Impact of Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography in the Management of Oligometastatic Renal Cell Carcinoma
- Author(s)
- Udovicich, C; Callahan, J; Bressel, M; Ong, WL; Perera, M; Tran, B; Azad, A; Haran, S; Moon, D; Chander, S; Shaw, M; Eapen, R; Goad, J; Lawrentschuk, N; Murphy, DG; Hofman, M; Siva, S;
- Journal Title
- European Urology Open Science
- Publication Type
- Research article
- Abstract
- BACKGROUND: Prostate-specific membrane antigen (PSMA) is overexpressed in the neovasculature of renal cell carcinoma (RCC). However, there remains limited evidence regarding the use of PSMA positron emission tomography/computed tomography (PET/CT) in RCC. OBJECTIVE: To assess the impact of PSMA PET/CT in the management of metastatic RCC. DESIGN SETTING AND PARTICIPANTS: This was a retrospective review of patients who underwent PSMA PET/CT from 2014 to 2020 for restaging or suspected metastatic RCC in a tertiary academic setting. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Management plans before and after PSMA PET/CT were recorded. Impact was classified as high (change of treatment intent, modality, or site), medium (change in treatment method), or low. Secondary outcomes included the patient-level detection rate, PSMA PET/CT parameters, sensitivity, and comparison to CT and, if available, fluorodeoxyglucose (FDG) PET/CT. RESULTS AND LIMITATIONS: Sixty-one patients met the inclusion criteria, of whom 54 (89%) had clear cell RCC. PSMA-positive disease was detected in 51 patients (84%). For 30 patients (49%) there was a change in management due to PSMA PET/CT (high impact, 29 patients, 48%). In 15 patients (25%), more metastases were detected on PSMA PET/CT than on CT. The sensitivity of combined PSMA PET/CT and diagnostic CT was 91% (95% confidence interval 77-98%). In a subcohort of 40 patients, the detection rate was 88% for PSMA and 75% for FDG PET/CT (p = 0.17). The maximum standardised uptake value (SUV(max)) was higher for PSMA than for FDG PET/CT (15.2 vs 8.0; p = 0.02). Limitations include selection bias due to the retrospective design, and a lack of corresponding histopathology for all patients. CONCLUSIONS: PSMA PET/CT is a promising imaging modality in metastatic RCC and led to a change in management in 49% of patients. PSMA PET/CT detected additional metastases compared to CT in 25% of patients and registered a significantly higher SUV(max) than FDG PET/CT. Prospective studies are required to further define its role. PATIENT SUMMARY: We report on a group of patients undergoing a new type of imaging for suspected advanced kidney cancer, called PSMA PET/CT. This imaging changed the management plan in 49% of the patients. PSMA PET/CT detected metastases in 84% of our patients and detected more metastases than computed tomography imaging in 25%.
- Publisher
- Elsevier
- Keywords
- Clear cell histology; Impact; Kidney cancer; Management change; Metastasis-directed therapy; Molecular imaging; Oligometastatic; Positron emission tomography/computed tomography; Prostate-specific membrane antigen; Renal cell carcinoma
- Department(s)
- Radiation Oncology; Cancer Imaging; Biostatistics and Clinical Trials; Medical Oncology; Surgical Oncology
- PubMed ID
- 36185587
- Publisher's Version
- https://doi.org/10.1016/j.euros.2022.08.001
- Open Access at Publisher's Site
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Creation Date: 2025-04-24 07:51:31
Last Modified: 2025-04-24 07:52:36