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Year : 2020  |  Volume : 36  |  Issue : 4  |  Page : 337-338
 

Re; Seniaray N, Verma R, Khanna S, Belho E, Pruthi A, Mahajan H. Localization and restaging of carcinoma prostate by 68Gallium prostate-specific membrane antigen positron emission tomography computed tomography in patients with biochemical recurrence. Indian J Urol 2020;36:191-9


Department of Urology, AIIMS, Bhubaneshwar, Odisha, India

Date of Submission22-Jul-2020
Date of Acceptance23-Aug-2020
Date of Web Publication1-Oct-2020

Correspondence Address:
Dr. Swarnendu Mandal
Department of Urology, AIIMS, Bhubaneshwar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_428_20

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How to cite this article:
Pandey A, Mandal S, Das MK, Nayak P. Re; Seniaray N, Verma R, Khanna S, Belho E, Pruthi A, Mahajan H. Localization and restaging of carcinoma prostate by 68Gallium prostate-specific membrane antigen positron emission tomography computed tomography in patients with biochemical recurrence. Indian J Urol 2020;36:191-9. Indian J Urol 2020;36:337-8

How to cite this URL:
Pandey A, Mandal S, Das MK, Nayak P. Re; Seniaray N, Verma R, Khanna S, Belho E, Pruthi A, Mahajan H. Localization and restaging of carcinoma prostate by 68Gallium prostate-specific membrane antigen positron emission tomography computed tomography in patients with biochemical recurrence. Indian J Urol 2020;36:191-9. Indian J Urol [serial online] 2020 [cited 2020 Oct 29];36:337-8. Available from: https://www.indianjurol.com/text.asp?2020/36/4/337/296770




We applaud the authors[1] for the comprehensive reporting of their experience with the68 gallium prostate-specific membrane antigen positron emission tomography-computed tomography (68 Ga PSMA PET/CT) in prostate cancer (PCa) patients with biochemical recurrence (BCR) after curative-intent treatment. Detection rates similar to a recent meta-analysis[2] were reported in this study.

Although two physicians independently evaluated each scan, there was no mention of how inter-observer disagreements were resolved. In addition, no equivocal finding was reported in any scan, a feature inherent to the reporting of any imaging. It is essential to document the percentage of recurrences detected based on unequivocal or nonconsensual findings, as they are less likely to change further management.

Additional imaging findings were not reported if any. They could have served to validate the PET findings further and also allow direct comparison of detection rates. Similarly, the serum prostate-specific antigen levels of patients with follow-up imaging were not reported, which could have validated the PET observations. In the absence of tissue diagnosis, these findings are essential to detect false-positive interpretations.

Ongoing androgen deprivation therapy (ADT) is associated with increased PSMA PET detection rates.[3] Overall, 54% (n = 92) patients in this study were on ADT, and the detection rate in this subset would have been interesting to note.

Finally, the value of any diagnostic modality is in its ability to change the management. Accordingly, EAU guidelines recommend PSMA PET to be performed in patients with BCR if the results will affect further treatment decisions.[4] There was no discussion on management changes based solely on the PSMA PET reports in this study.

In our opinion, PCa with BCR after radical therapy represents a heterogeneous population with different tumor biology and disease aggressiveness. Hence, risk-stratification and selective use of PSMA-PET in this setting are highly advisable to avoid over-investigation and management dilemmas. Moreover, the clinical impact of the increased detection rate by PSMA PET in the form of survival benefit is a question that remains unanswered.



 
   References Top

1.
Seniaray N, Verma R, Khanna S, Belho E, Pruthi A, Mahajan H. Localization and restaging of carcinoma prostate by 68Gallium prostate-specific membrane antigen positron emission tomography computed tomography in patients with biochemical recurrence. Indian J Urol 2020;36:191-9.  Back to cited text no. 1
  [Full text]  
2.
Tan N, Bavadian N, Calais J, Oyoyo U, Kim J, Turkbey IB, et al. Imaging of prostate specific membrane antigen targeted radiotracers for the detection of prostate cancer biochemical recurrence after definitive therapy: A systematic review and meta-analysis. J Urol 2019;202:231-40.  Back to cited text no. 2
    
3.
Ferraro DA, Rüschoff JH, Muehlematter UJ, Kranzbühler B, Müller J, Messerli M, et al. Immunohistochemical PSMA expression patterns of primary prostate cancer tissue are associated with the detection rate of biochemical recurrence with 68 Ga-PSMA-11-PET. Theranostics 2020;10:6082-94.  Back to cited text no. 3
    
4.
Professionals S-O. EAU Guidelines: Prostate Cancer. Uroweb. Available from: https://uroweb.org/guideline/prostate-cancer/#note_343. [Last accessed on 2020 Aug 23].  Back to cited text no. 4
    




 

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