Cargando…

Difficulties in Defining Oligometastatic Prostate Cancer: Implications for Clinical Trial Accrual and Community Practice Adoption of Metastasis-Directed Therapy Approaches

Background: Metastasis-directed therapy is widely utilized for oligometastatic prostate cancer patients, but standard imaging does not always identify metastases definitively and, even with PSMA PET, there may be equivocal findings. Not all clinicians have access to detailed imaging review, particul...

Descripción completa

Detalles Bibliográficos
Autores principales: Dorff, Tanya Barauskas, Kasparian, Saro, Garg, Natasha, Liu, Sandy, Pal, Sumanta Kumar, Wong, Jeffrey, Dandapani, Savita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10004229/
https://www.ncbi.nlm.nih.gov/pubmed/36902798
http://dx.doi.org/10.3390/jcm12052011
_version_ 1784904781323567104
author Dorff, Tanya Barauskas
Kasparian, Saro
Garg, Natasha
Liu, Sandy
Pal, Sumanta Kumar
Wong, Jeffrey
Dandapani, Savita
author_facet Dorff, Tanya Barauskas
Kasparian, Saro
Garg, Natasha
Liu, Sandy
Pal, Sumanta Kumar
Wong, Jeffrey
Dandapani, Savita
author_sort Dorff, Tanya Barauskas
collection PubMed
description Background: Metastasis-directed therapy is widely utilized for oligometastatic prostate cancer patients, but standard imaging does not always identify metastases definitively and, even with PSMA PET, there may be equivocal findings. Not all clinicians have access to detailed imaging review, particularly outside of academic cancer centers, and PET scan access is also limited. We sought to understand how imaging interpretation impacted recruitment to a clinical trial for oligometastatic prostate cancer. Methods: IRB approval was obtained to review medical records from all patients screened for the institutional IRB-approved clinical trial for men with oligometastatic prostate cancer involving androgen deprivation plus stereotactic radiation to all metastatic sites, as well as radium223 (NCT03361735). Clinical trial inclusion required at least one bone metastatic lesion and no more than five total sites of metastasis, including soft tissue sites. Tumor board discussion records were reviewed, along with results from additional radiology studies ordered or confirmatory biopsies performed. Clinical characteristics such as PSA level and Gleason score were studied for association with likelihood of oligometastatic disease confirmation. Results: At the time of data analysis, 18 subjects were deemed eligible and 20 were not eligible. The most common reasons for ineligibility were no confirmed bone metastasis in 16 patients (59%) and too many metastatic sites in 3 (11%). The median PSA of eligible subjects was 3.28 (range 0.4–45.5), whereas the median PSA of those found to be ineligible was 10.45 (range 3.7–26.3) when there were too many metastases identified, and 2.7 (range 0.2–34.5) when metastases were unconfirmed. PET imaging (PSMA or fluciclovine PET) increased the number of metastases, while MRI resulted in downstaging to non-metastatic disease. Conclusions: This research suggests that additional imaging (i.e., at least two independent imaging modalities of a possible metastatic lesion) or tumor board adjudication of imaging findings may be critical to correctly identify patients appropriate for enrollment in oligometastatic protocols. This should be considered as trials of metastasis-directed therapy for oligometastatic prostate cancer accrue and results are translated to broader oncology practice.
format Online
Article
Text
id pubmed-10004229
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-100042292023-03-11 Difficulties in Defining Oligometastatic Prostate Cancer: Implications for Clinical Trial Accrual and Community Practice Adoption of Metastasis-Directed Therapy Approaches Dorff, Tanya Barauskas Kasparian, Saro Garg, Natasha Liu, Sandy Pal, Sumanta Kumar Wong, Jeffrey Dandapani, Savita J Clin Med Brief Report Background: Metastasis-directed therapy is widely utilized for oligometastatic prostate cancer patients, but standard imaging does not always identify metastases definitively and, even with PSMA PET, there may be equivocal findings. Not all clinicians have access to detailed imaging review, particularly outside of academic cancer centers, and PET scan access is also limited. We sought to understand how imaging interpretation impacted recruitment to a clinical trial for oligometastatic prostate cancer. Methods: IRB approval was obtained to review medical records from all patients screened for the institutional IRB-approved clinical trial