PET Imaging in Prostate Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 31 January 2025 | Viewed by 8342

Special Issue Editors


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Guest Editor
Division of Nuclear Medicine, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
Interests: radiomic; pet/ct; radiotracers
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Co-Guest Editor
Department of Radiotherapy, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
Interests: urological malignancies; radiation oncology; new fractionation protocols; treatment accuracy; patient’s quality of life; prognostic and predictive factors; SBRT hypofractionation; oligometastatic disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The introduction of molecular imaging, namely positron emission tomography (PET) imaging, in prostate cancer has already changed the clinical outcomes and therapeutic management of patients. PET imaging has proved to have higher diagnostic accuracy compared to conventional imaging, especially for staging high-risk patients and identifying metastatic locations in the case of disease recurrence. Several PET radiopharmaceuticals have been proposed over the last decade, and these diagnostic techniques are now currently placed under the umbrella term “new-generation imaging”. 

The most successful approach is represented by targeting the prostate-specific membrane antigen (PSMA), and PSMA-PET has rapidly emerged as the new standard of care in prostate cancer. The main advantage of PSMA-PET is related to the high diagnostic accuracy and to the possibility to use it as therapeutic agent. PSMA can, in fact, be labeled to high energy isotopes (beta and alpha particles emitters) and used for radio-ligand therapy. 

However, PSMA is not expressed in all prostate cancer cells, namely in the later stage of the disease when tumor heterogeneity is higher, and molecular pathways are more complex. Accordingly, metabolic PET imaging with radio-labelled choline or fluorodeoxyglucose still plays a role in prostate cancer. Furthermore, new targets have recently been explored, such as the fibroblast activation protein (FAPi-PET) bombesin (RM2-PET).  

This Special Issue aims to collect original articles and reviews on the role of PET imaging in prostate cancer, with a special focus on innovative approaches and translational imaging.

Prof. Dr. Francesco Ceci
Dr. Giulia Marvaso
Guest Editors

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Keywords

  • positron emission tomography
  • PET
  • prostate-specific membrane antigen (PSMA)
  • theranostics
  • radio-ligand therapy
  • choline
  • FDG
  • fibroblast activation protein
  • FAPi
  • bombesin
  • prostate cancer
  • image-guided therapy
  • PSMA-guided therapy

Published Papers (4 papers)

