PSMA and Choline PET for the Assessment of Response to Therapy and Survival Outcomes in Prostate Cancer Patients: A Systematic Review from the Literature

doi:10.3390/cancers14071770

Review

. 2022 Mar 31;14(7):1770.

doi: 10.3390/cancers14071770.

PSMA and Choline PET for the Assessment of Response to Therapy and Survival Outcomes in Prostate Cancer Patients: A Systematic Review from the Literature

Pierpaolo Alongi¹, Riccardo Laudicella^{2

3

4}, Helena Lanzafame⁵, Andrea Farolfi⁶, Paola Mapelli⁷, Maria Picchio⁷, Irene A Burger^{4

8}, Andrei Iagaru⁹, Fabio Minutoli³, Laura Evangelista¹⁰

Affiliations

¹ Nuclear Medicine Unit, A.R.N.A.S. Ospedale Civico Di Cristina Benfratelli, 90127 Palermo, Italy.
² Nuclear Medicine Unit, Fondazione Istituto G.Giglio, 90015 Cefalù, Italy.
³ Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98122 Messina, Italy.
⁴ Department of Nuclear Medicine, University Hospital Zürich, University of Zurich, 8091 Zurich, Switzerland.
⁵ Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
⁶ Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, 40138 Bologna, Italy.
⁷ Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy.
⁸ Department of Nuclear Medicine, Kantonsspital Baden, 5404 Baden, Switzerland.
⁹ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, CA 94035, USA.
¹⁰ Nuclear Medicine Unit, Department of Medicine, University of Padua, 35128 Padova, Italy.

PMID: 35406542
PMCID: PMC8997431
DOI: 10.3390/cancers14071770

Review

PSMA and Choline PET for the Assessment of Response to Therapy and Survival Outcomes in Prostate Cancer Patients: A Systematic Review from the Literature

Pierpaolo Alongi et al. Cancers (Basel). 2022.

. 2022 Mar 31;14(7):1770.

doi: 10.3390/cancers14071770.

Authors

Affiliations

¹ Nuclear Medicine Unit, A.R.N.A.S. Ospedale Civico Di Cristina Benfratelli, 90127 Palermo, Italy.
² Nuclear Medicine Unit, Fondazione Istituto G.Giglio, 90015 Cefalù, Italy.
³ Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98122 Messina, Italy.
⁴ Department of Nuclear Medicine, University Hospital Zürich, University of Zurich, 8091 Zurich, Switzerland.
⁵ Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
⁶ Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, 40138 Bologna, Italy.
⁷ Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy.
⁸ Department of Nuclear Medicine, Kantonsspital Baden, 5404 Baden, Switzerland.
⁹ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, CA 94035, USA.
¹⁰ Nuclear Medicine Unit, Department of Medicine, University of Padua, 35128 Padova, Italy.

PMID: 35406542
PMCID: PMC8997431
DOI: 10.3390/cancers14071770

Abstract

The aims of this systematic review were to (1) assess the utility of PSMA-PET and choline-PET in the assessment of response to systemic and local therapy, and to (2) determine the value of both tracers for the prediction of response to therapy and survival outcomes in prostate cancer. We performed a systematic literature search in PubMed/Scopus/Google Scholar/Cochrane/EMBASE databases (between January 2010 and October 2021) accordingly. The quality of the included studies was evaluated following the "Quality Assessment of Prognostic Accuracy Studies" tool (QUAPAS-2). We selected 40 articles: 23 articles discussed the use of PET imaging with [⁶⁸Ga]PSMA-11 (16 articles/1123 patients) or [¹¹C]/[¹⁸F]Choline (7 articles/356 patients) for the prediction of response to radiotherapy (RT) and survival outcomes. Seven articles (three with [⁶⁸Ga]PSMA-11, three with [¹¹C]Choline, one with [¹⁸F]Choline) assessed the role of PET imaging in the evaluation of response to docetaxel (as neoadjuvant therapy in one study, as first-line therapy in five studies, and as a palliative regimen in one study). Seven papers with radiolabeled [¹⁸F]Choline PET/CT (n = 121 patients) and three with [⁶⁸Ga]PSMA-11 PET (n = 87 patients) were selected before and after enzalutamide/abiraterone acetate. Finally, [¹⁸F]Choline and [⁶⁸Ga]PSMA-11 PET/CT as gatekeepers for the treatment of metastatic prostate cancer with Radium-223 were assessed in three papers. In conclusion, in patients undergoing RT, radiolabeled choline and [⁶⁸Ga]PSMA-11 have an important prognostic role. In the case of systemic therapies, the role of such new-generation imaging techniques is still controversial without sufficient data, thus requiring additional in this scenario.

Keywords: PET; PSMA; choline; prognosis; prostate cancer; response to therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 2**
QUAPAS results for all selected studies.

**Figure 3**
Distribution of the papers in accordance with their main endpoint. Chemo = chemotherapy, Enza = enzalutamide; Abi = abiraterone acetate; RT = radiotherapy; 223Ra = 223radium-dichloride.

