Download PDF
Aktuelle Urol
DOI: 10.1055/a-2523-5885
Übersicht

Indikationen zur Durchführung der PSMA-PET-CT im Rahmen der Prostatakarzinomdiagnostik

Indications for performing PSMA-PET-CT as part of prostate cancer diagnostics
Philipp Krausewitz
1   Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Bonn, Germany (Ringgold ID: RIN39062)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund

Die Positronenemissionstomografie/Computertomografie mit prostataspezifischen Membranantigenen (PSMA-PET/CT) findet zunehmende Anwendung in der Diagnostik des Prostatakarzinoms.

Ziel der Arbeit/Fragestellung

Ziel dieses Reviews ist die Darstellung und Bewertung etablierter und innovativer Indikationen für die PSMA-PET/CT-Bildgebung.

Material und Methoden

Hintergrundwissen zur PSMA-PET/CT und behandlungsrelevante Leitlinienempfehlungen werden veranschaulicht und durch aktuelle Studienergebnisse ergänzt.

Ergebnisse

Die PSMA-PET/CT zeigt sich der konventionellen Bildgebung überlegen und kann in allen Stadien des Prostatakarzinoms je nach Indikation komplementär oder substitutiv eingesetzt werden. Sie bietet Vorteile in Form eines reduzierten Zeitaufwands und einer geringeren Strahlenbelastung. Der Einsatz der PSMA-PET/CT ermöglicht eine verbesserte Einschätzung des Krankheitsstatus und eine optimierte Therapieplanung. Ihre Anwendung erstreckt sich dabei vom initialen Karzinomverdacht über Diagnose und Staging bis hin zur Therapieplanung beim biochemischen Rezidiv und metastasiertem Prostatakarzinom. Derzeit fehlen jedoch Belege für den prognostischen Wert PSMA-PET/CT-basierter Therapieentscheidungen.

Schlussfolgerung

Die PSMA-PET/CT bietet einen signifikanten diagnostischen und therapeutischen Mehrwert für viele Prostatakarzinompatienten. Ihr Einsatz unterstützt die Evaluierung möglicher Intensivierungs- oder Deeskalationsstrategien und ermöglicht so eine personalisierte Therapieplanung.

Abstract

Background

Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) is increasingly being applied in the diagnostic landscape of prostate cancer.

Objective

This study aims to elucidate and assess both established and emerging indications for PSMA-PET/CT imaging.

Materials and methods

Current evidence on PSMA-PET/CT is summarised, with relevant guideline recommendations and enhanced by recent study findings.

Results

PSMA-PET/CT demonstrates superiority over conventional imaging techniques and can be applied either complementarily or substitutively across all stages of prostate cancer based on clinical indications. It offers advantages in terms of reduced time and radiation exposure. PSMA-PET/CT use enables a more accurate assessment of disease status and facilitates optimised treatment planning. Applications span from initial cancer suspicion through diagnosis, staging, and therapeutic planning in cases of biochemical recurrence and metastatic prostate cancer. However, evidence for the prognostic value of PSMA-PET/CT-guided therapy decisions is currently limited.

Conclusion

PSMA-PET/CT provides substantial diagnostic and therapeutic benefits for nearly all subgroups of prostate cancer patients. Its use supports the evaluation of possible intensification or de-escalation strategies, thereby enabling personalised treatment planning.

Schlüsselwörter

PSMA-PET/CT - Prostatakarzinom - Risikostratifizierung - Therapiesteuerung - metastasendirektive Therapie

Keywords

PSMA-PET/CT - prostate cancer - risk stratification - therapy guidance - metastasis-directed therapy


