How Does Routine Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Modify the Current Management of Prostate Cancer? A Multidisciplinary View.
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Oprea-Lager Daniela E, van Elst Tessa, Aluwini Shafak, Dewulf Els, der Poel Henk van, Stoevelaar Herman, Bangma Chris H, Beeker Aart, Boudewijns Steve, Budiharto Tom, de Jong Igle-Jan, de Vries Kim C, Donswijk Maarten L, Fütterer Jurgen J, Hamberg Paul, Heijmen Linda, Hoekstra Robert J, Kerkhofs Thomas M A, Lavalaye Jules, Bruin Daphne Luijendijk-de, Noordzij Walter, Oving Irma M, Robbrecht Debbie G J, Schaake Eva E, van de Luijtgaarden Addy C M, van den Bergh Roderick C N, van den Berkmortel Franchette, van der Hulle Tom, van der Mijn Johannes C K, van Dodewaard-de Jong Joyce M, van Kruchten Michel, van Leeuwen Pim J, van Limbergen Evert, van Moorselaar R Jeroen A, van Oort Inge M, van Roermund Joep G H, van Soest Robert J, Veninga Theo, Vis André N, Voortman Jens, Willemse Peter-Paul M, Yakar Derya, Mehra Niven
Аннотация
METHODS: A modified Delphi method involved two voting rounds and a face-to-face multidisciplinary meeting with 40 Dutch prostate cancer (PCa) experts. Consensus was reached if ≥75% of the panellists chose the same option. Appropriateness was assessed by the RAND Corporation/University of California Los Angeles appropriateness method.
KEY FINDINGS AND LIMITATIONS: There was consensus on performing metastatic screening with PSMA-PET/CT for unfavourable intermediate- or high-risk PCa. PSMA-PET/CT findings were considered feasible for determining treatment in synchronous metastatic hormone-sensitive prostate cancer, but there was no agreement on the validity of the CHAARTED criteria for interpreting the PSMA-PET/CT findings. If the PSMA-PET/CT findings led to upstaging after conventional imaging, 76% of panellists would opt for treatment intensification. In case of downstaging, 71% would choose for deintensification. Panellists would generally treat patients based on metastatic disease volume as per the CHAARTED criteria, except for bulky low-volume disease (LVD) and LVD with multiple (more than ten) bone metastases, all within the axial skeleton. This would be classified as LVD but treated as high-volume disease. Limitations are that the statements are largely consensus based and originate from a national (Dutch) perspective.
CONCLUSIONS AND CLINICAL IMPLICATIONS: PSMA-PET/CT was considered the preferred modality for initial PCa staging, which is nowadays the standard of care in The Netherlands. The majority of panellists would incorporate PSMA-PET/CT findings for treatment planning, including intensification and deintensification, but the criteria for interpreting metastatic disease volume on PSMA-PET/CT are still uncertain.
PATIENT SUMMARY: A group of Dutch medical specialists discussed on how to diagnose metastatic hormone-sensitive prostate cancer and choose the most appropriate treatment for patients with this condition. It was concluded that imaging based on Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) helps determine appropriate treatment options, with most experts supporting treatment adjustments based on PSMA-PET/computed tomography (CT) results. However, there is still some uncertainty about the criteria for interpreting the extent of metastatic disease with PSMA-PET/CT.