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1.
Eur Urol ; 85(3): 217-226, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37891072

ABSTRACT

BACKGROUND: High-risk localised prostate cancer (HRCaP) has high rates of biochemical recurrence; [177Lu]Lu-PSMA-617 is effective in men with advanced prostate cancer. OBJECTIVE: To investigate the dosimetry, safety, and efficacy of upfront [177Lu]Lu-PSMA-617 in men with HRCaP prior to robotic radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS: In this single-arm, phase I/II trial, we recruited men with HRCaP (any of prostate-specific antigen [PSA] >20 ng/ml, International Society of Urological Pathology (ISUP) grade group [GG] 3-5, and ≥cT2c), with high tumour uptake on [68Ga]Ga-PSMA-11 positron emission tomography/computed tomography (PSMA PET/CT), and scheduled for RP. INTERVENTION: Cohort A (n = 10) received one cycle and cohort B (n = 10) received two cycles of [177Lu]Lu-PSMA-617 (5 GBq) followed by surgery 6 weeks later. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was tumour radiation absorbed dose. Adverse events (AEs; Common Terminology Criteria for Adverse Events (CTCAE) version 5.0), surgical safety (Clavien-Dindo), imaging, and biochemical responses were evaluated (ClinicalTrials.gov: NCT04430192). RESULTS AND LIMITATIONS: Between May 29, 2020 and April 28, 2022, 20 patients were enrolled. The median PSA was 18 ng/ml (interquartile range [IQR] 11-35), Eighteen (90%) had GG ≥3, and six (30%) had N1 disease. The median (IQR) highest tumour radiation absorbed dose after cycle 1 for all lesions was 35.5 Gy (19.5-50.1), with 19.6 Gy (11.3-48.4) delivered to the prostate. Five patients received radiation to lymph nodes. Nine (45%) patients achieved >50% PSA decline. The most common AEs related to [177Lu]Lu-PSMA-617 were grade 1 fatigue in eight (40%), nausea in seven (35%), dry mouth in six (30%), and thrombocytopenia in four (20%) patients. No grade 3/4 toxicities or Clavien 3-5 complications occurred. Limitations include small a sample size. CONCLUSIONS: In men with HRCaP and high prostate-specific membrane antigen (PSMA) expression, [177Lu]Lu-PSMA-617 delivered high levels of targeted radiation doses with few toxicities and without compromising surgical safety. Further studies of [177Lu]Lu-PSMA-617 in this population are worthwhile to determine whether meaningful long-term oncological benefits can be demonstrated. PATIENT SUMMARY: In this study, we demonstrate that up to two cycles of [177Lu]Lu-PSMA-617 given prior to radical prostatectomy in patients with high-risk localised prostate cancer are safe and deliver targeted doses of radiation to tumour-affected tissues. It is tolerated well with minimal treatment-related adverse events, and surgery is safe with a low rate of complications. Activity measured through PSA reduction, repeat PSMA PET/CT, and histological response is promising.


Subject(s)
Dipeptides , Heterocyclic Compounds, 1-Ring , Prostatic Neoplasms, Castration-Resistant , Prostatic Neoplasms , Male , Humans , Prostate-Specific Antigen , Prostate/pathology , Positron Emission Tomography Computed Tomography/methods , Gallium Radioisotopes , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Prostatectomy/methods , Prostatic Neoplasms, Castration-Resistant/pathology , Lutetium/adverse effects , Treatment Outcome
2.
Eur J Nucl Med Mol Imaging ; 51(1): 295-303, 2023 12.
Article in English | MEDLINE | ID: mdl-37592084

ABSTRACT

PURPOSE: There is an emerging role of the use of Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET) in renal cell carcinoma. Herein, we report our experience in use of PSMA PET in recurrent or metastatic renal cell carcinoma (RCC). METHODS: A retrospective analysis of all patients who underwent PSMA PET for suspected recurrent or de-novo metastatic RCC between 2015 and 2020 at three institutions was performed. The primary outcome was change in management (intensification or de-intensification) following PSMA PET scan. Secondary outcomes included histopathological correlation of PSMA avid sites, comparison of sites of disease on PSMA PET to diagnostic CT and time to systemic treatment.


Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Prostatic Neoplasms , Male , Humans , Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/therapy , Carcinoma, Renal Cell/pathology , Prostate/pathology , Retrospective Studies , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/therapy , Kidney Neoplasms/pathology , Positron Emission Tomography Computed Tomography/methods , Positron-Emission Tomography , Prostate-Specific Antigen/metabolism , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/therapy , Prostatic Neoplasms/pathology , Gallium Radioisotopes
3.
BJU Int ; 128(3): 331-342, 2021 09.
Article in English | MEDLINE | ID: mdl-33682320

