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Kaplan İ, Kömek H, Can C, Akdeniz N, Güzel Y, Kepenek F, Şenol A, İleri S, Karaoğlan H, Solmaz İ, Yıldırım MS, Şenses V, Kaya F, Gündoğan C. Should new organ involvement be included in Response Evaluation Criteria in PSMA Imaging? Ann Nucl Med 2024; 38:825-834. [PMID: 38880859 DOI: 10.1007/s12149-024-01954-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The current study is intended to investigate the effect of new organ involvement on overall survival (OS) and modify the Response Evaluation Criteria in PSMA Imaging (RECIP) by including new organ involvement to RECIP 1.0. MATERIALS AND METHODS This retrospective study includes 114 patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC) between September 2017 and June 2022 who had received docetaxel treatment and had baseline and post-treatment prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) images. The inclusion criteria were patients with pre- and post-treatment [18F]FDG PET/CT images and whose [18F]FDG PET images were negative. Those whose data were unavailable, who had additional malignancy, or who received abiraterone, enzalutamide, or Lutetium (Lu)-177 treatment were excluded. Age, Gleason score (GS), TPSA (total prostate-specific antigen) levels, surgical history, and OS information were recorded for each patient. RESULTS The 114 patients herein had a median age of 72.5 (51-91) years and a median GS of 8 (7-10). New lesions were observed in 59 patients (51.7%) and new organ PSMA uptake was observed in 14 patients (12.2%). In the multivariate Cox regression analysis, volume-based treatment response (vTR)-total lesion PSMA (TLP), RECIP PSMA-VOL, modified RECIP (mRECIP) PSMA-VOL, and mRECIP TLP were independent prognostic factors for mortality (p < 0.001, p = 0.006, p = 0.003, and p = 0.003, respectively). The median OS of patients with new organ involvement and new lesion with PSMA uptake was 9.3 months (95% CI 2.1-16.5 months) and 11.8 months (95% CI 7.4-16.2 months), respectively. CONCLUSION The study concluded that new organ involvement had a shorter OS than new lesion involvement. In the mRECIP that we developed, unlike RECIP, we demonstrated that both PSMA-VOL and TLP value were independent prognostic factors for mortality.
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Affiliation(s)
- İhsan Kaplan
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey.
| | - Halil Kömek
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Canan Can
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Nadiye Akdeniz
- Department of Internal Medicine, Division of Medical Oncology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Yunus Güzel
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Ferat Kepenek
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Ayhan Şenol
- Department of Radiology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Serdar İleri
- Department of Internal Medicine, Division of Medical Oncology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Hüseyin Karaoğlan
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - İhsan Solmaz
- Department of Internal Medicine, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Mehmet Serdar Yıldırım
- Department of Internal Medicine, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Veysi Şenses
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Fulya Kaya
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Cihan Gündoğan
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
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Ventura D, Rassek P, Schindler P, Akkurt BH, Bredensteiner L, Bögemann M, Schlack K, Seifert R, Schäfers M, Roll W, Rahbar K. Early treatment response assessment with [ 177Lu]PSMA whole-body-scintigraphy compared to interim PSMA-PET. Cancer Imaging 2024; 24:126. [PMID: 39300507 DOI: 10.1186/s40644-024-00773-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Prostate-specific membrane antigen positron emission tomography (PSMA-PET) is an essential tool for patient selection before radioligand therapy (RLT). Interim-staging with PSMA-PET during RLT allows for therapy monitoring. However, its added value over post-treatment imaging is poorly elucidated. The aim of this study was to compare early treatment response assessed by post-therapeutic whole-body scans (WBS) with interim-staging by PSMA-PET after 2 cycles in order to prognosticate OS. METHODS Men with metastasized castration-resistant PC (mCRPC) who had received at least two cycles of RLT, and interim PSMA-PET were evaluated retrospectively. PROMISE V2 framework was used to categorize PSMA expression and assess response to treatment. Response was defined as either disease control rate (DCR) for responders or progression for non-responders. RESULTS A total of 188 men with mCRPC who underwent RLT between February 2015 and December 2021 were included. The comparison of different imaging modalities revealed a strong and significant correlation with Cramer V test: e.g. response on WBS during second cycle compared to interim PET after two cycles of RLT (cφ = 0.888, P < 0.001, n = 188). The median follow-up time was 14.7 months (range: 3-63 months; 125 deaths occurred). Median overall survival (OS) time was 14.5 months (95% CI: 11.9-15.9). In terms of OS analysis, early progression during therapy revealed a significantly higher likelihood of death: e.g. second cycle WBS (15 vs. 25 months, P < 0.001) with a HR of 2.81 (P < 0.001) or at PET timepoint after 2 cycles of RLT (11 vs. 24 months, P < 0.001) with a HR of 3.5 (P < 0.001). For early biochemical response, a PSA decline of at least 50% after two cycles of RLT indicates a significantly lower likelihood of death (26 vs. 17 months, P < 0.001) with a HR of 0.5 (P < 0.001). CONCLUSION Response assessment of RLT by WBS and interim PET after two cycles of RLT have high congruence and can identify patients at risk of poor outcome. This indicates that interim PET might be omitted for response assessment, but future trials corroborating these findings are warranted.
