What Are The Chances Of Prostate Cancer Returning After Radiation – Diagnostic performance and clinical value of 68Ga-PSMA-11 PET/CT in early recurrent prostate cancer after radical irradiation: an interdisciplinary study (IAEA-PSMA study)
Giuliano J. Cressi, Stefano Fanti, Enrique E. Loboto, Jolanta Konikoska, Omar Alonso, Sevastian Medina, Fuad Norozov, Thabo Lingana, Carlos Granados, Rakesh Kumar, Venkatesh Rangarajan, Akram Al-Kabari, Ali Makboor, Ali Nouri. Ezra Ahmed, Zohar Kedar, Ozlam Koch, Amut Elboga, Mithos Bogoni and Diana Paes.
- 1 What Are The Chances Of Prostate Cancer Returning After Radiation
- 2 Fighting Prostate Cancer For A *second* Time? Read This
- 3 The Long Term Risks Of Metastases In Men On Active Surveillance For Early Stage Prostate Cancer
- 4 Treatment May Help Prevent Bladder Cancer Recurrences
What Are The Chances Of Prostate Cancer Returning After Radiation
Biochemical recurrence (BCR) is a clinical problem in patients with prostate cancer (PCa), as the stage of recurrence determines further treatment. The use of PET and prostate-specific membrane antigen (PSMA) is more accurate than traditional imaging. This prospective, multicenter, international study was conducted to evaluate the diagnostic performance and clinical impact of PSMA PET/CT for BCR assessment in patients with PCa globally. Methods: Patients were recruited from 17 centers in 15 countries. Inclusion criteria included histopathological adenocarcinoma of the prostate, previous primary therapy, clinically established BCR, negative conventional imaging (CT and bone scintigraphy) and MRI findings with PSA levels of 4-10 ng/ml. All patients underwent PET/CT.
Fighting Prostate Cancer For A *second* Time? Read This
Ga-PSMA-11. Images and data were reviewed centrally. Multiple logistic regression analysis was used to identify independent predictors of positive PSMA results. Variables for this regression model were selected based on significant associations on univariate analysis with previous clinical knowledge: Gleason score, PSA level at PET scan, PSA doubling time, and primary treatment strategy. All patients were followed up for at least 6 months. Results: Of the 1004 patients, 77.7% initially underwent radical prostatectomy and 22.3% received radiation therapy. Overall, 65.1% had positive PSMA PET/CT findings. A positive PSMA PET/CT result was associated with Gleason score, PSA level at the time of PET scan, PSA time, and radiation therapy as initial treatment (
<0.001). Treatment was changed based on PSMA PET/CT findings in 56.8% of patients. Positive rates of PSMA PET/CT were similar and did not differ statistically between countries of different income levels. Conclusion: This multicenter international study of PSMA PET/CT confirmed the ability to detect local and metastatic recurrence in the majority of patients with BCR stage PCa. Positive PSMA PET/CT was associated with Gleason score, PSA level at the time of PET scan, PSA doubling time, and radiation therapy as initial treatment. The results of PSMA-PET/CT led to changes in treatment tactics in half of the cases. The study demonstrated the universal reliability and validity of PSMA PET/CT in the evaluation of patients with PCa and BCR.
Prostate cancer (PCa) is the second most common cancer in men, accounting for 7.8% of all cancers in this population (1). Increasing life expectancy worldwide and improved access to screening and diagnostics in developing countries are the main reasons for the increasing incidence of this disease (2).
Early treatment with curative intent may include radical prostatectomy or radiation therapy; However, the first relapse occurs in 50% of patients within 10 years (3–5). Biological relapse (BCR) is defined as an increase in serum prostate-specific antigen (PSA) levels after initial treatment according to defined criteria (6–8).
Copy Number Alteration Burden Predicts Prostate Cancer Relapse
A key question for proper treatment planning in BCR remains the question of whether an elevated PSA level indicates local, regional or distant recurrence. With increasing success rates of early salvage therapy, it is important to diagnose local tumor recurrence as early as possible. Curative radiotherapy after radical prostatectomy has been shown to be very effective (achieves durable response) when postoperative PSA levels are below 0.5 ng/mL, with good results. PSA levels will be less than 0.2 ng/ml. Below are ml (4, 9).
Although guidelines indicate that prostate-specific membrane antigen (PSMA) PET/CT is the modality of choice for BCR (10–17), some countries, especially low-income countries, still use traditional CT imaging and bone scintigraphy. . . Although the diagnostic performance of these methods is low, especially for patients with low PSA levels (11).
Most PSMA PET/CT studies were performed at a single institution or were previously planned. Moreover, most of the reported studies were conducted in academic centers in developing countries; Therefore, to our knowledge, there are no data from large international studies. The International Atomic Energy Agency initiated a research project in 15 countries to evaluate the feasibility and effectiveness of PSMA PET/CT for studying patients with PCa and BCR to inform international practice.
The primary objective of this study was to evaluate the diagnostic performance of PSMA PET/CT in BCR PCa patients worldwide using a multidisciplinary approach, as well as the impact of PSMA PET/CT on clinical management.
