Seifert R, Gafita A, Telli T, Voter Andrew, Herrmann K, Pomper Martin, Hadaschik B, Rowe Steven P, Fendler W P
Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.
Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Semin Nucl Med. 2024 Jan;54(1):60-68. doi: 10.1053/j.semnuclmed.2023.07.005. Epub 2023 Aug 10.
Imaging of advanced prostate cancer is a challenging task, as it requires longitudinal characterization of disease extent in a standardized way to enable appropriate treatment selection and evaluation of treatment efficacy. In the last years, prostate-specific membrane antigen (PSMA)-PET/CT has become the reference standard examination for patients with advanced prostate cancer. Together with the rise of PSMA-PET, standardized frameworks for the reporting of image findings have been proposed, eg, the Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) and the structured reporting system for PSMA targeted PET imaging (PSMA-RADS) framework. Therefore, recent evidence on PSMA-PET derived tumor volume as useful a biomarker for outcome prognostication and related frameworks will be discussed in the article. The PROMISE framework recommends quantifying the tumor volume per-organ system, which accounts for the fact that the location of the metastases greatly influence its biological aggressiveness. In addition, changes in PSMA-PET derived tumor volume have been shown to be promising biomarkers for response assessment. Limitations of PSMA-PET will also be discussed because the tumor volume might not always be suited for response assessment. As a pitfall of PSMA-based systems, decreasing PSMA-expression might erroneously be interpreted as response to therapy. Also, especially for patients with limited disease, the tumor volume might not be ideal for response assessment. Therefore, various frameworks have been introduced to objectively measure response to therapy with PSMA-PET. Amongst these, the PSMA-PET progression (PPP) criteria and the response evaluation criteria in PSMA (RECIP) are optimized for earlier and later phenotypes of advanced prostate cancer, respectively. Variables needed to determine PPP or RECIP outcome on PSMA-PET are recorded under the umbrella of PROMISE recommendations. In this article, various reporting and response assessment frameworks are explained and discussed. Also, recent evidence for the relevance of PSMA-PET biomarkers for clinical management and outcome prognostication are shown.
晚期前列腺癌的影像学检查是一项具有挑战性的任务，因为它需要以标准化的方式对疾病范围进行纵向特征描述，以便能够进行适当的治疗选择和治疗效果评估。在过去几年中，前列腺特异性膜抗原（PSMA）-PET/CT已成为晚期前列腺癌患者的参考标准检查。随着PSMA-PET的兴起，已经提出了用于报告影像结果的标准化框架，例如前列腺癌分子影像标准化评估（PROMISE）和PSMA靶向PET成像的结构化报告系统（PSMA-RADS）框架。因此，本文将讨论关于PSMA-PET衍生肿瘤体积作为预后生物标志物的有用性的最新证据以及相关框架。PROMISE框架建议按器官系统对肿瘤体积进行量化，这考虑到转移灶的位置会极大地影响其生物学侵袭性这一事实。此外，PSMA-PET衍生肿瘤体积的变化已被证明是用于反应评估的有前景的生物标志物。PSMA-PET的局限性也将被讨论，因为肿瘤体积可能并不总是适合反应评估。作为基于PSMA系统的一个陷阱，PSMA表达降低可能会被错误地解释为对治疗的反应。而且，特别是对于疾病局限的患者，肿瘤体积可能并非反应评估的理想指标。因此，已经引入了各种框架来客观地测量PSMA-PET对治疗的反应。其中，PSMA-PET进展（PPP）标准和PSMA反应评估标准（RECIP）分别针对晚期前列腺癌的早期和晚期表型进行了优化。在PROMISE建议的框架下记录确定PSMA-PET上PPP或RECIP结果所需的变量。在本文中，将解释和讨论各种报告和反应评估框架。此外，还展示了关于PSMA-PET生物标志物与临床管理和预后相关性的最新证据。