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Research

13 pages, 2747 KiB  
Article
Diagnostic Performance of 99mTc-iPSMA SPECT/CT in the Initial Staging of Patients with Unfavorable Intermediate-, High-, and Very High-Risk Prostate Cancer: A Comparative Analysis with 18F-PSMA-1007 PET/CT
by Joel E. Vargas-Ahumada, Sofía Denisse González-Rueda, Fabio Andrés Sinisterra-Solís, Pamela Casanova-Triviño, Quetzali Pitalúa-Cortés, Irma Soldevilla-Gallardo, Anna Scavuzzo, Miguel Angel Jimenez-Ríos and Francisco Osvaldo García-Pérez
Cancers 2023, 15(24), 5824; https://doi.org/10.3390/cancers15245824 - 13 Dec 2023
Cited by 1 | Viewed by 2366
Abstract
Prostate cancer is a leading cause of cancer death in men worldwide. Imaging plays a key role in disease detection and initial staging. Emerging data has shown the superiority of PSMA imaging with PET/CT over conventional imaging for primary diagnoses. Single photon emission [...] Read more.
Prostate cancer is a leading cause of cancer death in men worldwide. Imaging plays a key role in disease detection and initial staging. Emerging data has shown the superiority of PSMA imaging with PET/CT over conventional imaging for primary diagnoses. Single photon emission computed tomography is more available worldwide, and the imaging agent is low in cost. The aim of this study is to compare the diagnostic accuracy of 99mTc-EDDA/HYNIC-iPSMA SPECT/CT to 18F-PSMA-1007 PET/CT in the primary diagnosis of prostate cancer and the impact on clinical staging. Methods: In this prospective controlled study, 18 patients with histologically confirmed prostate cancer with unfavorable intermediate-, high-, and very high-risk characteristics were recruited to undergo 18F-PSMA-PET/CT and 99mTc-iPSMA SPECT/CT. The median age of the patients was 71 years old, and the median PSA level was 23.3 ng/mL. Lesions were divided into the prostate, seminal vesicles, lymph nodes, bone, and visceral metastases. Volumetric analysis was also performed between the two imaging modalities and correlated with PSA levels. Results: A total of 257 lesions were detected on 18F-PSMA-PET/CT: prostate (n = 18), seminal vesicles (n = 12), locoregional lymph nodes (n = 62), non-locoregional (n = 67), bone (n = 90), and visceral (n = 8). Of these, 99mTc-iPSMA-SPECT/CT detected 229 lesions, while both reviewers detected 100% of the lesions in the prostate (18/18), seminal vesicles (12/12), and visceral (8/8); LN LR (56/62; 90%), NLR (57/67; 85%), and bone (78/90; 86%). There were no statistically significant differences between volumetric parameters (t = −0.02122; p = 0.491596). Conclusions: 99mTc-iPSMA SPECT/CT is useful in the primary diagnosis of prostate cancer. Despite it showing a slightly lower lesion detection rate compared to 18F-PSMA PET/CT, it exhibited no impact on clinical staging and, consequently, the initial treatment intention. Full article
(This article belongs to the Special Issue PET Imaging in Prostate Cancer)
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11 pages, 1334 KiB  
Article
Peering through the PSMA PET Lens: The Role of the European Association of Urology Biochemical Recurrence Risk Groups after Radical Prostatectomy
by Charles Leplat, Teddy Jabbour, Romain Diamand, Arthur Baudewyns, Henri Alexandre Bourgeno, Qaid Ahmed Shagera, Patrick Flamen, Thierry Roumeguere, Alexandre Peltier and Carlos Artigas
Cancers 2023, 15(11), 2926; https://doi.org/10.3390/cancers15112926 - 26 May 2023
Viewed by 1307
Abstract
(1) Background: The European Association of Urology (EAU) biochemical recurrence (BCR) risk grouping relies on data from historical cohorts that used conventional imaging techniques. In the era of PSMA PET/CT, we compared the patterns of positivity in the two risk groups and provided [...] Read more.
(1) Background: The European Association of Urology (EAU) biochemical recurrence (BCR) risk grouping relies on data from historical cohorts that used conventional imaging techniques. In the era of PSMA PET/CT, we compared the patterns of positivity in the two risk groups and provided insight into positivity predictive factors. (2) Methods: Data from 1185 patients who underwent 68Ga-PSMA-11PET/CT for BCR was analyzed, out of which 435 patients treated initially treated by radical prostatectomy were included in the final analysis. (3) Results: A significantly higher rate of positivity in the BCR high-risk group was observed (59% vs. 36%, p < 0.001). BCR low-risk group demonstrated more local (26% vs. 6%, p < 0.001) and oligometastatic (100% vs. 81%, p < 0.001) recurrences. The BCR risk group and PSA level at the time of PSMA PET/CT were independent predictive factors of positivity. (4) Conclusions: This study confirms that the EAU BCR risk groups have different rates of PSMA PET/CT positivity. Even with a lower rate in the BCR low-risk group, oligometastatic disease was 100% in those with distant metastases. Given the presence of discordant positivity and risk classification, integrating PSMA PET/CT positivity predictors into risk calculators for BCR might improve patient classification for subsequent treatment options. Future prospective studies are still needed to validate the above findings and assumptions. Full article
(This article belongs to the Special Issue PET Imaging in Prostate Cancer)
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14 pages, 2389 KiB  
Article
PSMA-PET Guided Treatment in Prostate Cancer Patients with Oligorecurrent Progression after Previous Salvage Treatment
