Impact of Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography in the Management of Oligometastatic Renal Cell Carcinoma

Overview

Journal Eur Urol Open Sci

Date 2022 Oct 3

PMID 36185587

Authors

Cristian Udovicich

Jason Callahan

Mathias Bressel

Wee Loon Ong

Marlon Perera

Ben Tran

Arun Azad

Shankar Haran

Daniel Moon

Sarat Chander

Mark Shaw

Renu Eapen

Jeremy Goad

Nathan Lawrentschuk

Declan G Murphy

Michael Hofman

Shankar Siva

Affiliations

Soon will be listed here.

Abstract

Background: Prostate-specific membrane antigen (PSMA) is overexpressed in the neovasculature of renal cell carcinoma (RCC). However, there remains limited evidence regarding the use of PSMA positron emission tomography/computed tomography (PET/CT) in RCC.

Objective: To assess the impact of PSMA PET/CT in the management of metastatic RCC.

Design Setting And Participants: This was a retrospective review of patients who underwent PSMA PET/CT from 2014 to 2020 for restaging or suspected metastatic RCC in a tertiary academic setting.

Outcome Measurements And Statistical Analysis: Management plans before and after PSMA PET/CT were recorded. Impact was classified as high (change of treatment intent, modality, or site), medium (change in treatment method), or low. Secondary outcomes included the patient-level detection rate, PSMA PET/CT parameters, sensitivity, and comparison to CT and, if available, fluorodeoxyglucose (FDG) PET/CT.

Results And Limitations: Sixty-one patients met the inclusion criteria, of whom 54 (89%) had clear cell RCC. PSMA-positive disease was detected in 51 patients (84%). For 30 patients (49%) there was a change in management due to PSMA PET/CT (high impact, 29 patients, 48%). In 15 patients (25%), more metastases were detected on PSMA PET/CT than on CT. The sensitivity of combined PSMA PET/CT and diagnostic CT was 91% (95% confidence interval 77-98%). In a subcohort of 40 patients, the detection rate was 88% for PSMA and 75% for FDG PET/CT ( = 0.17). The maximum standardised uptake value (SUV) was higher for PSMA than for FDG PET/CT (15.2 vs 8.0; = 0.02). Limitations include selection bias due to the retrospective design, and a lack of corresponding histopathology for all patients.

Conclusions: PSMA PET/CT is a promising imaging modality in metastatic RCC and led to a change in management in 49% of patients. PSMA PET/CT detected additional metastases compared to CT in 25% of patients and registered a significantly higher SUV than FDG PET/CT. Prospective studies are required to further define its role.

Patient Summary: We report on a group of patients undergoing a new type of imaging for suspected advanced kidney cancer, called PSMA PET/CT. This imaging changed the management plan in 49% of the patients. PSMA PET/CT detected metastases in 84% of our patients and detected more metastases than computed tomography imaging in 25%.

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