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Evaluation of PSMA expression changes on PET/CT before and after initiation of novel antiandrogen drugs (enzalutamide or abiraterone) in metastatic castration-resistant prostate cancer patients
- Source :
- Annals of Nuclear Medicine. 33:945-954
- Publication Year :
- 2019
- Publisher :
- Springer Science and Business Media LLC, 2019.
-
Abstract
- To investigate the association between Prostate-Specific Membrane Antigen (PSMA) expression changes on positron emission tomography–computed tomography (PET/CT) and the response to treatment following the start of enzalutamide or abiraterone in metastatic castration-resistant prostate cancer (mCRPC) patients. All consecutive 68Ga-PSMA-11 PET/CT scans routinely performed at our institution during more than 4 years were retrospectively screened for inclusion. We included mCRPC patients with a baseline PSMA PET/CT performed less than 2 months before the start of either enzalutamide or abiraterone, and a follow-up PSMA PET/CT performed no more than a year after, while still under those novel antiandrogen drugs (NAD). The associated clinical records were reviewed. Patients were considered treatment responders if they presented decreasing PSA levels > 50% or a radiological response based on RECIST 1.1 criteria. PSMA expression changes on the follow-up PET/CT were assessed using per-patient dominant response criteria to classify patients as PSMA-responders (complete disappearance of pathologic PSMA uptake, or a decreased uptake of the majority of lesions) or PSMA-non-responders (new PSMA-expressing lesions, increased uptake of the majority of lesions, or stable PSMA expression of the disease). Descriptive statistics and measures of associations (two-sided Fisher’s exact test and Phi coefficient) were calculated. A total of 11 and 15 patients were included in the enzalutamide and abiraterone groups. Median follow-up was 110 (IQR 76–124) and 87 (IQR 71–242) days, respectively. All treatment responders (3 enzalutamide and 4 abiraterone) were considered PSMA-responders, and all treatment non-responders (8 enzalutamide, 11 abiraterone) were considered PSMA-non-responders. PSMA PET response was thus perfectly associated with conventional response criteria (p = 0.006, Phi = 1 for enzalutamide; p = 0.001, Phi = 1 for abiraterone). In our cohort, no PSMA expression flare phenomenon was detected on follow-up PET/CT scans at a median follow-up of 3 months. However, an early and short-lived flare cannot be excluded. This retrospective study suggests that, after a median follow-up of 3 months under enzalutamide or abiraterone, PSMA expression changes on PET/CT are strongly associated with response to treatment. Prospective studies are needed to better understand PSMA expression dynamics following the start of enzalutamide and abiraterone, along with the role of PSMA PET/CT in response assessment.
- Subjects :
- Glutamate Carboxypeptidase II
Male
Oncology
medicine.medical_specialty
medicine.drug_class
urologic and male genital diseases
Antiandrogen
030218 nuclear medicine & medical imaging
03 medical and health sciences
chemistry.chemical_compound
Prostate cancer
0302 clinical medicine
Positron Emission Tomography Computed Tomography
Internal medicine
Nitriles
Phenylthiohydantoin
Humans
Medicine
Enzalutamide
Radiology, Nuclear Medicine and imaging
Neoplasm Metastasis
Prospective cohort study
Aged
Retrospective Studies
PET-CT
business.industry
Retrospective cohort study
General Medicine
medicine.disease
Gene Expression Regulation, Neoplastic
Prostatic Neoplasms, Castration-Resistant
Abiraterone
Exact test
Treatment Outcome
chemistry
030220 oncology & carcinogenesis
Antigens, Surface
Benzamides
Androstenes
business
Subjects
Details
- ISSN :
- 18646433 and 09147187
- Volume :
- 33
- Database :
- OpenAIRE
- Journal :
- Annals of Nuclear Medicine
- Accession number :
- edsair.doi.dedup.....8fc51a4693f90b6397528de173355723