Prostate-specific membrane antigen (PSMA) is increasingly considered as a molecular target to achieve precision surgery for prostate cancer. A Delphi consensus was conducted to explore expert views in this emerging field and to identify knowledge and evidence gaps as well as unmet research needs that may help change practice and improve oncological outcomes for patients.
One hundred and five statements (scored by a 9-point Likert scale) were distributed through SurveyMonkey®. Following evaluation, a consecutive second round was performed to evaluate consensus (16 statements; 89% response rate). Consensus was defined using the disagreement index, assessed by the research and development project/University of California, Los Angeles appropriateness method.
Eighty-six panel participants (72.1% clinician, 8.1% industry, 15.1% scientists, and 4.7% other) participated, most with a urological background (57.0%), followed by nuclear medicine (22.1%). Consensus was obtained on the following: (1) The diagnostic PSMA-ligand PET/CT should ideally be taken < 1 month before surgery, 1-3 months is acceptable; (2) a 16-20-h interval between injection of the tracer and surgery seems to be preferred; (3) PSMA targeting is most valuable for identification of nodal metastases; (4) gamma, fluorescence, and hybrid imaging are the preferred guidance technologies; and (5) randomized controlled clinical trials are required to define oncological value. Regarding surgical margin assessment, the view on the value of PSMA-targeted surgery was neutral or inconclusive. A high rate of "cannot answer" responses indicates further study is necessary to address knowledge gaps (e.g., Cerenkov or beta-emissions).
This Delphi consensus provides guidance for clinicians and researchers that implement or develop PSMA-targeted surgery technologies. Ultimately, however, the consensus should be backed by randomized clinical trial data before it may be implemented within the guidelines.
European journal of nuclear medicine and molecular imaging. 2023 Nov 28 [Epub ahead of print]
Anne-Claire Berrens, Matthijs Scheltema, Tobias Maurer, Ken Hermann, Freddie C Hamdy, Sophie Knipper, Paolo Dell'Oglio, Elio Mazzone, Hilda A de Barros, Jonathan M Sorger, Matthias N van Oosterom, Philip D Stricker, Pim J van Leeuwen, Daphne D D Rietbergen, Renato A Valdes Olmos, Sergi Vidal-Sicart, Peter R Carroll, Tessa Buckle, Henk G van der Poel, Fijs W B van Leeuwen
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. ., Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Department of Nuclear Medicine, University of Duisburg-Essen, German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany., Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany., Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy., Intuitive Surgical, Inc., Sunnyvale, CA, USA., Department of Urology, St Vincents Hospital Sydney, Sydney, Australia., Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., Department of Nuclear Medicine, Hospital Clínic Barcelona, Barcelona, Spain., Department of Urology, University of California, San Francisco, CA, USA.