Possibilities of using prostate specific membrane antigen (PSMA) ligands in the diagnosis and treatment of prostate cancer

Česká verzia

Authors: Hana Sedláčková ¹; Olga Dolejšová ¹; Tomáš Pitra ¹; Jiří Ferda ²; Eva Ferdová ²; Jan Baxa ²; Milan Hora
Authors place of work: Urologická klinika, Fakultní nemocnice Plzeň ¹; Klinika zobrazovacích metod, Fakultní nemocnice Plzeň ²
Published in the journal: Ces Urol 2020; 24(4): 247-260
Category: Review article

Summary

Sedláčková H, Dolejšová O, Pitra T, Ferda J, Fer‑ dová E, Baxa J, Hora M. Possibilities of using prostate specific membrane antigen (PSMA) ligands in the diagnosis and treatment of prostate cancer.

Multiparametric magnetic resonance imaging of prostate (mpMR) or hybrid imaging using positron emission tomography and computed tomography or magnetic resonance imaging (PET/CT, PET/MR) entered into common practice in diagnostics. They have proven to be successful in diagnostics, but also in detection of biochemical recurrence. Due to the low specificity, but also the sensitivity, especially at low prostate specific antigen (PSA) level in the bio‑ chemical relapse (BCR) PSA ≤ 1 ug/l, new radiotracers are sought to improve diagnostics and then to conduce to the correct treatment decision. Given the fact that the overexpression of PSMA on prostate cancer cells, its further investigated for use in therapy such as radio-guided surgery or radiolabeled with alpha or beta radiation emitters for radiotherapy.

According to the available systematic reviews and clinical trials, the sensitivity and specificity in primary staging of prostate cancer using PSMA ligands is usually above 40% (23–100%) and more than 85% (67–100%), respectively. Whereas in the detection of biochemical relapse the sensitivity is above 75% and the specificity is about 99%. Using PSMA ligands in performing PET/CT or less frequently PET/MRI has the impact on changes in therapeutic procedure, approximately in 21% of patients in primary staging and in patients with biochemical relapse up to 51%.

Current promising results from clinical trials have led to the incorporation of hybrid imaging using PSMA ligands into European urological guidelines.

Keywords:

diagnostics – PET/CT – PET/MRI – prostate cancer – PSMA

Zdroje

1. von Eyben FE, Picchio M, von Eyben R, Rhee H, Bauman G. 68Ga‑Labeled Prostate‑specific Membrane Antigen Ligand Positron Emission Tomography/Computed Tomography for Prostate Cancer: A Systematic Review and Meta‑analysis. European Urology Focus 2018; 4(5): 686–693.

2. Zaman M, Fatima N, Zaman A, et al. Diagnostic Challenges in Prostate Cancer and 68Ga‑PSMA PET Imaging: A Game Changer? Asian Pac J Cancer Prev [Internet]. jen 2017 [citován 2. říjen 2019]; 18(10). Dostupné z: http://doi.org/10.22034/APJCP.2017. 18. 10.2625

3. Cary KC, Punnen S, Odisho AY, et al. Nationally representative trends and geographic variation in treatment of localized prostate cancer: the Urologic Diseases in America project. Prostate Cancer Pro‑ static, DiS 2015; 18(2): 149–154.

4. Dolejsova O, Eret V, Sobrova A, et al. Využití multiparametrickeé magnetické rezonance a srovnaní s ostatními moderními zobrazovacími metodami v predoperační diagnostice karcinomu prostaty. Ces Urol 2014; 18(4): 300–309.

5. Ferda J, Ferdová E, Tupý R, Baxa J. Hybridní zobrazení PET/MR u karcinomu prostaty. Čas Lék čes 2018; 157: 169–174: 6.

6. Ferda J, Vokurka S, Ferdová E, et al. The application of the prostatic specific membrane antigene ligand 68Ga‑PSMA-11 in imaging of prostatic tumors using PET/ CT and PET/MRI – initial experience with tolerance of the applied substance and imaging quality. Ces Radiol 2018; 72(1): 51–57: 7.

7. Herlemann A, Wenter V, Kretschmer A, et al. 68Ga‑PSMA Positron Emission Tomography/Computed Tomography Provides Accurate Staging of Lymph Node Regions Prior to Lymph Node Dissection in Patients with Prostate Cancer. European Urology 2016; 70(4): 553–557.

8. Rowe SP, Pienta KJ, Pomper MG, Gorin MA. PSMA‑RADS Version 1.0: A Step Towards Standardizing the Interpretation and Reporting of PSMA–targeted PET Imaging Studies. European Urology 2018; 73(4): 485–487.

9. Rhee H, Thomas P, Shepherd B, et al. Prostate Specific Membrane Antigen Positron Emission Tomography May Improve the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Localized Prostate Cancer. Journal of Urology 2016; 196(4): 1261–1267.

10. Perera M, Papa N, Roberts M, et al. Gallium-68 Prostate‑specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer – Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate‑specific Membrane Antigen‑avid Lesions: A Systematic Review and Meta‑analysis. European Urology 2020; 77(4): 403–417.

11. Ghosh A, Heston WDW. Tumor target prostate specific membrane antigen (PSMA) and its regulation in prostate cancer. Journal of Cellular Biochemistry 2004; 91(3): 528–539.

12. Eiber M, Fendler WP, Rowe SP, et al. Prostate‑Specific Membrane Antigen Ligands for Imaging and Therapy. Journal of Nuclear Medicine 2017; 58(Supplement 2): 67S–76S.

