Quantitative Analysis of Serial Positron Emission Tomography Imaging in Men with Metastatic Castration-resistant Prostate Cancer Treated with Enzalutamide

Shruti U. Gandhy; Fatima H. Karzai; Marijo Bilusic; Sheri McMahon; Lisa M. Cordes; Jennifer Marte; Amy J. Weisman; Timothy G. Perk; Liza Lindenberg; Esther Mena; Baris Turkbey; Philip M. Arlen; William L. Dahut; William D. Figg; Peter Choyke; James L. Gulley; Ravi A. Madan

doi:10.1016/j.euo.2023.09.010

Quantitative Analysis of Serial Positron Emission Tomography Imaging in Men with Metastatic Castration-resistant Prostate Cancer Treated with Enzalutamide

Shruti U. Gandhy, Fatima H. Karzai, Marijo Bilusic, Sheri McMahon, Lisa M. Cordes, Jennifer Marte, Amy J. Weisman, Timothy G. Perk, Liza Lindenberg, Esther Mena, Baris Turkbey, Philip M. Arlen, William L. Dahut, William D. Figg, Peter Choyke, James L. Gulley, Ravi A. Madan

Surgery

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Abstract

BACKGROUND: The emergence of positron emission tomography (PET) in prostate cancer is impacting clinical practice, but little is known about PET imaging as a tool to determine treatment failure in metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE: To evaluate PET imaging dynamics in mCRPC patients on enzalutamide with stable computed tomography (CT) and technetium-99m (Tc99) bone scans. DESIGN, SETTING, AND PARTICIPANTS: All patients were on treatment with enzalutamide for first-line mCRPC in a clinical trial at the National Cancer Institute (Bethesda, MD, USA). A volunteer sample had serial 18F-sodium fluoride (NaF) PET in parallel with CT and Tc99. Regions of interest (ROIs) on NaF were analyzed quantitatively for response. INTERVENTION: Patients were randomized to enzalutamide with/without a cancer immunotherapy, Prostvac. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A post hoc, descriptive analysis was performed comparing the changes seen on CT and Tc99 as per RECIST 1.1 with NaF PET scans including the use of a quantitative analysis. RESULTS AND LIMITATIONS: Eighteen mCRPC patients had 67 NaF scans. A total of 233 ROIs resolved after treatment, 52 (22%) of which eventually retuned while on therapy. In all, 394 new ROIs were seen, but 112(28%) resolved subsequently. Of 18 patients, 14 had new ROIs that ultimately resolved after appearing. Many patients experienced progression in a minority of lesions, and one patient with radiation intervention to oligoprogression had a remarkable response. This study is limited by its small number of patients and post hoc nature. CONCLUSIONS: These data highlight the dynamic nature of NaF PET in mCRPC patients treated with enzalutamide, where not all new findings were ultimately related to disease progression. This analysis also provides a potential strategy to identify and intervene in oligoprogression in prostate cancer. PATIENT SUMMARY: In this small analysis of patients with prostate cancer on enzalutamide, changes on 18F-sodium fluoride positron emission tomography (PET) imaging were not always associated with treatment failure. Caution may be indicated when using PET imaging to determine whether new therapy is needed.

Original language	English
Pages (from-to)	735-741
Number of pages	7
Journal	European Urology Oncology
Volume	7
Issue number	4
DOIs	https://doi.org/10.1016/j.euo.2023.09.010
State	Published - 1 Aug 2024

Keywords

Imaging
Prostate cancer
Prostate-specific membrane antigen
Quantitative analysis

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10.1016/j.euo.2023.09.010

Cite this

Gandhy, S. U., Karzai, F. H., Bilusic, M., McMahon, S., Cordes, L. M., Marte, J., Weisman, A. J., Perk, T. G., Lindenberg, L., Mena, E., Turkbey, B., Arlen, P. M., Dahut, W. L., Figg, W. D., Choyke, P., Gulley, J. L., & Madan, R. A. (2024). Quantitative Analysis of Serial Positron Emission Tomography Imaging in Men with Metastatic Castration-resistant Prostate Cancer Treated with Enzalutamide. European Urology Oncology, 7(4), 735-741. https://doi.org/10.1016/j.euo.2023.09.010

