According to research presented by the Society of Nuclear Medicine and Molecular Imaging 2022, current guidelines used to plan radiation treatments in patients with localized recurrence of prostate cancer should be updated to take into account information derived from new imaging modalities, such as PSMA PET. meeting. The study showed that PSMA PET was effective in identifying recurrences that fell wholly or partially outside the clinical target volume as determined by current guidelines. This suggests that PSMA PET may be an invaluable tool for therapy planning.
After a biochemical recurrence of prostate cancer, salvage radiation therapy may be a curative approach. This therapy was performed according to expert consensus contouring guidelines, such as the Radiation Therapy Oncology Group (RTOG) guidelines. In the current era of precision medicineStudy authors sought to determine whether PSMA PET imaging could provide more detailed data on patterns of recurrence to inform therapy planning.
Prostate cancer patients who experienced biochemical recurrence after radical prostatectomy were included in the analysis if their PSMA PET/CT imaging showed recurrence in the prostate bed. To analyze the patterns of repetition, two nuclear medicine physicians documented the areas of recurrence on the PSMA PET/CT, and four radiation oncologists (masked from the PSMA PET/CT findings) determined the clinical target volume using RTOG guidelines on the CT images of the PET/CT. PSMA recurrence sites were then compared to the RTOG-based clinical target volumes.
PSMA recurrence was fully covered by the clinical target volumes in 54 percent of patients. In 34 percent of patients, PSMA recurrence was only partially covered and in 13 percent of patients, PSMA recurrence was completely outside the clinical target volume.
“This study has the potential to redefine prostate bed contouring guidelines to improve the therapeutic ratio for patients receiving postoperative radiotherapy,” said Ida Sonni, MD, a project scientist in the Department of Radiology at the University of California, Los Angeles. “Nuclear medicine and molecular imaging Advances such as PSMA PET have the potential to guide individualized, tailored treatments that will ultimately benefit all of our patients.”
Ida Sonni et al, PSMA PET mapping of postoperative local recurrence and impact on prostate fossa contouring guidelines for salvage radiation therapy, Abstract 486SNMMI 2022 Annual Meeting.
Provided by Society of Nuclear Medicine and Molecular Imaging
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