EAU-EANM Consensus Statements on the Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Patients with Prostate Cancer and with Respect to [177Lu]Lu-PSMA Radioligand Therapy

Stefano Fanti, Alberto Brigantii, Louise Emmett, Karim Fizazi , Silke Gillessen, Karolien Goffin, Boris A Hadaschik, Ken Herrmann, Jolanta Kunikowska, Tobias Maurer, Steven MacLennan, Nicolas Mottet, Declan G Murphy, Daniela E. Oprea-Lager, Joe M O’Sullivan, Wim JG Oyen, Olivier Rouvière, Oliver Sartor, Arnulf Stenzl, Hendrik Van PoppelJochen Walz, Wim Witjes, Anders Bjartell*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) is useful for selected clinical indications in patients with prostate cancer (PCa) but it may have broader clinical utility owing to the emergence of lutetium-177-PSMA-617 ([177Lu]Lu-PSMA) therapy. However, robust data regarding the impact of PSMA PET/CT on patient management and treatment are lacking, and in many areas, the role of next-generation imaging has not been defined.
Objective
To assess expert opinion on the use of PSMA-based imaging and therapy to develop interim guidance.
Design, setting, and participants
A panel of 21 PCa experts from various disciplines received thematic topics and relevant literature. A questionnaire to assess proposed guidance statements regarding PSMA PET/CT and [177Lu]Lu-PSMA therapy was developed for completion remotely in a first e-Delphi round. A subsequent panel discussion was conducted during a 1-d meeting, which included a second Delphi round.
Outcome measurements and statistical analysis
Panellists voted anonymously on statements using a nine-point Likert scale from 1 = strongly disagree to 9 = strongly agree. Median scores were calculated and consensus was assessed using methods proposed by the Research and Development (RAND) corporation.
Results and limitations
Statements were developed to cover the following topics: PSMA PET/CT utility, clinical use, and choice of tracer; patient selection; and management of patients receiving [177Lu]Lu-PSMA for metastatic PCa. Consensus was reached for 33/36 statements. In-group bias is a potential limitation, as some statements were rephrased during discussions at the 1-d meeting.
Conclusions
Adoption of PSMA PET/CT as an imaging tool to guide [177Lu]Lu-PSMA therapy should be supported by indications for appropriate use.
Patient summary
A panel of experts in prostate cancer reached a consensus for the majority of statements proposed regarding the role of prostate-specific membrane antigen (PSMA)-based imaging and therapy, particularly the use of PSMA-based imaging in patients suitable for [177Lu]Lu-PSMA therapy and the need to perform PSMA-based imaging before considering patients as candidates for this therapy.
Original languageEnglish
JournalEuropean Urology Oncology
Early online date10 Jun 2022
DOIs
Publication statusE-pub ahead of print - 10 Jun 2022

Keywords

  • Computed tomography
  • consensus
  • diagnosis
  • Lutetium
  • patient selection
  • positron emission tomography
  • prostate cancer
  • PSMA
  • radioactive tracer
  • therapy

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