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Affiliation(s)
- David Ventura
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
- West German Cancer Center (WTZ), 48149, Münster site, Germany.
| | - Philipp Rassek
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
- West German Cancer Center (WTZ), 48149, Münster site, Germany
| | - Philipp Schindler
- West German Cancer Center (WTZ), 48149, Münster site, Germany
- Department of Radiology, University Hospital Münster, 48149, Münster, Germany
| | - Burak Han Akkurt
- West German Cancer Center (WTZ), 48149, Münster site, Germany
- Department of Radiology, University Hospital Münster, 48149, Münster, Germany
| | - Linus Bredensteiner
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Martin Bögemann
- West German Cancer Center (WTZ), 48149, Münster site, Germany
- Department of Urology, University Hospital Münster, 48149, Münster, Germany
| | - Katrin Schlack
- West German Cancer Center (WTZ), 48149, Münster site, Germany
- Department of Urology, University Hospital Münster, 48149, Münster, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Bern, 3010, Bern, Switzerland
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
- West German Cancer Center (WTZ), 48149, Münster site, Germany
- European Institute for Molecular Imaging (EIMI), University of Münster, 48149, Münster, Germany
| | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
- West German Cancer Center (WTZ), 48149, Münster site, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
- West German Cancer Center (WTZ), 48149, Münster site, Germany
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Rahbar Nikoukar L, Seifert R, Ventura D, Schindler P, Bögemann M, Rahbar K, Roll W. Prognostic value of pretherapeutic 68Ga-PSMA-11-PET based imaging parameters in mCRPC patients treated with PSMA radioligands. Nuklearmedizin 2024. [PMID: 39209284 DOI: 10.1055/a-2383-2468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
PURPOSE This study aims to evaluate the prognostic significance of various previously reported PSMA-PET parameters in patients undergoing 177Lu-PSMA radioligand therapy (RLT). While individual studies have investigated the prognostic value of one or few of these factors, comprehensive analyses are rare. METHODS Data of 82 patients undergoing 177Lu-PSMA-radiologand-therapy (RLT) were analyzed. Total tumor volume (tumor volume), average SUVmean of all tumor lesions (SUVmean) and the quotient of sum of SUVmean of all tumor lesions to SUVmean of the parotid glands (tumor-parotid-ratio; TPR) and of the kidneys (tumor-kidney-ratio; TKR) were included in analysis. RESULTS This study showed that a tumor volume of <290.6 ml is associated with a better survival in patients undergoing PSMA-RLT (median PFS: 4.2, median OS: 13.2 months) compared to patients with higher tumor volume (median PFS: 3.4,median OS: 6.2 months; p-value = 0.01 for PFS and <0.001 for OS). The average SUVmean correlated inversely with survival. Patients with a SUVmean > 10.7 had a median PFS of 4.2 and OS of 11.4 months while patients with SUVmean <10.7 had a median PFS of 1.6 and OS of 5 months (p-value <0.001 for both). The assessment of TPR showed no significant difference regarding OS and PFS. TKR showed a better PFS in patients with ratio > 0.33 (p-value 0.009) but no significant difference regarding OS. CONCLUSION The present study confirms that pretherapeutic PSMA-PET before RLT with 177Lu-PSMA has a prognostic value.
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Affiliation(s)
| | - Robert Seifert
- Clinic for Nuclear Medicine, University Hospital Münster, Münster, Germany
- 2. West German Cancer Center (WTZ), Münster site, Germany, Münster, Germany
| | - David Ventura
- Clinic for Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Philipp Schindler
- Radiology, University Hospital Münster, Münster, Germany
- 2. West German Cancer Center (WTZ), Münster site, Germany, Münster, Germany
| | - Martin Bögemann
- Clinic for Urology, University Hospital Münster, Münster, Germany
- West German Cancer Center (WTZ), Münster site, Germany, Münster, Germany
| | - Kambiz Rahbar
- Clinic for Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Center (WTZ), Münster site, Germany, Münster, Germany
| | - Wolfgang Roll
- Clinic for Nuclear Medicine, University Hospital Münster, Münster, Germany
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Bela Andela S, Amthauer H, Furth C, Rogasch JM, Beck M, Mehrhof F, Ghadjar P, van den Hoff J, Klatte T, Tahbaz R, Zips D, Hofheinz F, Zschaeck S. Quantitative PSMA-PET parameters in localized prostate cancer: prognostic and potential predictive value. Radiat Oncol 2024; 19:97. [PMID: 39080696 PMCID: PMC11288109 DOI: 10.1186/s13014-024-02483-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 06/28/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND PSMA-PET is increasingly used for staging prostate cancer (PCA) patients. However, it is not clear if quantitative imaging parameters of positron emission tomography (PET) have an impact on disease progression and are thus important for the prognosis of localized PCA. METHODS This is a monocenter retrospective analysis of 86 consecutive patients with localized intermediate or high-risk PCA and PSMA-PET before treatment The quantitative PET parameters maximum standardized uptake value (SUVmax), tumor asphericity (ASP), PSMA tumor volume (PSMA-TV), and PSMA total lesion uptake (PSMA-TLU = PSMA-TV × SUVmean) were assessed for their prognostic significance in patients with radiotherapy or surgery. Cox regression analyses were performed for biochemical recurrence-free survival, overall survival (OS), local control, and loco-regional control (LRC). RESULTS 67% of patients had high-risk disease, 51 patients were treated with radiotherapy, and 35 with surgery. Analysis of metric PET parameters in the whole cohort revealed a significant association of PSMA-TV (p = 0.003), PSMA-TLU (p = 0.004), and ASP (p < 0.001) with OS. Upon binarization of PET parameters, several other parameters showed a significant association with clinical outcome. When analyzing high-risk patients according to the primary treatment approach, a previously published cut-off for SUVmax (8.6) showed a significant association with LRC in surgically treated (p = 0.048), but not in primary irradiated (p = 0.34) patients. In addition, PSMA-TLU (p = 0.016) seemed to be a very promising biomarker to stratify surgical patients. CONCLUSION Our data confirm one previous publication on the prognostic impact of SUVmax in surgically treated patients with high-risk PCA. Our exploratory analysis indicates that PSMA-TLU might be even better suited. The missing association with primary irradiated patients needs prospective validation with a larger sample size to conclude a predictive potential. Trial registration Due to the retrospective nature of this research, no registration was carried out.
