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Feasibility and Optimal Time Point of [(68)Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery

BACKGROUND: Prostate-specific membrane antigen (PSMA) targeted molecular imaging using positron emission tomography (PET) has significantly improved the diagnosis and treatment of prostate cancer (PCA). OBJECTIVE: To assess the feasibility and compare the diagnostic accuracy of [(68)Ga]Ga-PSMA-11 PE...

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Autores principales: Huebner, Nicolai, Rasul, Sazan, Baltzer, Pascal, Clauser, Paola, Hermann Grubmüller, Karl, Mitterhauser, Markus, Hacker, Marcus, Heidenreich, Axel, Rajwa, Pawel, Fajkovic, Harun, Shariat, Shahrokh F., Grubmüller, Bernhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142741/
https://www.ncbi.nlm.nih.gov/pubmed/35638090
http://dx.doi.org/10.1016/j.euros.2022.04.003
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author Huebner, Nicolai
Rasul, Sazan
Baltzer, Pascal
Clauser, Paola
Hermann Grubmüller, Karl
Mitterhauser, Markus
Hacker, Marcus
Heidenreich, Axel
Rajwa, Pawel
Fajkovic, Harun
Shariat, Shahrokh F.
Grubmüller, Bernhard
author_facet Huebner, Nicolai
Rasul, Sazan
Baltzer, Pascal
Clauser, Paola
Hermann Grubmüller, Karl
Mitterhauser, Markus
Hacker, Marcus
Heidenreich, Axel
Rajwa, Pawel
Fajkovic, Harun
Shariat, Shahrokh F.
Grubmüller, Bernhard
author_sort Huebner, Nicolai
collection PubMed
description BACKGROUND: Prostate-specific membrane antigen (PSMA) targeted molecular imaging using positron emission tomography (PET) has significantly improved the diagnosis and treatment of prostate cancer (PCA). OBJECTIVE: To assess the feasibility and compare the diagnostic accuracy of [(68)Ga]Ga-PSMA-11 PET images taken at baseline, before the initiation of systemic treatment and preoperative images, using histopathology after cytoreductive surgery as reference. DESIGN, SETTING, AND PARTICIPANTS: We identified 20 patients in our prospectively maintained database with primary oligometastatic PCA who underwent cytoreductive radical prostatectomy and superextended pelvic lymph node dissection after systemic therapy, who had baseline and preoperative [(68)Ga]Ga-PSMA-11 PET imaging available. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We performed a region-based analysis to determine the diagnostic accuracy of imaging, using pathology as a reference. Regions were predefined as prostate, internal iliac left/right, obturator left/right, external iliac left/right, common iliac left/right, and presacral. RESULTS AND LIMITATIONS: Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic effectiveness were, respectively, 95.65%, 78.22%, 98.39%, 57.89%, and 83.00% for baseline [(68)Ga]Ga-PSMA-11 PET, compared to 56.52%, 98.05%, 88.30%, 89.66%, and 88.50% for preoperative [(68)Ga]Ga-PSMA-11 PET. On a receiver operating characteristic analysis, the diagnostic accuracy of baseline [(68)Ga]Ga-PSMA-11 PET with an area under the curve (AUC) of 0.87 (95% confidence interval [CI] 0.83–0.92) was significantly better than that of preoperative [(68)Ga]Ga-PSMA-11 PET after systemic therapy with an AUC of 0.77 (95% CI 0.70–0.85, p = 0.01). CONCLUSIONS: Baseline imaging, [(68)Ga]Ga-PSMA-11 PET has significantly better diagnostic accuracy, sensitivity, and NPV than images obtained preoperatively, in systemically pretreated patients. If a patient is suitable for local treatment and complete resection of the residual tumor is intended, [(68)Ga]Ga-PSMA-11 PET images taken prior to systemic therapy are significantly more accurate in selecting the relevant lymph nodes for resection. PATIENT SUMMARY: We found that prostate-specific membrane antigen positron emission tomography (PSMA-PET) imaging used early, before hormonal therapy or chemotherapy, provides more accurate information about the spread of the disease, than if used immediately before surgery but after hormonal therapy or chemotherapy. Early use of PSMA-PET has the potential to improve therapy also at later stages of the disease.
