Volume 14 Issue 4
Jul.  2023
Turn off MathJax
Article Contents
HU Guilan, TIAN Jian, LI Yongqiang, JI Zhigang, HUO Li, CHEN Yonghui. PSMA and 18F-FDG PET Imaging in the Treatment of Metastatic Prostate Cancer with 223Ra: Initial Application and Experience[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(4): 787-794. doi: 10.12290/xhyxzz.2023-0152
Citation: HU Guilan, TIAN Jian, LI Yongqiang, JI Zhigang, HUO Li, CHEN Yonghui. PSMA and 18F-FDG PET Imaging in the Treatment of Metastatic Prostate Cancer with 223Ra: Initial Application and Experience[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(4): 787-794. doi: 10.12290/xhyxzz.2023-0152

PSMA and 18F-FDG PET Imaging in the Treatment of Metastatic Prostate Cancer with 223Ra: Initial Application and Experience

doi: 10.12290/xhyxzz.2023-0152
Funds:

National High Level Hospital Clinical Research Funding 2022-PUMCH-B-072

More Information
  • Corresponding author: CHEN Yonghui, E-mail: chenyufirst@sina.com
  • Received Date: 2023-03-27
  • Accepted Date: 2023-04-20
  • Publish Date: 2023-07-30
  •   Objective  To share our experience of the use of prostate specific membrane antigen (PSMA) and/or 18F-fluoroodexyglucose (18F-FDG) positron emission tomography (PET) in the setting of radium-223 dichloride (223Ra) in treatment of bone metastases of prostate cancer in order to broaden the know-ledge of application of 223Ra in China.  Methods  Retrospective analysis was conducted for the patients with advanced prostate cancer treated with 223Ra in Peking Union Medical College Hospital between September 2021 to January 2023.The treatment outcomes and survival status were recorded.Characteristics of bone scans and PET imaging (including PSMA PET and/or 18F-FDG PET) before and after treatment were summarized.  Results  Nine patients were enrolled (2 additional patients were excluded for the reason of visceral metastases confirmed by pretreatment PET imaging), among whom 8 patients had metastatic castration resistant prostate cancer and 1 had metastatic hormone-sensitive prostate cancer.In total the 9 patients received 36 doses of 223Ra, and the numbers of patients receiving 6, 5, 4, 2, and 1 doses were 3, 1, 2, 2, and 1, respectively.At the middle or end of treatment, there was 1 case of partial remission, 1 case of stable disease, 6 cases of progressive disease, and 1 case was switched to endocrine therapy after 1 shot of 223Ra treatment so that the efficacy was not evaluated.At the time of the last follow-up (March 15, 2023), among the 9 patients, 4 died (1 due to heart failure and 3 due to disease progression) and 5 survived.For patients who died or with progressive disease, there was an inconsistency between the metastases shown on baseline PET images and bone scans, with the former modality revealing more bone metastases.PET imaging especially PSMA PET was more accurate than bone scan in assessing response and could avoid bone scintillation.  Conclusions  PSMA PET and/or 18F-FDG PET could help detect visceral metastases and assist in patient screening.The inconsistency between baseline PET images and bone scan images suggests a worse outcome of 223Ra treatment.During the efficacy evaluation process, PSMA and/or 18F-FDG PET (especially PSMA PET) also outperforms bone scan.
  • loading
  • [1] Parker C, Nilsson S, Heinrich D, et al. Alpha emitter radium-223 and survival in metastatic prostate cancer[J]. N Engl J Med, 2013, 369: 213-223. doi:  10.1056/NEJMoa1213755
    [2] Ahmadzadehfar H, Azgomi K, Hauser S, et al. 68Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with 223Ra: Proof of Concept[J]. J Nucl Med, 2017, 58: 438-444. doi:  10.2967/jnumed.116.178533
    [3] Jadvar H. The VISION Forward: Recognition and Implication of PSMA-/18F-FDG+mCRPC[J]. J Nucl Med, 2022, 63: 812-815. doi:  10.2967/jnumed.121.263274
    [4] Jadvar H, Quinn DI. Targeted alpha-particle therapy of bone metastases in prostate cancer[J]. Clin Nucl Med, 2013, 38: 966-971. doi:  10.1097/RLU.0000000000000290
    [5] Gafita A, Rauscher I, Weber M, et al. Novel Framework for Treatment Response Evaluation Using PSMA PET/CT in Patients with Metastatic Castration-Resistant Prostate Cancer (RECIP 1.0): An International Multicenter Study[J]. J Nucl Med, 2022, 63: 1651-1658.
    [6] Scher HI, Morris MJ, Stadler WM, et al. Trial Design and Objectives for Castration-Resistant Prostate Cancer: Updated Recommendations From the Prostate Cancer Clinical Trials Working Group 3[J]. J Clin Oncol, 2016, 34: 1402-1418. doi:  10.1200/JCO.2015.64.2702
    [7] Bruland OS, Nilsson S, Fisher DR, et al. High-linear energy transfer irradiation targeted to skeletal metastases by the alpha-emitter 223Ra: adjuvant or alternative to conventional modalities?[J]. Clin Cancer Res, 2006, 12: 6250-6257. doi:  10.1158/1078-0432.CCR-06-0841
    [8] Henriksen G, Breistol K, Bruland OS, et al. Significant antitumor effect from bone-seeking, alpha-particle-emitting 223Ra demonstrated in an experimental skeletal metastases model[J]. Cancer Res, 2002, 62: 3120-3125.
    [9] Henriksen G, Fisher DR, Roeske JC, et al. Targeting of osseous sites with alpha-emitting 223Ra: comparison with the beta-emitter 89Sr in mice[J]. J Nucl Med, 2003, 44: 252-259.
    [10] Sartor O, Coleman RE, Nilsson S, et al. An exploratory analysis of alkaline phosphatase, lactate dehydrogenase, and prostate-specific antigen dynamics in the phase 3 ALSYMPCA trial with radium-223[J]. Ann Oncol, 2017, 28: 1090-1097. doi:  10.1093/annonc/mdx044
    [11] Roudier MP, Morrissey C, True LD, et al. Histopathological assessment of prostate cancer bone osteoblastic metastases[J]. J Urol, 2008, 180: 1154-1160. doi:  10.1016/j.juro.2008.04.140
    [12] 董世强, 柳青, 徐子寒, 等. 前列腺癌骨转移的治疗进展及疗效评价[J]. 肿瘤, 2019, 39: 573-81. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLL201907008.htm
    [13] Hofman MS, Lawrentschuk N, Francis RJ, et al. 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[J]. Lancet, 2020, 395: 1208-1216. doi:  10.1016/S0140-6736(20)30314-7
    [14] Alipour R, Azad A, Hofman MS. Guiding management of therapy in prostate cancer: time to switch from conventional imaging to PSMA PET?[J]. Ther Adv Med Oncol, 2019, 11: 1-14.
    [15] Rosar F, Ribbat K, Ries M, et al. Neuron-specific enolase has potential value as a biomarker for 18F-FDG/68Ga-PSMA-11 PET mismatch findings in advanced mCRPC patients[J]. EJNMMI Res, 2020, 10: 52-62. doi:  10.1186/s13550-020-00640-2
    [16] Chen R, Wang Y, Zhu Y, et al. The Added Value of 18F-FDG PET/CT Compared with 68Ga-PSMA PET/CT in Patients with Castration-Resistant Prostate Cancer[J]. J Nucl Med, 2022, 63: 69-75. doi:  10.2967/jnumed.120.262250
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(5)  / Tables(2)

    Article Metrics

    Article views (1568) PDF downloads(73) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return