Current and potential future role of PSMA-PET in patients with castration-resistant prostate cancer.


Christian Daniel Fankhauser


Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. [Email]


OBJECTIVE : To review the current literature and discuss potential future roles of the novel positron emission tomography (PET) tracers targeting the prostate-specific membrane antigen (PSMA) in patients with castration-resistant prostate cancer (CRPC).
METHODS : A literature search on February 19th 2018 was conducted using the Medline database and . Additionally, illustrative cases of CRPC patients from our own institution who were restaged and treated based on PSMA-PET scan results are provided.
RESULTS : 11 Studies met the inclusion criteria. PSMA-PET detected more metastatic lesions compared to conventional bone scan. Several patients were up-staged from non-metastatic CRPC (nmCRPC) to metastatic CRPC (mCRPC). Currently, no clear consensus exists regarding treatment response assessment in PSMA-PET scans for mCRPC patients undergoing treatment. Also, the role of PSMA-PET as a gatekeeper for systemic therapy or radioligands is currently undefined. PSMA-guided metastasis-directed radiotherapy may not only alleviate local symptoms but has the potential to defer systemic treatment in patients with oligoprogressive CRPC.
CONCLUSIONS : Compared to bone scan, PSMA-PET is more sensitive and specific to detect metastases but the therapeutic consequences of PSMA-PET results in the setting of CRPC remain unclear. Until future studies define the role of PSMA-PET in patients with CRPC, the current standard for imaging remains bone scan and computerized tomography.


(68)Ga-PSMA,CRPC,Positron emission tomography computed tomography,Prostatic neoplasms,Review,