Can 68 Ga-PSMA-11 Positron Emission Tomography/Computerized Tomography Predict Pathological Response of Primary Prostate Cancer to Neoadjuvant Androgen Deprivation Therapy? A Pilot Study

No AccessJournal of UrologyAdult Urology1 Apr 2021Can 68Ga-PSMA-11 Positron Emission Tomography/Computerized Tomography Predict Pathological Response of Primary Prostate Cancer to Neoadjuvant Androgen Deprivation Therapy? A Pilot StudyThis article is commented on by the following:Editorial CommentEditorial Comment Mengxia Chen, Junlong Zhuang, Yao Fu, Suhan Guo, Shiming Zang, Shuyue Ai, Xuefeng Qiu, Feng Wang, and Hongqian Guo Mengxia ChenMengxia Chen Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China Institute of Urology, Nanjing University, Nanjing, China , Junlong ZhuangJunlong Zhuang Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China Institute of Urology, Nanjing University, Nanjing, China , Yao FuYao Fu Department of Pathology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China , Suhan GuoSuhan Guo Institute of Urology, Nanjing University, Nanjing, China , Shiming ZangShiming Zang Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China , Shuyue AiShuyue Ai Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China , Xuefeng QiuXuefeng Qiu †Correspondence: Medical School of Nanjing University, 140 Hanzhong Rd., Gulou, Ninjing, Jiangsu , China210029 E-mail Address: [email protected] Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China Institute of Urology, Nanjing University, Nanjing, China , Feng WangFeng Wang † E-mail Address: [email protected] Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China , and Hongqian GuoHongqian Guo † E-mail Address: [email protected] Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China Institute of Urology, Nanjing University, Nanjing, China View All Author Informationhttps://doi.org/10.1097/JU.0000000000001481AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We explored the role of 68Ga-PSMA-11 positron emission/computerized tomography as a predictor of pathological response to neoadjuvant androgen deprivation therapy combined with abiraterone for high risk prostate cancer. Materials and Methods: A total of 45 patients with localized high risk prostate cancer who had serial 68Ga-PSMA-11 positron emission tomography/computerized tomography scans before and after 6 months of androgen deprivation therapy plus abiraterone neoadjuvant treatment followed by radical prostatectomy were included in this study. Complete pathological response or minimal residual disease <5 mm on whole mount histopathology was defined as favorable pathological response. The diagnostic performance of prostate specific antigen response and positron emission tomography/computerized tomography response for favorable pathological response was calculated. Univariable and multivariable logistic regression analyses of clinical and imaging variables were also performed to identify favorable pathological response. Results: Compared to the prostate specific antigen response, positron emission tomography/computerized tomography response had a significantly higher specificity in diagnosing favorable pathological response (89.7% vs 62.1%, p=0.043). Preoperative nadir prostate specific antigen (OR 0.121, 95% CI 0.028–0.529, p=0.005), posttreatment maximum standardized uptake value (OR 7.072, 95% CI 2.035–24.579, p=0.002) and posttreatment tumor volume (OR 7.896, 95% CI 1.415–44.054, p=0.018) measured on positron emission tomography/computerized tomography were significantly associated with favorable pathological response in univariable logistic regression analysis. On multivariable logistic regression analysis, only posttreatment maximum standardized uptake value was found to be an independent predictor of favorable pathological response (OR 9.69, 95% CI 1.439–65.242, p=0.020). Conclusions: 68Ga-PSMA positron emission tomography/computerized tomography has a better diagnostic performance of pathological response to neoadjuvant treatment compared with prostate specific antigen, with maximum standardized uptake value being an independent predictive factor. This pilot study suggests that prostate specific membrane antigen positron emission tomography/computerized tomography may serve as a potential predictor of pathological response to neoadjuvant treatment. References 1. : Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2019; 17: 479. Google Scholar 2. : EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 2017; 71: 618. Google Scholar 3. : Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol 2011; 185: 869. Link, Google Scholar 4. : Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol 2009; 27: 4300. Google Scholar 5. : A systematic review and meta-analysis of randomised trials of neo-adjuvant hormone therapy for localised and locally advanced prostate carcinoma. Cancer Treat Rev 2009; 35: 9. Google Scholar 6. : Indirect comparisons of efficacy between combination approaches in metastatic hormone-sensitive prostate cancer: a systematic review and network meta-analysis. Eur Urol 2020; 77: 365. Google Scholar 7. : Intense androgen-deprivation therapy with abiraterone acetate plus leuprolide acetate in patients with localized high-risk prostate cancer: results of a randomized phase II neoadjuvant study. J Clin Oncol 2014; 32: 3705. Google Scholar 8. : Evaluation of intense androgen deprivation before prostatectomy: a randomized phase II trial of enzalutamide and leuprolide with or without abiraterone. J Clin Oncol 2019; 37: 923. Google Scholar 9. : Clinical and biological characterisation of localised high-risk prostate cancer: results of a randomised preoperative study of a luteinising hormone-releasing hormone agonist with or without abiraterone acetate plus prednisone. Eur