Molecular Imaging for Localized Prostate Cancer: Analysis of 2 Prospective Phase 0 Trials of PSMA Targeted Immuno-PET and –SPECT, and Implications for the Radiation Oncologist

Spratt, Daniel E.; Fareedy, Shoaib B; Lindgren, Sarah; Robinson, Brian D; Larson, Steven M; Scherr, Douglas S; Osborne, Joseph R; Bander, Neil H

Molecular Imaging for Localized Prostate Cancer: Analysis of 2 Prospective Phase 0 Trials of PSMA Targeted Immuno-PET and –SPECT, and Implications for the Radiation Oncologist

Mark

Spratt, Daniel E. ; Fareedy, Shoaib B ; Lindgren, Sarah ^LU

; Robinson, Brian D ; Larson, Steven M ; Scherr, Douglas S ; Osborne, Joseph R and Bander, Neil H (2014) American Society for Radiation Oncology (ASTRO) 56th Annual Meeting In International Journal of Radiation Oncology Biology Physics 90(1 Suppl). p.208-208

Abstract: Purpose/Objective(s): To report the efficacy and utility of PSMA-based molecular targeted imaging in localized prostate cancer using ¹¹¹In-J591 SPECT and ⁸⁹Zr-J591 immuno-PET.

Materials/Methods: Initiated in 2010, two sequential phase 0 prospective studies were performed on a total of 19 patients evaluating the roles of ¹¹¹In-J591 SPECT and ⁸⁹Zr-J591 immuno-PET. All patients had a baseline MRI followed by a preoperative ¹¹¹In-J591 SPECT or ⁸⁹Zr-J591 PET scan. Patients subsequently underwent radical prostatectomy with immediate imaging of the ex vivo specimens with micro-SPECT or micro-PET/CT. For the ⁸⁹Zr-J591 trial, the ex vivo specimens... (More); Purpose/Objective(s): To report the efficacy and utility of PSMA-based molecular targeted imaging in localized prostate cancer using ¹¹¹In-J591 SPECT and ⁸⁹Zr-J591 immuno-PET.

Materials/Methods: Initiated in 2010, two sequential phase 0 prospective studies were performed on a total of 19 patients evaluating the roles of ¹¹¹In-J591 SPECT and ⁸⁹Zr-J591 immuno-PET. All patients had a baseline MRI followed by a preoperative ¹¹¹In-J591 SPECT or ⁸⁹Zr-J591 PET scan. Patients subsequently underwent radical prostatectomy with immediate imaging of the ex vivo specimens with micro-SPECT or micro-PET/CT. For the ⁸⁹Zr-J591 trial, the ex vivo specimens were also imaged with a custom MRI solenoid coil insert for higher resolution imaging. Findings on MRI and histopathology from the surgical specimen were compared to the pre-surgical molecular imaging and ex vivo images.

Results: The ¹¹¹In-J591 SPECT: Eight patients were enrolled with a median age of 64 years. Median pre-treatment PSA was 6.8 ng/mL (2.8-22.7), and the median biopsy Gleason score was 7 (6-9). As SPECT imaging has limited lesion discriminatory power of detection, prostatectomy specimens were analyzed by the dominant tumor foci. The median pathologic Gleason score was 7 (7-9), and the median dominant lesion size was 9.5 mm (3-19 mm). Tumor was visible by MRI on 7 of the 8 patients, and was positive in all SPECT scans that correlated well to the prostatectomy specimen. One patient had positive lymph nodes on histopathology, but was negative by both MRI and SPECT. ⁸⁹Zr-J591 PET: Eleven patients were enrolled with a median age of 61.0 years. Median pre-treatment PSA was 5.2 ng/mL (3.5-12.0), and the median biopsy Gleason score was 7 (7-9). Twenty-two lesions were identified on histopathology. The median lesion size was 5.5 mm (2-21 mm), and the median pathologic Gleason score was 7 (6-9). Immuno-PET identification improved with increasing tumor size, and was true for both in vivo PET (p<0.0001) and micro-PET (p<0.0001). Furthermore, immuno-PET lesion identification improved with increasing Gleason score (for ex vivo micro-PET imaging, p=0.01; in vivo imaging, p=0.14). Lesions of Gleason score 3+3=6 were uniformly not detected by PET (0 of 14 lesions).

Conclusions: Targeted molecular PSMA imaging using the monoclonal antibody J591 has the ability to detect clinically significant localized prostate cancer. The ⁸⁹Zr-J591 PET has improved accuracy over ¹¹¹In-J591 SPECT to detect isolated intraprostatic foci, likely secondary to inherent SPECT resolution limits. Clinically significant disease (Gleason score ≥7) was readily detected by immuno-PET, and may potentially serve as a non-invasive means for active surveillance monitoring. Based on the success of these preliminary studies, we are initiating a phase 2 immuno-PET/MRI study to further evaluate the multitude of uses of one of the first successful molecular imaging agents in localized prostate cancer. (Less)