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Two stakeholder meetings were held in 2017 and 2019. The first was to define the study protocol, and the second was to define the short-term review and review of images and data. This study was conducted as part of a prospective, multicenter, international project at 17 centers in 15 countries (Azerbaijan, Brazil, Colombia, India, Israel, Italy, Jordan, Lebanon, Malaysia, Mexico, Pakistan, Poland, South Africa, Turkey, and Uruguay). . . Standard data recording forms were developed and agreed upon by the researchers. Data were collected on the incidence of positive PSMA PET/CT findings, location of positive findings, and impact on patient management (Supplementary Figure 1) (supplementary material available at http://). All centers received local ethical approval for patient recruitment and data collection in accordance with national guidelines. All subjects signed an informed consent form.
Patients with histopathologically confirmed adenocarcinoma of the prostate who have undergone primary treatment (radical prostatectomy or radiotherapy) and have BCR. All patients were followed up for 6 months after PSMA PET/CT.
6 Inclusion criteria: age over 18 years; histopathologically confirmed adenocarcinoma of the prostate; previous primary treatment for prostate cancer (radical prostatectomy or radiation therapy); BCR, defined as a PSA level greater than 0.2 ng/mL, confirmed by 2 consecutive measurements, after radical prostatectomy, or a significant increase in PSA level above the nadir after radiation therapy equivalent to 2 ng/mL; negative imaging (CT and bone scintigraphy) and MRI results in patients with PSA levels of 4–10 ng/ml; and informed written consent.
Exclusion criteria for 3 were a history of malignancy other than PCa; History of Paget’s disease; and BCR and PSA levels greater than or equal to 10 ng/mL.
The Long Term Risks Of Metastases In Men On Active Surveillance For Early Stage Prostate Cancer
21) were synthesized in the radiopharmaceutical laboratory of each participating center. PET studies were performed on dedicated PET/CT scanners, and image quality was assessed by board-certified nuclear medicine physicians.
Ga-PSMA-11 (2 MBq/kg; minimum 125 MBq) by slow intravenous injection. Routine imaging is performed 60 to 90 minutes after injection. Low-resolution (diagnostic) CT images were obtained from the mid-neck above the orbital-metal line. Three-dimensional PET images were acquired for a single anatomical exposure for a minimum of 2 minutes per bed. Anatomical images (head to toe images), contrast-enhanced CT, and diuretic and posterior images were taken.
PET/CT studies were reviewed by two board-certified nuclear medicine physicians with extensive experience in oncologic PSMA PET/CT imaging at each center, and all studies were reviewed retrospectively. The brainstorming session produced various results and the final results were used for analysis.
Studies were classified as positive or negative according to standard PCa imaging guidelines for finding findings based on review data (Fig. 1) (10). The physical location of the victims was recorded.
Treatment For Recurrent Prostate Cancer
(A–C) Negative PSMA PET/CT findings in 65-year-old patients undergoing radical prostatectomy with PNLD and BCR T3bN0 (PSA, 0.55 ng/mL). The treatment plan was not modified by PSMA PET/CT (radiation therapy) results (A: axial CT; B: axial fusion; C: maximum projection [MIP]). (D–F) Positive PSMA PET/CT findings in a 67-year-old patient undergoing radical prostatectomy with PNLD and BCR T2aN1 (PSA, 0.4 ng/mL). The treatment plan was changed from radiotherapy to ADT (D: axial CT; E: axial fusion; F: MIP) for lymph nodes measuring 0.4 cm in diameter (red arrow). (G-I) Positive PSMA PET/CT findings in a 65-year-old patient undergoing radical prostatectomy with PNLD and BCR T3aN0 (PSA, 0.2 ng/mL). The treatment plan was changed from radiation therapy to chemotherapy (G: axial CT; H: axial fusion; I: MIP) for metastatic bone disease (green arrow). PPLD = pelvic lymphadenectomy.
PSMA PET/CT results were compared with histology (if necessary, at the physician’s discretion); Similar imaging modalities such as contrast-enhanced CT, MRI, whole body MRI, and bone scan; and clinical and laboratory data (PSA behavior). All information was obtained during routine care.
Given the composite nature of the reference standard, neither sensitivity nor specificity can be calculated; In addition, direct assessment of negative findings, beyond the scope of the present study, focused on assessing the PSMA PET/CT detection rate (positivity rate), defined as the proportion of patients with positive PSMA PET/CT findings. .
Prior to PSMA PET/CT, urology ancillary teams completed a treatment intent questionnaire at the time of referral; Treatment options include radiation therapy alone, radiation therapy and androgen deprivation therapy (ADT), salvage lymphadenectomy, ADT alone, active surveillance, bilateral orchiectomy, second-generation ADT (abiraterone or enzalutamide), radionuclide therapy, and chemotherapy (taxane).
Treatment May Help Prevent Bladder Cancer Recurrences
After publication of PSMA PET/CT results
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