HealingWell
Search Close Search
☰

The Current Landscape of PSMA Imaging for Aggressive PCa

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 2/29/2024 9:07 AM (GMT 0)
The Current Landscape of Prostate-Specific Membrane Antigen (PSMA) Imaging Biomarkers for Aggressive Prostate Cancer (2024, Review, Full Text)

"Simple Summary
The review explores the critical role of prostate-specific membrane antigen (PSMA) PET/CT imaging in diagnosing, staging, and treating prostate cancer. PSMA PET/CT offers superior diagnostic capabilities for identifying prostate cancer’s spread, with potential as a prognostic indicator for the disease’s recurrence and survival. It highlights PSMA’s variability in expression, impacting personalised treatment plans, notably in radioligand therapy with [177Lu] Lu-PSMA-617. This technology enhances treatment strategies, improves outcomes, and reduces unnecessary interventions, marking a significant advancement in personalised prostate cancer management.

Abstract
The review examines the vital role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the diagnosis, staging, and treatment of prostate cancer (PCa). It focuses on the superior diagnostic abilities of PSMA PET/CT for identifying both nodal and distant PCa, and its potential as a prognostic indicator for biochemical recurrence and overall survival. Additionally, we focused on the variability of PSMA’s expression and its impact on personalised treatment, particularly the use of [177Lu] Lu-PSMA-617 radioligand therapy. This review emphasises the essential role of PSMA PET/CT in enhancing treatment approaches, improving patient outcomes, and reducing unnecessary interventions, positioning it as a key element in personalised PCa management.

1. Introduction

2. Correlation between PSMA’s Expression and Prognosis in Localised Disease
2.1. Low or Negative Expression of PSMA
2.2. Heterogeneity in PSMA’s Expression
2.3. Expression of PSMA and Histological Correlations: Pretreatment Biomarker
2.4. Correlation between Pretreatment PSMA PET and BCR

3. PSMA PET Imaging-Directed Therapy and Measures of Treatment Response
3.1. PSMA PET/CT Directed External Beam Radiation Therapy (RT)
3.2. PSMA PET/CT and Hormonal Therapy—A Measure of Treatment Response
3.3. PSMA PET/CT SUVMax and Taxane Therapy

4. PSMA Radioligand Therapy (RLT)

5. Conclusions"
Posted 2/29/2024 1:45 PM (GMT 0)
Nice article from AUS, more readable than most papers.

I really like the idea of incorporating PSMA scans with MRI scans as part of the initial diagnosis process. The missing link in my mind for normal cases is if there has been any local spread prior to treatment. Obviously, metastatic spread is a different issue but better to know that going in also.

Surgery allows sampling of lymph nodes but that is a doctor driven decision based on risk/benefit considerations with no guarantee that it means much unless positive. Radiation is always a guess based on limited imaging and biopsy results but the easiest to adjust for local spread. Locating the cancer within the prostate also lends itself to targeted radiation as well.

I don’t think we can move fast enough in that direction and there is some evidence that PSMA scans are being used more often in the diagnosis phase based some of the recent posts. There still is a small percentage of patients that do not benefit from PSMA expression but the report notes that this is smaller (3.4%) than I would have guessed.
Posted 2/29/2024 1:55 PM (GMT 0)
Hi Mumbo. I briefly discussed the PSMA insurance question about with my uro last visit and he thinks that, as with any new technology, it's going to take a little time for things to be worked out regarding the who, what, and when of insurance coverage.

This morning I also came across another article on the debate over PNLD (pelvic node lymph dissection) during surgery. It mentioned that PSMA will no doubt factor in, since it could be a substitute for node sampling; however, PNLD has the advantage of actually removing (some) positive nodes in addition to learning the status of lymph-node involvement.

Post Edited (DjinTonic) : 2/29/2024 6:14:49 AM (GMT-8)

Posted 2/29/2024 11:54 PM (GMT 0)
Yeah, it will be the same deal as the MRI before biopsy which seems to be still going on in some places. The tracer expense and handling is significant and will probably remain that way so I assume insurance companies will not like that.

The lymph node discussion is complicated. I only had four sampled and my Uro could not really justify any number. He said he takes the ones the look the best at the time depending on the diagnosis but does not want to overdo it and cause other problems. I am sure he would be in favor of a PSMA indication to guide the sampling.

My wife had the sentinel node procedure with dye years ago which found a speck of cancer so they took a bunch of lymph nodes out and has lymphedema to this day.
✚ New Topic ✚ Reply