See this image and copyright information in PMC

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References

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1. Brockman J.A., Alanee S., Vickers A., Scardino P.T., Wood D.P., Kibel A.S., Lin D.W., Bianco F.J., Jr., Rabah D., Klein E.A., et al. Nomogram predicting prostate cancer-specific mortality for men with biochemical recurrence after radical prostatectomy. Eur. Urol. 2015;67:1160–1167. doi: 10.1016/j.eururo.2014.09.019. - DOI - PMC - PubMed
1. Burgio S.L., Conteduca V., Rudnas B., Carrozza F., Campadelli E., Bianchi E., Fabbri P., Montanari M., Carretta E., Menna C., et al. PSA flare with abiraterone in patients with metastatic castration-resistant prostate cancer. Clin. Genitourin. Cancer. 2015;13:39–43. doi: 10.1016/j.clgc.2014.06.010. - DOI - PubMed
1. Pezaro C.J., Omlin A., Lorente D., Rodrigues D.N., Ferraldeschi R., Bianchini D., Mukherji D., Riisnaes R., Altavilla A., Crespo M., et al. Visceral disease in castration-resistant prostate cancer. Eur. Urol. 2014;65:270–273. doi: 10.1016/j.eururo.2013.10.055. - DOI - PMC - PubMed
1. Eisenhauer E.A., Therasse P., Bogaerts J., Schwartz L.H., Sargent D., Ford R., Dancey J., Arbuck S., Gwyther S., Mooney M., et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1. 1). Eur. J. Cancer. 2009;45:228–247. doi: 10.1016/j.ejca.2008.10.026. - DOI - PubMed

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[1] Carvalhal G.F., Daudi S.N., Kan D., Mondo D., Roehl K.A., Loeb S., Catalona W.J. Correlation between serum prostate-specific antigen and cancer volume in prostate glands of different sizes. Urology. 2010;76:1072–1076. doi: 10.1016/j.urology.2009.11.056. - DOI - PMC - PubMed

[2] Carvalhal G.F., Daudi S.N., Kan D., Mondo D., Roehl K.A., Loeb S., Catalona W.J. Correlation between serum prostate-specific antigen and cancer volume in prostate glands of different sizes. Urology. 2010;76:1072–1076. doi: 10.1016/j.urology.2009.11.056. - DOI - PMC - PubMed

[3] Brockman J.A., Alanee S., Vickers A., Scardino P.T., Wood D.P., Kibel A.S., Lin D.W., Bianco F.J., Jr., Rabah D., Klein E.A., et al. Nomogram predicting prostate cancer-specific mortality for men with biochemical recurrence after radical prostatectomy. Eur. Urol. 2015;67:1160–1167. doi: 10.1016/j.eururo.2014.09.019. - DOI - PMC - PubMed

[4] Brockman J.A., Alanee S., Vickers A., Scardino P.T., Wood D.P., Kibel A.S., Lin D.W., Bianco F.J., Jr., Rabah D., Klein E.A., et al. Nomogram predicting prostate cancer-specific mortality for men with biochemical recurrence after radical prostatectomy. Eur. Urol. 2015;67:1160–1167. doi: 10.1016/j.eururo.2014.09.019. - DOI - PMC - PubMed

[5] Burgio S.L., Conteduca V., Rudnas B., Carrozza F., Campadelli E., Bianchi E., Fabbri P., Montanari M., Carretta E., Menna C., et al. PSA flare with abiraterone in patients with metastatic castration-resistant prostate cancer. Clin. Genitourin. Cancer. 2015;13:39–43. doi: 10.1016/j.clgc.2014.06.010. - DOI - PubMed

[6] Burgio S.L., Conteduca V., Rudnas B., Carrozza F., Campadelli E., Bianchi E., Fabbri P., Montanari M., Carretta E., Menna C., et al. PSA flare with abiraterone in patients with metastatic castration-resistant prostate cancer. Clin. Genitourin. Cancer. 2015;13:39–43. doi: 10.1016/j.clgc.2014.06.010. - DOI - PubMed

[7] Pezaro C.J., Omlin A., Lorente D., Rodrigues D.N., Ferraldeschi R., Bianchini D., Mukherji D., Riisnaes R., Altavilla A., Crespo M., et al. Visceral disease in castration-resistant prostate cancer. Eur. Urol. 2014;65:270–273. doi: 10.1016/j.eururo.2013.10.055. - DOI - PMC - PubMed

[8] Pezaro C.J., Omlin A., Lorente D., Rodrigues D.N., Ferraldeschi R., Bianchini D., Mukherji D., Riisnaes R., Altavilla A., Crespo M., et al. Visceral disease in castration-resistant prostate cancer. Eur. Urol. 2014;65:270–273. doi: 10.1016/j.eururo.2013.10.055. - DOI - PMC - PubMed

[9] Eisenhauer E.A., Therasse P., Bogaerts J., Schwartz L.H., Sargent D., Ford R., Dancey J., Arbuck S., Gwyther S., Mooney M., et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1. 1). Eur. J. Cancer. 2009;45:228–247. doi: 10.1016/j.ejca.2008.10.026. - DOI - PubMed

[10] Eisenhauer E.A., Therasse P., Bogaerts J., Schwartz L.H., Sargent D., Ford R., Dancey J., Arbuck S., Gwyther S., Mooney M., et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1. 1). Eur. J. Cancer. 2009;45:228–247. doi: 10.1016/j.ejca.2008.10.026. - DOI - PubMed

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PSMA and Choline PET for the Assessment of Response to Therapy and Survival Outcomes in Prostate Cancer Patients: A Systematic Review from the Literature

Affiliations

PSMA and Choline PET for the Assessment of Response to Therapy and Survival Outcomes in Prostate Cancer Patients: A Systematic Review from the Literature

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