ABSTRACT

OBJECTIVE: To assess the activity and safety of sequential lutetium-177 (177 Lu)-PSMA-617 and docetaxel vs docetaxel on a background of androgen deprivation therapy (ADT) in men with de novo metastatic hormone-naïve prostate cancer (mHNPC). PATIENTS AND METHODS: UpFrontPSMA (NCT04343885) is an open-label, randomized, multicentre, phase 2 trial, recruiting 140 patients at 12 Australian centres. Key eligibility criteria include: prostate cancer with a histological diagnosis within 12 weeks of screening commencement; prostate-specific antigen (PSA) >10 ng/mL at diagnosis; ≤4 weeks on ADT; evidence of metastatic disease on computed tomography (CT) and/or bone scan; high-volume prostate-specific membrane antigen (PSMA)-avid disease with a maximum standardized uptake value >15; and absence of extensive discordant fluorodeoxyglcuose (FDG)-positive, PSMA-negative disease. 68 Ga-PSMA-11 and 18 F-FDG positron-emission tomography (PET)/CT undergo central review to determine eligibility. Patients are randomized 1:1 to experimental treatment, Arm A (177 Lu-PSMA-617 7.5GBq q6w × 2 cycles followed by docetaxel 75 mg/m2 q3w × 6 cycles), or standard-of-care treatment, Arm B (docetaxel 75 mg/m2 q3w × 6 cycles). All patients receive continuous ADT. Patients are stratified based on disease volume on conventional imaging and duration of ADT at time of registration. The primary endpoint is the proportion of patients with undetectable PSA (≤0.2 ng/L) at 12 months after study treatment commencement. Secondary endpoints include safety, time to castration resistance, overall survival, PSA and radiographic progression-free survival, objective tumour response rate, early PSMA PET response, health-related quality of life, and frequency and severity of adverse events. Enrolment commenced in April 2020. RESULTS AND CONCLUSIONS: The results of this trial will generate data on the activity and safety of 177 Lu-PSMA-617 in men with de novo mHNPC in a randomized phase 2 design.


Subject(s)
Antineoplastic Agents/administration & dosage , Clinical Trials, Phase II as Topic , Docetaxel/administration & dosage , Lutetium/administration & dosage , Prostate-Specific Antigen/administration & dosage , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/drug therapy , Radiopharmaceuticals/administration & dosage , Randomized Controlled Trials as Topic , Research Design , Antineoplastic Agents, Hormonal , Humans , Male , Multicenter Studies as Topic
4.
Future Oncol ; 17(17): 2225-2241, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33724868

ABSTRACT

Prostate-specific membrane antigen (PSMA) PET/CT is a novel imaging technique for the detection and staging of either primary or recurrent prostate cancer. Early studies demonstrated its improved sensitivity and specificity over and in combination with other currently employed imaging techniques, such as multiparametric MRI, bone scan, PET and CT. However, the lack of strength and confidence in these studies has meant incorporation of PSMA PET/CT into clinical guidelines and practice has been limited to date. In response, a number of high-quality prospective studies have recently emerged and reflect exciting results seen in preceding publications. Here we recount some of the key earlier publications, report results from the latest studies and look to the future discussing some of the eagerly awaited ongoing clinical trials.


Subject(s)
Antigens, Surface/metabolism , Glutamate Carboxypeptidase II/metabolism , Positron Emission Tomography Computed Tomography/methods , Prostatic Neoplasms/classification , Prostatic Neoplasms/diagnosis , Humans , Image Processing, Computer-Assisted , Male , Neoplasm Staging , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/metabolism
5.
Eur Urol ; 79(3): 351-352, 2021 03.
Article in English | MEDLINE | ID: mdl-33436167

ABSTRACT

Optimisation of prostate-specific membrane antigen (PSMA) based radioligand therapy (RLT) requires a focus on prospective trials.


Subject(s)
Precision Medicine , Prostate , Actinium , Humans , Male , Prospective Studies
6.
Eur Urol Focus ; 7(2): 234-237, 2021 03.
Article in English | MEDLINE | ID: mdl-33172774

ABSTRACT

LuTectomy is an open-label phase 1/2 nonrandomised clinical trial evaluating the dosimetry, efficacy, and toxicity of the lutetium-177-radiolabelled small molecule PSMA-617 in men with high-risk localised/locoregional advanced prostate cancer with high prostate-specific membrane antigen expression who are undergoing radical prostatectomy and pelvic lymph node dissection.


Subject(s)
Prostatectomy , Prostatic Diseases/surgery , Dipeptides , Heterocyclic Compounds, 1-Ring , Humans , Male , Prostate-Specific Antigen
7.
J Med Imaging Radiat Oncol ; 65(2): 213-215, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33103347

ABSTRACT

Adenoid cystic carcinoma is a rare disease and characterised by slow but unrelenting local progression and risk of haematogenous metastases. We present a case of locally unresectable disease where PSMA PET/CT provided complementary staging and early treatment response assessment.


Subject(s)
Carcinoma, Adenoid Cystic , Positron Emission Tomography Computed Tomography , Carcinoma, Adenoid Cystic/diagnostic imaging , Humans
8.
Clin Nucl Med ; 44(10): 797-798, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31348079

ABSTRACT

We report a case of a 75-year-old man with concomitant metastatic prostate cancer and progressive follicular lymphoma and the utility of molecular imaging in differentiating these 2 conditions. F-FDG PET/CT can offer accurate staging in many cancers, although its role in prostate cancer is limited. The role of F-DCFPyL (PSMA) PET/CT in prostate cancer is evolving and has been demonstrated to have a higher sensitivity than conventional bone scan and CT scan. Together, FDG and PSMA PET/CT studies may offer a noninvasive approach to individually characterize concomitant malignancies, aiding optimization of management and follow-up.


Subject(s)
Fluorodeoxyglucose F18 , Lymphoma, Follicular/diagnostic imaging , Lysine/analogs & derivatives , Neoplasms, Second Primary/diagnostic imaging , Positron Emission Tomography Computed Tomography , Prostatic Neoplasms/diagnostic imaging , Urea/analogs & derivatives , Aged , Humans , Lymphoma, Follicular/pathology , Male , Neoplasm Metastasis , Neoplasms, Second Primary/pathology , Prostatic Neoplasms/pathology
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