Possibilities of using prostate specific membrane antigen (PSMA) ligands in the diagnosis and treatment of prostate cancer

Czech version

Authors: Hana Sedláčková ¹; Olga Dolejšová ¹; Tomáš Pitra ¹; Jiří Ferda ²; Eva Ferdová ²; Jan Baxa ²; Milan Hora
Authors‘ workplace: Urologická klinika, Fakultní nemocnice Plzeň ¹; Klinika zobrazovacích metod, Fakultní nemocnice Plzeň ²
Published in: Ces Urol 2020; 24(4): 247-260
Category: Review article

Overview

Sedláčková H, Dolejšová O, Pitra T, Ferda J, Fer‑ dová E, Baxa J, Hora M. Possibilities of using prostate specific membrane antigen (PSMA) ligands in the diagnosis and treatment of prostate cancer.

Multiparametric magnetic resonance imaging of prostate (mpMR) or hybrid imaging using positron emission tomography and computed tomography or magnetic resonance imaging (PET/CT, PET/MR) entered into common practice in diagnostics. They have proven to be successful in diagnostics, but also in detection of biochemical recurrence. Due to the low specificity, but also the sensitivity, especially at low prostate specific antigen (PSA) level in the bio‑ chemical relapse (BCR) PSA ≤ 1 ug/l, new radiotracers are sought to improve diagnostics and then to conduce to the correct treatment decision. Given the fact that the overexpression of PSMA on prostate cancer cells, its further investigated for use in therapy such as radio-guided surgery or radiolabeled with alpha or beta radiation emitters for radiotherapy.

According to the available systematic reviews and clinical trials, the sensitivity and specificity in primary staging of prostate cancer using PSMA ligands is usually above 40% (23–100%) and more than 85% (67–100%), respectively. Whereas in the detection of biochemical relapse the sensitivity is above 75% and the specificity is about 99%. Using PSMA ligands in performing PET/CT or less frequently PET/MRI has the impact on changes in therapeutic procedure, approximately in 21% of patients in primary staging and in patients with biochemical relapse up to 51%.

Current promising results from clinical trials have led to the incorporation of hybrid imaging using PSMA ligands into European urological guidelines.

Keywords:

diagnostics – PET/CT – PET/MRI – prostate cancer – PSMA

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