Jérémie Calais, MD, MSc, presented “How to Integrate PSMA PET Findings Into Treatment Algorithms” during the 32nd Annual International Prostate Cancer Update (IPCU32) conference on March 8, 2022, in Snowbird, Utah.
How to cite: Calais, Jérémie. “How to Integrate PSMA PET Findings Into Treatment Algorithms” March 8, 2022. Accessed Apr 2024. https://grandroundsinurology.com/how-to-integrate-psma-pet-findings-into-treatment-algorithms/
How to Integrate PSMA PET Findings Into Treatment Algorithms – Summary
Jérémie Calais, MD, MSc, Associate Professor of Nuclear Medicine and Theranostics in the Department of Molecular and Medical Pharmacology at the University of California, Los Angeles (UCLA), Director of the UCLA Theranostics Program, and Director of the Clinical Research Program of the Ahmanson Translational Theranostics Division discusses how to integrate prostate-specific membrane antigen (PSMA) positron emission tomography (PET) findings into treatment algorithms. Dr. Calais begins by reviewing PSMA PET technologies that have been approved by the U.S. Food and Drug Administration (FDA) since late 2020 and, as of late 2021, are covered by Medicare. According to NCCN guidelines, PSMA PET/CT is a “front-line imaging tool,” with indications for bone and soft tissue imaging for initial staging, PSA persistence/recurrence, and for progressing metastatic hormone-sensitive prostate cancer (mHSPC) or non-metastatic castration-resistant prostate cancer (nmCRPC). Dr. Calais displays data illustrating how PSMA PET will lead to stage migration, with PSMA PET resulting in the redefinition of M1 disease stage with new categories emerging as well as PSMA PET redefining oligo-metastatic vs. poly-metastatic patients. He explains and shows data that illustrate that, while still not perfect, PSMA PET results in upstaging and improved outcomes of selected patients. Dr. Calais then asks how doctors should use this superior imaging technology to inform and help create the best treatment strategies for patients. He cites fluorodeoxyglucose (FDG)-PET in lymphoma as a model to follow. He next discusses PSMA PET predictive value at primary staging and for patient stratification. He explains PSMA PET N1-M1 upstaging predictive value and cites an online tool for clinicians. Dr. Calais then turns to PSMA PET predictive value at biochemical recurrence (BR) (before salvage radiotherapy). He cites PSMA PET staging in inclusion criteria of randomized phase-3 trials, explaining this is what is needed to integrate more of the PSMA PET scan into treatment algorithms. Dr. Calais discusses PSMA PET predictive value before oligo-metastasis-directed radiotherapy (MDT) in HSPC as well as in CRPC. Dr. Calais addresses PSMA PET predictive value in mCRPC patients treated with 177Lu-PSMA-617, citing the VISION trial and the VISION-PET screen failures. He cites a multicenter retrospective study showing those in the VISION screen failure category had worse PSA response and worse outcomes (as measured by progression-free survival as well as overall survival). Dr. Calais explains that PSMA PET should be integrated into the treatment algorithm for patients who are considered for therapy with 177Lu-PSMA-617 and then addresses nomograms that incorporate PSMA PET. He discusses PSMA PET for treatment response evaluation, explaining that there have been some proposals for scores but that these need to be validated in prospective trials.
About the 32nd Annual International Prostate Cancer Update (IPCU32):
Presented by Program Chair E. David Crawford, MD, The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 32 featured lectures, interactive discussions, panel roundtables, debates, and case reports. This conference was led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.