Publication History

Received: 05 November 2024

Accepted after revision: 21 January 2025

Article published online:
18 March 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Lopci E, Guazzoni G, Lazzeri M. et al. (68)Ga Prostate-specific Membrane Antigen PET/CT for Primary Diagnosis of Prostate Cancer: Complementary or Alternative to Multiparametric MR Imaging. Radiology 2018; 287: 725-726
    CrossrefPubMedSearch in Google Scholar
  • 2 Lopci E, Saita A, Lazzeri M. et al. (68)Ga-PSMA Positron Emission Tomography/Computerized Tomography for Primary Diagnosis of Prostate Cancer in Men with Contraindications to or Negative Multiparametric Magnetic Resonance Imaging: A Prospective Observational Study. J Urol 2018; 200: 95-103
    CrossrefPubMedSearch in Google Scholar
  • 3 Emmett L, Buteau J, Papa N. et al. The Additive Diagnostic Value of Prostate-specific Membrane Antigen Positron Emission Tomography Computed Tomography to Multiparametric Magnetic Resonance Imaging Triage in the Diagnosis of Prostate Cancer (PRIMARY): A Prospective Multicentre Study. Eur Urol 2021; 80: 682-689
    CrossrefPubMedSearch in Google Scholar
  • 4 Meissner VH, Rauscher I, Schwamborn K. et al. Radical Prostatectomy Without Prior Biopsy Following Multiparametric Magnetic Resonance Imaging and Prostate-specific Membrane Antigen Positron Emission Tomography. Eur Urol 2022; 82: 156-160
    CrossrefPubMedSearch in Google Scholar
  • 5 Chaloupka M, Apfelbeck M, Pyrgidis N. et al. Radical Prostatectomy without Prior Biopsy in Patients with High Suspicion of Prostate Cancer Based on Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen Positron Emission Tomography: A Prospective Cohort Study. Cancers (Basel) 2023; 15: 1266
    CrossrefPubMedSearch in Google Scholar
  • 6 Krausewitz P, Bundschuh RA, Gaertner FC. et al. DEPROMP Trial: the additive value of PSMA-PET/CT-guided biopsy for prostate cancer management in biopsy naïve men-study protocol for a randomized trial. Trials 2023; 24: 167
    CrossrefPubMedSearch in Google Scholar
  • 7 Zettinig O, Shah A, Hennersperger C. et al. Multimodal image-guided prostate fusion biopsy based on automatic deformable registration. Int J Comput Assist Radiol Surg 2015; 10: 1997-2007
    CrossrefPubMedSearch in Google Scholar
  • 8 Simopoulos DN, Natarajan S, Jones TA. et al. Targeted Prostate Biopsy Using (68)Gallium PSMA-PET/CT for Image Guidance. Urol Case Rep 2017; 14: 11-14
    CrossrefPubMedSearch in Google Scholar
  • 9 Zhang L-L, Li W-C, Xu Z. et al. (68)Ga-PSMA PET/CT targeted biopsy for the diagnosis of clinically significant prostate cancer compared with transrectal ultrasound guided biopsy: a prospective randomized single-centre study. Eur J Nucl Med Mol Imaging 2021; 48: 483-492
    CrossrefPubMedSearch in Google Scholar
  • 10 Kawada T, Yanagisawa T, Rajwa P. et al. Diagnostic Performance of Prostate-specific Membrane Antigen Positron Emission Tomography-targeted biopsy for Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2022; 5: 390-400
    CrossrefPubMedSearch in Google Scholar
  • 11 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. Lancet 2020; 395: 1208-1216
    CrossrefPubMedSearch in Google Scholar
  • 12 Chow KM, So WZ, Lee HJ. et al. Head-to-head Comparison of the Diagnostic Accuracy of Prostate-specific Membrane Antigen Positron Emission Tomography and Conventional Imaging Modalities for Initial Staging of Intermediate- to High-risk Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol 2023; 84: 36-48
    CrossrefPubMedSearch in Google Scholar
  • 13 Sonni I, Felker ER, Lenis AT. et al. Head-to-head comparison of (68)Ga-PSMA-11 PET/CT and mpMRI with histopathology gold-standard in the detection, intra-prostatic localization and local extension of primary prostate cancer: results from a prospective single-center imaging trial. J Nucl Med 2022; 63: 847-854
    CrossrefPubMedSearch in Google Scholar
  • 14 Luining WI, Hagens MJ, Meijer D. et al. The Probability of Metastases Within Different Prostate-specific Antigen Ranges Using Prostate-specific Membrane Antigen Positron Emission Tomography in Patients with Newly Diagnosed Prostate Cancer. Eur Urol Open Sci 2024; 59: 55-62
    CrossrefPubMedSearch in Google Scholar
  • 15 Fendler WP, Eiber M, Beheshti M. et al. PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0. Eur J Nucl Med Mol Imaging 2023; 50: 1466-1486
    CrossrefPubMedSearch in Google Scholar
