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Liu J, Santucci J, Woon DTS, Catterwell R, Perera M, Murphy DG, Lawrentschuk N. A Systematic Review on Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA PET) Evaluating Localized Low- to Intermediate-Risk Prostate Cancer: A Tool to Improve Risk Stratification for Active Surveillance? Life (Basel) 2024; 14:76. [PMID: 38255691 PMCID: PMC10817570 DOI: 10.3390/life14010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/28/2023] [Accepted: 01/01/2024] [Indexed: 01/24/2024] Open
Abstract
Active surveillance remains a treatment option for low- to intermediate-risk prostate cancer (PCa) patients. Prostate-specific membrane antigen positron emission tomography and computed tomography (PSMA PET/CT) has emerged as a useful modality to assess intraprostatic lesions. This systematic review aims to evaluate PSMA PET/CT in localized low- to intermediate-risk PCa to determine its role in active surveillance. Following PRISMA guidelines, a search was performed on Medline, Embase, and Scopus. Only studies evaluating PSMA PET/CT in localized low- to intermediate-risk PCa were included. Studies were excluded if patients received previous treatment, or if they included high-risk PCa. The search yielded 335 articles, of which only four publications were suitable for inclusion. One prospective study demonstrated that PSMA PET/CT-targeted biopsy has superior diagnostic accuracy when compared to mpMRI. One prospective and one retrospective study demonstrated MRI occult lesions in 12.3-29% of patients, of which up to 10% may harbor underlying unfavorable pathology. The last retrospective study demonstrated the ability of PSMA PET/CT to predict the volume of Gleason pattern 4 disease. Early evidence demonstrated the utility of PSMA PET/CT as a tool in making AS safer by detecting MRI occult lesions and patients at risk of upgrading of disease.
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Affiliation(s)
- Jianliang Liu
- EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, VIC 3005, Australia
- Department of Urology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC 3052, Australia;
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
| | - Jordan Santucci
- Department of Urology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
| | - Dixon T. S. Woon
- EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, VIC 3005, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC 3052, Australia;
- Department of Urology, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia
| | - Rick Catterwell
- Department of Urology, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
- Discipline of Surgery, University of Adelaide, Adelaide, SA 5005, Australia
| | - Marlon Perera
- Department of Urology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
- Department of Urology, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia
| | - Declan G. Murphy
- Department of Surgery, University of Melbourne, Melbourne, VIC 3052, Australia;
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
| | - Nathan Lawrentschuk
- EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, VIC 3005, Australia
- Department of Urology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC 3052, Australia;
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
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Caracciolo M, Castello A, Lopci E. PSMA PET/CT Versus mpMRI for the Detection of Clinically Significant Prostate Cancer: An Updated Overview. Semin Nucl Med 2024; 54:30-38. [PMID: 37951766 DOI: 10.1053/j.semnuclmed.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
In the last years, PSMA-PET imaging and multiparametric MRI (mpMRI) have improved the clinical management of prostate cancer (PCa) patients. Currently, mpMRI is recommended by the EAU (European Association of Urology) guidelines for the primary diagnosis of PCa, whereas PSMA-PET is reserved for disease staging, particularly in high risk localized or locally advanced disease, as well as for biochemical recurrence after surgery. Nevertheless, several studies have explored the added value of PSMA-PET in other clinical scenarios, including primary diagnosis and especially for the detection of clinically significant PCa (csPCa). In the present contribution, we will provide an overview and an update on the current literature on imaging detection of csPCa, with a particular focus on mpMRI, PSMA-PET and their comparison.
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Affiliation(s)
- Matteo Caracciolo
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Angelo Castello
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS - Humanitas Research Hospital, Rozzano, Milan, Italy.
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