for men with oligometastatic prostate cancer involving androgen deprivation plus stereotactic radiation to all metastatic sites, as well as radium223 (NCT03361735). Clinical trial inclusion required at least one bone metastatic lesion and no more than five total sites of metastasis, including soft tissue sites. Tumor board discussion records were reviewed, along with results from additional radiology studies ordered or confirmatory biopsies performed. Clinical characteristics such as PSA level and Gleason score were studied for association with likelihood of oligometastatic disease confirmation. Results: At the time of data analysis, 18 subjects were deemed eligible and 20 were not eligible. The most common reasons for ineligibility were no confirmed bone metastasis in 16 patients (59%) and too many metastatic sites in 3 (11%). The median PSA of eligible subjects was 3.28 (range 0.4–45.5), whereas the median PSA of those found to be ineligible was 10.45 (range 3.7–26.3) when there were too many metastases identified, and 2.7 (range 0.2–34.5) when metastases were unconfirmed. PET imaging (PSMA or fluciclovine PET) increased the number of metastases, while MRI resulted in downstaging to non-metastatic disease. Conclusions: This research suggests that additional imaging (i.e., at least two independent imaging modalities of a possible metastatic lesion) or tumor board adjudication of imaging findings may be critical to correctly identify patients appropriate for enrollment in oligometastatic protocols. This should be considered as trials of metastasis-directed therapy for oligometastatic prostate cancer accrue and results are translated to broader oncology practice. MDPI 2023-03-03 /pmc/articles/PMC10004229/ /pubmed/36902798 http://dx.doi.org/10.3390/jcm12052011 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Dorff, Tanya Barauskas
Kasparian, Saro
Garg, Natasha
Liu, Sandy
Pal, Sumanta Kumar
Wong, Jeffrey
Dandapani, Savita
Difficulties in Defining Oligometastatic Prostate Cancer: Implications for Clinical Trial Accrual and Community Practice Adoption of Metastasis-Directed Therapy Approaches
title Difficulties in Defining Oligometastatic Prostate Cancer: Implications for Clinical Trial Accrual and Community Practice Adoption of Metastasis-Directed Therapy Approaches
title_full Difficulties in Defining Oligometastatic Prostate Cancer: Implications for Clinical Trial Accrual and Community Practice Adoption of Metastasis-Directed Therapy Approaches
title_fullStr Difficulties in Defining Oligometastatic Prostate Cancer: Implications for Clinical Trial Accrual and Community Practice Adoption of Metastasis-Directed Therapy Approaches
title_full_unstemmed Difficulties in Defining Oligometastatic Prostate Cancer: Implications for Clinical Trial Accrual and Community Practice Adoption of Metastasis-Directed Therapy Approaches
title_short Difficulties in Defining Oligometastatic Prostate Cancer: Implications for Clinical Trial Accrual and Community Practice Adoption of Metastasis-Directed Therapy Approaches
title_sort difficulties in defining oligometastatic prostate cancer: implications for clinical trial accrual and community practice adoption of metastasis-directed therapy approaches
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10004229/
https://www.ncbi.nlm.nih.gov/pubmed/36902798
http://dx.doi.org/10.3390/jcm12052011
work_keys_str_mv AT dorfftanyabarauskas difficultiesindefiningoligometastaticprostatecancerimplicationsforclinicaltrialaccrualandcommunitypracticeadoptionofmetastasisdirectedtherapyapproaches
AT kaspariansaro difficultiesindefiningoligometastaticprostatecancerimplicationsforclinicaltrialaccrualandcommunitypracticeadoptionofmetastasisdirectedtherapyapproaches
AT gargnatasha difficultiesindefiningoligometastaticprostatecancerimplicationsforclinicaltrialaccrualandcommunitypracticeadoptionofmetastasisdirectedtherapyapproaches
AT liusandy difficultiesindefiningoligometastaticprostatecancerimplicationsforclinicaltrialaccrualandcommunitypracticeadoptionofmetastasisdirectedtherapyapproaches
AT palsumantakumar difficultiesindefiningoligometastaticprostatecancerimplicationsforclinicaltrialaccrualandcommunitypracticeadoptionofmetastasisdirectedtherapyapproaches
AT wongjeffrey difficultiesindefiningoligometastaticprostatecancerimplicationsforclinicaltrialaccrualandcommunitypracticeadoptionofmetastasisdirectedtherapyapproaches
AT dandapanisavita difficultiesindefiningoligometastaticprostatecancerimplicationsforclinicaltrialaccrualandcommunitypracticeadoptionofmetastasisdirectedtherapyapproaches