PSMA PET/CT Prompts Prostate Cancer Management Changes in 66 Percent of Patients With Recurrent Disease

Using PSMA PET/CT can change the disease treatment and management in two-thirds of patients who have prostate cancer, new research has confirmed.

In a presentation at the Society of Nuclear Medicine and Molecular Imaging 2020 virtual meeting, investigators from the University of Toronto in Ontario, Canada, discussed their assessment of the impact 18F-DCFPyL prostate-specific membrane antigen (PSMA) PET/CT has on how a patient’s cancer management is directed.

Related Content: Additional PET/CT Tracer to Detect Prostate Cancer

As the second most-common cancer among American men, prostate cancer strikes approximately one in nine patients during their lifetimes. Among that group, 30 percent-to-40 percent have a biochemical recurrence when their PSA levels rise after initial treatment.

Case example: PSMA PET/CT accurately detects recurrent prostate cancer in 67-year-old man. 18F-DCFPyL-PSMA PET/CT shows extensive, intensely PSMA-avid local recurrence in prostate (bottom row; solid arrow) in keeping with the known tumor recurrence in the prostate. Right: PET shows extensive, intensely PSMA-avid local recurrence in prostate (top row; solid arrow) and a solitary bone metastasis in left rib 2 (bottom row; dotted arrow). Courtesy: University of Toronto

DCFPyL PSMA PET/CT is known to effectively pinpoint prostate cancer. But, to determine how impactful it is in managing patients with a suspected limited recurrence, the team, led by Ur Metser, M.D., professor of radiology at the University of Toronto, conducted a prospective, large-scale multi-center trial with 410 men who had biochemical failure post-primary therapy. These men either had no or limited disease on CT scans and bone scintigraphy, and they had already received several prostate cancer treatments.

“The identification of extent of recurrent and specific sites of recurrence is crucial in determining the most appropriate mode of therapy for these men,” Metser said. “Findings from this study add to the body of evidence on the utility of PSMA PET in the management of prostate cancer patients.”

Related Content: PSMA-PET/CT Outpaces Conventional Imaging with High-Risk Prostate Cancer Detection

According to the study results, he said, PSMA PET/CT found disease in more than half of the men who had negative CT and bone scan scintigraphy. The PET/CT also identified additional disease sites in roughly two-thirds of men who had limited metastases detected prior to the scan. These findings led to PSMA PET-directed management changes in 66 percent of patients, including conversion from observation or systemic therapy to surgery or radiation or adding nodal-directed therapy to salvage surgery or radiation.

While PSMA PET is still investigational in North America, he said, this study’s evidence could support efforts for regulatory approval to make molecular imaging with 18F-DCFPyL more widely available. It could also open the door for clinical trials to assess whether it can effectively be incorporated into patient care as a treatment planning tool.