Current Clinical Applications of PSMA-PET for Prostate Cancer Diagnosis, Staging, and Treatment

Cancers, Journal Year: 2024, Volume and Issue: 16(24), P. 4263 - 4263

Published: Dec. 21, 2024

Over the past decade, prostate-specific membrane antigen positron emission tomography (PSMA-PET) has revolutionized prostate cancer (PCa) imaging, offering greater sensitivity and specificity compared to conventional imaging modalities such as CT, MRI, bone scintigraphy. PSMA-PET is particularly valuable in staging newly diagnosed patients with intermediate- high-risk disease, detecting biochemical recurrence, evaluating metastatic cases. By utilizing radiotracers that accumulate specifically PSMA-expressing cells, even small metastases can be detected, a detailed assessment of extent enabling more targeted diagnostic evaluations. Among most utilized radiotracers, [68Ga]- [18F]-labeled PSMA tracers enable precise low disease burden. This precision also supports advanced therapeutic approaches, including metastasis-directed therapy for oligometastatic cases systemic treatment options, radioligand therapy, which presents new perspectives metastatic, castration-resistant PCa. review examines evolution diagnostics PCa while comparing current recommendations from leading clinical guidelines. The integration into practice redefined management PCa, improving accuracy personalized strategies, lacking prospective long-term outcome data. As continues expand application, this highlights its significant advancements critically addressing limitations ensure balanced evidence-based implementation care.

Language: Английский

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Progression-directed Therapy in Oligoprogressive Castration-resistant Prostate Cancer: Final Results from the Prospective, Single-arm, Phase 2 MEDCARE Trial

European Urology Oncology, Journal Year: 2024, Volume and Issue: unknown

Published: April 1, 2024

Language: Английский

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Is There a Role for FAPI PET in Urological Cancers?

Molecular Diagnosis & Therapy, Journal Year: 2024, Volume and Issue: 28(6), P. 721 - 725

Published: Aug. 24, 2024

This work aims to investigate the utility of positron emission tomography/computed tomography (PET/CT) with fibroblast activation protein inhibitors (FAPI) in urological neoplasms, including prostate cancer, urothelial carcinoma, and renal cell carcinoma. Although available data are very preliminary, FAPI PET showed potential for detecting primary cancer low prostate-specific membrane antigen expression, while PET/CT outperformed biochemical recurrence. In demonstrated increased detection rates compared deoxy-2-[18F]fluoro-d-glucose PET/CT, particular small lymph node metastases, whose identification is still an unmet clinical need. Limited conclusion, emerges as a promising imaging modality bladder cancer. Further research warranted establish its role guiding therapeutic decisions novel theranostic agent.

Language: Английский

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Ultrasound and advanced imaging techniques in prostate cancer diagnosis: A comparative study of mpMRI, TRUS, and PET/CT

Journal of X-Ray Science and Technology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 12, 2025

Objective This study aims to assess and compare the diagnostic performance of three advanced imaging modalities—multiparametric magnetic resonance (mpMRI), transrectal ultrasound (TRUS), positron emission tomography/computed tomography (PET/CT)—in detecting prostate cancer in patients with elevated PSA levels abnormal DRE findings. Methods A retrospective analysis was conducted on 150 male aged 50–75 years DRE. The accuracy each modality assessed through sensitivity, specificity, area under curve (AUC) clinically significant (Gleason score ≥ 7). Results MpMRI demonstrated highest performance, a sensitivity 90%, specificity 85%, AUC 0.92, outperforming both TRUS (sensitivity 76%, 78%, 0.77) PET/CT 82%, 80%, 0.81). detected tumors 80% cases. Although had similar detection rates for tumors, their overall lower. Minor adverse events occurred 5% undergoing TRUS, while no complications were associated mpMRI or PET/CT. Conclusion These findings suggest that is most reliable early cancer. It reduces need unnecessary biopsies optimizes patient management.

Language: Английский

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The expanding role of next-generation imaging in prostate cancer management: a cross-sectional survey exploring the clinical practice of uro-oncologists in North-Eastern Italy; on behalf of GUONE (Gruppo Uro-Oncologico del Nord-Est)

Therapeutic Advances in Urology, Journal Year: 2025, Volume and Issue: 17

Published: March 1, 2025

Background: Next-generation imaging (NGI) technologies such as multiparametric magnetic resonance (mpMRI) and total-body NGI (tbNGI) methodologies including choline, fluciclovine or PSMA positron emission tomography/computed tomography (PET/CT), whole-body MRI (wbMRI), PET/MRI are becoming increasingly available, but their use in different prostate cancer (PCa) settings is under debate. The Gruppo Uro-Oncologico del Nord-Est (GUONE) designed a survey to explore the current clinical practice of utilization specific macro-region North-Eastern Italy. Methods: A cross-sectional was conducted by administering an anonymous online multiple-choice questionnaire uro-oncologists practicing Italy, using Google Forms ® platform. investigated following settings: primary staging PCa; management biochemical (BCR) local recurrence (LR); re-staging metastatic hormone-sensitive PCa (mHSPC), castration-resistant (mCRPC), non-metastatic CRPC (nmCRPC), oligometastatic (OMPC). Results: In all, 100 accessed completed survey. N/M staging, tbNGI increases accordance with NCCN risk groups. Re-staging choline PET/CT prevalent choice case BCR after radical prostatectomy. Moreover, when PSA value rises, there parallel increased tbNGI. When LR suspected, plus mpMRI most selected option. (PSMA PET/CT) preferred mHSPC, mCRPC, nmCRPC patients progression disease. Overall, limited wbMRI all investigated. Conclusion: Our describes expanding role modalities patients, from advanced assessment treatment response. Several controversial issues have emerged, which need be addressed prospective studies develop standardized cost-effective utilization.

