Prostate-Specific Membrane Antigen-Radioguided Salvage Hemiablation High Intensity Focused Ultrasound for Radio-Recurrent Prostate Cancer

Department of urology, Jules Bordet Institute, Université libre de Bruxelles, Belgium
Department of nuclear medecine, Jules Bordet Institute, Université libre de Bruxelles, Belgium

Corresponding Author: Fouad Aoun,Department of urology, Jules Bordet Institute, Université libre de Bruxelles, Belgium,Tel: 32 2 541 31 11,E-mail: fouad.aoun@bordet.be

Received: Nov 06, 2015 Accepted: Nov 08, 2015 Published: Nov 14, 2015

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Abstract

Prostate-specific membrane antigen (PSMA) is a membrane glycoprotein that is a well-characterized and clinically validated marker of prostate cancer (PCa)

Gallium 68 (68Ga)–labeled PSMA PET/CT uses the affinity of the 68Ga-labeled PSMA ligand to PSMA expressing cells. Promising results were reported for an accurate staging in patients presenting with biochemical recurrence (BCR) after primary treatment even at low PSA levels. We present the case of a 56 years old patient presenting with a BCR (PSA=21 ng/ml) several years after external radiation beam therapy. Abdominopelvic CT scan and bone scan were negative. A suspicious lesion on PSMA-ligand PET imaging was detected in the prostate with no evidence of regional or distant hypermetabolic lesions

Keywords

Prostate-specific membrane antigen (PSMA) is a membrane glycoprotein that is a well-characterized and clinically validated marker of prostate cancer (PCa) [1].

Gallium 68 (68Ga)–labeled PSMA PET/CT uses the affinity of the 68Ga-labeled PSMA ligand to PSMA expressing cells [1].

Promising results were reported for an accurate staging in patients presenting with biochemical recurrence (BCR) after primary treatment even at low PSA levels [2].

We present the case of a 56 years old patient presenting with a BCR (PSA=21 ng/ml) several years after external radiation beam therapy.

Abdominopelvic CT scan and bone scan were negative.

A suspicious lesion on PSMA-ligand PET imaging was detected in the prostate with no evidence of regional or distant hypermetabolic lesions (Figure 1).

A prostatic biopsy confirmed the recurrence and the patient was scheduled for salvage hemiablation HIFU

Most patients with BCR after primary treatment receive androgen deprivation therapy (ADT). However, the potential nature of ADT, its negative impact on quality of life and the lack of efficacy on cancer specific and overall survival opened the door for the development of more accurate staging strategies and for the implementation of minimal invasive therapeutic modalities.

This case is a timely issue given the new evidence suggesting that the accurate staging of PSMA-ligand PET imaging and the effectiveness of hemiablation salvage HIFU in patients who present unilateral small sized local recurrence after primary radiation therapy [3,4]. Preliminary results show that hemiablation salvage HIFU is safe, feasible and associated with reduced morbidity and better functional outcomes.

Figures at a glance

Figure 1

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References

Aoun F, Kourie HR, Artigas C, Roumeguère T (2015) Next revolution in molecular theranostics: personalized medicine for urologic cancers. Future Oncol11:2205-2219.
Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, et al. (2014) Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 41:11-20.
Freitag MT, Radtke JP, Hadaschik BA, Kopp-Schneider A, Eder M, et al. (2015) Comparison of hybrid 68Ga-PSMA PET/MRI and 68Ga-PSMA PET/CT in the evaluation of lymph node and bone metastases of prostate cancer. Eur J Nucl Med Mol Imaging.
Baco E, Gelet A, Crouzet S, Rud E, Rouvière O, et al. (2014) Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. BJU Int114:532-540.