How Does Routine Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Modify the Current Management of Prostate Cancer? A Multidisciplinary View
European Urology Open Science, vol. 75, pp. 69–79
Abstract
Background and objective: Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) and new treatment modalities have expanded the possibilities for diagnosing and managing metastatic prostate cancer, but have also raised questions about their implementation in daily clinical practice. We sought consensus on definitions, preferred imaging modality for staging, and treatment selection in the era of next-generation imaging. Methods: A modified Delphi method involved two voting rounds and a face-to-face multidisciplinary meeting with 40 Dutch prostate cancer (PCa) experts. Consensus was reached if ≥75% of the panellists chose the same option. Appropriateness was assessed by the RAND Corporation/University of California Los Angeles appropriateness method. Key findings and limitations: There was consensus on performing metastatic screening with PSMA-PET/CT for unfavourable intermediate- or high-risk PCa. PSMA-PET/CT findings were considered feasible for determining treatment in synchronous metastatic hormone-sensitive prostate cancer, but there was no agreement on the validity of the CHAARTED criteria for interpreting the PSMA-PET/CT findings. If the PSMA-PET/CT findings led to upstaging after conventional imaging, 76% of panellists would opt for treatment intensification. In case of downstaging, 71% would choose for deintensification. Panellists would generally treat patients based on metastatic disease volume as per the CHAARTED criteria, except for bulky low-volume disease (LVD) and LVD with multiple (more than ten) bone metastases, all within the axial skeleton. This would be classified as LVD but treated as high-volume disease. Limitations are that the statements are largely consensus based and originate from a national (Dutch) perspective. Conclusions and clinical implications: PSMA-PET/CT was considered the preferred modality for initial PCa staging, which is nowadays the standard of care in The Netherlands. The majority of panellists would incorporate PSMA-PET/CT findings for treatment planning, including intensification and deintensification, but the criteria for interpreting metastatic disease volume on PSMA-PET/CT are still uncertain. Patient summary: A group of Dutch medical specialists discussed on how to diagnose metastatic hormone-sensitive prostate cancer and choose the most appropriate treatment for patients with this condition. It was concluded that imaging based on Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) helps determine appropriate treatment options, with most experts supporting treatment adjustments based on PSMA-PET/computed tomography (CT) results. However, there is still some uncertainty about the criteria for interpreting the extent of metastatic disease with PSMA-PET/CT.
Authors 43
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Daniela E. Oprea‐Lager corresponding
Radboud University Medical Center · Amsterdam University Medical Centers · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
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Radboud University Medical Center · Canisius-Wilhelmina Ziekenhuis
Affiliation as printed
Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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University Medical Center Groningen
Affiliation as printed
Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
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Affiliation as printed
Centre for Decision Analysis & Support, Ismar Healthcare NV, Lier, Belgium
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The Netherlands Cancer Institute · Amsterdam University Medical Centers · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Urology, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Affiliation as printed
Centre for Decision Analysis & Support, Ismar Healthcare NV, Lier, Belgium
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Affiliation as printed
Department of Urology, Erasmus MC, Rotterdam, The Netherlands
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Spaarne Ziekenhuis · Spaarne Gasthuis
Affiliation as printed
Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
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Affiliation as printed
Department of Medical Oncology, Bravis Hospital Roosendaal, Roosendaal, The Netherlands
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Affiliation as printed
Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
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University Medical Center Groningen
Affiliation as printed
Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
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Erasmus MC · Erasmus MC Cancer Institute
Affiliation as printed
Department of Radiotherapy, Erasmus MC, Rotterdam, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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Sint Franciscus Gasthuis · Franciscus Vlietland
Affiliation as printed
Department of Medical Oncology, Franciscus Gasthuis & Vlietland, Rotterdam & Schiedam, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Internal Medicine, Division of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
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Affiliation as printed
Department of Nuclear Medicine, Sint Antonius Hospital, Utrecht & Nieuwegein, The Netherlands
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Affiliation as printed
Department of Urology, Martini Hospital, Groningen, The Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Nuclear Medicine & Molecular Imaging, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Affiliation as printed
Department of Internal Medicine, Ziekenhuis Groep Twente, Almelo, The Netherlands
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Erasmus MC · Erasmus MC Cancer Institute
Affiliation as printed
Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Radiotherapy, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Affiliation as printed
Department of Medical Oncology, Reinier Haga Prostate Cancer Centre, Delft, The Netherlands
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Affiliation as printed
Department of Urology, Erasmus MC, Rotterdam, The Netherlands
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Affiliation as printed
Department of Internal Medicine-Medical Oncology, Zuyderland MC, Sittard, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Affiliation as printed
Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
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University Medical Center Groningen
Affiliation as printed
Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Maastricht University Medical Centre · Maastro Clinic
Affiliation as printed
Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Amsterdam University Medical Centers · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Urology, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands
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Sint Franciscus Gasthuis · Franciscus Vlietland
Affiliation as printed
Department of Urology, Franciscus Gasthuis & Vlietland, Rotterdam & Schiedam, The Netherlands
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Affiliation as printed
Department of Radiotherapy, Institute Verbeeten, Tilburg, The Netherlands
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Amsterdam University Medical Centers · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Urology, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
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Amsterdam University Medical Centers · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Medical Oncology, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
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University Medical Center Utrecht
Affiliation as printed
Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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University Medical Center Groningen · University of Groningen · The Netherlands Cancer Institute
Affiliation as printed
Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
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