Language: Английский

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Nuclear medicine imaging for bone metastases assessment: what else besides bone scintigraphy in the era of personalized medicine?

Frontiers in Medicine, Journal Year: 2024, Volume and Issue: 10

Published: Jan. 15, 2024

Accurate detection and reliable assessment of therapeutic responses in bone metastases are imperative for guiding treatment decisions, preserving quality life, ultimately enhancing overall survival. Nuclear imaging has historically played a pivotal role this realm, offering diverse range radiotracers modalities. While the conventional scan using 99m Tc marked bisphosphonates remained widely utilized, its diagnostic performance is hindered by certain limitations. Positron emission tomography, particularly when coupled with computed provides improved spatial resolution various pathology-specific radiotracers. This review aims to evaluate different nuclear modalities clinical practice detecting monitoring origins, addressing their limitations implications image interpretation.

Language: Английский

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ML Models Built Using Clinical Parameters and Radiomic Features Extracted from 18F-Choline PET/CT for the Prediction of Biochemical Recurrence after Metastasis-Directed Therapy in Patients with Oligometastatic Prostate Cancer

Diagnostics, Journal Year: 2024, Volume and Issue: 14(12), P. 1264 - 1264

Published: June 15, 2024

Oligometastatic patients at [18F]F-Fluorocholine (18F-choline) PET/CT may be treated with metastasis-directed therapy (MDT). The aim of this study was to combine radiomic parameters extracted from 18F-choline and clinical data build machine learning (ML) models able predict MDT efficacy. Methods: Oligorecurrent (≤5 lesions) were collected. A per-patient per-lesion analysis performed, using 2-year biochemical recurrence (BCR) after as the standard reference. Clinical features (RFts) used for training five ML Models both CT PET images. performance metrics calculated (i.e., Area Under Curve—AUC; Classification Accuracy—CA). Results: total 46 metastases selected segmented in 29 patients. BCR occurred 20 (69%) 2 years follow-up. In total, 73 33 robust RFTs datasets, respectively. showed better performances than discriminating MDT, Stochastic Gradient Descent (SGD) being best model (AUC = 0.95; CA 0.90). Conclusion: built RFts via can accurately oligorecurrent PCa If validated externally, could improve selection treatment MDT.

Language: Английский

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Atypical Metastases from Prostate Cancer: Alpha-Methylacyl-Coenzyme A Racemase (AMACR) as a Potential Molecular Target in Prostate-Specific Membrane Antigen-Negative Prostate Adenocarcinoma

Biomolecules, Journal Year: 2024, Volume and Issue: 15(1), P. 17 - 17

Published: Dec. 26, 2024

Prostate cancer (PCa) is a high-prevalence disease usually characterized by metastatic spread to the pelvic lymph nodes and bones development of visceral metastases only in late stages disease. Positron Emission Tomography (PET) plays key role detection PCa metastases. Several PET radiotracers are used patients according stage pathological features disease, particular 68Ga/18F-prostate-specific membrane antigen (PSMA) ligands. Moreover, 2-deoxy-2-[18F]fluoro-D-glucose 18F-FDG shows when dedifferentiated neoplastic clones lose PSMA expression. In some cases, may present atypical sites metastases, with uncommon appearance at imaging different radiotracers. We case patient biochemical recurrence (ISUP Grade Group IV; PSA 4.7 ng/mL) showing (the testis multiple lung nodules) absent expression high [18F]FDG avidity. The showed diffuse positivity alpha-methylacyl-coenzyme A racemase (AMACR). literature review was performed collecting cases detected via imaging, aim highlighting relationship between presentation, pathology findings.

Language: Английский

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Therapeutic Challenges in Metastatic Castration-Resistant Prostate Cancer: A Case Study and Review of Prostate-Specific Membrane Antigen-Targeted Therapy Failures in Highly Prostate-Specific Membrane Antigen-Avid Disease

Cureus, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 22, 2024

Prostate cancer (PCa) is a leading cause of cancer-related deaths globally, with metastatic castration-resistant prostate (mCRPC) posing significant treatment challenges. This case report discusses 65-year-old male mCRPC who initially responded to hormonal therapy but later showed disease progression despite additional chemotherapy. He subsequently received 177Lu-PSMA and 225Ac-PSMA therapies, both which failed halt having an intense PSMA avid disease. highlights the complexity responses in mCRPC, particularly when avidity does not correlate therapeutic effectiveness. It suggests that underlying genomic alterations may contribute resistance, highlighting potential role circulating tumor DNA (ctDNA) identifying biomarkers predict outcomes. Further research necessary explore these genomics, along other resistance mechanisms, enhance personalized strategies for patients mCRPC.

Language: Английский

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The Value of Stereotactic Proton Therapy for Metastasis-Directed Therapy in Castration-Refractory Prostate Cancer: A Planning Comparison with Stereotactic Photon Therapy

Published: Jan. 1, 2024

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Language: Английский

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