Enhancing PSMA-uptake with androgen deprivation therapy - a new way to detect prostate cancer metastases?

Conrad Leitsmann, Paul Thelen, Marianne Schmid, Johannes Meller, Carsten-Oliver Sahlmann, Birgit Meller, Lutz Trojan, Arne Strauss, Conrad Leitsmann, Paul Thelen, Marianne Schmid, Johannes Meller, Carsten-Oliver Sahlmann, Birgit Meller, Lutz Trojan, Arne Strauss

Abstract

Purpose: 68Ga-PSMA PET/CT imaging is a promising modality for the staging of recurrent prostate cancer (PCa). Current evidence suggests limited diagnostic value of the 68Ga-PSMA PET/CT in PSA-levels ≤0.3ng/mL. Experimental data have demonstrated na increase in PSMA-expression in PCa metastases by androgen deprivation in vitro. The aim of the current study was to investigate a possible enhancing effect of PSMA with low-dose androgen deprivation in patients with BCR and low PSA-levels.

Materials and methods: Five patients with PCa and BCR, following radical prostatectomy, underwent 68Ga-PSMA PET/CT. A consecutive 68Ga-PSMA PET/CT was performed 6 to 11 days after injection of 80mg of Degarelix (Firmagon®). We recorded PSA and testosterone serum-levels and changes of PSMA-uptake in 68Ga-PSMA PET/CT images.

Results: Median PSA prior 68Ga-PSMA PET/CT was 0.27ng/mL. All patients had a decrease in testosterone serum levels from median 2.95μg/l to 0.16μg/l following Degarelix injection. We observed an increase in the standardized uptake value (SUV) in PSMA-positive lymphogenous and osseous lesions in two patients following androgen deprivation. In another two patients, no PSMA positive signals were detected in either the fi rst or the second scan.

Conclusion: Our preliminary results of this feasibility assessment indicate a possible enhancing effect of PSMA-imaging induced by low-dose ADT. Despite several limitations and the small number of patients, this could be a new approach to improve staging by 68Ga-PSMA PET/CT in PCa patients with BCR after primary therapy. Further prospective studies with larger number of patients are needed to validate our findings.

Keywords: Radiotherapy; Magnetic Resonance Imaging; Prostatic Neoplasms.

Conflict of interest statement

None declared.

Copyright® by the International Brazilian Journal of Urology.

Figures

Figure 1. Patient 1, first scan, left:…
Figure 1. Patient 1, first scan, left: osseous metastasis in the scapula, right: lymph node in the left iliac region.
Figure 2. Patient 1, second scan, left:…
Figure 2. Patient 1, second scan, left: osseous metastasis in the scapula, right: lymph node in the left iliac region.

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