68Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography in advanced prostate cancer: Current state and future trends

Cristian Udovicich, Marlon Perera, Michael S Hofman, Shankar Siva, Andres Del Rio, Declan G Murphy, Nathan Lawrentschuk, Cristian Udovicich, Marlon Perera, Michael S Hofman, Shankar Siva, Andres Del Rio, Declan G Murphy, Nathan Lawrentschuk

Abstract

The early and accurate detection of prostate cancer is important to ensure timely management and appropriate individualized treatment. Currently, conventional imaging has limitations particularly in the early detection of metastases and at prostate-specific antigen (PSA) levels < 2.0 ng/mL. Furthermore, disease management such as salvage radiotherapy is best at low PSA levels. Thus, it is critical to capture the disease in the oligometastatic stage as disease progression and commencement of systemic therapies can be delayed by metastasis-directed therapy. Prostate-specific membrane antigen (PSMA) is overexpressed in prostatic cancer cells. Novel imaging modalities using radiolabeled tracers with PSMA such as 68Ga-PSMA-positron emission tomography (PET)/computed tomography (CT) have shown promising results. We review the literature regarding 68Ga-PSMA-PET/CT in the setting of primary prostate cancer and biochemical recurrence. At present, the best utilization of 68Ga-PSMA-PET/CT appears to be in biochemical recurrence. 68Ga-PSMA-PET/CT has high diagnostic accuracy for lymph node metastases and has been shown to have superior detection rates to conventional imaging, especially at low PSA levels. The exact role of 68Ga-PSMA-PET/CT in primary prostate cancer is not yet entirely clear. It has an improved detection rate for smaller lesions and may be able to identify nodal or distant metastatic disease at an earlier stage. While still experimental, there may also be value in combining 68Ga-PSMA-PET to multiparametric magnetic resonance imaging for staging of intraprostatic disease. To date, 68Ga-PSMA-PET/CT has been shown to have considerable clinical value and to impact treatment selection for patients with prostate cancer. Still in its infancy, the results of future clinical trials will be excitedly awaited.

Keywords: Biochemical recurrence; Positron emission tomography; Prostate cancer; Radical prostatectomy; Staging.