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Affiliation(s)
- Stephanie Bela Andela
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Holger Amthauer
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Furth
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julian M Rogasch
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Beck
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Mehrhof
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Pirus Ghadjar
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jörg van den Hoff
- Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Tobias Klatte
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rana Tahbaz
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Zips
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frank Hofheinz
- Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Sebastian Zschaeck
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Ahmadzadehfar H, Seifert R, Afshar-Oromieh A, Kratochwil C, Rahbar K. Prostate Cancer Theranostics With 177Lu-PSMA. Semin Nucl Med 2024; 54:581-590. [PMID: 38570288 DOI: 10.1053/j.semnuclmed.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
This review paper highlights the transformative role of PSMA-targeted diagnostics and therapy in prostate cancer management, particularly focusing on 177Lu-PSMA-617, approved by the FDA and EMA for metastatic castration-resistant prostate cancer (mCRPC) patients post-chemotherapy and ARPI treatment. Originating from the VISION trial's success, this paper navigates the current radioligand therapy (RLT) indications, emphasizing practical patient selection, planning, and treatment execution. It critically examines Lu-PSMA's comparative effectiveness against cabazitaxel and Ra-223, addressing decision-making dilemmas for mCRPC treatments. Furthermore, the paper discusses Lu-PSMA in chemotherapy-naïve patients and its application in hormone-sensitive prostate cancer, underlined by ongoing global studies. A significant concern is Lu-PSMA's long-term safety profile, particularly nephrotoxicity risks, necessitating further investigation. The possibility of Lu-PSMA rechallenge in responsive patients is explored, stressing the need for comprehensive analyses and real-world data to refine treatment protocols. Conclusively, PSMA-targeted therapy marks a significant advance in prostate cancer therapy, advocating for its integration into a multimodal, patient-centric treatment approach. The review underscores the imperative for additional comparative studies to optimize treatment sequences and outcomes, ultimately enhancing long-term prognosis and disease control in prostate cancer management.
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Affiliation(s)
- Hojjat Ahmadzadehfar
- Department of Nuclear Medicine, Klinikum Westfalen, Dortmund, Germany; Department of Nuclear Medicine, Institute of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus, Bochum, Germany.
| | - Robert Seifert
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; West German Cancer Center, Münster, Germany
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Hartrampf PE, Hüttmann T, Seitz AK, Kübler H, Serfling SE, Higuchi T, Schlötelburg W, Michalski K, Gafita A, Rowe SP, Pomper MG, Buck AK, Werner RA. Prognostic Performance of RECIP 1.0 Based on [ 18F]PSMA-1007 PET in Prostate Cancer Patients Treated with [ 177Lu]Lu-PSMA I&T. J Nucl Med 2024; 65:560-565. [PMID: 38453363 DOI: 10.2967/jnumed.123.266702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/05/2024] [Indexed: 03/09/2024] Open
Abstract
In metastatic castration-resistant prostate cancer (mCRPC) patients treated with prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT), the recently proposed criteria for evaluating response to PSMA PET (RECIP 1.0) based on 68Ga- and 18F-labeled PET agents provided prognostic information in addition to changes in prostate-specific antigen (PSA) levels. Our aim was to evaluate the prognostic performance of this framework for overall survival (OS) in patients undergoing RLT and imaged with [18F]PSMA-1007 PET/CT and compare the prognostic performance with the PSA-based response assessment. Methods: In total, 73 patients with mCRPC who were scanned with [18F]PSMA-1007 PET/CT before and after 2 cycles of RLT were retrospectively analyzed. We calculated the changes in serum PSA levels (ΔPSA) and quantitative PET parameters for the whole-body tumor burden (SUVmean, SUVmax, PSMA tumor volume, and total lesion PSMA). Men were also classified following the Prostate Cancer Working Group 3 (PCWG3) criteria for ΔPSA and RECIP 1.0 for PET imaging response. We performed univariable Cox regression analysis, followed by multivariable and Kaplan-Meier analyses. Results: Median OS was 15 mo with a median follow-up time of 14 mo. Univariable Cox regression analysis provided significant associations with OS for ΔPSA (per percentage, hazard ratio [HR], 1.004; 95% CI, 1.002-1.007; P < 0.001) and PSMA tumor volume (per unit, HR, 1.003; 95% CI, 1.000-1.005; P = 0.03). Multivariable Cox regression analysis confirmed ΔPSA (per percentage, HR, 1.004; 95% CI, 1.001-1.006; P = 0.006) as an independent prognosticator for OS. Kaplan-Meier analyses provided significant segregation between individuals with versus those without any PSA response (19 mo vs. 14 mo; HR, 2.00; 95% CI, 0.95-4.18; P = 0.04). Differentiation between patients with or without progressive disease (PD) was also feasible when applying PSA-based PCWG3 (19 mo vs. 9 mo for non-PD and PD, respectively; HR, 2.29; 95% CI, 1.03-5.09; P = 0.01) but slightly failed when applying RECIP 1.0 (P = 0.08). A combination of both response systems (PCWG3 and RECIP 1.0), however, yielded the best discrimination between individuals without versus those with PD (19 mo vs. 8 mo; HR, 2.78; 95% CI, 1.32-5.86; P = 0.002). Conclusion: In patients with mCRPC treated with RLT and imaged with [18F]PSMA-1007, frameworks integrating both the biochemical (PCWG3) and PET-based response (RECIP 1.0) may best assist in identifying subjects prone to disease progression.