  • 16 Stabile A, Pellegrino A, Mazzone E. et al. Can Negative Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Avoid the Need for Pelvic Lymph Node Dissection in Newly Diagnosed Prostate Cancer Patients? A Systematic Review and Meta-analysis with Backup Histology as Reference Standard. Eur Urol Oncol 2022; 5: 1-17
    CrossrefPubMedSearch in Google Scholar
  • 17 Amiel T, Würnschimmel C, Heck M. et al. Regional Lymph Node Metastasis on Prostate Specific Membrane Antigen Positron Emission Tomography Correlates with Decreased Biochemical Recurrence-Free and Therapy-Free Survival after Radical Prostatectomy: A Retrospective Single-Center Single-Arm Observational Study. J Urol 2021; 205: 1663-1670
    CrossrefPubMedSearch in Google Scholar
  • 18 Kesch C, Radtke J-P, Wintsche A. et al. Correlation between genomic index lesions and mpMRI and (68)Ga-PSMA-PET/CT imaging features in primary prostate cancer. Sci Rep 2018; 8: 16708
    CrossrefPubMedSearch in Google Scholar
  • 19 Kalapara AA, Nzenza T, Pan HYC. et al. Detection and localisation of primary prostate cancer using (68) gallium prostate-specific membrane antigen positron emission tomography/computed tomography compared with multiparametric magnetic resonance imaging and radical prostatectomy specimen pathology. BJU Int 2020; 126: 83-90
    CrossrefPubMedSearch in Google Scholar
  • 20 Jafarvand M, Farolfi A, Benz M. et al. PSMA PET/CT for prostate cancer patients after focal therapy: a single center retrospective analysis. J Nucl Med 2023; 64: P1241-P1241
    PubMedSearch in Google Scholar
  • 21 Tarr GP, Kashyap P, Dixit DD. et al. Utility of Ga(68) prostate-specific membrane antigen positron-emission tomography for pre-operative staging of high-risk prostate cancer in a prospective cohort. J Med Imaging Radiat Oncol 2020; 64: 78-86
    CrossrefPubMedSearch in Google Scholar
  • 22 Ferraro DA, Garcia Schüler HI, Muehlematter UJ. et al. Impact of (68)Ga-PSMA-11 PET staging on clinical decision-making in patients with intermediate or high-risk prostate cancer. Eur J Nucl Med Mol Imaging 2020; 47: 652-664
    CrossrefPubMedSearch in Google Scholar
  • 23 Dewes S, Schiller K, Sauter K. et al. Integration of (68)Ga-PSMA-PET imaging in planning of primary definitive radiotherapy in prostate cancer: a retrospective study. Radiat Oncol 2016; 11: 73
    CrossrefPubMedSearch in Google Scholar
  • 24 Petit C, Delouya G, Taussky D. et al. PSMA-PET/CT-Guided Intensification of Radiation Therapy for Prostate Cancer (PSMAgRT): Findings of Detection Rate, Effect on Cancer Management, and Early Toxicity From a Phase 2 Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2023; 116: 779-787
    CrossrefPubMedSearch in Google Scholar
  • 25 Leitlinienprogramm Onkologie der Arbeitsgemeinschaft der Wissenschaftlichen Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Prostatakarzinom, Langversion 7.0, AWMF Registernummer: 043/022OL. 2024 Accessed October 29, 2024 at: http://www.leitlinienprogramm-onkologie.de/leitlinien/prostatakarzinom/
    PubMedSearch in Google Scholar
  • 26 Cornford P, Tilki D, Bergh RCN van den. et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2024. Eur Urol 2022; 79: 243-262
    CrossrefPubMedSearch in Google Scholar
  • 27 Ekmekcioglu Ö, Busstra M, Klass ND. et al. Bridging the Imaging Gap: PSMA PET/CT Has a High Impact on Treatment Planning in Prostate Cancer Patients with Biochemical Recurrence-A Narrative Review of the Literature. J Nucl Med 2019; 60: 1394-1398
    CrossrefPubMedSearch in Google Scholar
  • 28 Roach PJ, Francis R, Emmett L. et al. The Impact of (68)Ga-PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study. J Nucl Med 2018; 59: 82-88
    CrossrefPubMedSearch in Google Scholar
  • 29 Pozdnyakov A, Kulanthaivelu R, Bauman G. et al. The impact of PSMA PET on the treatment and outcomes of men with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2023; 26: 240-248
    CrossrefPubMedSearch in Google Scholar
  • 30 Freedland SJ, Almeida Luz M de, Giorgi U de. et al. Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer. N Engl J Med 2023; 389: 1453-1465
    CrossrefPubMedSearch in Google Scholar
  • 31 Armstrong WR. et al. PSMA PET findings in an “EMBARK-like” cohort of patients with high-risk non-metastatic hormone-sensitive prostate cancer: A single center post-hoc retrospective analysis. JCO 2023; 41: 5091-5091
    CrossrefPubMedSearch in Google Scholar
  • 32 Barbato F, Fendler WP, Rauscher I. et al. PSMA-PET for the assessment of metastatic hormone-sensitive prostate cancer volume of disease. J Nucl Med 2021; 62: 1747-1750