References

    1. Mottet N., Bellmunt J., Bolla M., Briers E., Cumberbatch M.G., De Santis M. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017 Apr 25;71(4):618–629.
    1. Cornford P., Bellmunt J., Bolla M., Briers E., De Santis M., Gross T. EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol. 2017 Apr;71(4):630–642.
    1. Tosoian J.J., Gorin M.A., Ross A.E., Pienta K.J., Tran P.T., Schaeffer E.M. Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations. Nat Rev Urol. 2016;14:15–25.
    1. Ost P., Bossi A., Decaestecker K., De Meerleer G., Giannarini G., Karnes R.J. Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol. 2015;67:852–863.
    1. Yao H.H., Hong M.K., Corcoran N.M., Siva S., Foroudi F. Advances in local and ablative treatment of oligometastasis in prostate cancer. Asia Pac J Clin Oncol. 2014;10:308–321.
    1. Ost P., Jereczek-Fossa B.A., As N Van, Zilli T., Muacevic A., Olivier K. Progression-free survival following stereotactic body radiotherapy for oligometastatic prostate cancer treatment-naive recurrence: a multi-institutional analysis. Eur Urol. 2016;69:9–12.
    1. Yassaie O., McLaughlin B., Perera M., Manning T., Lawrentschuk N., Malcolm A. Primary care follow-up of radical prostatectomy patients: a regional New Zealand experience. Prostate Int. 2016;4:136–139.
    1. McGrath S., Christidis D., Perera M., Hong S.K., Manning T., Vela I. Prostate cancer biomarkers: Are we hitting the mark? Prostate Int. 2016;4:130–135.
    1. Evangelista L., Briganti A., Fanti S., Joniau S., Reske S., Schiavina R. New clinical indications for 18F/11C-choline, new tracers for positron emission tomography and a promising hybrid device for prostate cancer staging: a systematic review of the literature. Eur Urol. 2016;70:161–175.
    1. Maurer T., Eiber M., Schwaiger M., Gschwend J.E. Current use of PSMA-PET in prostate cancer management. Nat Rev Urol. 2016;13:226–235.
    1. Afshar-Oromieh A., Malcher A., Eder M., Eisenhut M., Linhart H.G., Hadaschik B.A. PET imaging with a [Ga-68]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013;40:486–495.
    1. Ghosh A., Heston W.D.W. Tumor target prostate specific membrane antigen (PSMA) and its regulation in prostate cancer. J Cell Biochem. 2004;91:528–539.
    1. Leek J., Lench N., Maraj B., Bailey A., Carr I.M., Andersen S. Prostate-specific membrane antigen: evidence for the existence of a second related human gene. Br J Cancer. 1995;72:583–588.
    1. Dong J., Lamb P.W., Rinker-schaeffer C.W., Vukanovic J., Ichikawa T., John T. KAIl, a metastasis suppressor gene for prostate cancer on human chromosome 11p11.2. Science. 1995;268:884–886.
    1. Silver D.A., Pellicer I., Fair W.R., Heston W.D., Cordon-Cardo C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res. 1997;3:81–85.
    1. Cunha A.C., Weigle B., Kiessling A., Bachmann M., Rieber E.P. Tissue-specificity of prostate specific antigens: comparative analysis of transcript levels in prostate and non-prostatic tissues. Cancer Lett. 2006;236:229–238.
    1. DeMarzo A.M., Nelson W.G., Isaacs W.B., Epstein J.I. Pathological and molecular aspects of prostate cancer. Lancet. 2003;361:955–964.
    1. Wright G.L., Haley C., Beckett M Lou, Schellhammer P.F. Expression of prostate-specific membrane antigen in normal, benign, and malignant prostate tissues. Urol Oncol Semin Orig Investig. 1995;1:18–28.
    1. Sweat S.D., Pacelli A., Murphy G.P., Bostwick D.G. Prostate-specific membrane antigen expression is greatest in prostate adenocarcinoma and lymph node metastases. Urology. 1998;52:637–640.
    1. Bostwick D.G., Pacelli A., Blute M., Roche P., Murphy G.P. Prostate specific membrane antigen expression in prostatic intraepithelial neoplasia and adenocarcinoma: a study of 184 cases. Cancer. 1998;82:2256–2261.
    1. Evans M.J., Smith-Jones P.M., Wongvipat J., Navarro V., Kim S., Bander N.H. Noninvasive measurement of androgen receptor signaling with a positron-emitting radiopharmaceutical that targets prostate-specific membrane antigen. Proc Natl Acad Sci USA. 2011;108:9578–9582.
    1. Mannweiler S., Amersdorfer P., Trajanoski S., Terrett J.A., King D., Mehes G. Heterogeneity of prostate-specific membrane antigen (PSMA) expression in prostate carcinoma with distant metastasis. Pathol Oncol Res. 2009;15:167–172.
    1. Mhawech-Fauceglia P., Zhang S., Terracciano L., Sauter G., Chadhuri A., Herrmann F.R. Prostate-specific membrane antigen (PSMA) protein expression in normal and neoplastic tissues and its sensitivity and specificity in prostate adenocarcinoma: an immunohistochemical study using mutiple tumour tissue microarray technique. Histopathology. 2007;50:472–483.
    1. Siva S., Callahan J., Pryor D., Martin J., Lawrentschuk N., Hofman M.S. Utility of (68) Ga prostate specific membrane antigen – positron emission tomography in diagnosis and response assessment of recurrent renal cell carcinoma. J Med Imaging Radiat Oncol. 2017 In press.
    1. Perera M., Papa N., Christidis D., Wetherell D., Hofman M.S., Murphy D.G. Sensitivity, specificity, and predictors of positive 68Ga- prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol. 2016;70:926–937.
    1. Meredith G., Wong D., Yaxley J., Coughlin G., Thompson L., Kua B. The use of (68) Ga-PSMA PET CT in men with biochemical recurrence after definitive treatment of acinar prostate cancer. BJU Int. 2016;118(Suppl):49–55.
    1. Graziani T., Ceci F., Castellucci P., Polverari G., Lima G.M., Lodi F. (11)C-Choline PET/CT for restaging prostate cancer. Results from 4,426 scans in a single-centre patient series. Eur J Nuc Med Mol Imaging. 2016;43:1971–1979.
    1. Schwenck J., Rempp H., Reischl G., Kruck S., Stenzl A., Nikolaou K. Comparison of 68Ga-labelled PSMA-11 and 11C-choline in the detection of prostate cancer metastases by PET/CT. Eur J Nuc Med Mol Imaging. 2017;44:92–101.