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Affiliation(s)
- Philipp E Hartrampf
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany;
| | - Thomas Hüttmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Anna Katharina Seitz
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
| | - Hubert Kübler
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
| | | | - Takahiro Higuchi
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Wiebke Schlötelburg
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Kerstin Michalski
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Andrei Gafita
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Steven P Rowe
- Division of Molecular Imaging and Therapeutics, Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; and
| | - Martin G Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Andreas K Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Rudolf A Werner
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
- Division of Nuclear Medicine, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
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7
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Belge Bilgin G, Bilgin C, Burkett BJ, Orme JJ, Childs DS, Thorpe MP, Halfdanarson TR, Johnson GB, Kendi AT, Sartor O. Theranostics and artificial intelligence: new frontiers in personalized medicine. Theranostics 2024; 14:2367-2378. [PMID: 38646652 PMCID: PMC11024845 DOI: 10.7150/thno.94788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024] Open
Abstract
The field of theranostics is rapidly advancing, driven by the goals of enhancing patient care. Recent breakthroughs in artificial intelligence (AI) and its innovative theranostic applications have marked a critical step forward in nuclear medicine, leading to a significant paradigm shift in precision oncology. For instance, AI-assisted tumor characterization, including automated image interpretation, tumor segmentation, feature identification, and prediction of high-risk lesions, improves diagnostic processes, offering a precise and detailed evaluation. With a comprehensive assessment tailored to an individual's unique clinical profile, AI algorithms promise to enhance patient risk classification, thereby benefiting the alignment of patient needs with the most appropriate treatment plans. By uncovering potential factors unseeable to the human eye, such as intrinsic variations in tumor radiosensitivity or molecular profile, AI software has the potential to revolutionize the prediction of response heterogeneity. For accurate and efficient dosimetry calculations, AI technology offers significant advantages by providing customized phantoms and streamlining complex mathematical algorithms, making personalized dosimetry feasible and accessible in busy clinical settings. AI tools have the potential to be leveraged to predict and mitigate treatment-related adverse events, allowing early interventions. Additionally, generative AI can be utilized to find new targets for developing novel radiopharmaceuticals and facilitate drug discovery. However, while there is immense potential and notable interest in the role of AI in theranostics, these technologies do not lack limitations and challenges. There remains still much to be explored and understood. In this study, we investigate the current applications of AI in theranostics and seek to broaden the horizons for future research and innovation.
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Affiliation(s)
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic Rochester, MN, USA
| | | | - Jacob J. Orme
- Department of Oncology, Mayo Clinic Rochester, MN, USA
| | | | | | | | - Geoffrey B Johnson
- Department of Radiology, Mayo Clinic Rochester, MN, USA
- Department of Immunology, Mayo Clinic Rochester, MN, USA
| | | | - Oliver Sartor
- Department of Radiology, Mayo Clinic Rochester, MN, USA
- Department of Oncology, Mayo Clinic Rochester, MN, USA
- Department of Urology, Mayo Clinic Rochester, MN, USA
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8
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Seifert R, Gafita A, Telli T, Voter A, Herrmann K, Pomper M, Hadaschik B, Rowe SP, Fendler WP. Standardized PSMA-PET Imaging of Advanced Prostate Cancer. Semin Nucl Med 2024; 54:60-68. [PMID: 37573199 DOI: 10.1053/j.semnuclmed.2023.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
Imaging of advanced prostate cancer is a challenging task, as it requires longitudinal characterization of disease extent in a standardized way to enable appropriate treatment selection and evaluation of treatment efficacy. In the last years, prostate-specific membrane antigen (PSMA)-PET/CT has become the reference standard examination for patients with advanced prostate cancer. Together with the rise of PSMA-PET, standardized frameworks for the reporting of image findings have been proposed, eg, the Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) and the structured reporting system for PSMA targeted PET imaging (PSMA-RADS) framework. Therefore, recent evidence on PSMA-PET derived tumor volume as useful a biomarker for outcome prognostication and related frameworks will be discussed in the article. The PROMISE framework recommends quantifying the tumor volume per-organ system, which accounts for the fact that the location of the metastases greatly influence its biological aggressiveness. In addition, changes in PSMA-PET derived tumor volume have been shown to be promising biomarkers for response assessment. Limitations of PSMA-PET will also be discussed because the tumor volume might not always be suited for response assessment. As a pitfall of PSMA-based systems, decreasing PSMA-expression might erroneously be interpreted as response to therapy. Also, especially for patients with limited disease, the tumor volume might not be ideal for response assessment. Therefore, various frameworks have been introduced to objectively measure response to therapy with PSMA-PET. Amongst these, the PSMA-PET progression (PPP) criteria and the response evaluation criteria in PSMA (RECIP) are optimized for earlier and later phenotypes of advanced prostate cancer, respectively. Variables needed to determine PPP or RECIP outcome on PSMA-PET are recorded under the umbrella of PROMISE recommendations. In this article, various reporting and response assessment frameworks are explained and discussed. Also, recent evidence for the relevance of PSMA-PET biomarkers for clinical management and outcome prognostication are shown.
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Affiliation(s)
- R Seifert
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.
