TOPLINE:
Prostate-specific membrane antigen– positron emission tomography (PSMA-PET) identified metastatic illness in 46% of clients with high-risk prostate cancer formerly categorized as nonmetastatic by standard imaging. Outcomes were favorable in 84% of clients, with polymetastatic illness discovered in 24% of cases.
METHOD:
- Reoccurring nonmetastatic hormone-sensitive prostate cancer is defined by increasing prostate-specific antigen (PSA) levels while ignorant or responsive to androgen deprivation treatment, without proof of transition on standard imaging.
- A post hoc, retrospective, cross-sectional analysis consisted of 182 clients from 4 potential research studies performed from September 2016 to September 2021, with individuals having frequent prostate cancer after extreme prostatectomy, conclusive radiotherapy, or salvage radiotherapy.
- Addition requirements incorporated PSA levels > > 1.0 ng/mL after extreme prostatectomy and salvage radiotherapy or > > 2.0 ng/mL above nadir after conclusive radiotherapy, PSA doubling time ≤ 9 months, and serum testosterone ≥ 150 ng/dL.
- Scientists at University of California, Los Angeles carried out Gallium-68-PSMA-11 PET/computed tomography imaging with an average injection of 5.0 mCi and uptake time of 61 minutes, with 98% of clients getting CT contrast.
TAKEAWAY:
- PSMA-PET findings were favorable in 80% of clients after extreme prostatectomy, 92% after conclusive radiotherapy, 85% after extreme prostatectomy and salvage radiotherapy, and 84% general (153 of 182 clients).
- Far-off metastatic illness was spotted in 34% of clients after extreme prostatectomy, 56% after conclusive radiotherapy, 60% after extreme prostatectomy and salvage radiotherapy, and 46% total.
- Polymetastatic illness (≥ 5 sores) was determined in 19% of clients after extreme prostatectomy, 36% after conclusive radiotherapy, 23% after extreme prostatectomy and salvage radiotherapy, and 24% total.
- According to the authors, these findings recommend that clients’ high-risk nonmetastatic hormone-sensitive prostate cancers are understaged by standard imaging.
IN PRACTICE:
“In an associate of clients with high-risk hormone-sensitive prostate cancer without proof of metastatic illness by standard imaging, PSMA-PET outcomes were favorable in 84% of clients, discovered M1 illness phase in 46% of clients, and discovered polymetastatic illness in 24% of clients … The outcomes challenge the analysis of previous research studies, such as the EMBARK trial, and support the developing function of PSMA-PET for client choice in scientific and trial interventions in prostate cancer,” the authors of the brand-new paper composed. “Further research studies are required to evaluate its independent prognostic worth and usage for treatment assistance.”
SOURCE:
This research study was led by Adrien Holzgreve, MD, and Wesley R. Armstrong, BS, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles. It was released online on January 3 in JAMA Network Open
RESTRICTIONS:
The analysis consisted of considerably less clients treated with combined extreme prostatectomy and salvage radiotherapy than the initial EMBARK trial (29% vs 49%). Clients in this research study had a lower average PSA doubling time and serum PSA level at registration than those in the EMBARK research study. The retrospective nature of this research study prevented methodical standard imaging that would be basic for scientific trial registration.
