World J Mens Health.  2020 Jan;38(1):32-47. 10.5534/wjmh.180133.

Performance and Impact of Prostate Specific Membrane Antigen-Based Diagnostics in the Management of Men with Biochemical Recurrence of Prostate Cancer and its Role in Salvage Lymph Node Dissection

Affiliations
  • 1Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. Marieke.krimphove@kgu.de
  • 2Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Abstract

Up to 50% of patients initially treated for prostate cancer in a curative intent experience biochemical recurrence, possibly requiring adjuvant treatment. However, salvage treatment decisions, such as lymph node dissection or radiation therapy, are typically based on prostate specific antigen (PSA) recurrence. Importantly, common imaging modalities (e.g., computed tomography [CT], magnetic resonance imaging, and bone scan) are limited and the detection of recurrent disease is particularly challenging if PSA is low. Prostate specific membrane antigen (PSMA) positron-emission tomography/computed tomography (PET/CT) is a novel and promising imaging modality which aims to overcome the incapability of early identification of distant and regional metastases. Within this review, we summarize the current evidence related to PSMA-PET/CT in prostate cancer men diagnosed with biochemical recurrence after local treatment with curative intent. We discuss detection rates of PSMA-PET/CT stratified by PSA-levels and its impact on clinical decision making. Furthermore, we compare different image-fusion techniques such as PSMA-PET vs. F-/C-Choline-PET scans vs. PSMA-single photon emission computed tomography/CT. Finally, we touch upon the contemporary role of radio-guided-PSMA salvage lymphadenectomy.

Keyword

Positron-emission tomography; Prostate-specific membrane antigen, human; Prostatic neoplasms; Salvage therapy

MeSH Terms

Clinical Decision-Making
Humans
Lymph Node Excision*
Lymph Nodes*
Magnetic Resonance Imaging
Male
Membranes*
Neoplasm Metastasis
Positron-Emission Tomography
Prostate*
Prostate-Specific Antigen
Prostatic Neoplasms*
Recurrence*
Salvage Therapy
Prostate-Specific Antigen
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