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Androgen deprivation therapy and its modulation of PSMA expression in prostate cancer: mini review and case series of patients studied with sequential [68Ga]-Ga-PSMA-11 PET/CT

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Abstract

Purpose and background

[68Ga]-Ga-PSMA-PET/CT (PSMA-PET) is routinely performed in many patients who have received or are receiving Androgen Deprivation Therapy (ADT). However, potentially occurring interactions of ADT on PSMA expression in men with Prostate cancer (PCa) have not been yet fully investigated nor understood. Since an influence of ADT on the expression of PSMA was observed in both in vitro and in vivo studies, relevant implications for image interpretation and PSMA-radioligand therapy (RLT) timing may arise from a better understanding of such a phenomenon.

Methods

In this mini review, we analyzed the most relevant clinical literature on this topic (PubMed). We also presented a case series of two patients who underwent sequential PSMA-PET during ADT.

Results

We found a total of five studies which investigated the effect of ADT on PSMA expression on 43 patients at different stages of the natural history of the disease. Four studies investigated the effect of short-term ADT and detected an increase of PSMA expression (more or less heterogeneous). The remaining study investigated the long-term ADT effect, demonstrating a decrease in most lesions.

In our case series, despite a complete PSA response, we observed a rapid up-regulation of PSMA expression in our PSMA-PET imaging immediately after ADT administration.

Conclusions

Although clinical evidence remains inconclusive, a short-term ADT administration may seem to increase PSMA expression in some selected cases, while long-term ADT might have the opposite effect at least in castrate sensitive prostate cancer (CSPC) patients, even if potentially leading to an early selection of those lesions most at risk of becoming castrate resistant.

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Authors and Affiliations

  1. Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Riccardo Mei, Andrea Farolfi, Stefano Fanti & Paolo Castellucci

  2. Medical Oncology, Department of Oncology, Azienda Ospedaliera S. Maria, Terni, Italy

    Sergio Bracarda

  3. Department of Theranostics and Nuclear Medicine, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia

    Louise Emmett

  4. Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany

    Alessandro Lambertini

Authors
  1. Riccardo Mei
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  2. Sergio Bracarda
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  3. Louise Emmett
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  4. Andrea Farolfi
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  5. Alessandro Lambertini
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  6. Stefano Fanti
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  7. Paolo Castellucci
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Contributions

SB provided contribution to patient’s data acquisition. PC, RM and AF provided substantial contribution to case series data analysis and interpretation. PC critically revised the literature, organized the review and drafted the first version of the manuscript. PC, LE, RM, critically revised the first draft for important intellectual content. LE kindly revised the manuscript for linguistic content. All authors approved the final version to be published.

Corresponding author

Correspondence to Paolo Castellucci.

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Conflict of interests

RM, LE, AF, AL, SF, PC have stated that they have no conflicts of interest. SB: Advisory Board Member for Pfizer, BMS, Novartis, MSD, Roche, Astellas, Janssen Ipsen, Bayer. Travel accommodation with Pfizer, BMS, Roche, Astellas, Jannsen, Ipsen, Astrazeneca, Exelixis.

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Informed consent was obtained from all patients included in the case series.

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Mei, R., Bracarda, S., Emmett, L. et al. Androgen deprivation therapy and its modulation of PSMA expression in prostate cancer: mini review and case series of patients studied with sequential [68Ga]-Ga-PSMA-11 PET/CT. Clin Transl Imaging 9, 215–220 (2021). https://doi.org/10.1007/s40336-021-00421-4

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  • DOI: https://doi.org/10.1007/s40336-021-00421-4

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