by Lorenzo Bianchi, Francesco Ceci, Eleonora Balestrazzi, Francesco Costa, Matteo Droghetti, Pietro Piazza, Alessandro Pissavini, Massimiliano Presutti, Andrea Farolfi, Riccardo Mei, Paolo Castellucci, Giorgio Gandaglia, Alessandro Larcher, Daniele Robesti, Alexandre Mottrie, Alberto Briganti, Alessio Giuseppe Morganti, Stefano Fanti, Francesco Montorsi, Riccardo Schiavina and Eugenio Brunocillaadd Show full author list remove Hide full author list
Cancers 2023, 15(7), 2027; https://doi.org/10.3390/cancers15072027 - 29 Mar 2023
Cited by 8 | Viewed by 2100
Abstract
Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is used to select recurrent prostate cancer (PCa) patients for metastases-directed therapy (MDT). We aimed to evaluate the oncologic outcomes of second-line PSMA-guided MDT in oligo-recurrent PCa patients. Methods: we performed a retrospective analysis of [...] Read more.
Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is used to select recurrent prostate cancer (PCa) patients for metastases-directed therapy (MDT). We aimed to evaluate the oncologic outcomes of second-line PSMA-guided MDT in oligo-recurrent PCa patients. Methods: we performed a retrospective analysis of 113 recurrent PCa after previous radical prostatectomy and salvage therapies with oligorecurrent disease at PSMA-PET (≤3 lesions in N1/M1a-b) in three high-volume European centres. Patients underwent second-line salvage treatments: MDT targeted to PSMA (including surgery and/or radiotherapy), and the conventional approach (observation or Androgen Deprivation Therapy [ADT]). Patients were stratified according to treatments (MDT vs. conventional approach). Patients who underwent MDT were stratified according to stage in PSMA-PET (N1 vs. M1a-b). The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were Metastases-free survival (MFS) and Castration Resistant PCa free survival (CRPC-FS). Kaplan-Meier analyses assessed PFS, MFS and CRPC-FS. Multivariable Cox regression models identified predictors of progression and metastatic disease. Results: Overall, 91 (80%) and 22 (20%) patients were treated with MDT and the conventional approach, respectively. The median follow-up after PSMA-PET was 31 months. Patients who underwent MDT had a similar PFS compared to the conventional approach (p = 0.3). Individuals referred to MDT had significantly higher MFS and CRPC-FS compared to those who were treated with the conventional approach (73.5% and 94.7% vs. 30.5% and 79.5%; all p ≤ 0.001). In patients undergoing MDT, no significant differences were found for PFS and MFS according to N1 vs. M1a-b disease, while CRPC-FS estimates were significantly higher in patients with N1 vs. M1a-b (100% vs. 86.1%; p = 0.02). At multivariable analyses, age (HR = 0.96) and ADT during second line salvage treatment (HR = 0.5) were independent predictors of PFS; MDT (HR 0.27) was the only independent predictor of MFS (all p ≤ 0.04) Conclusion: Patients who underwent second-line PSMA-guided MDT experienced higher MFS and CRPC-FS compared to men who received conventional management. Full article
(This article belongs to the Special Issue PET Imaging in Prostate Cancer)
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12 pages, 1838 KiB  
Article
Detection Efficacy of 68Ga-PSMA-11 PET/CT in Biochemical Recurrence of Prostate Cancer with Very Low PSA Levels: A 7-Year, Two-Center “Real-World” Experience
by Caroline Burgard, Manuela A. Hoffmann, Madita Frei, Hans-Georg Buchholz, Fadi Khreish, Robert J. Marlowe, Mathias Schreckenberger, Samer Ezziddin and Florian Rosar
Cancers 2023, 15(5), 1376; https://doi.org/10.3390/cancers15051376 - 21 Feb 2023
Cited by 11 | Viewed by 2027
Abstract
In biochemical recurrence of prostate cancer (BCR), prompt tumor localization guides early treatment, potentially improving patient outcomes. Gallium-68 prostate-specific membrane antigen-11 positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) detection rates of lesions suspicious for prostate cancer are well known to rise along [...] Read more.
In biochemical recurrence of prostate cancer (BCR), prompt tumor localization guides early treatment, potentially improving patient outcomes. Gallium-68 prostate-specific membrane antigen-11 positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) detection rates of lesions suspicious for prostate cancer are well known to rise along with prostate-specific antigen (PSA) concentration. However, published data are limited regarding very low values (≤0.2 ng/mL). We retrospectively analyzed ~7-year “real-world” experience in this setting in a large post-prostatectomy cohort (N = 115) from two academic clinics. Altogether 44 lesions were detected in 29/115 men (25.2%) (median [minimum–maximum] 1 [1–4]/positive scan). The apparent oligometastatic disease was found in nine patients (7.8%) at PSA as low as 0.03 ng/mL. Scan positivity rates were highest when PSA was >0.15 ng/mL, PSA doubling time was ≤12 months, or the Gleason score was ≥7b (in 83 and 107 patients, respectively, with available data); these findings were statistically significant (p ≤ 0.04), except regarding PSA level (p = 0.07). Given the benefits of promptly localizing recurrence, our observations suggest the potential value of 68Ga-PSMA-11 PET/CT in the very low PSA BCR setting, especially in cases with more rapid PSA doubling time or with high-risk histology. Full article
(This article belongs to the Special Issue PET Imaging in Prostate Cancer)
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