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Evolving Role of PSMA PET/CT in Clinically Localized Prostate Cancer
Conventional imaging for prostate cancer — computed tomography (CT) scans of the abdomen and pelvis and bone scans — has long been used to determine the presence or absence of metastatic disease in men with clinically localized disease with high-risk features. The recent FDA approvals of both gallium- and fluoride-based prostate-specific membrane antigen (PSMA) PET/CT in men with biochemical recurrence was based on trials demonstrating higher detection rates than obtained with conventional imaging.
In a prospective, single-arm, phase 3 study at two institutions, patients with intermediate- to high-risk disease being evaluated for radical prostatectomy each underwent a 68Ga-PSMA-11 PET study using either PET/CT or PET/MRI. Images were interpreted by nuclear medicine physicians and the reports were sent to the referring physician, who could use the results to make treatment decisions.
Of 764 patients enrolled, 277 (36%) underwent prostatectomy and node dissection, of whom 75 (27%) had pelvic nodal metastases. 68Ga-PSMA-11 PET studies for the patients who underwent prostatectomy were interpreted by three blinded, independent readers. The primary endpoint — sensitivity and specificity for detection of involved pelvic lymph nodes, compared with histopathology — was 0.40 and 0.95, respectively. Positive and negative predictive values were 0.75 and 0.81, respectively.
Comment
As noted by editorialists, this study's results are similar to those of a similar trial using 18F-DCFPyL PSMA PET/CT, but the current study was larger and used a prospective design that simulated actual clinical practice. The editorialists conclude, “clinicians taking care of patients with high-risk prostate cancer being assessed for prostatectomy can use a positive PET scan as a true positive…, whereas a negative scan cannot be used to exclude disease.”
Citation(s)
Author:
Hope TA et al.
Title:
Diagnostic accuracy of 68Ga-PSMA-11 PET for pelvic nodal metastasis detection prior to radical prostatectomy and pelvic lymph node dissection: A multicenter prospective phase 3 imaging trial.
Source:
JAMA Oncol
2021
Sep
16; [e-pub].
(Abstract/FREE Full Text)
Author:
Osborne JR et al.
Title:
Prostate-specific membrane antigen positron emission tomography and the new algorithm for patients with prostate cancer prior to prostatectomy.
Source:
JAMA Oncol
2021
Sep
16; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Robert Dreicer, MD, MS, MACP, FASCO