68Ga-prostate-specific membrane antigen (PSMA) PET/CT as a clinical decision-making tool in biochemically recurrent prostate cancer

Amy Davies, Marcus Foo, Chun Loo Gan, John Kourambas, Nicholas Redgrave, Scott Donnellan, Sree Appu, Scott Williams, Andrew Coleman, Eva Segelov, Jason Bradley, Geoffrey Soo, Shakher Ramdave, Edmond M. Kwan, Arun A. Azad

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: PSMA PET/CT has demonstrated superior sensitivity over conventional imaging in the detection of local and distant recurrence in biochemically relapsed (BCR) prostate cancer. We prospectively investigated the management impact of 68Ga-PSMA PET/CT imaging in men with BCR, with the aim of identifying baseline clinicopathological predictors for management change. Patients and methods: Men with BCR who met eligibility criteria underwent 68Ga-PSMA-11 PET/CT at Monash Health (Melbourne, Australia). Intended management plans were prospectively documented before and after 68Ga-PSMA PET/CT imaging. Binary logistic regression analysis was performed to identify potential clinicopathological predictors of management change. Descriptive statistics were used to characterize the nature of these changes. Results: Seventy men underwent 68Ga-PSMA-11 PET/CT imaging. Median age was 67 years (IQR 63–72) and median PSA was 0.48 ng/ml (IQR 0.21–1.9). PSMA-avid disease was observed in 56% (39/70) of patients. Pre-scan management plan was altered following scanning in 43% (30/70) of patients. Management changes were significantly more common in patients with higher baseline PSA levels (PSA≥2 ng/ml, p = 0.01). 18/36 (50%) of the patients initially planned for watchful waiting had their management changed, including the use of salvage pelvic radiotherapy (n = 7) and stereotactic ablative body radiotherapy to oligometastatic disease (n = 6). Conclusion: Management change after 68Ga-PSMA PET/CT for BCR is common and typically resulted in treatment intensification strategies in those planned for a watchful waiting approach. This study adds to the growing pool of evidence supporting the clinical utility of PSMA PET/CT imaging in the care of patients with BCR after definitive therapy.

Original languageEnglish
Number of pages6
JournalAsia-Pacific Journal of Clinical Oncology
DOIs
Publication statusAccepted/In press - 1 Oct 2021

Keywords

  • biochemical relapse
  • decision making
  • prostate cancer
  • PSMA PET/CT

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