Prostate-specific Membrane Antigen-based Imaging of Castration-resistant Prostate Cancer

Manuel Weber; Boris Hadaschik; Justin Ferdinandus; Kambiz Rahbar; Martin Bögemann; Ken Herrmann; Wolfgang P Fendler; Claudia Kesch

doi:10.1016/j.euf.2021.01.002

Prostate-specific Membrane Antigen-based Imaging of Castration-resistant Prostate Cancer

Eur Urol Focus. 2021 Mar;7(2):279-287. doi: 10.1016/j.euf.2021.01.002. Epub 2021 Jan 20.

Authors

Manuel Weber¹, Boris Hadaschik², Justin Ferdinandus³, Kambiz Rahbar⁴, Martin Bögemann⁵, Ken Herrmann³, Wolfgang P Fendler³, Claudia Kesch²

Affiliations

¹ Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; West German Cancer Center. Electronic address: manuel.weber@uk-essen.de.
² West German Cancer Center; Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.
³ Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; West German Cancer Center.
⁴ West German Cancer Center; Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.
⁵ West German Cancer Center; Department of Urology, University Hospital Münster, Münster, Germany.

PMID: 33483289
DOI: 10.1016/j.euf.2021.01.002

Abstract

Context: Positron emission tomography (PET) targeting prostate-specific membrane antigen (PSMA) has unprecedented accuracy for localization of initial or recurrent prostate cancer (PC). There is now growing evidence regarding the value of PSMA-PET in patients with advanced PC.

Objective: To review the value of PSMA-PET/computed tomography (CT) in the context of castration-resistant PC (CRPC).

Evidence acquisition: A search of the PubMed database using the terms "PSMA PET castration resistant prostate cancer" (years 2011-2020) was performed. Reviews, case reports/series, non-English articles, preclinical studies, access-restricted studies, and studies on PSMA radioligand therapy without further analysis of PSMA-PET parameters were subsequently excluded.

Evidence synthesis: Compared to conventional imaging, PSMA-PET better identifies the true extent of CRPC, especially nonmetastatic CRPC. The clinical benefit of this stage migration is still unclear and needs to be evaluated in further studies. High accuracy of PSMA-PET holds promise for better, PET-guided metastasis-directed treatment in patients with oligometastatic CRPC. PSMA-PET is an essential eligibility criterion for [¹⁷⁷Lu]-PSMA theranostic applications. Preliminary evidence indicates the value of PSMA-PET for the assessment of treatment responses.

Conclusions: Among other applications, PSMA-PET offers more precise staging for nonmetastatic CRPC. In particular, target localization for metastasis-directed therapy and target expression assessment for PSMA radioligand therapy also hold promise. Potential translation of this diagnostic tool into an oncologic benefit needs to be defined in future trials.

Patient summary: This review describes how prostate-specific membrane antigen positron emission tomography (PSMA-PET), a new sensitive imaging tool for prostate cancer, might help to guide clinicians in making treatment decisions for advanced prostate cancer.

Keywords: Castration-resistant prostate cancer; Positron emission tomography; Prostate Cancer Working Group criteria; Prostate cancer; Prostate-specific membrane antigen.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Humans
Male
Neoplasm Recurrence, Local
Prostate
Prostatic Neoplasms, Castration-Resistant* / diagnostic imaging