Should new organ involvement be included in Response Evaluation Criteria in PSMA Imaging?

PURPOSE: The current study is intended to investigate the effect of new organ involvement on overall survival (OS) and modify the Response Evaluation Criteria in PSMA Imaging (RECIP) by including new organ involvement to RECIP 1.0. MATERIALS AND METHODS: This retrospective study includes 114 patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC) between September 2017 and June 2022 who had received docetaxel treatment and had baseline and post-treatment prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) images. The inclusion criteria were patients with pre- and post-treatment [18F]FDG PET/CT images and whose [18F]FDG PET images were negative. Those whose data were unavailable, who had additional malignancy, or who received abiraterone, enzalutamide, or Lutetium (Lu)-177 treatment were excluded. Age, Gleason score (GS), TPSA (total prostate-specific antigen) levels, surgical history, and OS information were recorded for each patient. RESULTS: The 114 patients herein had a median age of 72.5 (51-91) years and a median GS of 8 (7-10). New lesions were observed in 59 patients (51.7%) and new organ PSMA uptake was observed in 14 patients (12.2%). In the multivariate Cox regression analysis, volume-based treatment response (vTR)-total lesion PSMA (TLP), RECIP PSMA-VOL, modified RECIP (mRECIP) PSMA-VOL, and mRECIP TLP were independent prognostic factors for mortality (p < 0.001, p = 0.006, p = 0.003, and p = 0.003, respectively). The median OS of patients with new organ involvement and new lesion with PSMA uptake was 9.3 months (95% CI 2.1-16.5 months) and 11.8 months (95% CI 7.4-16.2 months), respectively. CONCLUSION: The study concluded that new organ involvement had a shorter OS than new lesion involvement. In the mRECIP that we developed, unlike RECIP, we demonstrated that both PSMA-VOL and TLP value were independent prognostic factors for mortality.

68 Ga-PSMA Versus 18 F-FDG PET/CT in the Evaluation of Epithelioid Hemangioendothelioma.

ABSTRACT: A 32-year-old man with epithelioid hemangioendothelioma was imaged with 68 Ga-PSMA PET/CT to evaluate the potential of 177 Lu-PSMA radionuclide therapy after progression findings were observed on follow-up 18 F-FDG PET/CT imaging. Liver lesions showed low FDG SUV max . The lesion-to-background ratio (TBR) was calculated as 5.1/2.9 on 18 F-FDG PET/CT imaging. However, 68 Ga-PSMA PET/CT showed moderate PSMA SUV max . TBR was calculated as 4.5/1.1. In conclusion, in this case report, we demonstrated that 68 Ga-PSMA with moderate TBR in epithelioid hemangioendothelioma may be promising for 177 Lu-PSMA radionuclide therapy.

Outcomes of bronchoscopic lung volume reduction coil treatment in patients with severe emphysema.

Background: This study aims to evaluate the outcomes of bronchoscopic lung volume reduction coil treatment in patients with severe emphysema. Methods: Between February 2016 and March 2019, a total of 20 severe emphysema patients (19 males, 1 female; mean age: 65.2±5.2 years; range, 52 to 73 years) who underwent bronchoscopic lung volume reduction coil treatment were included. Each patient underwent pre- and post-treatment (6 and 12 months) pulmonary function tests, 6-min walking distance, modified Medical Research Council dyspnea scores, and diffusing capacity of the lung for carbon monoxide tests. Results: An mean number of 12.0±3.8 coils was placed in each lobe. There were significant improvements in the patients' pulmonary function tests and quality of life 12 months after the treatment. There was a significant difference in dyspnea as assessed by the modified Medical Research Council dyspnea scores 12 months after treatment compared to pre-treatment scores (p<0.05). There was no change in the pulmonary function tests six months after treatment, while a significant improvement was seen at 12 months (p<0.05). Conclusion: Bronchoscopic lung volume reduction coil treatment seems to be a promising modality for severe emphysema patients with significant improvements in the pulmonary function test results, modified Medical Research Council dyspnea scores, and 6-min walking distance.