Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) is useful for selected clinical indications in patients with prostate cancer (PCa) but it may have broader clinical utility owing to the emergence of lutetium-177-PSMA-617 ([177Lu]Lu-PSMA) therapy. However, robust data regarding the impact of PSMA PET/CT on patient management and treatment are lacking, and in many areas, the role of next-generation imaging has not been defined.
To assess expert opinion on the use of PSMA-based imaging and therapy to develop interim guidance.
A panel of 21 PCa experts from various disciplines received thematic topics and relevant literature. A questionnaire to assess proposed guidance statements regarding PSMA PET/CT and [177Lu]Lu-PSMA therapy was developed for completion remotely in a first e-Delphi round. A subsequent panel discussion was conducted during a 1-d meeting, which included a second Delphi round.
Panellists voted anonymously on statements using a nine-point Likert scale from 1 = strongly disagree to 9 = strongly agree. Median scores were calculated and consensus was assessed using methods proposed by the Research and Development (RAND) corporation.
Statements were developed to cover the following topics: PSMA PET/CT utility, clinical use, and choice of tracer; patient selection; and management of patients receiving [177Lu]Lu-PSMA for metastatic PCa. Consensus was reached for 33/36 statements. In-group bias is a potential limitation, as some statements were rephrased during discussions at the 1-d meeting.
Adoption of PSMA PET/CT as an imaging tool to guide [177Lu]Lu-PSMA therapy should be supported by indications for appropriate use.
A panel of experts in prostate cancer reached a consensus for the majority of statements proposed regarding the role of prostate-specific membrane antigen (PSMA)-based imaging and therapy, particularly the use of PSMA-based imaging in patients suitable for [177Lu]Lu-PSMA therapy and the need to perform PSMA-based imaging before considering patients as candidates for this therapy.
European urology oncology. 2022 Jun 10 [Epub ahead of print]
Stefano Fanti, Alberto Briganti, Louise Emmett, Karim Fizazi, Silke Gillessen, Karolien Goffin, Boris A Hadaschik, Ken Herrmann, Jolanta Kunikowska, Tobias Maurer, Steven MacLennan, Nicolas Mottet, Declan G Murphy, Daniela E Oprea-Lager, Joe M O'Sullivan, Wim J G Oyen, Olivier Rouvière, Oliver Sartor, Arnulf Stenzl, Hendrik Van Poppel, Jochen Walz, Wim Witjes, Anders Bjartell
Nuclear Medicine Division, IRCCS AOU Bologna, Bologna, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy., Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, Australia., Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France., Institute of Oncology of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland., Department of Nuclear Medicine, University Hospital Leuven, KU Leuven, Leuven, Belgium., Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany., Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany., Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland., Department of Urology and Martini-Klinik Prostate Cancer Center, Universitätsklinikum, Hamburg-Eppendorf, Germany., Academic Urology Unit, University of Aberdeen, Aberdeen, UK., Department of Urology, University Hôpital Nord, Saint Etienne, France., Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia., Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands., Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK., Humanitas University and Humanitas Clinical and Research Center, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands., Department of Urinary and Vascular Imaging, Hospices Civils de Lyon, Hospital Edouard Herriot, Lyon, France; Faculty of Medicine Lyon Est, University of Lyon, University Lyon 1, Lyon, France., Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA., Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany., Department of Urology, Katholieke Universiteit Leuven, Leuven, Belgium., Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France., European Association of Urology Research Foundation, Arnhem, The Netherlands., Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Medical Faculty, Lund University, Lund, Sweden. Electronic address: .