Advertisement

Der Urologe

pp 1–6 | Cite as

Prostataspezifische Membranantigen(PSMA)-basierte Diagnostik und Therapie des Prostatakarzinoms

  • A. Afshar-OromiehEmail author
  • I. Alberts
  • C. Sachpekidis
  • A. Rominger
Leitthema
  • 50 Downloads

Zusammenfassung

Hintergrund

Die Positronenemissionstomographie/Computertomographie (PET/CT) mit Liganden des Prostataspezifischen Membranantigens (PSMA) und die PSMA-Therapie haben sich seit ihrer klinischen Einführung in 2011 weltweit rasant ausgebreitet.

Fragestellung

Aktuelle Erkenntnisse sowohl über die PSMA-PET/CT als auch über die PSMA-Therapie werden zusammengefasst.

Material und Methode

Erkenntnisse aus der Literatur und Erfahrungen der Autoren wurden zusammengetragen.

Ergebnisse

Es zeigt sich eine sehr hohe Sensitivität und Spezifität der PSMA-PET/CT sowohl beim Rezidivprostatakarzinom (‑PC) als auch beim Primärstaging des PC mit mittlerem und hohem Risikoprofil. Die Ergebnisse der PSMA-Therapie als Drittlinientherapie bei Patienten mit metastasiertem, kastrationsresistentem PC sind vielversprechend.

Schlussfolgerungen

Die PSMA-PET/CT hat sich mittlerweile als Goldstandard in der Diagnostik des Rezidiv-PC etabliert und ist dabei, dieselbe Rolle auch beim Primärstaging des PC mit mittlerem und hohem Risikoprofil zu übernehmen. Die PSMA-Therapie wird in einer stets wachsenden Zahl an Zentren als Drittlinientherapie bei metastasiertem, kastrationsresistentem PC routinemäßig durchgeführt.

Schlüsselwörter

PET/CT Radiotherapie Radioliganden Rezidiv Tumormarker 

Prostate-specific membrane antigen (PSMA)-based diagnostics and treatment of prostate cancer

Abstract

Background

Since their clinical introduction in 2011, PSMA-PET/CT (PSMA: prostate-specific membrane antigen) as well as PSMA therapy of prostate cancer (PC) have spread rapidly worldwide.

Objectives

To summarize the current knowledge about both PSMA-PET/CT and PSMA therapy of PC.

Methods

The knowledge derived from the literature as well as the authors’ experiences were collected in this review.

Results

PSMA-PET/CT demonstrates a very high sensitivity and specificity for the detection of recurrent PC as well as for the primary staging of intermediate- and high-risk PC. PSMA therapy shows promising results in third-line treatment for patients with castration-resistant, metastatic PC.

Conclusions

PSMA-PET/CT is meanwhile established as the gold standard for the detection of recurrent PC and is in the process of assuming the same role for primary staging of intermediate- to high-risk PC. PSMA therapy serves as a promising third-line therapy in an increasing number of centers.