Urol 2019; 76: 418. Google Scholar 10. : Neoadjuvant enzalutamide prior to prostatectomy. Clin Cancer Res 2017; 23: 2169. Google Scholar 11. : Post prostatectomy outcomes of patients with high-risk prostate cancer treated with neoadjuvant androgen blockade. Prostate Cancer Prostatic Dis 2018; 21: 364. Google Scholar 12. : Prostate-specific membrane antigen protein expression in tumor tissue and risk of lethal prostate cancer. Cancer Epidemiol Biomarkers Pre 2013; 22: 2354. Google Scholar 13. : Assessment of 68Ga-PSMA-11 PET accuracy in localizing recurrent prostate cancer: a prospective single-arm clinical trial. JAMA Onco 2019; 5: 856. Google Scholar 14. : Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 2020; 395: 1208. Google Scholar 15. : Prostate-specific membrane antigen cleavage of vitamin B9 stimulates oncogenic signaling through metabotropic glutamate receptors. J Exp Med 2018; 215: 159. Google Scholar 16. : Influence of androgen deprivation therapy on PSMA expression and PSMA-ligand PET imaging of prostate cancer patients. Eur J Nucl Med Mol Imaging 2020; 47: 9. Google Scholar 17. : Combination of (68)Ga-PSMA PET/CT and multiparametric MRI improves the detection of clinically significant prostate cancer: a lesion-by-lesion analysis. J Nucl Med 2019; 60: 944. Google Scholar 18. : Patterns of spread of adenocarcinoma in the prostate as related to cancer volume. Prostate 2001; 49: 48. Google Scholar 19. Retraction. Pharmacogenomic strategies provide a rational approach to the treatment of cisplatin-resistant patients with advanced cancer. J Clin Oncol 25:4350–7, 2007. J Clin Oncol 2010; 28: 5229. Google Scholar 20. : Seven-month prostate-specific antigen is prognostic in metastatic hormone-sensitive prostate cancer treated with androgen deprivation with or without docetaxel. J Clin Oncol 2018; 36: 376. Google Scholar 21. : Consensus statements on PSMA PET/CT response assessment criteria in prostate cancer. Eur J Nucl Med Mol Imaging 2020; doi: 10.1007/s00259-020-04934-4. Crossref, Google Scholar 22. : Nonparametric analysis of clustered ROC curve data. Biometrics 1997; 53: 567. Google Scholar 23. : (68)Ga-PSMA PET/CT imaging predicting intraprostatic tumor extent, extracapsular extension and seminal vesicle invasion prior to radical prostatectomy in patients with prostate cancer. Nucl Med Mol Imaging 2017; 51: 314. Google Scholar 24. : 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. Google Scholar 25. : Prostate-specific antigen: a review of the validation of the most commonly used cancer biomarker. Cancer 2004; 101: 894. Google Scholar 26. : Prognostic value of biochemical response to neoadjuvant androgen deprivation before external beam radiotherapy for prostate cancer: a systematic review of the literature. Cancer Treat Rev 2016; 46: 35. Google Scholar 27. : Prostate-specific antigen nadir and cancer-specific mortality following hormonal therapy for prostate-specific antigen failure. J Clin Oncol 2005; 23: 6556. Google Scholar 28. : Absolute prostate-specific antigen value after androgen deprivation is a strong independent predictor of survival in new metastatic prostate cancer: data from Southwest Oncology Group Trial 9346 (INT-0162). J Clin Oncol 2006; 24: 3984. Google Scholar 29. : Clinical and genomic characterization of low-prostate-specific antigen, high-grade prostate cancer. Eur Urol 2018; 74: 146. Google Scholar Supported by grants from Nanjing Medical Science and technique Development Foundation (QRX17128), the National Natural Science Foundation of China (81772710,81972388), the Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Key Medical Discipline (Laboratory) (ZDXKB2016014). © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyJan 25, 2021, 12:00:00 AMEditorial CommentJournal of UrologyJan 25, 2021, 12:00:00 AMEditorial Comment Volume 205Issue 4April 2021Page: 1082-1089Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsprostatectomyforecastingpathology, clinicalprostate-specific antigenneoadjuvant therapyMetricsAuthor Information Mengxia Chen Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China Institute of Urology, Nanjing University, Nanjing, China Equal study contribution. More articles by this author Junlong Zhuang Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China Institute of Urology, Nanjing University, Nanjing, China Equal study contribution. More articles by this author Yao Fu Department of Pathology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China Equal study contribution. More articles by this author Suhan Guo Institute of Urology, Nanjing University, Nanjing, China More articles by this author Shiming Zang Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China More articles by this author Shuyue Ai Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China More articles by this author Xuefeng Qiu Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China Institute of Urology, Nanjing University, Nanjing, China †Correspondence: Medical School of Nanjing University, 140 Hanzhong Rd., Gulou, Ninjing, Jiangsu , China210029 E-mail Address: [email protected] More articles by this author Feng Wang Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China † E-mail Address: [email protected] More articles by this author Hongqian Guo Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China Institute of Urology, Nanjing University, Nanjing, China † E-mail Address: [email protected] More articles by this author Expand All Supported by grants from Nanjing Medical Science and technique Development Foundation (QRX17128), the National Natural Science Foundation of China (81772710,81972388), the Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Key Medical Discipline (Laboratory) (ZDXKB2016014). Advertisement PDF DownloadLoading ...