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Interval Changes in PSMA PET/CT During Radium-223 Therapy for Metastatic Bone Disease from Castration-Resistant Prostate Cancer

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Abstract

Background

Radium-223, an alpha-emitting therapeutic radiopharmaceutical, prolongs overall survival (OS) in patients with symptomatic bone-predominant metastatic castration-resistant prostate cancer (mCRPC). PSMA PET/CT is a molecular imaging tool for whole-body imaging of prostate cancer and may inform on the mechanisms of radium-223 activity and treatment resistance in mCRPC patients.

Methods

In an open-label, single-arm, prospective trial, we enrolled patients with bone-predominant mCRPC to undergo baseline PSMA PET/CT, 6 cycles of radium-223, and post-therapy PSMA PET/CT. We assessed the relationship between multiple parameters of interval change on PSMA PET/CT on aPROMISE PSMA automated analysis and a human reader, and laboratory measurements.

Results

Fourteen patients were enrolled and 9 patients completed both protocol-defined PSMA PET/CT. Of the 9 evaluable patients, 1 (11%) had a complete response and 8 (89%) had PSMA PET progressive disease. All patients showed decreases in PSMA uptake in some disease sites evident on the baseline scan. The change in overall burden of disease on PSMA PET was more strongly correlated with changes in PSA (ρ = 0.95) than ALP (ρ = 0.62). Progression in bone was a common finding on post-treatment PSMA PET/CT.

Conclusion

PSMA PET was able to assess response in individual lesions during radium-223 therapy in mCRPC patients. PSMA PET responses in previously established disease sites were universal, but most patients also showed overall PSMA PET progression during 6 cycles of radium-223. Given high correlation with changes in PSA, PSMA PET may be of limited value in follow-up during or after radium-223 in bone-predominant mCRPC.

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Data Availability

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Acknowledgements

The authors wish to acknowledge Aline Mamo for her untiring administrative support.

Funding

This study was supported by a grant of 43,555 $CAD funded by Bayer Inc.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Jewish General Hospital, 3755 Cote St Catherine Rd, G19, Montreal, QC, H3T1E2, Canada

    Stephan Probst

  2. Dept of Urology, Skåne University, Jan Waldenströms gata 5, 205 02, Malmö, SE, Sweden

    Anders Bjartell

  3. Dept of Translational Medicine, Lund University, Scheelevägen 27, 223 70, Lund, SE, Sweden

    Anders Bjartell & Aseem Anand

  4. Division of Hematology, Jewish General Hospital, 3755 Cote St Catherine Rd, Montreal, QC, H3T1E2, Canada

    Tayna Skamene

  5. Division of Medical Oncology, Jewish General Hospital, 3755 Cote St Catherine Rd, Montreal, QC, H3T1E2, Canada

    Cristiano Ferrario

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  1. Stephan Probst
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Contributions

Each author contributed to data analysis, writing, editing, and final review of the manuscript.

Corresponding author

Correspondence to Stephan Probst.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the IRB of CIUSSS West-Central Montreal, Jewish General Hospital, A-903 3755, Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada, H3T 1E2, under protocol no. 17–029. IRB-approved written informed consent was obtained from all patients.

Conflict of Interest

Stephan Probst reports funding for the current study from Bayer Inc. as his only conflict of interest. Aseem Anand reports being an employee of Exini Diagnostics AB as his only conflict of interest. Anders Bjartell, Tayna Skamene, and Cristiano Ferrario report that they have no conflict of interest. No other declarations by any of the authors.

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Key Points

• Question: Can PSMA PET/CT inform on the response to radium-223 in mCRPC patients?

• Pertinent findings: PSMA PET appears to be able to assess response in individual lesions during radium-223, and the overall change in burden of disease on PSMA PET is highly correlated with changes in PSA.

• Implications for patient care: PSMA PET may be of limited value at present to follow mCRPC patients undergoing radium-223 therapy outside of a clinical trial but further research could evaluate the eventual incorporation of PSMA PET in this clinical scenario.

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Probst, S., Bjartell, A., Anand, A. et al. Interval Changes in PSMA PET/CT During Radium-223 Therapy for Metastatic Bone Disease from Castration-Resistant Prostate Cancer. Nucl Med Mol Imaging 56, 188–195 (2022). https://doi.org/10.1007/s13139-022-00754-6

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  • DOI: https://doi.org/10.1007/s13139-022-00754-6

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