Current and potential future role of PSMA-PET in patients with castration-resistant prostate cancer

To review the current literature and discuss potential future roles of the novel positron emission tomography (PET) tracers targeting the prostate-specific membrane antigen (PSMA) in patients with castration-resistant prostate cancer (CRPC).

A literature search on February 19th 2018 was conducted using the Medline database and www.clinicaltrials.gov . Additionally, illustrative cases of CRPC patients from our own institution who were restaged and treated based on PSMA-PET scan results are provided.

11 Studies met the inclusion criteria. PSMA-PET detected more metastatic lesions compared to conventional bone scan. Several patients were up-staged from non-metastatic CRPC (nmCRPC) to metastatic CRPC (mCRPC). Currently, no clear consensus exists regarding treatment response assessment in PSMA-PET scans for mCRPC patients undergoing treatment. Also, the role of PSMA-PET as a gatekeeper for systemic therapy or radioligands is currently undefined. PSMA-guided metastasis-directed radiotherapy may not only alleviate local symptoms but has the potential to defer systemic treatment in patients with oligoprogressive CRPC.

Compared to bone scan, PSMA-PET is more sensitive and specific to detect metastases but the therapeutic consequences of PSMA-PET results in the setting of CRPC remain unclear. Until future studies define the role of PSMA-PET in patients with CRPC, the current standard for imaging remains bone scan and computerized tomography.

World journal of urology. 2018 Jul 20 [Epub ahead of print]

Christian Daniel Fankhauser, Cédric Poyet, Stephanie G C Kroeze, Benedikt Kranzbühler, Helena I Garcia Schüler, Matthias Guckenberger, Philipp A Kaufmann, Thomas Hermanns, Irene A Burger

Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. ., Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland., Department of Radiation Oncology, University of Zurich, Zurich, Switzerland., Department of Nuclear Medicine, University of Zurich, Zurich, Switzerland.

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