@article{3697d64ebe594974bcddb7e20b8bb7a5,

title = "Quantitative Analysis of Serial Positron Emission Tomography Imaging in Men with Metastatic Castration-resistant Prostate Cancer Treated with Enzalutamide",

abstract = "BACKGROUND: The emergence of positron emission tomography (PET) in prostate cancer is impacting clinical practice, but little is known about PET imaging as a tool to determine treatment failure in metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE: To evaluate PET imaging dynamics in mCRPC patients on enzalutamide with stable computed tomography (CT) and technetium-99m (Tc99) bone scans. DESIGN, SETTING, AND PARTICIPANTS: All patients were on treatment with enzalutamide for first-line mCRPC in a clinical trial at the National Cancer Institute (Bethesda, MD, USA). A volunteer sample had serial 18F-sodium fluoride (NaF) PET in parallel with CT and Tc99. Regions of interest (ROIs) on NaF were analyzed quantitatively for response. INTERVENTION: Patients were randomized to enzalutamide with/without a cancer immunotherapy, Prostvac. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A post hoc, descriptive analysis was performed comparing the changes seen on CT and Tc99 as per RECIST 1.1 with NaF PET scans including the use of a quantitative analysis. RESULTS AND LIMITATIONS: Eighteen mCRPC patients had 67 NaF scans. A total of 233 ROIs resolved after treatment, 52 (22%) of which eventually retuned while on therapy. In all, 394 new ROIs were seen, but 112(28%) resolved subsequently. Of 18 patients, 14 had new ROIs that ultimately resolved after appearing. Many patients experienced progression in a minority of lesions, and one patient with radiation intervention to oligoprogression had a remarkable response. This study is limited by its small number of patients and post hoc nature. CONCLUSIONS: These data highlight the dynamic nature of NaF PET in mCRPC patients treated with enzalutamide, where not all new findings were ultimately related to disease progression. This analysis also provides a potential strategy to identify and intervene in oligoprogression in prostate cancer. PATIENT SUMMARY: In this small analysis of patients with prostate cancer on enzalutamide, changes on 18F-sodium fluoride positron emission tomography (PET) imaging were not always associated with treatment failure. Caution may be indicated when using PET imaging to determine whether new therapy is needed.",

keywords = "Imaging, Prostate cancer, Prostate-specific membrane antigen, Quantitative analysis",

author = "Gandhy, {Shruti U.} and Karzai, {Fatima H.} and Marijo Bilusic and Sheri McMahon and Cordes, {Lisa M.} and Jennifer Marte and Weisman, {Amy J.} and Perk, {Timothy G.} and Liza Lindenberg and Esther Mena and Baris Turkbey and Arlen, {Philip M.} and Dahut, {William L.} and Figg, {William D.} and Peter Choyke and Gulley, {James L.} and Madan, {Ravi A.}",

note = "Publisher Copyright: Published by Elsevier B.V.",

year = "2024",

month = aug,

day = "1",

doi = "10.1016/j.euo.2023.09.010",

language = "English",

volume = "7",

pages = "735--741",

journal = "European Urology Oncology",

issn = "2588-9311",

publisher = "Elsevier B.V.",

number = "4",

}

Gandhy, SU, Karzai, FH, Bilusic, M, McMahon, S, Cordes, LM, Marte, J, Weisman, AJ, Perk, TG, Lindenberg, L, Mena, E, Turkbey, B, Arlen, PM, Dahut, WL, Figg, WD, Choyke, P, Gulley, JL & Madan, RA 2024, 'Quantitative Analysis of Serial Positron Emission Tomography Imaging in Men with Metastatic Castration-resistant Prostate Cancer Treated with Enzalutamide', European Urology Oncology, vol. 7, no. 4, pp. 735-741. https://doi.org/10.1016/j.euo.2023.09.010

TY - JOUR

T1 - Quantitative Analysis of Serial Positron Emission Tomography Imaging in Men with Metastatic Castration-resistant Prostate Cancer Treated with Enzalutamide

AU - Gandhy, Shruti U.

AU - Karzai, Fatima H.

AU - Bilusic, Marijo

AU - McMahon, Sheri

AU - Cordes, Lisa M.

AU - Marte, Jennifer

AU - Weisman, Amy J.

AU - Perk, Timothy G.

AU - Lindenberg, Liza

AU - Mena, Esther

AU - Turkbey, Baris

AU - Arlen, Philip M.

AU - Dahut, William L.

AU - Figg, William D.

AU - Choyke, Peter

AU - Gulley, James L.

AU - Madan, Ravi A.

