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Digital archive of theses discussed at the University of Pisa


Thesis etd-04122021-195348

Thesis type
Tesi di specializzazione (4 anni)
Thesis title
[68Ga]PSMA-11 PET/CT in prostate cancer: accurate localization for an accurate treatment management
Course of study
relatore Prof.ssa Erba, Paola Anna
correlatore Prof. Volterrani, Duccio
  • treatment management
  • recurrence biochemical
  • prostate cancer
  • [68Ga]PSMA-11 PET/CT
Graduation session start date
Biochemical recurrence (BCR) after primary therapy for localized or locally advanced prostate cancer (PCa) is a frequent event. Within 10 years, 20–40% of patients undergoing radical prostatectomy (RP) and 30–50% of patients undergoing radiotherapy (RT) will experience BCR. Because BCR after RP or RT occurs before clinical and radiographic evidence of cancer, the diagnostic yield of conventional imaging techniques is poor in asymptomatic patients. Several clinical parameters such as serum prostate specific antigen (PSA) levels, PSA doubling time (PSAdt), PSA velocity (PSAvel), pathologic Gleason score (ISUP Grade Group), pathologic stage, and nodal invasion are used to stratify patients into various risk groups for local vs systemic recurrence. Although these models (nomograms) are characterized by a good accuracy in predicting local versus distant relapse, they cannot reliably predict recurrence sites and the extent of metastatic disease. A variety of prognostic schemata have been proposed, including many nomograms. Performance status; extent of disease; pain status; location of disease (e.g., bone or liver); levels of hemoglobin, serum alkaline phosphatase, lactate dehydrogenase, albumin, aspartate aminotransferase, circulating tumor cells, and plasma cell-free DNA; neutrophil-to-lymphocyte ratio; and kinetics of disease progression contribute to the prognosis.
PSMA is expressed in most tumors, although intrapatient heterogeneity of expression has been reported.69 PSMA ligands or anti-PSMA antibodies can be conjugated to radionuclides (either alpha- or beta-particle emitters) or cytotoxic agents, and multiple PSMA strategies are currently undergoing evaluation.

The definition of BCR represents itself an inhomogeneous category, since it can include patients presenting first-time PSA relapse, patients already treated with salvage radiotherapy (S-RT), hormone-naïve patients or receiving ADT, and patients who already failed several lines of therapy, including the new generation of antiandrogens (abiraterone, enzalutamide) or chemotherapy. Thus, different clinical stages of disease are included in the same definition. Low PSA values do not necessarily reflect early recurrence, while high PSA values are not necessarily related to advanced disease. As a consequence, the diagnostic performance of 68Ga-PSMA-11 PET/CT may vary considering these different stages in patients with PSA failure.
We aim to evaluate the role of PSMA‐PET/CT in a patient population with a significant risk of metastatic disease, in BRC prostate cancer patient and to evaluate the contribution of each exam on the intention to treat, thus patients man.++
Rate of positive patients, at different PSA levels (PSA level of 0.2-0.5; 0.51-1;1.1-2; 2.1-6 ng/mL), with oligometastatic and plurimetastatic disease in [68Ga]PSMA-11 PET/CT Biochemical failure (BCR) occurs in 89 patients with PCa after initial treatment with radical intent. Despite a radiological and functional assessment is not recommended until patients become symptomatic, functional imaging has been demonstrated a significant impact in clinical decision making in this setting.
PSMA has been found to be an excellent agent for targeted imaging and therapy. It is overexpressed one-hundred to one thousand-fold in 95% of prostate cancer cells. Immunohistochemical studies have shown that PSMA expression increases in case of dedifferentiated, metastatic, or hormone-refractory disease and its expression level is a significant prognosticator for disease outcome. A variety of PSMA ligands have been developed targeting both the intracellular and extracellular epitopes of PSMA