| | - A Gafita
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - T Telli
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Andrew Voter
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - K Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Martin Pomper
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - B Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Steven P Rowe
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - W P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; PET Committee of the German Society of Nuclear Medicine, Göttingen, Germany
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Seifert R, Emmett L, Rowe SP, Herrmann K, Hadaschik B, Calais J, Giesel FL, Reiter R, Maurer T, Heck M, Gafita A, Morris MJ, Fanti S, Weber WA, Hope TA, Hofman MS, Fendler WP, Eiber M. Second Version of the Prostate Cancer Molecular Imaging Standardized Evaluation Framework Including Response Evaluation for Clinical Trials (PROMISE V2). Eur Urol 2023; 83:405-412. [PMID: 36935345 DOI: 10.1016/j.eururo.2023.02.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/18/2022] [Accepted: 02/01/2023] [Indexed: 03/19/2023]
Abstract
CONTEXT Prostate-specific membrane antigen (PSMA) targeting positron emission tomography (PET) is emerging to become a reference imaging tool for the staging and restaging of patients with prostate cancer for both clinical routine and trials. The prostate cancer molecular imaging standardized evaluation (PROMISE) criteria have been proposed as a framework for whole-body staging (molecular imaging TNM staging, denoted miTNM staging) to describe the prostate cancer disease extent on PSMA-PET. OBJECTIVE To create a comprehensive and integrated framework for PSMA-PET image interpretation and reporting. EVIDENCE ACQUISITION We propose the PROMISE V2 framework, which integrates an updated miTNM system, improved assessment of local disease, and a slightly modified PSMA-expression score for clinical routine. We have added a response monitoring framework defining qualitative and quantitative parameters to be recorded for a longitudinal assessment in clinical trials. EVIDENCE SYNTHESIS We provide a comprehensive literature review on the current use of the PROMISE framework in clinical research and prospective trials. PROMISE variables demonstrate a clear association with survival. PSMA expression assessed by the PSMA-expression score was used in several trials, and a low PSMA-expression score is a negative prognosticator of overall survival after 177Lu-PSMA radioligand therapy. The proposed imaging parameters recorded for response assessment in clinical trials can be utilized to determine response according to PSMA-PET progression (PPP) or Response Evaluation Criteria in PSMA-PET/Computed Tomography (RECIP) frameworks, but also future response criteria. CONCLUSIONS PROMISE V2 offers standardized reporting of disease extent for clinical routine and research. Parameters recorded within clinical trials facilitate objective response assessment. PATIENT SUMMARY Prostate-specific membrane antigen (PSMA) targeting positron emission tomography (PET) has become a standard imaging examination for prostate cancer. We propose a comprehensive framework for the analysis and reporting of PSMA-PET findings that will improve the communication between imaging experts and uro-oncologists.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins, University School of Medicine, Baltimore, MD, USA; The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; Ahmanson Translational Theranostics, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, CA, USA
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Jeremie Calais
- Ahmanson Translational Theranostics, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, CA, USA
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Robert Reiter
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tobias Maurer
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Heck
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Andrei Gafita
- Ahmanson Translational Theranostics, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, CA, USA
| | - Michael J Morris
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Wolfgang A Weber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; PET Committee of the German Society of Nuclear Medicine, Göttingen, Germany
| | - Matthias Eiber
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Esen B, Herrmann K, Bavbek S, Kordan Y, Tilki D, Esen T. Prostate-specific Membrane Antigen Positron Emission Tomography as a Biomarker to Assess Treatment Response in Patients with Advanced Prostate Cancer. Eur Urol Focus 2023:S2405-4569(23)00040-8. [PMID: 36842919 DOI: 10.1016/j.euf.2023.02.001] [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: 12/21/2022] [Revised: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
CONTEXT Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) has superior accuracy for detection of metastatic lesions in patients with prostate cancer (PC). Although PSMA PET has a prominent role in primary and secondary imaging of PC, data on its role in assessing treatment response in advanced PC are limited. OBJECTIVE To review current data in the literature regarding the impact of antiandrogen therapy on PSMA expression of metastatic sites and the role of serial (baseline and at least 1 follow-up scan) PSMA PET to assess treatment response in patients with metastatic PC. EVIDENCE ACQUISITION A comprehensive literature search in the PubMed database was performed using the terms "PSMA expression prostate", "PSMA regulation", "PSMA PET response assessment", and "serial PSMA PET". EVIDENCE SYNTHESIS Serial PSMA PET studies (baseline and at least 1 follow-up scan) provide valuable data regarding PSMA expression changes after systemic treatment in patients with metastatic PC. PSMA PET-detected flare and upregulation of PSMA expression following hormonal intervention seem to be early events resolving after 3 mo of treatment. PSMA PET imaging is essential in selecting patients for 177Lu-PSMA radioligand therapy (RLT). Growing evidence favors its use in assessing treatment responses after RLT. Preliminary evidence indicates the value of PSMA PET for assessment of the treatment response in patients receiving systemic treatment other than RLT for metastatic PC. CONCLUSIONS PSMA flare following antiandrogen therapy seems to be an early event and thus PET scans should be performed no earlier than 3 mo after the start of treatment. PSMA PET has a promising role in tailoring treatment according to the specific needs of individual patients and assessing responses following systemic treatment in patients with advanced PC. PATIENT SUMMARY This review describes how a sensitive imaging method can be used to assess the tumor response to treatment for metastatic prostate cancer.
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Affiliation(s)
- Barış Esen
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey.
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Sevil Bavbek
- Department of Medical Oncology, VKF American Hospital, Istanbul, Turkey
| | - Yakup Kordan
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Derya Tilki
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tarık Esen
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
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11
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Kemppainen J, Kangasmäki A, Malaspina S, Pape B, Jalomäki J, Kairemo K, Kononen J, Joensuu T. Single Center Experience with a 4-Week 177Lu-PSMA-617 Treatment Interval in Patients with Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2022; 14:cancers14246155. [PMID: 36551641 PMCID: PMC9776672 DOI: 10.3390/cancers14246155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
Background: 177Lu-PSMA-617 is a promising theragnostic treatment for metastatic castration-resistant prostate cancer (mCRPC). However, both the optimal treatment dose and interval in mCRPC and the rate of identification of responders from non-responders among possible treatment candidates are unknown. Methods: 62 men with mCRPC who were treated with 177Lu-PSMA-617 during 1/2017−2/2019 were included in the study. Treatment responses, overall survival (OS) and progression free survival (PFS) were determined. The median follow-up time was 1.4 years (IQR 0.5−2.2). Tumor volume of metastases (MTV), SUVmax and tumor lesion activity (TLA) were quantitated from pre-treatment PSMA PET/CT images together with pre-treatment PSA. Results: An average of three treatment cycles (2−5) were given within a four-week interval. PFS was 4.9 months (2.4−9.6) and OS was 17.2 months (6−26.4). There were no major adverse events reported. A significant PSA response of >50% was found in 58.7% of patients, which was significantly associated with longer OS, p < 0.004. PSA response was not associated with staging PSMA-derived parameters. Conclusions: 177Lu-PSMA-617 treatment in four-week intervals was safe and effective. Almost 60% of patients had a significant PSA response, which was associated with better OS. Pre-treatment PSA kinetics or staging PSMA PET/CT-derived parameters were not helpful in identifying treatment responders from non-responders; better biomarkers are needed to aid in patient selection.