Keywords

PET/CT Radiotherapy Radioligand Recurrence Tumor marker 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Afshar-Oromieh, I. Alberts, C. Sachpekidis und A. Rominger geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Afshar-Oromieh A, Haberkorn U, Eder M, Eisenhut M, Zechmann CM (2012) [68 Ga]Gallium-labelled PSMA ligand as superior PET tracer for the diagnosis of prostate cancer: comparison with 18F-FECH. Eur J Nucl Med Mol Imaging 39:1085–1086CrossRefGoogle Scholar
  2. 2.
    Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA et al (2013) PET imaging with a [68 Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging 40:486–495CrossRefGoogle Scholar
  3. 3.
    Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG et al (2014) Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 41:11–20CrossRefGoogle Scholar
  4. 4.
    Alonso O, Dos Santos G, Garcia Fontes M, Balter H, Engler H (2018) (68)Ga-PSMA and (11)C-Choline comparison using a tri-modality PET/CT-MRI (3.0 T) system with a dedicated shuttle. Eur J Hybrid Imaging 2:9CrossRefGoogle Scholar
  5. 5.
    Barbaud M, Frindel M, Ferrer L, Le Thiec M, Rusu D, Rauscher A et al (2019) 68 Ga-PSMA-11 PET-CT study in prostate cancer patients with biochemical recurrence and non-contributive 18F-Choline PET-CT: Impact on therapeutic decision-making and biomarker changes. Prostate 79:454–461CrossRefGoogle Scholar
  6. 6.
    Bluemel C, Krebs M, Polat B, Linke F, Eiber M, Samnick S et al (2016) 68 ga-PSMA-PET/CT in patients with biochemical prostate cancer recurrence and negative 18F-choline-PET/CT. Clin Nucl Med 41:515–521CrossRefGoogle Scholar
  7. 7.
    Emmett L, Metser U, Bauman G, Hicks RJ, Weickhardt A, Davis ID et al (2018) A prospective, multi-site, international comparison of F‑18 fluoro-methyl-choline, multi-parametric magnetic resonance and ga-68 HBED-CC (PSMA-11) in men with high-risk features and biochemical failure after radical prostatectomy: clinical performance and patient outcomes. J Nucl Med.  https://doi.org/10.2967/jnumed.118.220103 CrossRefPubMedGoogle Scholar
  8. 8.
    Schwenck J, Rempp H, Reischl G, Kruck S, Stenzl A, Nikolaou K et al (2017) Comparison of (68)Ga-labelled PSMA-11 and (11)C-choline in the detection of prostate cancer metastases by PET/CT. Eur J Nucl Med Mol Imaging 44:92–101CrossRefGoogle Scholar
  9. 9.
    Afshar-Oromieh A, Vollnberg B, Alberts I, Bahler A, Sachpekidis C, Dijkstra L et al (2019) Comparison of PSMA-ligand PET/CT and multiparametric MRI for the detection of recurrent prostate cancer in the pelvis. Eur J Nucl Med Mol Imaging 46(11):2289–2297.  https://doi.org/10.1007/s00259-019-04438-w. Epub 2019 Jul 27CrossRefPubMedGoogle Scholar
  10. 10.
    Zacho HD, Nielsen JB, Afshar-Oromieh A, Haberkorn U, deSouza N, De Paepe K et al (2018) Prospective comparison of (68)Ga-PSMA PET/CT, (18)F-sodium fluoride PET/CT and diffusion weighted-MRI at for the detection of bone metastases in biochemically recurrent prostate cancer. Eur J Nucl Med Mol Imaging 45:1884–1897CrossRefGoogle Scholar
  11. 11.
    Sawicki LM, Kirchner J, Buddensieck C, Antke C, Ullrich T, Schimmoller L et al (2019) Prospective comparison of whole-body MRI and (68)Ga-PSMA PET/CT for the detection of biochemical recurrence of prostate cancer after radical prostatectomy. Eur J Nucl Med Mol Imaging 46:1542–1550CrossRefGoogle Scholar
  12. 12.
    Mottet N, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V et al (2011) EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 59:572–583CrossRefGoogle Scholar
  13. 13.
    Afshar-Oromieh A, Holland-Letz T, Giesel FL, Kratochwil C, Mier W, Haufe S et al (2017) Diagnostic performance of (68)Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging 44:1258–1268CrossRefGoogle Scholar
  14. 14.
    Caroli P, Sandler I, Matteucci F, De Giorgi U, Uccelli L, Celli M et al (2018) (68)Ga-PSMA PET/CT in patients with recurrent prostate cancer after radical treatment: prospective results in 314 patients. Eur J Nucl Med Mol Imaging 45:2035–2044CrossRefGoogle Scholar
  15. 15.
    Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M et al (2015) The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 42:197–209CrossRefGoogle Scholar
  16. 16.
    Marchal C, Redondo M, Padilla M, Caballero J, Rodrigo I, Garcia J et al (2004) Expression of prostate specific membrane antigen (PSMA) in prostatic adenocarcinoma and prostatic intraepithelial neoplasia. Histol Histopathol 19:715–718PubMedGoogle Scholar
  17. 17.
    Kasperzyk JL, Finn SP, Flavin R, Fiorentino M, Lis R, Hendrickson WK et al (2013) Prostate-specific membrane antigen protein expression in tumor tissue and risk of lethal prostate cancer. Cancer Epidemiol Biomarkers Prev 22:2354–2363CrossRefGoogle Scholar
  18. 18.
    Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B et al (2015) Evaluation of hybrid (6)(8)ga-PSMA Ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med 56:668–674CrossRefGoogle Scholar
  19. 19.