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spelling pubmed-91427412022-05-29 Feasibility and Optimal Time Point of [(68)Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery Huebner, Nicolai Rasul, Sazan Baltzer, Pascal Clauser, Paola Hermann Grubmüller, Karl Mitterhauser, Markus Hacker, Marcus Heidenreich, Axel Rajwa, Pawel Fajkovic, Harun Shariat, Shahrokh F. Grubmüller, Bernhard Eur Urol Open Sci Prostate Cancer BACKGROUND: Prostate-specific membrane antigen (PSMA) targeted molecular imaging using positron emission tomography (PET) has significantly improved the diagnosis and treatment of prostate cancer (PCA). OBJECTIVE: To assess the feasibility and compare the diagnostic accuracy of [(68)Ga]Ga-PSMA-11 PET images taken at baseline, before the initiation of systemic treatment and preoperative images, using histopathology after cytoreductive surgery as reference. DESIGN, SETTING, AND PARTICIPANTS: We identified 20 patients in our prospectively maintained database with primary oligometastatic PCA who underwent cytoreductive radical prostatectomy and superextended pelvic lymph node dissection after systemic therapy, who had baseline and preoperative [(68)Ga]Ga-PSMA-11 PET imaging available. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We performed a region-based analysis to determine the diagnostic accuracy of imaging, using pathology as a reference. Regions were predefined as prostate, internal iliac left/right, obturator left/right, external iliac left/right, common iliac left/right, and presacral. RESULTS AND LIMITATIONS: Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic effectiveness were, respectively, 95.65%, 78.22%, 98.39%, 57.89%, and 83.00% for baseline [(68)Ga]Ga-PSMA-11 PET, compared to 56.52%, 98.05%, 88.30%, 89.66%, and 88.50% for preoperative [(68)Ga]Ga-PSMA-11 PET. On a receiver operating characteristic analysis, the diagnostic accuracy of baseline [(68)Ga]Ga-PSMA-11 PET with an area under the curve (AUC) of 0.87 (95% confidence interval [CI] 0.83–0.92) was significantly better than that of preoperative [(68)Ga]Ga-PSMA-11 PET after systemic therapy with an AUC of 0.77 (95% CI 0.70–0.85, p = 0.01). CONCLUSIONS: Baseline imaging, [(68)Ga]Ga-PSMA-11 PET has significantly better diagnostic accuracy, sensitivity, and NPV than images obtained preoperatively, in systemically pretreated patients. If a patient is suitable for local treatment and complete resection of the residual tumor is intended, [(68)Ga]Ga-PSMA-11 PET images taken prior to systemic therapy are significantly more accurate in selecting the relevant lymph nodes for resection. PATIENT SUMMARY: We found that prostate-specific membrane antigen positron emission tomography (PSMA-PET) imaging used early, before hormonal therapy or chemotherapy, provides more accurate information about the spread of the disease, than if used immediately before surgery but after hormonal therapy or chemotherapy. Early use of PSMA-PET has the potential to improve therapy also at later stages of the disease. Elsevier 2022-05-05 /pmc/articles/PMC9142741/ /pubmed/35638090 http://dx.doi.org/10.1016/j.euros.2022.04.003 Text en © 2022 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Prostate Cancer
Huebner, Nicolai
Rasul, Sazan
Baltzer, Pascal
Clauser, Paola
Hermann Grubmüller, Karl
Mitterhauser, Markus
Hacker, Marcus
Heidenreich, Axel
Rajwa, Pawel
Fajkovic, Harun
Shariat, Shahrokh F.
Grubmüller, Bernhard
Feasibility and Optimal Time Point of [(68)Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery
title Feasibility and Optimal Time Point of [(68)Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery
title_full Feasibility and Optimal Time Point of [(68)Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery
title_fullStr Feasibility and Optimal Time Point of [(68)Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery
title_full_unstemmed Feasibility and Optimal Time Point of [(68)Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery
title_short Feasibility and Optimal Time Point of [(68)Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery
title_sort feasibility and optimal time point of [(68)ga]gallium-labeled prostate-specific membrane antigen ligand positron emission tomography imaging in patients undergoing cytoreductive surgery after systemic therapy for primary oligometastatic prostate cancer: implications for patient selection and extent of surgery
topic Prostate Cancer
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142741/
https://www.ncbi.nlm.nih.gov/pubmed/35638090
http://dx.doi.org/10.1016/j.euros.2022.04.003
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