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https://ahro.austin.org.au/austinjspui/handle/1/31023| Title: | Impact of Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography in the Management of Oligometastatic Renal Cell Carcinoma. | Austin Authors: | Udovicich, Cristian;Callahan, Jason;Bressel, Mathias;Ong, Wee Loon ;Perera, Marlon ;Tran, Ben;Azad, Arun;Haran, Shankar;Moon, Daniel;Chander, Sarat;Shaw, Mark;Eapen, Renu S ;Goad, Jeremy;Lawrentschuk, Nathan;Murphy, Declan G;Hofman, Michael;Siva, Shankar | Affiliation: | Department of Surgery, The University of Melbourne, Melbourne, Australia Medical Education, The University of Melbourne, Melbourne, Australia Department of Urology, The Royal Melbourne Hospital, Parkville, Australia Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia Alfred Health Radiation Oncology, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia Surgery (University of Melbourne) Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia Royal Melbourne Hospital Clinical School, The University of Melbourne, Melbourne, Australia Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia Clinical Pathology, The University of Melbourne, Melbourne, Australia Urology Department of Urology, St. Vincent's Health, Fitzroy, Australia Olivia Newton-John Cancer Research Institute |
Issue Date: | Oct-2022 | Date: | 2022 | Publication information: | European Urology Open Science 2022; 44: 60-68 | Abstract: | 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. To assess the impact of PSMA PET/CT in the management of metastatic RCC. 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. 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. 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. 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. 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%. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/31023 | DOI: | 10.1016/j.euros.2022.08.001 | Journal: | European Urology Open Science | PubMed URL: | 36185587 | Type: | Journal Article | Subjects: | Clear cell histology Impact Kidney cancer Management change Metastasis-directed therapy Molecular imaging Oligometastatic Positron emission tomography/computed tomography Prostate-specific membrane antigen Renal cell carcinoma |
| Appears in Collections: | Journal articles |
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