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Affiliation(s)
- Jukka Kemppainen
- Docrates Cancer Center, 00180 Helsinki, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, 20520 Turku, Finland
- Correspondence: ; Tel.: +358-10-773-2050
| | | | - Simona Malaspina
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, 20520 Turku, Finland
| | - Bernd Pape
- Department of Mathematics and Statistics, University of Vaasa, 65101 Vaasa, Finland
| | | | - Kalevi Kairemo
- Docrates Cancer Center, 00180 Helsinki, Finland
- Department of Nuclear Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
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Gafita A, Rauscher I, Fendler WP, Murthy V, Hui W, Armstrong WR, Herrmann K, Weber WA, Calais J, Eiber M, Weber M, Benz MR. Measuring response in metastatic castration-resistant prostate cancer using PSMA PET/CT: comparison of RECIST 1.1, aPCWG3, aPERCIST, PPP, and RECIP 1.0 criteria. Eur J Nucl Med Mol Imaging 2022; 49:4271-4281. [PMID: 35767071 DOI: 10.1007/s00259-022-05882-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/16/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the adapted Prostate Cancer Working Group Criteria 3 (aPCWG3), the adapted Positron Emission Tomography Response Criteria in Solid Tumors (aPERCIST), the PSMA PET Progression (PPP), and the Response Evaluation Criteria In PSMA-Imaging (RECIP) 1.0 for response evaluation using prostate-specific membrane antigen (PSMA)-PET/CT in men with metastatic castration-resistant prostate cancer (mCRPC) treated with 177Lu-PSMA radioligand therapy. METHODS A total of 124 patients were included in this multicenter retrospective study. All patients received 177Lu-PSMA and underwent PSMA-PET/CT scans at baseline (bPET) and at 12 weeks (iPET). Imaging responses according to RECIST 1.1, aPCWG3, aPERCIST, PPP, and RECIP 1.0 were interpreted by consensus among three blinded readers. Changes in total tumor burden were obtained using the semi-automatic qPSMA software. The response according to each criterion was classified to progressive disease (PD) vs no-PD. Primary outcome measure was the prognostic value (by Cox regression analysis) for overall survival (OS). Secondary outcome measure was the inter-reader reliability (by Cohen's κ coefficient). RESULTS A total of 43 (35%) of patients had non-measurable disease according to RECIST 1.1. Sixteen (13%), 66 (52%), 72 (58%), 69 (56%), and 39 (32%) of 124 patients had PD according to RECIST 1.1, aPCWG3, aPERCIST, PPP, and RECIP, respectively. PD vs no-PD had significantly higher risk of death according to aPCWG3 (HR = 2.37; 95%CI, 1.62-3.48; p < 0.001), aPERCIST (HR = 2.48; 95%CI, 1.68-3.66; p < 0.001), PPP (HR = 2.72; 95%CI, 1.85-4.01; p < 0.001), RECIP 1.0 (HR = 4.33; 95%CI, 2.80-6.70; p < 0.001), but not according to RECIST 1.1 (HR = 1.29; 95%CI, 0.73-2.27; p = 0.38). The κ index of RECIST 1.1, aPCWG3, aPERCIST 1.0, PPP, and RECIP 1.0 for identifying PD vs no-PD were 0.50 (95%CI, 0.32-0.76), 0.72 (95%CI, 0.63-0.82), 0.68 (95%CI, 0.63-0.73), 0.73 (95%CI, 0.63-0.83), and 0.83 (95%CI, 0.77-0.88), respectively. CONCLUSION PSMA-PET-specific criteria for early response evaluation in men with mCRPC treated with 177Lu-PSMA achieved higher prognostic values and inter-reader reliabilities in comparison to conventional CT assessment or to criteria adapted to PSMA-PET from other imaging modalities. RECIP 1.0 identified the fewest patients with PD and achieved the highest risk of death for PD vs. no-PD, suggesting that other classification methods tend to overcall progression. Prospective validation of our findings on an independent patient cohort is warranted.
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Affiliation(s)
- Andrei Gafita
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA. .,Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany.
| | - Isabel Rauscher
- Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Vishnu Murthy
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA
| | - Wang Hui
- Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Wesley R Armstrong
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Matthias R Benz
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA.,Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
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13
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Hartrampf PE, Seitz AK, Weinzierl FX, Serfling SE, Schirbel A, Rowe SP, Kübler H, Buck AK, Werner RA. Baseline clinical characteristics predict overall survival in patients undergoing radioligand therapy with [ 177Lu]Lu-PSMA I&T during long-term follow-up. Eur J Nucl Med Mol Imaging 2022; 49:4262-4270. [PMID: 35650263 PMCID: PMC9525362 DOI: 10.1007/s00259-022-05853-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/24/2022] [Indexed: 12/14/2022]
Abstract
Background Radioligand therapy (RLT) with 177Lu-labeled prostate-specific membrane antigen (PSMA) ligands is associated with prolonged overall survival (OS) in patients with advanced, metastatic castration-resistant prostate cancer (mCRPC). A substantial number of patients, however, are prone to treatment failure. We aimed to determine clinical baseline characteristics to predict OS in patients receiving [177Lu]Lu-PSMA I&T RLT in a long-term follow-up. Materials and methods Ninety-two mCRPC patients treated with [177Lu]Lu-PSMA I&T with a follow-up of at least 18 months were retrospectively identified. Multivariable Cox regression analyses were performed for various baseline characteristics, including laboratory values, Gleason score, age, prior therapies, and time interval between initial diagnosis and first treatment cycle (intervalDiagnosis-RLT, per 12 months). Cutoff values for significant predictors were determined using receiver operating characteristic (ROC) analysis. ROC-derived thresholds were then applied to Kaplan–Meier analyses. Results Baseline C-reactive protein (CRP; hazard ratio [HR], 1.10, 95% CI 1.02–1.18; P = 0.01), lactate dehydrogenase (LDH; HR, 1.07, 95% CI 1.01–1.11; P = 0.01), aspartate aminotransferase (AST; HR, 1.16, 95% CI 1.06–1.26; P = 0.001), and intervalDiagnosis-RLT (HR, 0.95, 95% CI 0.91–0.99; P = 0.02) were identified as independent prognostic factors for OS. The following respective ROC-based thresholds were determined: CRP, 0.98 mg/dl (area under the curve [AUC], 0.80); LDH, 276.5 U/l (AUC, 0.83); AST, 26.95 U/l (AUC, 0.73); and intervalDiagnosis-RLT, 43.5 months (AUC, 0.68; P < 0.01, respectively). Respective Kaplan–Meier analyses demonstrated a significantly longer median OS of patients with lower CRP, lower LDH, and lower AST, as well as prolonged intervalDiagnosis-RLT (P ≤ 0.01, respectively). Conclusion In mCRPC patients treated with [177Lu]Lu-PSMA I&T, baseline CRP, LDH, AST, and time interval until RLT initiation (thereby reflecting a possible indicator for tumor aggressiveness) are independently associated with survival. Our findings are in line with previous findings on [177Lu]Lu-PSMA-617, and we believe that these clinical baseline characteristics may support the nuclear medicine specialist to identify long-term survivors.
