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OtherTheranostics

Assessing Response to [177Lu]PSMA Radioligand Therapy using modified PSMA PET Progression Criteria

Kerstin Michalski, Claudius Klein, Tonio Brueggemann, Philipp T Meyer, Cordula Annette Jilg and Juri Ruf
Journal of Nuclear Medicine March 2021, jnumed.120.260836; DOI: https://doi.org/10.2967/jnumed.120.260836
Kerstin Michalski
1 Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany, Germany;
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  • ORCID record for Kerstin Michalski
Claudius Klein
1 Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany, Germany;
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Tonio Brueggemann
1 Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany, Germany;
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Philipp T Meyer
1 Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany, Germany;
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Cordula Annette Jilg
2 Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Juri Ruf
1 Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany, Germany;
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Abstract

Introduction: Positron emission tomography/computer tomography (PET/CT) targeting the prostate specific membrane antigen (PSMA) plays a key role in staging of patients with prostate cancer (PCa). Moreover, it is not only used for the assessment of adequate PSMA expression of PCa cells before PSMA-targeting radioligand therapy (PSMA RLT) but also for re-staging during the course of therapy to evaluate response to treatment. Whereas no established criteria exist for systematic response evaluation so far, recently proposed PSMA PET Progression (PPP) criteria might fill this gap. The aim of this study was to assess the feasibility of PPP criteria in patients undergoing PSMA RLT and their prognostic implications. Methods: In this retrospective analysis, PSMA PET/CT scans of 46 patients acquired before and after completion of PSMA RLT were analyzed separately by two readers using modified PPP criteria. After interobserver agreement assessment, consensus results (progressive vs. non-progressive disease) were compared in a multivariate cox regression model (endpoint overall survival, OS). Results: Interobserver agreement on modified PPP criteria was substantial (Cohens κ = 0.73) with a concordance in 87% of patients. Median OS of all patients after PSMA RLT (n = 46) was 9.0 [95% confidence interval (CI) 7.8 - 10.2] months. Progression according to modified PPP criteria was found in 32 patients and was a significant (p ≤0.001) prognostic marker for OS with a hazard ratio of 15.5 [95% CI 3.4 - 70.2]. Conclusion: Response assessment in patients undergoing PSMA RLT using modified PPP criteria are reproducible and highly prognostic for OS. Modified PPP criteria should be validated in future prospective trials.

  • Oncology: GU
  • PET/CT
  • Radionuclide Therapy
  • PPP
  • PSMA PET/CT
  • radioligand therapy
  • response assessment
  • Copyright © 2021 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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Journal of Nuclear Medicine: 62 (4)
Journal of Nuclear Medicine
Vol. 62, Issue 4
April 1, 2021
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Assessing Response to [177Lu]PSMA Radioligand Therapy using modified PSMA PET Progression Criteria
Kerstin Michalski, Claudius Klein, Tonio Brueggemann, Philipp T Meyer, Cordula Annette Jilg, Juri Ruf
Journal of Nuclear Medicine Mar 2021, jnumed.120.260836; DOI: 10.2967/jnumed.120.260836

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Assessing Response to [177Lu]PSMA Radioligand Therapy using modified PSMA PET Progression Criteria
Kerstin Michalski, Claudius Klein, Tonio Brueggemann, Philipp T Meyer, Cordula Annette Jilg, Juri Ruf
Journal of Nuclear Medicine Mar 2021, jnumed.120.260836; DOI: 10.2967/jnumed.120.260836
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Keywords

  • Oncology: GU
  • PET/CT
  • Radionuclide Therapy
  • PPP
  • PSMA PET/CT
  • radioligand therapy
  • response assessment
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