to evaluate the role of the 68ga-psma in the staging and
TRANSCRIPT
To evaluate the role of the 68Ga-PSMA in the staging and
management of the Prostatic Cancer in various clinical
scenarios.
Sikandar M Shaikh,
DMRD,DNB,EDiR,MNAMS
Hyderabad,
Telangana
INDIA
PURPOSE
Prostate cancer is one of the commonest biologically and clinically a
heterogeneous disease in males which has varied diagnostic
challenges.
The biggest challenge in this is to detect recurrent disease.
Biochemical response using Prostate Specific Antigen (PSA) and
various imaging modalities including F FDG PET-CT has limited role
as most of them have poor sensitivity and specificity.
Thus we evaluated the role of Ga68-PSMA (Prostate Specific
Membrane Antigen) imaging in prostate cancer, which is a new PET
tracer.
MATERIAL AND METHODS
We evaluated Ga68-PSMA PET scans of 65 patients with
diagnosed prostate cancer.
Whole body PET-CT was done after injecting Ga68-PSMA for
either staging or re staging to evaluate the response to therapy.
RESULTS
65 PSMA scans were performed initially .
Ga68-PSMA scan showed more number of areas involved by extra-prostatic
disease in 53.2% of cases when done at baseline before commencing any
treatment.
The sensitivity of Ga68-PSMA at baseline when compared with histopathological
diagnosis was 95% with 95% CI ranging from 86% to 98%.
The positive predictive value was high at 98% with 95% CI ranging from 91% to
99%.
In 7 (12%) patients who underwent surgical management post therapy
Ga68-PSMA scan was able to detect disease progression / post surgical
relapse in 100% of cases.
The outcome of post surgical prostate cancer was compared with other
cases where surgery was not done.
In those who did not surgery due to higher staging these cases showed
better response by hormone therapy (p 61; 0.03) and radiotherapy (p 61;
0.01) on Ga68-PSMA.
The sensitivity of Ga68-PSMA response with biochemical response was
66.7% with 95% CI ranging between 46 %- 82.7%.
Ga68-PSMA response did not correlate with biochemical response.
CASE 1
64 Years old
Diagnosed Prostatic cancer
Gleason score 6
CASE 2
Post Radical Prostatectomy
Follow up case
Extensive recurrence
Contd case 2
CASE 3
63 years old Post operative
Post chemotherapy
Follow up
CASE 4 Diagnosed case. Gleeson score 8
CASE 5
CASE 6 Extensive skeletal metastases
CASE 7 Post radiotherapy recurrence
CONCLUSION
Thus Ga68-PSMA has very good sensitivity for diagnosis, staging,
restaging, evaluation of therapy response and prognostication in
prostate cancer
CLINICAL RELEVANCE/APPLICATION
Thus PET-CT PSMA has very high sensitivity as compared with
F FDG PET-CT
THANK YOU FOR YOUR KIND ATTENTION