Please use this url to cite or link to this publication: https://lup.lub.lu.se/record/cfb675e7-25d2-4505-9edc-4fd69a58bb92

author

Spratt, Daniel E. ; Fareedy, Shoaib B ; Lindgren, Sarah ^LU

; Robinson, Brian D ; Larson, Steven M ; Scherr, Douglas S ; Osborne, Joseph R and Bander, Neil H

publishing date

2014-09-01

type

Contribution to journal

publication status

published

subject

in

International Journal of Radiation Oncology Biology Physics

volume

90

issue

1 Suppl

pages

208 - 208

publisher

Elsevier

conference name

American Society for Radiation Oncology (ASTRO) 56th Annual Meeting

conference location

San Fransisco, United States

conference dates

2014-09-14 - 2014-09-17

ISSN

0360-3016

DOI

10.1016/j.ijrobp.2014.05.770

language

English

LU publication?

no

id

cfb675e7-25d2-4505-9edc-4fd69a58bb92

date added to LUP

2022-12-13 14:04:43

date last changed

2022-12-14 08:39:01

@misc{cfb675e7-25d2-4505-9edc-4fd69a58bb92,
  abstract     = {{<b>Purpose/Objective(s):</b> To report the efficacy and utility of PSMA-based molecular targeted imaging in localized prostate cancer using <sup>111</sup>In-J591 SPECT and <sup>89</sup>Zr-J591 immuno-PET.<br/><br/><b>Materials/Methods:</b> Initiated in 2010, two sequential phase 0 prospective studies were performed on a total of 19 patients evaluating the roles of <sup>111</sup>In-J591 SPECT and <sup>89</sup>Zr-J591 immuno-PET. All patients had a baseline MRI followed by a preoperative <sup>111</sup>In-J591 SPECT or <sup>89</sup>Zr-J591 PET scan. Patients subsequently underwent radical prostatectomy with immediate imaging of the ex vivo specimens with micro-SPECT or micro-PET/CT. For the <sup>89</sup>Zr-J591 trial, the ex vivo specimens were also imaged with a custom MRI solenoid coil insert for higher resolution imaging. Findings on MRI and histopathology from the surgical specimen were compared to the pre-surgical molecular imaging and ex vivo images.<br/><br/><b>Results:</b> The <sup>111</sup>In-J591 SPECT: Eight patients were enrolled with a median age of 64 years. Median pre-treatment PSA was 6.8 ng/mL (2.8-22.7), and the median biopsy Gleason score was 7 (6-9). As SPECT imaging has limited lesion discriminatory power of detection, prostatectomy specimens were analyzed by the dominant tumor foci. The median pathologic Gleason score was 7 (7-9), and the median dominant lesion size was 9.5 mm (3-19 mm). Tumor was visible by MRI on 7 of the 8 patients, and was positive in all SPECT scans that correlated well to the prostatectomy specimen. One patient had positive lymph nodes on histopathology, but was negative by both MRI and SPECT. <sup>89</sup>Zr-J591 PET: Eleven patients were enrolled with a median age of 61.0 years. Median pre-treatment PSA was 5.2 ng/mL (3.5-12.0), and the median biopsy Gleason score was 7 (7-9). Twenty-two lesions were identified on histopathology. The median lesion size was 5.5 mm (2-21 mm), and the median pathologic Gleason score was 7 (6-9). Immuno-PET identification improved with increasing tumor size, and was true for both in vivo PET (<i>p</i>&lt;0.0001) and micro-PET (<i>p</i>&lt;0.0001). Furthermore, immuno-PET lesion identification improved with increasing Gleason score (for ex vivo micro-PET imaging, <i>p</i>=0.01; in vivo imaging, <i>p</i>=0.14). Lesions of Gleason score 3+3=6 were uniformly not detected by PET (0 of 14 lesions).<br/><br/><b>Conclusions:</b> Targeted molecular PSMA imaging using the monoclonal antibody J591 has the ability to detect clinically significant localized prostate cancer. The <sup>89</sup>Zr-J591 PET has improved accuracy over <sup>111</sup>In-J591 SPECT to detect isolated intraprostatic foci, likely secondary to inherent SPECT resolution limits. Clinically significant disease (Gleason score ≥7) was readily detected by immuno-PET, and may potentially serve as a non-invasive means for active surveillance monitoring. Based on the success of these preliminary studies, we are initiating a phase 2 immuno-PET/MRI study to further evaluate the multitude of uses of one of the first successful molecular imaging agents in localized prostate cancer.}},
  author       = {{Spratt, Daniel E. and Fareedy, Shoaib B and Lindgren, Sarah and Robinson, Brian D and Larson, Steven M and Scherr, Douglas S and Osborne, Joseph R and Bander, Neil H}},
  issn         = {{0360-3016}},
  language     = {{eng}},
  month        = {{09}},
  note         = {{Conference Abstract}},
  number       = {{1 Suppl}},
  pages        = {{208--208}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Radiation Oncology Biology Physics}},
  title        = {{Molecular Imaging for Localized Prostate Cancer: Analysis of 2 Prospective Phase 0 Trials of PSMA Targeted Immuno-PET and –SPECT, and Implications for the Radiation Oncologist}},
  url          = {{http://dx.doi.org/10.1016/j.ijrobp.2014.05.770}},
  doi          = {{10.1016/j.ijrobp.2014.05.770}},
  volume       = {{90}},
  year         = {{2014}},
}

Lund University Publications

LUND UNIVERSITY LIBRARIES

Molecular Imaging for Localized Prostate Cancer: Analysis of 2 Prospective Phase 0 Trials of PSMA Targeted Immuno-PET and –SPECT, and Implications for the Radiation Oncologist