    Sahlmann CO, Meller B, Bouter C, Ritter CO, Strobel P, Lotz J et al (2016) Biphasic (6)(8)Ga-PSMA-HBED-CC-PET/CT in patients with recurrent and high-risk prostate carcinoma. Eur J Nucl Med Mol Imaging 43:898–905CrossRefGoogle Scholar
  20. 20.
    Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C et al (2016) (68)ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer. Eur Urol 70:553–557CrossRefGoogle Scholar
  21. 21.
    Sheikhbahaei S, Afshar-Oromieh A, Eiber M, Solnes LB, Javadi MS, Ross AE et al (2017) Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging. Eur J Nucl Med Mol Imaging 44:2117–2136CrossRefGoogle Scholar
  22. 22.
    Sheikhbahaei S, Werner RA, Solnes LB, Pienta KJ, Pomper MG, Gorin MA et al (2019) Prostate-specific membrane antigen (PSMA)-targeted PET imaging of prostate cancer: an update on important pitfalls. Semin Nucl Med 49:255–270CrossRefGoogle Scholar
  23. 23.
    Evans MJ, Smith-Jones PM, Wongvipat J, Navarro V, Kim S, Bander NH et al (2011) Noninvasive measurement of androgen receptor signaling with a positron-emitting radiopharmaceutical that targets prostate-specific membrane antigen. Proc Natl Acad Sci USA 108:9578–9582CrossRefGoogle Scholar
  24. 24.
    Afshar-Oromieh A, Debus N, Uhrig M, Hope TA, Evans MJ, Holland-Letz T et al (2018) Impact of long-term androgen deprivation therapy on PSMA ligand PET/CT in patients with castration-sensitive prostate cancer. Eur J Nucl Med Mol Imaging 45:2045–2054CrossRefGoogle Scholar
  25. 25.
    Cantiello F, Gangemi V, Cascini GL, Calabria F, Moschini M, Ferro M et al (2017) Diagnostic accuracy of (64)copper prostate-specific membrane antigen positron emission tomography/computed tomography for primary lymph node staging of intermediate- to high-risk prostate cancer: our preliminary experience. Urology 106:139–145CrossRefGoogle Scholar
  26. 26.
    Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G et al (2016) Diagnostic efficacy of (68)gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol 195:1436–1443CrossRefGoogle Scholar
  27. 27.
    Obek C, Doganca T, Demirci E, Ocak M, Kural AR, Yildirim A et al (2017) The accuracy of (68)Ga-PSMA PET/CT in primary lymph node staging in high-risk prostate cancer. Eur J Nucl Med Mol Imaging 44:1806–1812CrossRefGoogle Scholar
  28. 28.
    Zhang Q, Zang S, Zhang C, Fu Y, Lv X, Zhang Q et al (2017) Comparison of (68)Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer. J Transl Med 15:230CrossRefGoogle Scholar
  29. 29.
    Tulsyan S, Das CJ, Tripathi M, Seth A, Kumar R, Bal C (2017) Comparison of 68 Ga-PSMA PET/CT and multiparametric MRI for staging of high-risk prostate cancer68Ga-PSMA PET and MRI in prostate cancer. Nucl Med Commun 38:1094–1102CrossRefGoogle Scholar
  30. 30.
    Park SY, Zacharias C, Harrison C, Fan RE, Kunder C, Hatami N et al (2018) Gallium 68 PSMA-11 PET/MR imaging in patients with intermediate- or high-risk prostate cancer. Radiology 288:495–505CrossRefGoogle Scholar
  31. 31.
    Kratochwil C, Giesel FL, Stefanova M, Benesova M, Bronzel M, Afshar-Oromieh A et al (2016) PSMA-targeted Radionuclide therapy of metastatic castration-resistant prostate cancer with 177Lu-labeled PSMA-617. J Nucl Med 57:1170–1176CrossRefGoogle Scholar
  32. 32.
    Rahbar K, Ahmadzadehfar H, Kratochwil C, Haberkorn U, Schafers M, Essler M et al (2017) German multicenter study investigating 177Lu-PSMA-617 radioligand therapy in advanced prostate cancer patients. J Nucl Med 58:85–90CrossRefGoogle Scholar
  33. 33.
    Hofman MS, Violet J, Hicks RJ, Ferdinandus J, Thang SP, Akhurst T et al (2018) (177)Lu]-PSMA-617 radionuclide treatment in patients with metastatic castration-resistant prostate cancer (LuPSMA trial): a single-centre, single-arm, phase 2 study. Lancet Oncol 19:825–833CrossRefGoogle Scholar
  34. 34.
    Brauer A, Grubert LS, Roll W, Schrader AJ, Schafers M, Bogemann M et al (2017) (177)Lu-PSMA-617 radioligand therapy and outcome in patients with metastasized castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging 44:1663–1670CrossRefGoogle Scholar
  35. 35.
    Sathekge M, Bruchertseifer F, Knoesen O, Reyneke F, Lawal I, Lengana T et al (2019) (225)Ac-PSMA-617 in chemotherapy-naive patients with advanced prostate cancer: a pilot study. Eur J Nucl Med Mol Imaging 46:129–138CrossRefGoogle Scholar
  36. 36.
    Kratochwil C, Bruchertseifer F, Rathke H, Hohenfellner M, Giesel FL, Haberkorn U et al (2018) Targeted alpha-therapy of metastatic castration-resistant prostate cancer with (225)ac-PSMA-617: swimmer-plot analysis suggests efficacy regarding duration of tumor control. J Nucl Med 59:795–802CrossRefGoogle Scholar
  37. 37.
    Kratochwil C, Schmidt K, Afshar-Oromieh A, Bruchertseifer F, Rathke H, Morgenstern A et al (2018) Targeted alpha therapy of mCRPC: dosimetry estimate of (213)Bismuth-PSMA-617. Eur J Nucl Med Mol Imaging 45:31–37CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • A. Afshar-Oromieh
    • 1
    Email author
  • I. Alberts
    • 1
  • C. Sachpekidis
    • 1
  • A. Rominger
    • 1
  1. 1.Klinik für NuklearmedizinInselspital BernBernSchweiz

Personalised recommendations