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Affiliation(s)
- Philipp E Hartrampf
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Anna Katharina Seitz
- Department of Urology and Paediatric Urology, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Franz-Xaver Weinzierl
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Sebastian E Serfling
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Andreas Schirbel
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Steven P Rowe
- Department of Radiology and Radiological Science, The Russell H Morgan, Johns Hopkins University School of Medicine, 601 N Caroline Str, Baltimore, MD, USA
| | - Hubert Kübler
- Department of Urology and Paediatric Urology, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Rudolf A Werner
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.,Department of Radiology and Radiological Science, The Russell H Morgan, Johns Hopkins University School of Medicine, 601 N Caroline Str, Baltimore, MD, USA
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14
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Unterrainer LM, Beyer L, Zacherl MJ, Gildehaus FJ, Todica A, Kunte SC, Holzgreve A, Sheikh GT, Herlemann A, Casuscelli J, Brendel M, Albert NL, Wenter V, Schmidt-Hegemann NS, Kunz WG, Cyran CC, Ricke J, Stief CG, Bartenstein P, Ilhan H, Unterrainer M. Total Tumor Volume on 18F-PSMA-1007 PET as Additional Imaging Biomarker in mCRPC Patients Undergoing PSMA-Targeted Alpha Therapy with 225Ac-PSMA-I&T. Biomedicines 2022; 10:946. [PMID: 35625683 PMCID: PMC9138410 DOI: 10.3390/biomedicines10050946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 01/25/2023] Open
Abstract
Background: PSMA-based alpha therapy using 225Ac-PSMA-I&T provides treatment for metastatic castration-resistant prostate cancer (mCRPC), even after the failure of 177Lu-PSMA radioligand therapy (RLT). In clinical routine, the total tumor volume (TTV) on PSMA PET impacts therapy outcomes and plays an increasing role in mCRPC patients. Hence, we aimed to assess TTV and its changes during 225Ac-PSMA-I&T RLT. Methods: mCRPC patients undergoing RLT with 225Ac-PSMA-I&T with available 18F-PSMA-1007 PET/CT prior to therapy initiation were included. TTV was assessed in all patients using established cut-off values. Image derived, clinical and biochemistry parameters (PSA, LDH, AP, pain score) were analyzed prior to and after two cycles of 225Ac-PSMA. Changes in TTV and further parameters were directly compared and then correlated with established response criteria, such as RECIST 1.1 or mPERCIST. Results: 13 mCRPC patients were included. The median overall survival (OS) was 10 months. Prior to 225Ac-PSMA RLT, there was no significant correlation between TTV with other clinical parameters (p > 0.05 each). Between short-term survivors (STS, <10 months OS) and long-term survivors (LTS, ≥10 months OS), TTV and PSA were comparable (p = 0.592 & p = 0.286, respectively), whereas AP was significantly lower in the LTS (p = 0.029). A total of 7/13 patients completed two cycles and underwent a follow-up 18F-PSMA-1007 PET/CT. Among these patients, there was a significant decrease in TTV (median 835 vs. 201 mL, p = 0.028) and PSA (median 687 ng/dL vs. 178 ng/dL, p = 0.018) after two cycles of 225Ac-PSMA RLT. Here, percentage changes of TTV after two cycles showed no direct correlation to all other clinical parameters (p > 0.05 each). In two patients, new PET-avid lesions were detected on 18F-PSMA-1007 PET/CT. However, TTV and PSA were decreasing or stable. Conclusion: PET-derived assessment of TTV is an easily applicable imaging biomarker independent of other established parameters prior to 225Ac-PSMA RLT in these preliminary follow-up data. Even after the failure of 177Lu-PSMA, patients with extensive TTV seem to profit from RLT. All but one patient who was eligible for ≥2 cycles of 225Ac-PSMA-RLT demonstrated drastic TTV decreases without direct correlation to other biomarkers, such as serum PSA changes. Changes in TTV might hence improve the response assessment compared to standard classifiers by reflecting the current tumor load independent of the occurrence of new lesions.
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Affiliation(s)
- Lena M. Unterrainer
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Mathias J. Zacherl
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Franz J. Gildehaus
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Sophie C. Kunte
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Gabriel T. Sheikh
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Annika Herlemann
- Department of Urology, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (A.H.); (J.C.); (C.G.S.)
| | - Jozefina Casuscelli
- Department of Urology, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (A.H.); (J.C.); (C.G.S.)
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Nathalie L. Albert
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Vera Wenter
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Nina-Sophie Schmidt-Hegemann
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany;
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (W.G.K.); (C.C.C.); (J.R.); (M.U.)
| | - Clemens C. Cyran
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (W.G.K.); (C.C.C.); (J.R.); (M.U.)
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (W.G.K.); (C.C.C.); (J.R.); (M.U.)
| | - Christian G. Stief
- Department of Urology, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (A.H.); (J.C.); (C.G.S.)
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (L.B.); (M.J.Z.); (F.J.G.); (A.T.); (S.C.K.); (A.H.); (G.T.S.); (M.B.); (N.L.A.); (V.W.); (P.B.); (H.I.)
| | - Marcus Unterrainer
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich (LMU Munich), 81377 Munich, Germany; (W.G.K.); (C.C.C.); (J.R.); (M.U.)