    1. Afshar-Oromieh A., Zechmann C.M., Malcher A., Eder M., Eisenhut M., Linhart H.G. Comparison of PET imaging with a Ga-68-labelled PSMA ligand and F-18-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nuc Med Mol Imaging. 2014;41:11–20.
    1. Rauscher I., Maurer T., Beer A.J., Graner F.-P., Haller B., Weirich G. Value of 68Ga-PSMA HBED-CC PET for the assessment of lymph node metastases in prostate cancer patients with biochemical recurrence: comparison with histopathology after salvage lymphadenectomy. J Nucl Med. 2016;57:1713–1719.
    1. Papa N., Perera M., Hofman M.S., Bolton D., Lawrentschuk N. Reply to Fabio Zattoni, Filiberto Zattoni, and Laura Evangelista’s Letter to the Editor re: Marlon Perera, Nathan Papa, Daniel Christidis, et al. Sensitivity, specificity, and predictors of positive (68)Ga-prostate-specific membrane antigen positron emission. Eur Urol. 2017;71:e66–e67.
    1. Evangelista L., Zattoni F., Guttilla A., Saladini G., Zattoni F., Colletti P.M. Choline PET or PET/CT and biochemical relapse of prostate cancer: a systematic review and meta-analysis. Clin Nucl Med. 2013;38:305–314.
    1. Murphy D.G., Hofman M., Lawrentschuk N., Maurer T. Bringing clarity or confusion? The role of prostate-specific membrane antigen positron-emission/computed tomography for primary staging in prostate cancer. BJU Int. 2017;119:194–195.
    1. Budaus L., Leyh-Bannurah S.R., Salomon G., Michl U., Heinzer H., Huland H. Initial Experience of (68)Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol. 2016;69:393–396.
    1. van Leeuwen P.J., Emmett L., Ho B., Delprado W., Ting F., Nguyen Q. Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU Int. 2017;119:209–215.
    1. Maurer T., Gschwend J.E., Rauscher I., Souvatzoglou M., Haller B., Weirich G. Diagnostic efficacy of gallium-PSMA positron emission tomography compared to conventional imaging in lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol. 2015;195:1436–1443.
    1. Hijazi S., Meller B., Leitsmann C., Strauss A., Meller J., Ritter C.O. Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by Ga-68-PSMA-positron emission tomography/computerized tomography. Prostate. 2015;75:1934–1940.
    1. Toner L., Papa N., Perera M., Katelaris N., Weerakoon M., Chin K. Multiparametric magnetic resonance imaging for prostate cancer-a comparative study including radical prostatectomy specimens. World J Urol. 2017 In press.
    1. Fendler W.P., Schmidt D.F., Wenter V., Thierfelder K.M., Zach C., Stief C. 68Ga-PSMA-HBED-CC PET/CT detects location and extent of primary prostate cancer. J Nucl Med. 2016;57:1–26.
    1. Rhee H., Thomas P., Shepherd B., Greenslade S., Vela I., Russell P.J. Prostate specific membrane antigen positron emission tomography may improve the diagnostic accuracy of multiparametric magnetic resonance imaging in localized prostate cancer as confirmed by whole mount histopathology. J Urol. 2016;196:1261–1267.
    1. Eiber M., Weirich G., Holzapfel K., Souvatzoglou M., Haller B., Rauscher I. Simultaneous (68)Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol. 2016;70:829–836.
    1. Hamoen E.H.J., de Rooij M., Witjes J.A., Barentsz J.O., Rovers M.M. Use of the Prostate Imaging Reporting and Data System (PI-RADS) for prostate cancer detection with multiparametric magnetic resonance imaging: a diagnostic meta-analysis. Eur Urol. 2014;67:1112–1121.
    1. Perera M., Krishnananthan N., Lindner U., Lawrentschuk N. An update on focal therapy for prostate cancer. Nat Rev Urol. 2016;13:641–653.
    1. Wetherell D., Bolton D., Kavanagh L., Perera M. Current role of salvage robotic-assisted laparoscopic prostatectomy. World J Urol. 2013;31:463–469.
    1. Parker C., Gillessen S., Heidenreich A., Horwich A. ESMO guidelines committee. Cancer of the prostate: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v69–v77.
    1. American Urological Association. Guideline for the Management of Clinically Localized Prostate Cancer [Internet]. 2007 [cited 2017 Jan 5]. Available from: .
    1. Evans S.M., Nag N., Roder D., Brooks A., Millar J.L., Moretti K.L. Development of an International prostate cancer outcomes registry. BJU Int. 2016;117(Suppl 4):60–67.
    1. Bluemel C., Linke F., Herrmann K., Simunovic I., Eiber M., Kestler C. Impact of (68)Ga-PSMA PET/CT on salvage radiotherapy planning in patients with prostate cancer and persisting PSA values or biochemical relapse after prostatectomy. Eur J Nuc Med Mol Imaging. 2016;6:78.
    1. Albisinni S., Artigas C., Aoun F., Biaou I., Grosman J., Gil T. Clinical impact of (68) Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer with rising prostate-specific antigen after treatment with curative intent: preliminary analysis. BJU Int. 2017 In press.
    1. Van Leeuwen P.J., Stricker P., Hruby G., Kneebone A., Ting F., Thompson B. 68Ga-PSMA has a high detection rate of prostate cancer recurrence outside the prostatic fossa in patients being considered for salvage radiation treatment. BJU Int. 2016;117:732–739.
    1. Henkenberens C., von Klot C.A., Ross T.L., Bengel F.M., Wester H.J., Merseburger A.S. (68)Ga-PSMA ligand PET/CT-based radiotherapy in locally recurrent and recurrent oligometastatic prostate cancer: early efficacy after primary therapy. Strahlenther Onkol. 2016;192:431–439.
    1. Shakespeare T.P. Effect of prostate-specific membrane antigen positron emission tomography on the decision-making of radiation oncologists. Radiat Oncol. 2015;10:233.
    1. Tendulkar R.D., Agrawal S., Gao T., Efstathiou J.A., Pisansky T.M., Michalski J.M. Contemporary update of a multi-institutional predictive nomogram for salvage radiotherapy after radical prostatectomy. J Clin Oncol. 2017 In press.
    1. Sweeney C., Chen Y.-H., Liu G., Carducci M., Jarrard D., Eisenberger M. Long term efficacy and QOL data of chemohormonal therapy (C-HT) in low and high volume hormone naïve metastatic prostate cancer (PrCa): E3805 CHAARTED trial. Ann Oncol. 2016;27(Suppl 6):720PD.

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