With New Technology Comes Great Responsibility: Prostate-Specific Membrane Antigen Imaging in Recurrent Prostate Cancer

Madan, Ravi A.; Mena, Esther; Lindenberg, Liza; Choyke, Peter L.

doi:10.1200/jco.22.00493

Cited by 6 publications

(3 citation statements)

References 28 publications

(52 reference statements)

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“…This complicates the interpretation of data on the efficacy and usefulness of diagnostic investigations. The ability of PSMA PET/CT to detect recurrence at an earlier stage of disease suggests greater opportunities for life-prolonging treatment; however, given the often indolent clinical course of recurrent PC, the potential benefits of earlier, aggressive therapeutic intervention in patients with limited recurrence will need to be weighed carefully against the risk of associated toxicities and quality of life impairment ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Prostate-Specific Membrane Antigen Expression on PET/CT in Patients with Metastatic Castration-Resistant Prostate Cancer: A Retrospective Observational Study

et al. 2023

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Rationale: Monitoring therapy response in patients with metastatic castration-resistant prostate cancer ([m]CRPC) treated with novel hormonal therapies, taxanes and newly approved therapies is crucial for optimizing treatment. [ 68 Ga]Ga-prostate-specific membrane antigen (PSMA)-11 positron emission tomography/computed tomography (PSMA PET/CT) is a promising target for managing treatment in patients with prostate cancer. PSMA is overexpressed in patients with mCRPC; understanding how expression might change in patients undergoing treatment could determine its potential for guiding clinical decisions. We examined PSMA expression in patients with CRPC and compared PET/CT response with prostate-specific antigen (PSA) variation as prognostic factor for progression-free and overall survival (PFS and OS). Methods: Single-centre, retrospective observational cohort study in patients with CRPC enrolled in the PSMA-PROSTATA registry study (EudraCT: 2015-004589-27). First and second (if applicable) PSMA PET/CT were performed to determine PSMA expression (absence/presence). PET/CT response was assessed as responders (patients with stable disease, partial or complete response) versus non-responders (patients with progressive disease) comparing the first with the second PET/CT PET/CT. PSA variation (increase/decrease from baseline) was assessed across the same time period. PFS was defined as time between second PET/CT and PSA recurrence or evidence of radiological progression. Results: Overall, 160 patients with CRPC were included in the analysis. At first PET/CT, nearly all (n=152; 95.0%) patients had PSMA expression (classified as mCRPC), irrespective of prior systemic therapy. Maximized standardized uptake value (SUVmax) was positively associated with baseline PSA levels and velocity (both P<0.001). According to PET/CT response, median SUVmax on first PET/CT was numerically lower in non-responders versus responders (17.5 vs 20.4; P=0.127). Similarly, patients with a PSA increase had significantly lower median SUVmax on first PET/CT (15.8) compared with those with a PSA decrease (30.4; P=0.018). PSA change was, on average, 146% in non-responders and -57% in responders between first and second PET/CT (P<0.001). Agreement between PET/CT and PSA response was 79% (k=0.553, P<0.001).Among the 63 patients included in PFS/OS analyses, 76.2% had a relapse and 36.5% died before 24month follow-up; median PFS and OS were 6.1 months and 24 months, respectively. PET/CT response, independent of PSA variation, was a significant prognostic factor for PFS. OS was not significantly different between PET/CT responders and non-responders. Conclusion: PSMA PET/CT may be a useful imaging method predictive of treatment response in patients with mCRPC, regardless of ongoing systemic therapy. Data also suggest that response assessed by PET/CT is a potentially more significant prognostic factor than PSA for PFS. Further studies are needed to understand the potential involvement of PSMA expression on survival.

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Section: Discussionmentioning

confidence: 99%

Prostate-Specific Membrane Antigen Expression on PET/CT in Patients with Metastatic Castration-Resistant Prostate Cancer: A Retrospective Observational Study

et al. 2023

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“…2,3 However, the benefits of PSMA PET findings in recurrent prostate cancer are more elusive as practitioners must balance quality-of-life considerations with the potential overtreatment of micrometastatic disease in an indolent disease state that could last a decade or more. 4 Nonetheless, PSMA PET imaging is here to stay, and we need to define how it will improve care for patients with prostate cancer without the presumption of benefit.…”

mentioning

confidence: 99%

Restaging With Prostate-Specific Membrane Antigen Imaging in Metastatic Castration-Resistant Prostate Cancer: When Seeing More Is Detrimental to Care

Madan,

Yu,

Posadas

et al. 2024

JCO

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“…This is despite the National Comprehensive Cancer Network (NCCN) updates on guidelines for prostate cancer imaging, where they suggested foregoing conventional imaging stating it is not a prerequisite prior to obtaining a PSMA-PET which can be an equally effective frontline imaging ( 8 ). While the increasing use of PSMA-PET has revolutionized the field by increasing detection of metastatic disease in both primary and recurrent settings alike, there still exists the conundrum of lack of prospective trial data to guide clinical practice and confirm survival improvements as it relates to earlier discovery of subclinical disease seen on PET imaging with concomitant negative correlative conventional imaging ( 9 ). The choice of PSMA-PET imaging in various settings also varies.…”

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confidence: 99%

Assessment of real-world application of advanced prostate cancer management in Japan

Aragon‐Ching¹

2022

Transl Androl Urol

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With New Technology Comes Great Responsibility: Prostate-Specific Membrane Antigen Imaging in Recurrent Prostate Cancer

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 6 publications

References 28 publications

Prostate-Specific Membrane Antigen Expression on PET/CT in Patients with Metastatic Castration-Resistant Prostate Cancer: A Retrospective Observational Study

Prostate-Specific Membrane Antigen Expression on PET/CT in Patients with Metastatic Castration-Resistant Prostate Cancer: A Retrospective Observational Study

Restaging With Prostate-Specific Membrane Antigen Imaging in Metastatic Castration-Resistant Prostate Cancer: When Seeing More Is Detrimental to Care

Assessment of real-world application of advanced prostate cancer management in Japan

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