PEPPER-studie: PSMA-PET/CT in Primary staging of Prostate ... ... Gallium-68 PSMA-PET/CT...

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Transcript of PEPPER-studie: PSMA-PET/CT in Primary staging of Prostate ... ... Gallium-68 PSMA-PET/CT...

  • Ludwike van Kalmthout, arts-onderzoeker

    ‘Week van de Urologie’

    St. Antonius Ziekenhuis, 28 september 2017

    PEPPER-studie: PSMA-PET/CT in Primary staging of Prostate CancER

  • Anatomie: het mannelijk bekken

  • Dhr. H., 63 jaar

    • Door huisarts verwezen naar uroloog

    • PSA 54.9 ng/ml

    • Rectaal toucher: verharde rechter prostaathelft

    • Echo prostaat: tumor in beide

    prostaatkwabben met

    ingroei in zaadblaasjes

    • Prostaatbiopten: Gleason Score 9

    Conclusie: Hoog-risico prostaatkanker

  • Aanvullend Onderzoek

    • 1. Uitzaaiingen in de lymfeklieren:

    ◦ CT/MRI ◦ Lymfeklierdissectie

    • 2. Uitzaaiingen in de botten:

    ◦ Botscan

  • Lymfeklierdissectie

  • Lymfeklierdissectie

  • 1. Botuitzaaiingen 2. Dhr. H.: Botuitzaaiingen?

  • Gallium-68 PSMA-PET/CT

    ◦ Veelbelovende nieuwe scan

    ◦ Brengt zowel uitzaaiingen in lymfeklieren als botten in beeld

    ◦ PET/CT: combinatie van moleculaire en anatomische informatie ◦ PSMA: Prostaat Specifiek Membraan Antigeen ◦ Gallium-68 PSMA: Radioactief gelabelde stof

  • Procedure - Infuus met Gallium-68 PSMA - Scannen: 60 minuten

  • PET Fusie PET en CT CT

    Dhr. H: Gallium-68 PSMA PET/CT

  • Dhr. H: Gallium-68 PSMA-PET/CT

  • PEPPER-studie: Waarom?

    • 20% van de hoog-risico patiënten met ‘schone’

    botscan heeft wèl afwijkingen op de Gallium-68 PSMA PET/CT

    ◦ Zinloze lymfeklierdissectie

    • In regio Utrecht wordt de Gallium-68 PSMA PET/CT al ingezet als

    reguliere scan

    • Maar: nog weinig bekend over de precieze nauwkeurigheid

  • PEPPER-studie: Kernpunten • Onderzoeksvraag: Hoe nauwkeurig is de Gallium-68 PSMA PET/CT in het aantonen

    van uitzaaiingen van prostaatkanker?

    • Details:

    ◦ 100 patienten ◦ Zowel PSMA PET/CT als een lymfeklieroperatie ◦ Vergelijking afwijkingen op scan met het uitgenomen weefsel ◦ Start: volgende week

    • Multicenter:

    ◦ St. Antonius Ziekenhuis Nieuwegein-Utrecht ◦ UMC Utrecht ◦ Meander Medisch Centrum Amersfoort ◦ …?

  • Vragen?

    • Uroloog:

    Harm van Melick

    [email protected]

    • Arts-Onderzoeker:

    Ludwike van Kalmthout

    [email protected]

    • Nucleair Geneeskundige:

    Jules Lavalaye

    [email protected]

    mailto:[email protected] mailto:[email protected] mailto:[email protected] mailto:[email protected] mailto:[email protected] mailto:[email protected]

  • Referenties • Budaus L, Leyh-Bannurah S-R, Salomon G, Michl U, Heinzer H, Huland H, et al. Initial Experience of

    (68)Ga-PSMA PET/CT Imaging in High-risk Prostate Cancer Patients Prior to Radical Prostatectomy. Eur

    Urol. Switzerland; 2016 Mar;69(3):393–6.

    • Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G, et al. Diagnostic Efficacy of

    (68)Gallium-PSMA-PET compared to Conventional Imaging in Lymph Node Staging of of 130 consecutive

    Patients with Intermediate to High-Risk Prostate Cancer. J Urol [Internet]. 2015 Dec 9

    • Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C, et al. (68)Ga-PSMA

    Positron Emission Tomography/Computed Tomography Provides Accurate Staging of Lymph Node

    Regions Prior to Lymph Node Dissection in Patients with Prostate Cancer. Eur Urol [Internet]. 2016 Jan

    19

    • van Leeuwen PJ, Emmett L, Ho B, Delprado W, Ting F, Nguyen Q, et al. Prospective Evaluation of

    68Gallium-PSMA Positron Emission Tomography/Computerized Tomography for Preoperative Lymph

    Node Staging in Prostate Cancer. BJU Int [Internet]. 2016 May 21

  • • Perera M1, Papa N1, Christidis D1, Wetherell D1, Hofman MS2, Murphy DG3, Bolton D4, Lawrentschuk

    N5. Sensitivity, Specificity, and Predictors of Positive 68Ga-Prostate-specific Membrane Antigen

    Positron Emission Tomography in Advanced Prostate Cancer: A Systematic Review and Meta-analysis.

    Eur Urol. 2016 Jun 27.

    • Afshar-Oromieh A1, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, Eisenhut M, Boxler S,

    Hadaschik BA, Kratochwil C, Weichert W, Kopka K, Debus J, Haberkorn U. The diagnostic value of PET/CT

    imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer.

    Eur J Nucl Med Mol Imaging. 2015 Feb;42(2):197-209. doi: 10.1007/s00259-014-2949-6. Epub 2014 Nov

    20.

    • Morigi JJ1, Stricker PD2, van Leeuwen PJ2, Tang R3, Ho B4, Nguyen Q2, Hruby G5, Fogarty G6, Jagavkar

    R6, Kneebone A5, Hickey A4, Fanti S7, Tarlinton L4, Emmett L3. Prospective Comparison of 18F-

    Fluoromethylcholine Versus 68Ga-PSMA PET/CT in Prostate Cancer Patients Who Have Rising PSA After

    Curative Treatment and Are Being Considered for Targeted Therapy. J Nucl Med. 2015 Aug;56(8):1185-

    90. doi: 10.2967/jnumed.115.160382. Epub 2015 Jun 25.

    • Joniau S, Van den Bergh L, Lerut E, Deroose CM, Haustermans K, Oyen R, Budiharto T, Ameye F,

    Bogaerts K, Van Poppel H. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol. 2013

    Mar;63(3):450-8. doi: 10.1016/j.eururo.2012.06.057. Epub 2012 Jul 6.

    15

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