Impact of prostate-specific membrane antigen positron emission tomography/computed tomography in the management of oligometastatic renal cell carcinoma Journal Article

Authors: Udovicich, C.; Callahan, J.; Bressel, M.; Ong, W. L.; Perera, M.; Tran, B.; Azad, A.; Haran, S.; Moon, D.; Chander, S.; Shaw, M.; Eapen, R.; Goad, J.; Lawrentschuk, N.; Murphy, D. G.; Hofman, M.; Siva, S.
Article Title: Impact of prostate-specific membrane antigen positron emission tomography/computed tomography in the management of oligometastatic renal cell carcinoma
Abstract: Background: Prostate-specific membrane antigen (PSMA) is overexpressed in the neovasculature of renal cell carcinoma (RCC). However, there remains limited evidence regarding the use of PSMA positron emission tomography/computed tomography (PET/CT) in RCC. Objective: To assess the impact of PSMA PET/CT in the management of metastatic RCC. Design, setting, and participants: This was a retrospective review of patients who underwent PSMA PET/CT from 2014 to 2020 for restaging or suspected metastatic RCC in a tertiary academic setting. Outcome measurements and statistical analysis: Management plans before and after PSMA PET/CT were recorded. Impact was classified as high (change of treatment intent, modality, or site), medium (change in treatment method), or low. Secondary outcomes included the patient-level detection rate, PSMA PET/CT parameters, sensitivity, and comparison to CT and, if available, fluorodeoxyglucose (FDG) PET/CT. Results and limitations: Sixty-one patients met the inclusion criteria, of whom 54 (89%) had clear cell RCC. PSMA-positive disease was detected in 51 patients (84%). For 30 patients (49%) there was a change in management due to PSMA PET/CT (high impact, 29 patients, 48%). In 15 patients (25%), more metastases were detected on PSMA PET/CT than on CT. The sensitivity of combined PSMA PET/CT and diagnostic CT was 91% (95% confidence interval 77–98%). In a subcohort of 40 patients, the detection rate was 88% for PSMA and 75% for FDG PET/CT (p = 0.17). The maximum standardised uptake value (SUVmax) was higher for PSMA than for FDG PET/CT (15.2 vs 8.0; p = 0.02). Limitations include selection bias due to the retrospective design, and a lack of corresponding histopathology for all patients. Conclusions: PSMA PET/CT is a promising imaging modality in metastatic RCC and led to a change in management in 49% of patients. PSMA PET/CT detected additional metastases compared to CT in 25% of patients and registered a significantly higher SUVmax than FDG PET/CT. Prospective studies are required to further define its role. Patient summary: We report on a group of patients undergoing a new type of imaging for suspected advanced kidney cancer, called PSMA PET/CT. This imaging changed the management plan in 49% of the patients. PSMA PET/CT detected metastases in 84% of our patients and detected more metastases than computed tomography imaging in 25%. © 2022 The Authors
Keywords: adult; controlled study; human tissue; aged; major clinical study; histopathology; cancer patient; cancer diagnosis; metastasis; computer assisted tomography; molecular imaging; retrospective study; renal cell carcinoma; prostate specific membrane antigen; kidney cancer; fluorodeoxyglucose; gallium 68; impact; prostate-specific membrane antigen; maximum standardized uptake value; positron emission tomography/computed tomography; human; male; female; article; oligometastatic; positron emission tomography-computed tomography; clear cell histology; management change; metastasis-directed therapy
Journal Title: European Urology Open Science
Volume: 44
ISSN: 2666-1691
Publisher: Elsevier BV  
Date Published: 2022-10-01
Start Page: 60
End Page: 68
Language: English
DOI: 10.1016/j.euros.2022.08.001
PROVIDER: scopus
PMCID: PMC9520507
PUBMED: 36185587
Notes: Article -- Export Date: 3 October 2022 -- Source: Scopus
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MSK Authors
  1. Marlon Lakmal Perera
    22 Perera