rule in local recurrence in conjunction with mpMRI [24,25]. When using both 68 Ga-PSMA-11 PET/CT and mpMRI, one study found a positive predictive value of 98% with targeted biopsy [26]. PET/MRI and whole-body MRI are also emerging tools that warrant further study [27,28].…”

Section: Future Directionsmentioning

confidence: 99%

External validation of a risk model predicting failure of salvage focal ablation for prostate cancer

et al. 2023

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ObjectivesTo externally validate a published model predicting failure within 2 years after salvage focal ablation in men with localised radiorecurrent prostate cancer using a prospective, UK multicentre dataset.Patients and methodsPatients with biopsy‐confirmed ≤T3bN0M0 cancer after previous external beam radiotherapy or brachytherapy were included from the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial (NCT01883128; 2014–2018; six centres), and from the high‐intensity focussed ultrasound (HIFU) Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) UK‐based registries (2006–2022; nine centres). Eligible patients underwent either salvage focal HIFU or cryotherapy, with the choice based predominantly on anatomical factors. Per the original multivariable Cox regression model, the predicted outcome was a composite failure outcome. Model performance was assessed at 2 years post‐salvage with discrimination (concordance index [C‐index]), calibration (calibration curve and slope), and decision curve analysis. For the latter, two clinically‐reasonable risk threshold ranges of 0.14–0.52 and 0.26–0.36 were considered, corresponding to previously published pooled 2‐year recurrence‐free survival rates for salvage local treatments.ResultsA total of 168 patients were included, of whom 84/168 (50%) experienced the primary outcome in all follow‐ups, and 72/168 (43%) within 2 years. The C‐index was 0.65 (95% confidence interval 0.58–0.71). On graphical inspection, there was close agreement between predicted and observed failure. The calibration slope was 1.01. In decision curve analysis, there was incremental net benefit vs a ‘treat all’ strategy at risk thresholds of ≥0.23. The net benefit was therefore higher across the majority of the 0.14–0.52 risk threshold range, and all of the 0.26–0.36 range.ConclusionIn external validation using prospective, multicentre data, this model demonstrated modest discrimination but good calibration and clinical utility for predicting failure of salvage focal ablation within 2 years. This model could be reasonably used to improve selection of appropriate treatment candidates for salvage focal ablation, and its use should be considered when discussing salvage options with patients. Further validation in larger, international cohorts with longer follow‐up is recommended.

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“…castration resistant prostate cancer) usually occurs within 1-3 years after start of hormonal treatment, requiring further systemic treatment with for example second-line hormonal treatment or chemotherapy. 29,[78][79][80] Local treatment for recurrent prostate cancer…”

Section: Locally Recurrent Prostate Cancermentioning

confidence: 99%

“…75,77 However, pathological assessment of biopsies is problematic given the risk of false negatives due to sampling errors and radiation effects hindering accurate classification. 78,79 In a study by Rasing et al 80 the positive predictive value of combined mp-MRI and PSMA-PET/CT for detecting recurrent prostate cancer was 97.6% in 41 patients treated with FS-HDR-BT, indicating the limited added value of targeted biopsies in these patients. However, these results are only valid for those in whom mp-MRI and PSMA-PET/CT are concordant.…”

Section: Identification Of Recurrent Prostate Cancermentioning

confidence: 99%

“…Histological confirmation by targeted biopsies is therefore encouraged in case of discordance between mp-MRI and PSMA-PET/CT and in case of low or ambiguous suspicion. 80 The debate on the exact value of targeted biopsies in the recurrent setting, and specifically its role in selecting patients who are eligible for salvage treatment, is still ongoing. Another important debate is how to best define of the Gross Tumour Volume (GTV).…”

Section: Identification Of Recurrent Prostate Cancermentioning

confidence: 99%

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MRI-guided stereotactic radiotherapy for localised prostate cancer

Willigenburg¹

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Although the incidence of prostate cancer is high, improvements in treatments have led to high survival rates in patients with low- and intermediate-risk prostate cancer. Therefore, it is even more important that treatments for these patients are minimally invasive and cause as little side effects as possible. The last decades, radiotherapy treatments have changed significantly. One of the clinically introduced innovations is the MR-Linac, a combination of a linear accelerator and an MRI scanner. This machine allows high-quality imaging before and during treatment and daily treatment plan optimisation based on the changing anatomy. This enables more precise radiotherapy and therefore better sparing of healthy organs, which will potentially lead to less side effects such as urinary complaints and erectile dysfunction. This thesis provides insight into the clinical introduction and first period of prostate cancer treatment on the MR-Linac. In part 1 of this thesis, new workflows and technological developments for MRI-guided prostate cancer treatment are presented, which are aimed at enabling extremely hypofractionated radiotherapy for prostate cancer in one or two treatment fractions. With these new workflows, the irradiated volumes can be reduced significantly. Furthermore, early (patient-reported) outcomes of MRI-guided prostate cancer radiotherapy are investigated within two cohort studies, including the international MOMENTUM study. These clinical results are already promising. Part 2 of this thesis focusses on re-irradiation in patients with recurrent prostate cancer after primary radiotherapy treatment. We present research on the feasibility of so-called single-fraction ‘focal salvage’ radiotherapy using external beam radiotherapy on the MR-Linac. The work presented in this thesis is part of the first steps towards MRI-guided, extremely high-precision radiotherapy treatment for (recurrent) prostate cancer in only one or two treatment sessions.

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Value of Targeted Biopsies and Combined PSMA PET/CT and mp-MRI Imaging in Locally Recurrent Prostate Cancer after Primary Radiotherapy

Cited by 13 publications

References 58 publications

Hybrid magnetic resonance and PET imaging for prostate cancer recurrence

Hybrid magnetic resonance and PET imaging for prostate cancer recurrence

External validation of a risk model predicting failure of salvage focal ablation for prostate cancer

MRI-guided stereotactic radiotherapy for localised prostate cancer

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