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15
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Aksu A, Vural Topuz Ö, Yilmaz B, Karahan Şen NP, Acar E, Çapa Kaya G. Prediction of early biochemical response after 177Lu-PSMA radioligand therapy with 68Ga-PSMA PET, a different perspective with quantitative parameters. Nucl Med Commun 2022; 43:468-474. [PMID: 35045552 DOI: 10.1097/mnm.0000000000001539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In this study, our aim was to evaluate the relationship of the quantitative data obtained from pretreatment 68Ga prostate-specific membrane antigen (PSMA) PET-computerized tomography (PET/CT) with treatment response of the patients with the diagnosis of metastatic castrationresistant prostate cancer (mCRPC) who received 177Lu-PSMA radioligand therapy (RLT). METHODS The patients who were given three or four cycles of 177Lu-PSMA RLT between January 2016 and June 2018 were evaluated retrospectively. Volumetric data; PSMA tumor volume (TV) and total lesion (TL) PSMA, were obtained from 68Ga-PSMA PET/CT for whole (PSMA-TVT and TL-PSMAT). The distance between the two furthest lesions (Dmax) was calculated. Posttreatment early prostate-specific antigen (PSA) values on the fourteenth day after treatment were obtained. According to the PSA responses, the patients were divided into two groups as progressed and nonprogressed. In univariate analysis, the relationship of PET quantitative data with biochemical response groups was evaluated with Mann-Whitney U test. Logistic regression was used in multivariate analysis. RESULTS A total of 38 patients were included in the study. In univariate analysis, Dmax, PSMA-TVT and TL-PSMAT values were obtained at lower levels in the progressed group. In multivariate analysis, only Dmax was found to be a prognostic factor in predicting early biochemical response. CONCLUSION Dmax is the most prognostic parameter in predicting the early biochemical response in patients with mCRPC; high total tumor volume and burden are also parameters that give us an idea about the response to treatment. The success rate will be higher if 177Lu-PSMA RLT treatment is planned for patients with higher tumor volume and spread.
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Affiliation(s)
- Ayşegül Aksu
- Department of Nuclear Medicine, Başakşehir Çam and Sakura City Hospital, İstanbul
| | - Özge Vural Topuz
- Department of Nuclear Medicine, Başakşehir Çam and Sakura City Hospital, İstanbul
| | - Burçak Yilmaz
- Department of Nuclear Medicine, Başakşehir Çam and Sakura City Hospital, İstanbul
| | | | - Emine Acar
- Department of Nuclear Medicine, Kent Hospital, İzmir, Turkey
| | - Gamze Çapa Kaya
- Department of Nuclear Medicine, School of Medicine, Dokuz Eylul University
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16
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Changing Threshold-Based Segmentation Has No Relevant Impact on Semi-Quantification in the Context of Structured Reporting for PSMA-PET/CT. Cancers (Basel) 2022; 14:cancers14020270. [PMID: 35053434 PMCID: PMC8773894 DOI: 10.3390/cancers14020270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Molecular imaging of patients with prostate cancer is widely utilized. We aimed to determine whether changes in post-processing parameters, such as maximum intensity thresholds, can significantly alter results. We investigated 623 lesions that were positive on a molecular imaging scan and could not find any relevant impact on results when certain parameters were changed, in particular in lesions indicative for metastases of prostate cancer. Abstract Prostate-specific membrane antigen (PSMA)-directed positron emission tomography/computed tomography (PET/CT) is increasingly utilized for staging of men with prostate cancer (PC). To increase interpretive certainty, the standardized PSMA reporting and data system (RADS) has been proposed. Using PSMA-RADS, we characterized lesions in 18 patients imaged with 18F-PSMA-1007 PET/CT for primary staging and determined the stability of semi-quantitative parameters. Six hundred twenty-three lesions were categorized according to PSMA-RADS and manually segmented. In this context, PSMA-RADS-3A (soft-tissue) or -3B (bone) lesions are defined as being indeterminate for the presence of PC. For PMSA-RADS-4 and -5 lesions; however, PC is highly likely or almost certainly present [with further distinction based on absence (PSMA-RADS-4) or presence (PSMA-RADS-5) of correlative findings on CT]. Standardized uptake values (SUVmax, SUVpeak, SUVmean) were recorded, and volumetric parameters [PSMA-derived tumor volume (PSMA-TV); total lesion PSMA (TL-PSMA)] were determined using different maximum intensity thresholds (MIT) (40 vs. 45 vs. 50%). SUVmax was significantly higher in PSMA-RADS-5 lesions compared to all other PSMA-RADS categories (p ≤ 0.0322). In particular, the clinically challenging PSMA-RADS-3A lesions showed significantly lower SUVmax and SUVpeak compared to the entire PSMA-RADS-4 or -5 cohort (p < 0.0001), while for PSMA-RADS-3B this only applies when compared to the entire PSMA-RADS-5 cohort (p < 0.0001), but not to the PSMA-RADS-4 cohort (SUVmax, p = 0.07; SUVpeak, p = 0.08). SUVmean (p = 0.30) and TL-PSMA (p = 0.16) in PSMA-RADS-5 lesions were not influenced by changing the MIT, while PSMA-TV showed significant differences when comparing 40 vs. 50% MIT (p = 0.0066), which was driven by lymph nodes (p = 0.0239), but not bone lesions (p = 0.15). SUVmax was significantly higher in PSMA-RADS-5 lesions compared to all other PSMA-RADS categories in 18F-PSMA-1007 PET/CT. As such, the latter parameter may assist the interpreting molecular imaging specialist in assigning the correct PSMA-RADS score to sites of disease, thereby increasing diagnostic certainty. In addition, changes of the MIT in PSMA-RADS-5 lesions had no significant impact on SUVmean and TL-PSMA in contrast to PSMA-TV.
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