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European Journal of Nuclear Medicine and Molecular Imaging

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15.11.2019 | Original Article

The effect of androgen deprivation therapy on ⁶⁸Ga-PSMA tracer uptake in non-metastatic prostate cancer patients

verfasst von: Cem Onal, Ozan Cem Guler, Nese Torun, Mehmet Reyhan, Ali Fuat Yapar

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 3/2020

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Abstract

Purpose

To evaluate the effect of neoadjuvant androgen deprivation treatment (ADT) on prostate-specific membrane antigen (PSMA) tracer uptake demonstrated in ⁶⁸Ga-PSMA-positron emission tomography (PET/CT) in non-metastatic hormone-naïve prostate cancer (PC) patients.

Materials and methods

The clinical data of 108 PC patients who received neoadjuvant ADT were retrospectively analyzed. All patients had a baseline ⁶⁸Ga-PSMA-PET/CT scan, and a second scan was delivered median of 2.9 months after the initiation of ADT. The maximum standardized uptake value (SUV_max) of primary tumor (SUV_p) and metastatic lymph nodes (SUV_ln) as well as PSA response were assessed between pre- and post-ADT ⁶⁸Ga-PSMA-PET/CT scans.

Results

There were significant decreases in posttreatment serum PSA, SUV_p, and SUV_ln. A decrease in SUV_p was seen in 91 patients (84%) with a median value of 66% (range, 5–100%), while 17 patients (16%) had no change in or an increase in PSMA tracer uptake with a median value of 24% (range, 0–198%). Patients with Gleason score (GS) of 7 had significantly higher metabolic response rates compared to other patients. The disease progression was significantly higher only in patients with GS > 7 disease compared to GS 7 disease. The PSA response to ADT was the lowest in patients with ISUP high-grade tumors. A total of 16 patients (15%) had progressive disease, and in 9 patients (8%), radiotherapy decisions were modified according to posttreatment ⁶⁸Ga-PSMA-PET/CT scans.

Conclusions

The current study includes the largest number of patients analyzed to date and demonstrates that ADT causes a significant decrease in serum PSA values and SUV_p and SUV_ln. The authors demonstrate that ⁶⁸Ga-PSMA-PET/CT may be used as a quantitative imaging modality after neoadjuvant ADT in hormone-naïve non-metastatic PC patients.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30. https://doi.org/10.3322/caac.21442.CrossRefPubMed

Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff RO, Storme G, et al. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol. 2010;11:1066–73. https://doi.org/10.1016/s1470-2045(10)70223-0.CrossRefPubMed

Lawton CA, Winter K, Murray K, Machtay M, Mesic JB, Hanks GE, et al. Updated results of the phase III Radiation Therapy Oncology Group (RTOG) trial 85-31 evaluating the potential benefit of androgen suppression following standard radiation therapy for unfavorable prognosis carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 2001;49:937–46.CrossRefPubMed

Forman JD, Kumar R, Haas G, Montie J, Porter AT, Mesina CF. Neoadjuvant hormonal downsizing of localized carcinoma of the prostate: effects on the volume of normal tissue irradiation. Cancer Investig. 1995;13:8–15.CrossRef

Onal C, Topkan E, Efe E, Yavuz M, Arslan G, Yavuz A. The effect of concurrent androgen deprivation and 3D conformal radiotherapy on prostate volume and clinical organ doses during treatment for prostate cancer. Br J Radiol. 2009;82:1019–26. https://doi.org/10.1259/bjr/65939531.CrossRefPubMedPubMedCentral

Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol. 2017;71:630–42. https://doi.org/10.1016/j.eururo.2016.08.002.CrossRefPubMed

Kwak C, Jeong SJ, Park MS, Lee E, Lee SE. Prognostic significance of the nadir prostate specific antigen level after hormone therapy for prostate cancer. J Urol. 2002;168:995–1000. https://doi.org/10.1097/01.ju.0000024925.67014.21.CrossRefPubMed

Fitzpatrick JM, Banu E, Oudard S. Prostate-specific antigen kinetics in localized and advanced prostate cancer. BJU Int. 2009;103:578–87. https://doi.org/10.1111/j.1464-410X.2009.08345.x.CrossRefPubMed

Kim AY, Kim CK, Park SY, Park BK. Diffusion-weighted imaging to evaluate for changes from androgen deprivation therapy in prostate cancer. AJR Am J Roentgenol. 2014;203:W645–50. https://doi.org/10.2214/ajr.13.12277.CrossRefPubMed

10.

Hotker AM, Mazaheri Y, Zheng J, Moskowitz CS, Berkowitz J, Lantos JE, et al. Prostate cancer: assessing the effects of androgen-deprivation therapy using quantitative diffusion-weighted and dynamic contrast-enhanced MRI. Eur Radiol. 2015;25:2665–72. https://doi.org/10.1007/s00330-015-3688-1.CrossRefPubMedPubMedCentral

11.

