68-Ga PSMA PET/CT in Advanced Prostate Cancer (Ang.)

68-Ga PSMA PET/CT in Advanced Prostate Cancer (Ang.)

Nieprzeczytany postautor: zosia bluszcz » 29 paź 2017, 10:53

68Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography in advanced prostate cancer: Current state and future trends
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4. 68Ga-PSMA-PET CT in primary staging of high-risk PCa
The use of 68Ga-PSMA-PET/CT in the primary staging of high- risk PCa is increasingly being reported.33 Most of this has been performed in patients with intermediate- or high-risk disease.25

In a retrospective analysis, Budaus et al34 analyses 30 patients that underwent preoperative 68Ga-PSMA-PET/CT imaging prior to RP and extended pelvic LND. Twelve of these patients were histopathologically positive for LNMs, and 68Ga-PSMA-PET/CT detected four of these with no false-positive findings. After analysis, the sensitivity and specificity was 33.3% and 100%, respectively.

A study of similar methodology was performed by van Leeuwen et al.35 After histopathological correlation, 11 of 30 patients had LNM. The sensitivity and specificity was 56% and 98%, respectively. It appears that only the smallest of LNMs were undetected with a mean size of 2.7mm for 68Ga-PSMA-PET/CT-negative lesions.

The largest series performed in this cohort was reported by Maurer et al,36 who compared 68Ga-PSM-PET/CT to conventional imaging (CT and MRI) for the detection of LNM for patients prior to RP and pelvic LND. 68Ga-PSMA-PET/CT resulted in a sensitivity and specificity of 65.9% and 98.9% on a per-patient level compared with 44.9% and 85.4% for conventional imaging.

Schewnck et al28 compared 68Ga-PSMA-PET/CT and choline-PET in the initial stag-ing of PCa. In all 20 patients, uptake was detected in the prostate by both imaging modalities. While more lymph node and bone metastases were detected on a per-lesion level by 68Ga-PSMA-PET/CT, there was no significant difference on a per-patient level.

While there is improved clarity in the role of 68Ga-PSMA-PET/CT in BCR, the role in primary staging is yet to be definitively determined.
The benefit of 68Ga-PSMA-PET/CT in primary staging in this setting appears to be identifying metastatic disease earlier and in uncommon locations, such as the mesorectum.
37
The identification of such disease may considerably alter the treatment algorithms for a given patient. No doubt, higher-volume prospective series with oncological outcomes are required. A phase III randomized controlled trial comparing 68Ga-PSMA-PET/CT to conventional imaging is currently being undertaken in Australia (ProPSMA study, Australian New Zealand Clinical Trials Registry 12617000005358).


5. 68Ga-PSMA-PET in staging of intraprostatic disease
Multiparametric MRI (mpMRI) represents a promising imaging modality in the diagnosis of primary PCa.38
68Ga-PSMA-PET/CT in combination with CT and mpMRI has increasingly been utilized in experimental protocols to diagnose and localize intraprostatic PCa.39e41

Fendler et al39 studied the value of 68Ga-PSMA-PET/CT in localization of primary tumor lesions. 68Ga-PSMA-PET/CT was performed shortly before RP was correlated with histopathological six-segment prostate specimens. On a per-segment analysis, 68Ga- PSMA-PET/CT had a sensitivity and specificity of 67% and 92%, respectively. However, of the 21 patients, two (10%) were 68Ga- PSMA-PET/CT negative. The sensitivity for detection of seminal vesicle invasion was 73%, with a specificity of 100%.

Several groups have explored the utility of the novel integrated PET/MRI unit in combination with the 68Ga-PSMA ligand.
Eiber et al41 correlated findings from mpMRI, PET and combined 68Ga-PSMA PET/MRI with histopathological findings from prostate biopsy for a cohort of in- termediate and high-risk patients. On a per-patient basis, the sensitivity of 68Ga PSMA PET/MRI was superior (98%) to that of PET alone (92%) and mpMRI (66%).

On a per-sextant basis comparing 68Ga PSMA PET/MRI to a recent meta-analysis,42 a similar sensitivity (76% vs. 78%) with a superior specificity was found (97% vs. 79%).
Current data suggest that 68Ga PSMA-PET/MRI may improve diagnostic yield and localization of primary intraprostatic PCa.
Despite the experimental status of such techniques, the improved localization may play a role with the growing evidence base for focal therapies for localized PCa.43
Moreover, 68Ga PSMA-PET/MRI may aid the prompt detection of local intraprostatic recurrence after radiotherapy; particularly in light of the increased feasibility of salvage prostatectomy. (...)


Udovicich C, et al., 68Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography in advanced prostate cancer: Current state and future trends, Prostate Int (2017), http://dx.doi.org/10.1016/j.prnil.2017.02.003


68Ga PSMA PET- CT in advanced prostate cancer. Current state and future trends.pdf
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