In prostate cancer (PCa), questions remain on indications for prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging and PSMA radioligand therapy, integration of advanced imaging in nomogram-based decision-making, dosimetry, and development of new theranostic applications.
We aimed to critically review developments in molecular hybrid imaging and systemic radioligand therapy, to reach a multidisciplinary consensus on the current state of the art in PCa.
The results of a systematic literature search informed a two-round Delphi process with a panel of 28 PCa experts in medical or radiation oncology, urology, radiology, medical physics, and nuclear medicine. The results were discussed and ratified in a consensus meeting.
Forty-eight statements were scored on a Likert agreement scale and six as ranking options. Agreement statements were analysed using the RAND appropriateness method. Ranking statements were analysed using weighted summed scores.
After two Delphi rounds, there was consensus on 42/48 (87.5%) of the statements. The expert panel recommends PSMA PET to be used for staging the majority of patients with unfavourable intermediate and high risk, and for restaging of suspected recurrent PCa. There was consensus that oligometastatic disease should be defined as up to five metastases, even using advanced imaging modalities. The group agreed that [177Lu]Lu-PSMA should not be administered only after progression to cabazitaxel and that [223Ra]RaCl2 remains a valid therapeutic option in bone-only metastatic castration-resistant PCa. Uncertainty remains on various topics, including the need for concordant findings on both [18F]FDG and PSMA PET prior to [177Lu]Lu-PSMA therapy.
There was a high proportion of agreement among a panel of experts on the use of molecular imaging and theranostics in PCa. Although consensus statements cannot replace high-certainty evidence, these can aid in the interpretation and dissemination of best practice from centres of excellence to the wider clinical community.
There are situations when dealing with prostate cancer (PCa) where both the doctors who diagnose and track the disease development and response to treatment, and those who give treatments are unsure about what the best course of action is. Examples include what methods they should use to obtain images of the cancer and what to do when the cancer has returned or spread. We reviewed published research studies and provided a summary to a panel of experts in imaging and treating PCa. We also used the research summary to develop a questionnaire whereby we asked the experts to state whether or not they agreed with a list of statements. We used these results to provide guidance to other health care professionals on how best to image men with PCa and what treatments to give, when, and in what order, based on the information the images provide.
European urology. 2023 Sep 22 [Epub ahead of print]
Daniela-Elena Oprea-Lager, Steven MacLennan, Anders Bjartell, Alberto Briganti, Irene A Burger, Igle de Jong, Maria De Santis, Uta Eberlein, Louise Emmett, Karim Fizazi, Silke Gillessen, Ken Herrmann, Sandra Heskamp, Andrei Iagaru, Barbara Alicja Jereczek-Fossa, Jolanta Kunikowska, Marnix Lam, Cristina Nanni, Joe M O'Sullivan, Valeria Panebianco, Evis Sala, Mike Sathekge, Roman Sosnowski, Derya Tilki, Bertrand Tombal, Giorgio Treglia, Nina Tunariu, Jochen Walz, Derya Yakar, Rudi Dierckx, Oliver Sartor, Stefano Fanti
Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands. Electronic address: ., Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK., Department of Translational Medicine, Medical Faculty, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Skåne, Sweden., Department of Urology, Vita e Salute San Raffaele University, Milan, Italy., Nuclear Medicine Department, Kantonspital Baden, Baden, Switzerland., Department of Urology, University Medical Center Groningen, Groningen, The Netherlands., Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany., Theranostics and Nuclear Medicine Department, St Vincent's Hospital Sydney, Sydney, Australia., Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France., Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; Department of Medical Oncology, Università della Svizzera Italiana, Lugano, Switzerland., Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany., Department of Medical Imaging-Nuclear Medicine Radboudumc, Nijmegen, The Netherlands., Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, Stanford, CA, USA., Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy., Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland., Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands., Nuclear Medicine Unit, IRCCS Azienda Ospitaliero-Universitaria di Bologna, Bologna, Italy., Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK; Northern Ireland Cancer Centre, Belfast, UK., Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy., Department of Radiology, Università Cattolica del Sacro Cuore and Advanced Radiology Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Nuclear Medicine Department, University of Pretoria, Pretoria, South Africa; Nuclear Medicine Department, Steve Biko Academic Hospital, Pretoria, South Africa., Department of Urooncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey., Department of Surgery, Cliniques Universitaires Saint Luc, Brussels, Belgium., Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland., Clinical Radiology, Drug Development Unit and Prostate Cancer Targeted Therapy Clinical Trials, Royal Marsden Hospital, London, UK., Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France., Department of Radiology, University Medical Center of Groningen, Groningen, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, Groningen, The Netherlands., Departments of Medicine and Urology, Tulane University School of Medicine, New Orleans, LA, USA., Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola, Bologna, Italy.