The role of PSMA PET/CT in clinically limited prostate cancer

This article comes from NEJM Journal Watch Evolving Role of PSMA PET/CT in Clinically Localized Prostate Cancer PSMA PET/CT in Clinically Localized Prostate Cancer Comment by Robert Dreicer, MD, MS, MACP, FASCO For intermediate-risk and high-risk prostate cancer patients, PSMA PET/CT may guide treatment decisions for prostatectomy
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Routine imaging tests for prostate cancer (computerized tomography [CT] scans and bone scans of the abdominal and pelvic cavity) have long been used to determine whether patients with clinically limited prostate cancer with high-risk features have metastases
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The US FDA recently approved gallium and fluoride-based prostate-specific membrane antigen (PSMA) PET/CT for patients with biochemical recurrence.
The basis is that the detection rate of PSMA PET/CT is higher than that of conventional imaging examinations
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The investigators conducted a prospective, single-group, phase 3 study in two institutions.
They evaluated in intermediate and high-risk prostate cancer patients receiving 68Ga-PSMA-11 PET (using PET/CT or PET/MRI) Radical prostatectomy
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The image is interpreted by a nuclear medicine physician, and the report is sent to the referring physician, who can make treatment decisions based on the results
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Of the 764 patients included in this study, 277 (36%) underwent prostatectomy and lymph node dissection, of which 75 (27%) had pelvic lymph node metastasis
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The 68Ga-PSMA-11 PET of patients undergoing prostatectomy was interpreted by three blinded independent readers
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The primary endpoint is the sensitivity and specificity of the detection of affected pelvic lymph nodes compared with histopathology.
The results showed that these two items were 0.
40 and 0.
95, respectively
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The positive and negative predictive values ​​were 0.
75 and 0.
81, respectively
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As the comment writer pointed out, the results of this study are similar to those of a similar trial using 18F-DCFPyL PSMA PET/CT, but this trial is larger in scale and adopts a prospective design that simulates clinical practice
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The comment writer concluded: “Clinicians who perform prostatectomy evaluation for high-risk prostate cancer patients can judge the patient as a true positive based on the positive PET scan result, but cannot rule out the patient with metastasis based on the negative scan result
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"Commented article [1] Hope TA et al.
Diagnostic accuracy of 68Ga-PSMA-11 PET for pelvic nodal metastasis detection prior to radical prostatectomy and pelvic lymph node dissection: A multicenter prospective phase 3 imaging trial.
JAMA Oncol 2021 Sep 16; [e-pub].
(https://doi.
org/10.
1001/jamaoncol.
2021.
3771)[2] Osborne JR et al.
Prostate-specific membrane antigen positron emission tomography and the new algorithm for patients with prostate cancer prior to prostatectomy.
JAMA Oncol 2021 Sep 16; [e-pub].
(https://doi.
org/10.
1001/jamaoncol.
2021.
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