N1 - Publisher Copyright: Published by Elsevier B.V.

PY - 2024/8/1

Y1 - 2024/8/1

N2 - BACKGROUND: The emergence of positron emission tomography (PET) in prostate cancer is impacting clinical practice, but little is known about PET imaging as a tool to determine treatment failure in metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE: To evaluate PET imaging dynamics in mCRPC patients on enzalutamide with stable computed tomography (CT) and technetium-99m (Tc99) bone scans. DESIGN, SETTING, AND PARTICIPANTS: All patients were on treatment with enzalutamide for first-line mCRPC in a clinical trial at the National Cancer Institute (Bethesda, MD, USA). A volunteer sample had serial 18F-sodium fluoride (NaF) PET in parallel with CT and Tc99. Regions of interest (ROIs) on NaF were analyzed quantitatively for response. INTERVENTION: Patients were randomized to enzalutamide with/without a cancer immunotherapy, Prostvac. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A post hoc, descriptive analysis was performed comparing the changes seen on CT and Tc99 as per RECIST 1.1 with NaF PET scans including the use of a quantitative analysis. RESULTS AND LIMITATIONS: Eighteen mCRPC patients had 67 NaF scans. A total of 233 ROIs resolved after treatment, 52 (22%) of which eventually retuned while on therapy. In all, 394 new ROIs were seen, but 112(28%) resolved subsequently. Of 18 patients, 14 had new ROIs that ultimately resolved after appearing. Many patients experienced progression in a minority of lesions, and one patient with radiation intervention to oligoprogression had a remarkable response. This study is limited by its small number of patients and post hoc nature. CONCLUSIONS: These data highlight the dynamic nature of NaF PET in mCRPC patients treated with enzalutamide, where not all new findings were ultimately related to disease progression. This analysis also provides a potential strategy to identify and intervene in oligoprogression in prostate cancer. PATIENT SUMMARY: In this small analysis of patients with prostate cancer on enzalutamide, changes on 18F-sodium fluoride positron emission tomography (PET) imaging were not always associated with treatment failure. Caution may be indicated when using PET imaging to determine whether new therapy is needed.

AB - BACKGROUND: The emergence of positron emission tomography (PET) in prostate cancer is impacting clinical practice, but little is known about PET imaging as a tool to determine treatment failure in metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE: To evaluate PET imaging dynamics in mCRPC patients on enzalutamide with stable computed tomography (CT) and technetium-99m (Tc99) bone scans. DESIGN, SETTING, AND PARTICIPANTS: All patients were on treatment with enzalutamide for first-line mCRPC in a clinical trial at the National Cancer Institute (Bethesda, MD, USA). A volunteer sample had serial 18F-sodium fluoride (NaF) PET in parallel with CT and Tc99. Regions of interest (ROIs) on NaF were analyzed quantitatively for response. INTERVENTION: Patients were randomized to enzalutamide with/without a cancer immunotherapy, Prostvac. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A post hoc, descriptive analysis was performed comparing the changes seen on CT and Tc99 as per RECIST 1.1 with NaF PET scans including the use of a quantitative analysis. RESULTS AND LIMITATIONS: Eighteen mCRPC patients had 67 NaF scans. A total of 233 ROIs resolved after treatment, 52 (22%) of which eventually retuned while on therapy. In all, 394 new ROIs were seen, but 112(28%) resolved subsequently. Of 18 patients, 14 had new ROIs that ultimately resolved after appearing. Many patients experienced progression in a minority of lesions, and one patient with radiation intervention to oligoprogression had a remarkable response. This study is limited by its small number of patients and post hoc nature. CONCLUSIONS: These data highlight the dynamic nature of NaF PET in mCRPC patients treated with enzalutamide, where not all new findings were ultimately related to disease progression. This analysis also provides a potential strategy to identify and intervene in oligoprogression in prostate cancer. PATIENT SUMMARY: In this small analysis of patients with prostate cancer on enzalutamide, changes on 18F-sodium fluoride positron emission tomography (PET) imaging were not always associated with treatment failure. Caution may be indicated when using PET imaging to determine whether new therapy is needed.

KW - Imaging

KW - Prostate cancer

KW - Prostate-specific membrane antigen

KW - Quantitative analysis

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U2 - 10.1016/j.euo.2023.09.010

DO - 10.1016/j.euo.2023.09.010

M3 - Article

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SN - 2588-9311

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