13. Afshar‑Oromieh A, Malcher A, Eder M, et al. PET imaging with a [68Ga]gallium‑labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. European Journal of Nuclear Medicine and Molecular Imaging 2013; 40(4): 486–495.

14. Eiber M, Herrmann K, Calais J, et al. Prostate Cancer Molecular Imaging Standardized Evaluation (PRO‑ MISE): Proposed miTNM Classification for the Interpretation of PSMA‑Ligand PET/CT. Journal of Nuclear Medicine 2018; 59(3): 469–478.

15. Afshar‑Oromieh A, Avtzi E, Giesel FL, et al. The diagnostic value of PET/CT imaging with the 68Ga‑ ‑labelled PSMA ligand HBED‑CC in the diagnosis of recurrent prostate cancer. European Journal of Nuclear Medicine and Molecular Imaging 2015; 42(2): 197–209.

16. Rauscher I, Düwel C, Haller B, et al. Efficacy, Predictive Factors, and Prediction Nomograms for 68Ga‑labeled Prostate‑specific Membrane Antigen‑ligand Positron‑emission Tomography/Computed Tomography in Early Biochemical Recurrent Prostate Cancer After Radical Prostatectomy. European Urology 2018; 73(5): 656–661.

17. Dietlein M, Kobe C, Kuhnert G, et al. Comparison of [18 F]DCFPyL and [68Ga]Ga‑PSMA‑HBED‑CC for PSMA‑PET Imaging in Patients with Relapsed Prostate Cancer. Molecular Imaging and Biology 2015; 17(4): 575–584.

18. De Visschere PJL, Standaert C, Fütterer JJ, et al. A Systematic Review on the Role of Imaging in Early Recurrent Prostate Cancer. European Urology Oncology 2019; 2(1): 47–76.

19. Eiber M, Weirich G, Holzapfel K, et al. Simultaneous 68Ga‑PSMA HBED‑CC PET/MRI Improves the Localization of Primary Prostate Cancer. European Urology 2016; 70(5): 829–836.

20. Giesel FL, Hadaschik B, Cardinale J, et al. F-18 labelled PSMA-1007: biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. European Journal of Nuclear Medicine and Molecular Imaging 2017; 44(4): 678–688.

21. Maurer T, Gschwend JE, Rauscher I, et al. Diagnostic Efficacy of 68Gallium‑PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer. Journal of Urology 2016; 195(5): 1436–1443.

22. Uprimny C, Kroiss AS, Decristoforo C, et al. 68Ga‑PSMA-11 PET/CT in primary staging of prostate can‑ cer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. European Journal of Nuclear Medicine and Molecular Imaging 2017; 44(6): 941–949.

23. Stejskal J, Jaskova V, Pavlicko A, et al. Diagnostika karcinomu prostaty pomocí fuzní biopsie. Ces Urol 2018; 22(2): 87–98.

24. Zalesky M, Stejskal J, Minarik I, et al. Porovnání detekce signifikantniho a nesignifikantniho karcinomu pomoci systematicke a cilene fuzní MRI/TRUS biopsie prostaty. Ces Urol 2018; 22(2): 115–121.

25. Kudlackova S, Kral M, Koranda P, Student V. 18-F cholin PET CT v primodiagnostice karcinomu pro‑ staty. Ces Urol 2016; 20(1): 57–64.

26. Zettinig O, Shah A, Hennersperger C, et al. Multimodal image‑guided prostate fusion biopsy based on automatic deformable registration. International Journal of Computer Assisted Radiology and Surgery 2015; 10(12): 1997–2007.

27. Storz E, Shah A, Zettinig O, et al. 217 PSMA‑PET/MRI‑guided transrectal fusion biopsy for the detection of prostate cancer. European Urology Supplements 2015; 14: e217.

28. Krimphove M, Theissen L, Cole A, et al. Performance and Impact of Prostate Specific Membrane Antigen‑Based Diagnostics in the Management of Men with Biochemical Recurrence of Prostate Cancer and Its Role in Salvage Lymph Node Dissection. The World Journal of Men’s Health 2020; 38(1): 32–47.

29. Rauscher I, Düwel C, Wirtz M, et al. Value of 111In‑prostate‑specific membrane antigen (PSMA)-radio‑guided surgery for salvage lymphadenectomy in recurrent prostate cancer: correlation with histopathology and clinical follow‑up. BJU International 2017; 120(1): 40–47.

30. Maurer T, Robu S, Schottelius M, et al. 99mTechnetium‑based Prostate‑specific Membrane Antigen– radioguided Surgery in Recurrent Prostate Cancer. European Urology 2019; 75(4): 659–666.

31. Zhang Q, Helfand BT, Carneiro BA, et al. Efficacy Against Human Prostate Cancer by Prostate‑specific Membrane Antigen‑specific, Transforming Growth Factor‑β Insensitive Genetically Targeted CD8+ T‑cells Derived from Patients with Metastatic Castrate‑resistant Disease. European Urology 2018; 73(5): 648–652.

32. Lamb AD, Bryant RJ, Mills IG, Hamdy FC. First Report of Prostate‑specific Membrane Antigen–targeted Immunotherapy in Prostate Cancer: The Future is Bright. European Urology 2018; 73(5): 653–655.

33. Roach PJ, Francis R, Emmett L, et al. The Impact of 68Ga‑PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study. Journal of Nuclear Medicine 2018; 59(1): 82–88.

34. Han S, Woo S, Kim YJ, Suh CH. Impact of 68Ga‑PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta‑analysis. European Urology 2018; 74(2): 179–190.