Sweat SD, Pacelli A, Murphy GP, Bostwick DG. Prostate-specific membrane antigen expression is greatest in prostate adenocarcinoma and lymph node metastases. Urology. 1998;52:637–40.CrossRefPubMed

12.

Giovacchini G, Picchio M, Coradeschi E, Scattoni V, Bettinardi V, Cozzarini C, et al. [(11)C]choline uptake with PET/CT for the initial diagnosis of prostate cancer: relation to PSA levels, tumour stage and anti-androgenic therapy. Eur J Nucl Med Mol Imaging. 2008;35:1065–73. https://doi.org/10.1007/s00259-008-0716-2.CrossRefPubMed

13.

Meller B, Bremmer F, Sahlmann CO, Hijazi S, Bouter C, Trojan L, et al. Alterations in androgen deprivation enhanced prostate-specific membrane antigen (PSMA) expression in prostate cancer cells as a target for diagnostics and therapy. EJNMMI Res. 2015;5:66. https://doi.org/10.1186/s13550-015-0145-8.CrossRefPubMedPubMedCentral

14.

Hope TA, Truillet C, Ehman EC, Afshar-Oromieh A, Aggarwal R, Ryan CJ, et al. 68Ga-PSMA-11 PET imaging of response to androgen receptor inhibition: first human experience. J Nucl Med. 2017;58:81–4. https://doi.org/10.2967/jnumed.116.181800.CrossRefPubMedPubMedCentral

15.

Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42:197–209. https://doi.org/10.1007/s00259-014-2949-6.CrossRefPubMed

16.

Afshar-Oromieh A, Holland-Letz T, Giesel FL, Kratochwil C, Mier W, Haufe S, et al. Diagnostic performance of (68)Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging. 2017;44:1258–68. https://doi.org/10.1007/s00259-017-3711-7.CrossRefPubMedPubMedCentral

17.

Afshar-Oromieh A, Debus N, Uhrig M, Hope TA, Evans MJ, Holland-Letz T, et al. Impact of long-term androgen deprivation therapy on PSMA ligand PET/CT in patients with castration-sensitive prostate cancer. Eur J Nucl Med Mol Imaging. 2018;45:2045–54. https://doi.org/10.1007/s00259-018-4079-z.CrossRefPubMedPubMedCentral

18.

Emmett LM, Yin C, Crumbaker M, Hruby G, Kneebone A, Epstein R, et al. Rapid modulation of PSMA expression by androgen deprivation: serial (68)Ga PSMA-11 PET in men with hormone sensitive and castrate resistant prostate cancer commencing androgen blockade. J Nucl Med. 2018. https://doi.org/10.2967/jnumed.118.223099.CrossRefPubMed

19.

D'Amico AV, Whittington R, Schultz D, Malkowicz SB, Tomaszewski JE, Wein A. Outcome based staging for clinically localized adenocarcinoma of the prostate. J Urol. 1997;158:1422–6.CrossRefPubMed

20.

Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50(Suppl 1):122S–50S. https://doi.org/10.2967/jnumed.108.057307.CrossRefPubMed

21.

Fuccio C, Schiavina R, Castellucci P, Rubello D, Martorana G, Celli M, et al. Androgen deprivation therapy influences the uptake of 11C-choline in patients with recurrent prostate cancer: the preliminary results of a sequential PET/CT study. Eur J Nucl Med Mol Imaging. 2011;38:1985–9. https://doi.org/10.1007/s00259-011-1867-0.CrossRefPubMed

22.

Chondrogiannis S, Marzola MC, Ferretti A, Grassetto G, Maffione AM, Rampin L, et al. Is the detection rate of 18F-choline PET/CT influenced by androgen-deprivation therapy? Eur J Nucl Med Mol Imaging. 2014;41:1293–300. https://doi.org/10.1007/s00259-014-2720-z.CrossRefPubMed

23.

Bansal A, Singhi SC, Jayashree M. Penicillin and gentamicin therapy vs amoxicillin/clavulanate in severe hypoxemic pneumonia. Indian J Pediatr. 2006;73:305–9.CrossRefPubMed

24.

Minner S, Wittmer C, Graefen M, Salomon G, Steuber T, Haese A, et al. High level PSMA expression is associated with early PSA recurrence in surgically treated prostate cancer. Prostate. 2011;71:281–8. https://doi.org/10.1002/pros.21241.CrossRefPubMed

25.

