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Introduction <p>Focal therapy (FT) is a promising alternative to radical treatments for localized Prostate Cancer (PCa) in selected patients. However, it is not yet considered a standard treatment option, and there is currently no consensus on managing patients after FT. In this context, Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET) may support multiparametric MRI (mpMRI) for both pre-operative planning and follow-up. The aim of this systematic review was to provide a comprehensive overview of the current applications of PSMA-PET in the field of FT and to analyze its future perspectives.</p> Evidence acquisition <p>A literature search was performed using PubMed and Scopus databases, following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. All studies reporting data on PSMA-PET performed before and/or after FT for PCa were included. A narrative synthesis was employed to summarize the review findings. No quantitative synthesis was performed due to the heterogeneity and limitations of the studies.</p> Evidence synthesis <p>Seven studies (2 case reports, 1 retrospective, and 4 prospective single-center studies) were included in this review. A moderate-severe risk of bias was assessed for the included studies. In the field of FT, PSMA-PET showed promising but yet not validated results with several possible applications: (1) pre-operative planning and staging, aiming to improve patient selection trough the identification of intraprostatic suspected lesions and more accurate local and systemic staging; (2) guidance for biopsy and Region of Interest (ROI) definition; (3) follow-up imaging tool, aiming to decrease the number of unnecessary surveillance biopsies.</p> Conclusions <p>Limited evidence exists regarding the use of PSMA-PET in the field of FT, considering pre-operative setting, treatment guidance and its use as a non-invasive tool to evaluate treatment success or failure and for follow-up. In this scenario, even if the current evidence is still limited and inconclusive, PSMA-PET showed promising results with several possible applications.</p>

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Is there a role of PSMA-PET in focal therapy planning and follow-up?

  • 期刊论文

  • 发表日期：

    2025年2月13日

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  • Rossella Nicoletti,
  • Andrea Alberti,
  • Vineet Gauhar,
  • Elena Ciaralli,
  • Chi Hang Yee,
  • Peter Chiu,
  • David Leung,
  • Daniele Castellani,
  • Theodoros Tokas,
  • Bhaskar Somani,
  • Francesco Sessa,
  • Dmitry Enikeev,
  • Nikhil Vasdev,
  • Sergio Serni,
  • Riccardo Campi,
  • Mauro Gacci,
  • Antony Chi Fai Ng,
  • Jeremy Yuen Chun Teoh

摘要

Introduction

Focal therapy (FT) is a promising alternative to radical treatments for localized Prostate Cancer (PCa) in selected patients. However, it is not yet considered a standard treatment option, and there is currently no consensus on managing patients after FT. In this context, Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET) may support multiparametric MRI (mpMRI) for both pre-operative planning and follow-up. The aim of this systematic review was to provide a comprehensive overview of the current applications of PSMA-PET in the field of FT and to analyze its future perspectives.

Evidence acquisition

A literature search was performed using PubMed and Scopus databases, following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. All studies reporting data on PSMA-PET performed before and/or after FT for PCa were included. A narrative synthesis was employed to summarize the review findings. No quantitative synthesis was performed due to the heterogeneity and limitations of the studies.

Evidence synthesis

Seven studies (2 case reports, 1 retrospective, and 4 prospective single-center studies) were included in this review. A moderate-severe risk of bias was assessed for the included studies. In the field of FT, PSMA-PET showed promising but yet not validated results with several possible applications: (1) pre-operative planning and staging, aiming to improve patient selection trough the identification of intraprostatic suspected lesions and more accurate local and systemic staging; (2) guidance for biopsy and Region of Interest (ROI) definition; (3) follow-up imaging tool, aiming to decrease the number of unnecessary surveillance biopsies.

Conclusions

Limited evidence exists regarding the use of PSMA-PET in the field of FT, considering pre-operative setting, treatment guidance and its use as a non-invasive tool to evaluate treatment success or failure and for follow-up. In this scenario, even if the current evidence is still limited and inconclusive, PSMA-PET showed promising results with several possible applications.