The Role of Prostate Specific Membrane Antigen Positron Emission Tomography/Computerised Tomography (PSMA PET/CT) Imaging in Advanced Prostate Cancer
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Embargo End Date
2025-06-03
ICR Authors
Authors
Abdel-aty, H
Document Type
Thesis or Dissertation
Date
2024-12-03
Date Accepted
Abstract
PSMA is a transmembrane protein preferentially expressed on prostate cancer cells and has diagnostic and therapeutic applications, known as “theranostics”. PSMA PET/CT is an advanced imaging technique with better sensitivity and specificity in detecting metastatic disease compared to conventional imaging with computerised tomography (CT) and isotope bone scan. This thesis quantitatively analyses the disease stage “frameshift” observed with PSMA PET/CT in very-high risk non-metastatic/low volume metastatic hormone-sensitive prostate cancer (mHSPC) and discusses its impact on treatment decisions. PSMA PET/CT has rapidly integrated into our standard practice for initial prostate cancer diagnosis, albeit there is little known about its potential for improved patient outcomes. This thesis reports on clinical outcomes following PSMA PET/CT-guided treatments in mHSPC and compares these with conventional imaging outcomes, referencing the STAMPEDE trial. In parallel to the increased accessibility to PSMA PET/CT, there have been advancements in mHSPC treatment. The advent of targeted therapies such as Stereotactic Ablative Body Radiotherapy (SABR) for metachronous oligometastatic disease and radioligand therapies (RLT) such as 177Lutetium [177Lu]Lu-PSMA-617 for metastatic castrate resistant prostate cancer (mCRPC) have shown improved outcomes. The STAMPEDE2 trial investigates these treatments earlier in the mHSPC, treatment paradigm. This thesis describes the STAMPEDE2 trial design and setup, integrating next generation imaging sub-studies to bridge the evidence gap between conventional and next generation imaging modalities. Traditionally, radiotherapy for prostate cancer with nodal metastases involves bilateral nodal chain irradiation, provided it is safely encompassed within the pelvic radiation field. This thesis explores if PSMA PET/CT imaging can enable optimised radiotherapy strategies by mapping nodal metastases relative to the dominant intra-prostatic lesion (DIL), potentially reducing radiation field size and long-term toxicities.
Citation
2024
DOI
Source Title
Publisher
Institute of Cancer Research (University Of London)
ISSN
eISSN
Collections
Research Team
Prostate & Bladder Cancer