SNMMI 2020: PSMA-PET/CT changes prostate cancer management

By Kate Madden Yee, AuntMinnie.com staff writer

July 15, 2020 -- PET/CT imaging with an F-18 DCFPyL prostate-specific membrane antigen (PSMA) radiopharmaceutical changed prostate cancer management in two-thirds of cases, according to research presented July 13 at the Society of Nuclear Medicine and Molecular Imaging (SNMMI) 2020 virtual annual meeting.

Previous research has suggested that PSMA-PET/CT is effective for diagnosing prostate cancer, but its impact on management of patients with suspected recurrent disease has been unclear, wrote a team led by Dr. Ur Metser of the University of Toronto in Canada. To address the question, the group conducted a study using PSMA-PET/CT that included 410 men with suspected recurrent cancer who had no disease on conventional CT or bone scintigraphy and who had undergone multiple prostate cancer treatments.

PSMA-PET/CT accurately detects recurrent prostate cancer in 67-year-old man
PSMA-PET/CT accurately detects recurrent prostate cancer in 67-year-old man. F-18 DCFPyL-PSMA PET/CT shows extensive, intensely PSMA-avid local recurrence in prostate (bottom row; solid arrow) in keeping with 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 two (bottom row; dotted arrow). Image courtesy of Dr. Ur Metser of the University of Toronto; caption courtesy of the SNMMI.

Of the 410 men, 64% had PET-detected lesions. In all, 56% of men with negative conventional imaging results had lesions detected by PET; among those with lesions on conventional imaging, 63% were found to have new ones. PET/CT imaging also showed the following:

  • 12% of men had localized disease.
  • 23% had regional nodal without distant disease.
  • 29% had distant disease.
  • 35% had recurrent disease in the pelvis.

PSMA-PET/CT altered treatment in 66% of the men, the most common shifts being from observation or systemic therapy to surgery or radiation.

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

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Last Updated bc 7/16/2020 6:39:58 AM

3 comments so far ...
7/16/2020 5:33:39 AM
stephenstrum
[18F]DCFPyL PSMA PET/CT or PET/MRI has been investigated with over 59 peer-reviewed citations, 40 of them in the last two years.  Yet, in our constipated medical system the only applicable PET isotope available is 68Ga-PSMA-11 PET/CT for assessing prostate cancer (PC) extent of disease.  And, despite this technology being routinely used in Australia and in use in Europe for ten years, only two medical centers: UCLA and UCSF, are doing 68Ga-PSMA-11 PET/CT and this is on study protocol, not being FDA approved. 
As this post on Aunt Minnie has shown, the treatment of men with PC was dramatically altered by more accurate assessment of where active disease is.  Yet despite this, the use of insensitive imaging such as CT and Tc99 bone scanning remains "state-of-the-art."  This is a sick joke and it is costing patient's quality of life and quantity of life. 
We have become a 3rd world nation in how slow we are to approve new and better imaging tools.  Our FDA is dysfunctional, like many other areas in our government.  Let's see medical imaging become more translational. 

7/16/2020 7:50:13 PM
radman89
Oh, wow! i did not know that FDA rejected the UCLA/UCSF approval. I was actually looking forward to its use clinically. I agree that we lag so far behind europe/australia right now..

7/17/2020 11:43:17 AM
stephenstrum
Perhaps I was wrong and the FDA just passed this in the last few weeks. If so, I have not heard the news despite the many sources of information I have.  But let me take this opportunity to say that the FDA has been more obstructive than helpful regarding needed advances in cancer imaging.  The most egregious rejection in my lifetime in medicine is that of ultrasmall superparamagnetic iron oxide (USPIO) aka Combidex aka ferumoxtran-10 aka nano-MRI for visualizing metastatic nodes in virtually every solid tumor, including common malignancies such as prostate cancer, lung, breast, renal, etc cancers. And given that such an advance involves MRI and not CT, the lack of radiation exposure is another plus.  As I type this, one of my PC patients is in quarantine in The Netherlands getting ready for a nano-MRI at Radboud University.  Those setting on ODAC, instead of doing their due diligence and investigating Combidex more thoroughly, simply voted against Combidex. Millions of lives, billions if not trillions of dollars, all wasted because of the ignorance of that ODAC panel.  What we are seeing in this country is a move towards mediocrity and not excellence.