When metastasis-directed remedy (MDT) is carried out for sufferers with oligorecurrent prostate most cancers (PCa), imaging steerage with prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) might facilitate considerably longer progression-free survival (PFS) than choline PET/CT steerage.
In a retrospective examine, lately printed within the Journal of Nuclear Medication, researchers in contrast PSMA PET/CT-guided MDT versus choline PET/CT-guided MDT. Every cohort had 120 sufferers with oligorecurrent PCa. Physicians utilized (18F)fluorocholine for all sufferers within the choline PET/CT group whereas these within the PSMA PET/CT group had scans with (68Ga)Ga-PSMA-11 or (18F)F-PSMA-1007, in accordance with the examine.
The researchers discovered that 86.7 p.c of sufferers (104/120) within the choline PET/CT group skilled post-MDT PCa development compared to 49.2 p.c (59/120) within the cohort that had PSMA PET/CT-guided MDT. Sufferers within the PSMA PET/CT group additionally had a 33.2 month median PFS in distinction to 13.8 months for sufferers who had choline PET/CT guided MDT.
The researchers discovered that 86.7 p.c of sufferers (104/120) within the choline PET/CT group skilled post-MDT PCa development compared to 49.2 p.c (59/120) within the cohort that had PSMA PET/CT-guided MDT.
“ … We noticed a considerably longer median PFS in sufferers present process PSMA PET/CT–guided MDT than in these present process choline PET/CT–guided MDT,” wrote lead examine creator Matteo Bauckneht, M.D., a nuclear medication researcher affiliated with IRCCS Ospedale Policlinico San Martino in Genova, Italy, and colleagues.
Noting that the few research which have in contrast (68Ga)Ga-PSMA-11 and (18F)F-PSMA-1007 have primarily centered on diagnostic accuracy, the examine authors additionally evaluated the influence of each PET radiotracers for MDT steerage in 44-patient, propensity-matched cohorts.
(Editor’s notice: For extra content material on prostate most cancers imaging, click on right here.)
Three Key Takeaways
- Important enchancment in progression-free survival (PFS). Sufferers with oligorecurrent prostate most cancers who underwent PSMA PET/CT-guided metastasis-directed remedy (MDT) skilled a considerably longer median PFS (33.2 months) in comparison with those that had choline PET/CT-guided MDT (13.8 months).
- Decreased post-therapy prostate most cancers (PCa) development. The analysis indicated {that a} smaller proportion of sufferers (49.2 p.c) skilled post-MDT development within the PSMA PET/CT group in comparison with the choline PET/CT group (86.7 p.c), demonstrating the superior efficacy of PSMA PET/CT in guiding MDT.
- Decrease nadir prostate-specific antigen (PSA) serum ranges. The examine authors noticed that sufferers within the (68Ga)Ga-PSMA-11 steerage group had considerably decrease nadir PSA serum ranges (0.53 ng/mL) in comparison with these within the (18F)F-PSMA-1007 guided group (1.69 ng/mL), suggesting higher therapy focusing on and effectiveness.
Sufferers within the (68Ga)Ga-PSMA-11 steerage group had a considerably decrease nadir prostate-specific antigen (PSA) serum degree than those that had (18F)F-PSMA-1007 guided MDT (0,53 ng/mL vs. 1.69 ng/mL), in accordance with the researchers. In addition they identified that (68Ga)Ga-PSMA-11 steerage for MDT resulted in additional than a 19-month distinction in median PFS (41.5 months vs. 22.4 months for (18F)F-PSMA-1007 steerage.
“One doable rationalization for our findings is the propensity of (18F)F-PSMA-1007 to exhibit unspecific bone uptake, probably resulting in false-positive outcomes. Mistaking unspecific uptake for metastatic lesions may end in inappropriate focusing on throughout stereotactic physique radiotherapy, thereby affecting the tracer’s effectiveness in guiding MDT,” posited Bauckneht and colleagues.
(Editor’s notice: For associated content material, see “Research Examines Prognostic Worth of 68Ga-PSMA-11 PET/CT for Sufferers at Excessive Threat of PCa,” “Research: PSMA PET/CT Agent Might Rule Out csPCa in 93 % of PI-RADS 3 Lesions” and “ECR Research Examines Key Predictive Elements for Metastasis in Sufferers with Excessive-Threat Prostate Most cancers.”)
Past the inherent limitations of a retrospective, observational examine, the researchers acknowledged that restricted statistical energy might restrict extrapolation of the examine findings to a broader inhabitants. In addition they famous that the kind and length of androgen deprivation remedy (ADT) utilized previous to MDT weren’t assessed. The examine authors identified a development of extra frequent use of concurrent ADT with PSMA-matched cohorts in distinction to choline PET/CT cohorts.