Obek C, Doganca T, Demirci E, Ocak M, Kural AR, Yildirim A, et al. The accuracy of (68)Ga-PSMA PET/CT in primary lymph node staging in high-risk prostate cancer. Eur J Nucl Med Mol Imaging. 2017;44:1806–12. https://doi.org/10.1007/s00259-017-3752-y.CrossRefPubMed

26.

Evans MJ, Smith-Jones PM, Wongvipat J, Navarro V, Kim S, Bander NH, et al. Noninvasive measurement of androgen receptor signaling with a positron-emitting radiopharmaceutical that targets prostate-specific membrane antigen. Proc Natl Acad Sci U S A. 2011;108:9578–82. https://doi.org/10.1073/pnas.1106383108.CrossRefPubMedPubMedCentral

27.

Gupta M, Choudhury PS, Rawal S, Goel HC, Rao SA. Evaluation of RECIST, PERCIST, EORTC, and MDA criteria for assessing treatment response with Ga68-PSMA PET-CT in metastatic prostate cancer patient with biochemical progression: a comparative study. Nucl Med Mol Imaging. 2018;52:420–9. https://doi.org/10.1007/s13139-018-0548-3.CrossRefPubMedPubMedCentral

28.

Schmidkonz C, Cordes M, Schmidt D, Bauerle T, Goetz TI, Beck M, et al. (68)Ga-PSMA-11 PET/CT-derived metabolic parameters for determination of whole-body tumor burden and treatment response in prostate cancer. Eur J Nucl Med Mol Imaging. 2018;45:1862–72. https://doi.org/10.1007/s00259-018-4042-z.CrossRefPubMed

29.

Schmuck S, von Klot CA, Henkenberens C, Sohns JM, Christiansen H, Wester HJ, et al. Initial experience with volumetric (68)Ga-PSMA I&T PET/CT for assessment of whole-body tumor burden as a quantitative imaging biomarker in patients with prostate cancer. J Nucl Med. 2017;58:1962–8. https://doi.org/10.2967/jnumed.117.193581.CrossRefPubMed

30.

Koerber SA, Utzinger MT, Kratochwil C, Kesch C, Haefner MF, Katayama S, et al. (68)Ga-PSMA-11 PET/CT in newly diagnosed carcinoma of the prostate: correlation of intraprostatic PSMA uptake with several clinical parameters. J Nucl Med. 2017;58:1943, 8. https://doi.org/10.2967/jnumed.117.190314.CrossRefPubMed

31.

Bakht MK, Derecichei I, Li Y, Ferraiuolo RM, Dunning M, Oh SW, et al. Neuroendocrine differentiation of prostate cancer leads to PSMA suppression. Endocr Relat Cancer. 2018;26:131–46. https://doi.org/10.1530/ERC-18-0226.CrossRefPubMed

32.

Park SC, Rim JS, Choi HY, Kim CS, Hong SJ, Kim WJ, et al. Failing to achieve a nadir prostate-specific antigen after combined androgen blockade: predictive factors. Int J Urol. 2009;16:670–5. https://doi.org/10.1111/j.1442-2042.2009.02329.x.CrossRefPubMed

33.

James ND, Sydes MR, Clarke NW, Mason MD, Dearnaley DP, Spears MR, et al. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet. 2016;387:1163–77. https://doi.org/10.1016/S0140-6736(15)01037-5.CrossRefPubMedPubMedCentral

34.

Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev BY, et al. Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med. 2017;377:352–60. https://doi.org/10.1056/NEJMoa1704174.CrossRefPubMed

35.

Kyriakopoulos CE, Chen YH, Carducci MA, Liu G, Jarrard DF, Hahn NM, et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer: long-term survival analysis of the randomized phase III E3805 CHAARTED trial. J Clin Oncol. 2018;36:1080–7. https://doi.org/10.1200/JCO.2017.75.3657.CrossRefPubMedPubMedCentral

36.

Hara T, Bansal A, DeGrado TR. Effect of hypoxia on the uptake of [methyl-3H]choline, [1-14C] acetate and [18F]FDG in cultured prostate cancer cells. Nucl Med Biol. 2006;33:977–84. https://doi.org/10.1016/j.nucmedbio.2006.08.002.CrossRefPubMed

Titel: The effect of androgen deprivation therapy on 68Ga-PSMA tracer uptake in non-metastatic prostate cancer patients
verfasst von: Cem Onal
Ozan Cem Guler
Nese Torun
Mehmet Reyhan
Ali Fuat Yapar
Publikationsdatum: 15.11.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 3/2020
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-019-04581-4

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

The effect of androgen deprivation therapy on ⁶⁸Ga-PSMA tracer uptake in non-metastatic prostate cancer patients

Abstract

Purpose

Materials and methods

Results

Conclusions

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Purpose

Materials and methods

Results

Conclusions

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