Can 68 Ga-PSMA PET/CT Guide Treatment for Biochemical Recurrence After Prostatectomy?

What is it about?

This study evaluated the role of multiparametric magnetic resonance imaging (mpMRI) and Gallium-68 (68 Ga)-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) in guiding salvage therapy for patients with biochemical recurrence (BCR) after radical prostatectomy. A total of 117 patients underwent paired scans to investigate BCR, of whom 53.0% (62/117) had detectable lesions on initial scans and 47.0% (55/117) did not. Of those without detectable lesions, 8/55 patients proceeded to immediate salvage radiotherapy (sRT) and 47/55 were observed. Of patients with negative imaging who were initially observed, 46.8% (22/47) did not reach threshold for repeat imaging, while 53.2% were rescanned due to rising PSA levels. Of these rescanned patients, 31.9% (15/47) were spared sRT due to proven distant disease, or due to absence of disease on repeat imaging. The study found that patients with high-risk features who underwent sRT despite negative imaging demonstrated satisfactory PSA responses to sRT. The study suggests that mpMRI and 68 Ga-PSMA PET/CT can help tailor salvage therapy to detected lesions, potentially reducing unnecessary sRT-related morbidity. However, the study's observational design and lack of cause-specific or overall survival data are limitations.

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Why is it important?

This study highlights the potential of using multiparametric magnetic resonance imaging (mpMRI) and Gallium-68 (68 Ga)-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) in guiding salvage therapy for patients with biochemical recurrence (BCR) post-radical prostatectomy. By using these advanced imaging techniques, patients can be spared unnecessary salvage radiation therapy-related morbidity. The findings support the use of mpMRI and 68 Ga-PSMA PET/CT in guiding the timing and necessity of salvage therapy tailored to detected lesions, which could lead to better management of patients with BCR. Key Takeaways: 1. The study involved 117 patients who underwent paired scans to investigate BCR, with 53.0% (62/117) having detectable lesions on initial scans and 47.0% (55/117) not having any detectable lesions. 2. Of the patients with negative imaging who were initially observed, 46.8% (22/47) did not reach threshold for repeat imaging, while 53.2% were rescanned due to rising PSA levels. 3. Of the patients rescanned, 31.9% (15/47) were spared early salvage radiotherapy (sRT) due to proven distant disease or absence of disease on repeat imaging. 4. Patients with high-risk features who underwent sRT despite negative imaging demonstrated satisfactory PSA responses to sRT. 5. The study highlights the potential of using mpMRI and 68 Ga-PSMA PET/CT in guiding salvage therapy and reducing unnecessary sRT-related morbidity.