(UroToday.com) The 2023 European Association of Urology (EAU) annual congress held in Milan, Italy between March 10th and 13th, 2023 was host to a prostate cancer biopsy indication session evaluating the additive value of positron emission tomography (PET), micro-ultrasound, and/or markers in this setting. Dr. Lorenzo Bianchi presented the results of his group’s study evaluating PSMA-PET/CT’s detection ability and clinical impact for high-risk prostate cancer patients suitable for radical treatments.
Dr. Bianchi began by noting that PSMA-PET improves the diagnostic performance in staging high-risk prostate cancer (PCa) patients.1 However, there is a lack of high-level data regarding the potential benefit of treatment changes due to PSMA-PET/CT. The authors aimed to investigate the PSMA-PET/CT-detected metastatic distribution in high-risk PCa patients scheduled for radical treatment, the subsequent treatment changes, and the impact of radical treatments performed according to PSMA-PET/CT findings.
This study enrolled 207 patients with a histopathologic diagnosis of high-risk PCa suitable for radical treatment. A PSMA-PET/CT was performed for staging purposes. A major treatment change was defined as a change from radical prostatectomy to radiotherapy, and vice versa, or from radical treatment to systemic therapy, and vice versa. A minor treatment change was defined as any additional treatment to those originally planned. The treatment effectiveness was described according to PSMA-PET/CT results.
Using miTNM classification, staging for the 207 patients demonstrated:
- N0M0: 142 (69%)
- N1: 36 (17%)
- M1a: 4 (2%)
- M1b: 23 (11%)
- M1c: 2 (1%)
The pre- and post-PSMA PET/CT treatment plans are summarized below by the initial scheduled treatment strategy:
In summary, 19 (11%) patients had a major treatment change, whereas 3 (2%) had a minor treatment change. 20/29 miM1 patients (69%) underwent RP + ePLND +/- SBRT. Out of the 20 miM1a-b patients who underwent surgery alone, 4 (20%) had PSA persistence and were treated with SBRT targeted to PSMA-PET/CT positive lesions, with the remaining 16 (80%) having undetectable PSA post-surgery.
In conclusion:
- PSMA-PET/CT for staging high-risk PCa patients increases the detection of distant suspicious lesions
- The overall effective treatment change by PSMA-PET/CT is approximately 10%, however further prospective studies are needed to evaluate whether findings of PSMA-PET/CT should be taken into account when considering treatment changes
Written by: Rashid K. Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 European Association of Urology (EAU) 38th annual congress held in Milan, Italy between March 10-13, 2023
References:
- Hofman MS, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 2020;395(10231):1208-1216.