    CrossrefPubMedSearch in Google Scholar
  • 33 Perera M, Papa N, Roberts M. et al. Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer-Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate-specific Membrane Antigen-avid Lesions: A Systematic Review and Meta-analysis. Eur Urol 2020; 77: 403-417
    CrossrefPubMedSearch in Google Scholar
  • 34 Phillips R, Shi WY, Deek M. et al. Outcomes of Observation vs Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer: The ORIOLE Phase 2 Randomized Clinical Trial. JAMA Oncol 2020; 6: 650-659
    CrossrefPubMedSearch in Google Scholar
  • 35 Francini E, Gray KP, Xie W. et al. Time of metastatic disease presentation and volume of disease are prognostic for metastatic hormone sensitive prostate cancer (mHSPC). Prostate 2018; 78: 889-895
    CrossrefPubMedSearch in Google Scholar
  • 36 Sweeney CJ, Chen Y-H, Carducci M. et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med 2015; 373: 737-746
    CrossrefPubMedSearch in Google Scholar
  • 37 Fizazi K, Tran N, Fein L. et al. Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 2017; 377: 352-360
    CrossrefPubMedSearch in Google Scholar
  • 38 Gandaglia G, Karakiewicz PI, Briganti A. et al. Impact of the Site of Metastases on Survival in Patients with Metastatic Prostate Cancer. Eur Urol 2015; 68: 325-334
    CrossrefPubMedSearch in Google Scholar
  • 39 Nieuwenhove S van, Damme J van, Padhani AR. et al. Whole-body magnetic resonance imaging for prostate cancer assessment: Current status and future directions. J Magn Reson Imaging 2022; 55: 653-680
    CrossrefPubMedSearch in Google Scholar
  • 40 Fanti S, Minozzi S, Castellucci P. et al. PET/CT with (11)C-choline for evaluation of prostate cancer patients with biochemical recurrence: meta-analysis and critical review of available data. Eur J Nucl Med Mol Imaging 2016; 43: 55-69
    CrossrefPubMedSearch in Google Scholar
  • 41 Thomas L, Balmus C, Ahmadzadehfar H. et al. Assessment of Bone Metastases in Patients with Prostate Cancer-A Comparison between (99m)Tc-Bone-Scintigraphy and (68)GaGa-PSMA PET/CT. Pharmaceuticals (Basel) 2017; 10: 68
    CrossrefPubMedSearch in Google Scholar
  • 42 Hoeh B, Garcia CC, Wenzel M. et al. Triplet or Doublet Therapy in Metastatic Hormone-sensitive Prostate Cancer: Updated Network Meta-analysis Stratified by Disease Volume. Eur Urol Focus 2023; 9: 838-842
    CrossrefPubMedSearch in Google Scholar
  • 43 Fendler WP, Weber M, Iravani A. et al. Prostate-Specific Membrane Antigen Ligand Positron Emission Tomography in Men with Nonmetastatic Castration-Resistant Prostate Cancer. Clin Cancer Res 2019; 25: 7448-7454
    CrossrefPubMedSearch in Google Scholar
  • 44 Sartor O, Bono J de, Chi KN. et al. Lutetium-177-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer. N Engl J Med 2021; 385: 1091-1103
    CrossrefPubMedSearch in Google Scholar
  • 45 Seifert R, Seitzer K, Herrmann K. et al. Analysis of PSMA expression and outcome in patients with advanced Prostate Cancer receiving (177)Lu-PSMA-617 Radioligand Therapy. Theranostics 2020; 10: 7812-7820
    CrossrefPubMedSearch in Google Scholar
  • 46 Hartrampf PE, Serfling SE, Michalski K. et al. PSMA PET/CT for Response Assessment of (177)Lu-PSMA Therapy. Seminars in Nuclear Medicine 2024; 54: 69-76
    CrossrefPubMedSearch in Google Scholar
  • 47 Seitz AK, Rauscher I, Haller B. et al. Preliminary results on response assessment using (68)Ga-HBED-CC-PSMA PET/CT in patients with metastatic prostate cancer undergoing docetaxel chemotherapy. Eur J Nucl Med Mol Imaging 2018; 45: 602-612
    CrossrefPubMedSearch in Google Scholar
  • 48 Grubmüller B, Senn D, Kramer G. et al. Response assessment using (68)Ga-PSMA ligand PET in patients undergoing (177)Lu-PSMA radioligand therapy for metastatic castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging 2019; 46: 1063-1072
    CrossrefPubMedSearch in Google Scholar
  • 49 Kind F, Eder A-C, Jilg CA. et al. Prognostic Value of Tumor Volume Assessment on PSMA PET After (177)Lu-PSMA Radioligand Therapy Evaluated by PSMA PET/CT Consensus Statement and RECIP 1.0. J Nucl Med 2023; 64: 605-610
    CrossrefPubMedSearch in Google Scholar
  • 50 Schmuck S, Klot CA von, Henkenberens C. et al. Initial Experience with Volumetric (68)Ga-PSMA I&T PET/CT for Assessment of Whole-Body Tumor Burden as a Quantitative Imaging Biomarker in Patients with Prostate Cancer. J Nucl Med 2017; 58: 1962-1968
    CrossrefPubMedSearch in Google Scholar